Universal design for learning in anatomy education of healthcare students: A scoping review

There are concerns among healthcare practitioners about poor anatomical knowledge among recent healthcare graduates. Universal Design for Learning (UDL) is a framework developed to enhance students' experience of learning and help students to become motivated learners. This scoping review identified whether UDL has been utilized in third level healthcare education and if so, whether it had been used to enhance student motivation to study anatomy. Seven online databases were searched for studies reporting the use of UDL in the curricula of medical, dental, occupational therapy (OT) or speech and language therapy (SLT) programs. Studies were screened for eligibility with set inclusion criteria. Data were extracted and analyzed. Analysis revealed that UDL was not specifically mentioned in any of the studies thus there are no published studies on UDL being formally applied in healthcare education. However, the authors identified 33 publications that described teaching methods which aligned with UDL in anatomy curricula and a thematic analysis yielded four main themes relating to teaching strategies being employed. Universal design for learning was not mentioned specifically, indicating that educators may not be aware of the educational framework, although they appeared to be utilizing aspects of it in their teaching. The review revealed that there is a lack of research concerning the anatomy education of OT and SLT students. The role of UDL in enhancing motivation to learn anatomy in medical, dental, OT and SLT programs has yet to be explored.     

Anatomy education in occupational therapy curricula: Perspectives of practitioners in the United States

The study of human anatomy is an integral component in the education of future occupational therapists, yet there is a paucity of research that explores the anatomy needs of students and new practitioners. As a follow up from a pilot study that surveyed a small cohort of practicing therapists, this article aimed to determine occupational therapy (OT) practitioners' views on anatomy course structure and content deemed important to include in OT curricula, entry level practitioners' anatomy knowledge, and application of anatomy in current practice. A Likert scale and free text questionnaire was distributed to practicing occupational therapists across the United States. Fifty‐four percent of the participants in this cohort favored a standalone course, as compared to 94% in the pilot study group. Anatomy course content areas were comparable across groups. Systems identified as essential to cover in an OT anatomy course included skeletal, muscular, and nervous. Regions included the upper limb, thorax/trunk, head and neck, and lower limb. Seventy percent of participants in both groups felt that entry‐level practitioners had adequate anatomy knowledge; 30% did not. Practice areas requiring anatomy knowledge included assessment of joint movement, muscle strength, pain, and functional mobility. Qualitative analysis of free text response data revealed the importance of anatomy knowledge in OT assessment and intervention strategies, determining the impact of injury or disease on occupational performance, client safety, and communication with other health care professionals and families. Anat Sci Educ 11: 243–253. © 2017 American Association of Anatomists.     

Movement System Theory and Anatomical Competence: Threshold Concepts for Physical Therapist Anatomy Education

This viewpoint proposes eight anatomy threshold concepts related to physical therapist education, considering both movement system theory and anatomical competence. Movement system theory provides classifications and terminology that succinctly identifies and describes physical therapy practice from a theoretical and philosophical framework. The cardiovascular, pulmonary, endocrine, integumentary, nervous, and musculoskeletal systems are all included within this schema as the movement system theory encompasses all body systems interacting to create movement across the lifespan. Implementing movement system theory requires an ability to use human anatomy in physical therapist education and practice. Understanding the human body is a mandatory prerequisite for effective diagnosis, assessment, treatment, and patient evaluation. Anatomical competence refers to the ability to apply anatomic knowledge within the appropriate professional and clinical contexts. Exploring the required anatomical concepts for competent entry-level physical therapist education and clinical practice is warranted. The recommended threshold concepts (fluency, dimensionality, adaptability, connectivity, complexity, stability or homeostasis, progression or development, and humanity) could serve as an integral and long-awaited tool for guiding anatomy educators in physical therapy education.     

Perceptions of anatomy: critical components in the clinical setting

The evolution in undergraduate medical school curricula has significantly impacted anatomy education. This study investigated the perceived role of clinical anatomy and evaluated perceptions of medical students' ability to apply anatomical knowledge in the clinic. The aim of this study was to develop a framework to enhance anatomical educational initiatives. Unlike previous work, multiple stakeholders (clinicians, medical students, and academic anatomists) in anatomy education were evaluated. Participants completed an eleven-point Likert scale survey written by the investigators. Responses from both clinical educators and medical students at Penn State Milton S. Hershey Medical Center and College of Medicine suggest that medical students are perceived as ill-prepared to transfer anatomy to the clinic. Although some areas of patient management differ in relevancy to anatomical education, there are areas of clinical care which were uniformly ranked as relying heavily on anatomical knowledge (imaging and diagnostic studies, physical examination, and arrival at correct diagnosis) by a variety of clinical specialists. Our results suggest a need for advanced anatomy courses to be taught coincidental with medical students' clinical education. Development of these courses would optimally rely on input from both clinicians and academic anatomists, as both cohorts rated clinical anatomy similarly (P ≥ 0.05). Additionally, we hypothesize that preclinical students' application of anatomy would be enhanced if clinical context was derived from areas of clinical care which rely heavily on anatomy, whereas courses designed for advanced medical students will benefit from anatomical context focused on specialty specific aspects of clinical care identified in this study.     

Using generalizability analysis to estimate parameters for anatomy assessments: A multi‐institutional study

With integrated curricula and multidisciplinary assessments becoming more prevalent in medical education, there is a continued need for educational research to explore the advantages, consequences, and challenges of integration practices. This retrospective analysis investigated the number of items needed to reliably assess anatomical knowledge in the context of gross anatomy and histology. A generalizability analysis was conducted on gross anatomy and histology written and practical examination items that were administered in a discipline‐based format at Indiana University School of Medicine and in an integrated fashion at the University of Alabama School of Medicine and Rush University Medical College. Examination items were analyzed using a partially nested design in which items were nested within occasions (i:o) and crossed with students (s). A reliability standard of 0.80 was used to determine the minimum number of items needed across examinations (occasions) to make reliable and informed decisions about students' competence in anatomical knowledge. Decision study plots are presented to demonstrate how the number of items per examination influences the reliability of each administered assessment. Using the example of a curriculum that assesses gross anatomy knowledge over five summative written and practical examinations, the results of the decision study estimated that 30 and 25 items would be needed on each written and practical examination to reach a reliability of 0.80, respectively. This study is particularly relevant to educators who may question whether the amount of anatomy content assessed in multidisciplinary evaluations is sufficient for making judgments about the anatomical aptitude of students. Anat Sci Educ 10: 109–119. © 2016 American Association of Anatomists.     

Inclusion in Malaysian integrated preschools

Inclusive education has been introduced through a number of policy developments in Malaysia over the last 10 years but there is little research investigating the extent and nature of inclusive education for preschoolers with special educational needs (SEN). This study surveyed both regular and special education teachers in Malaysian integrated preschools asking them about the level and nature of inclusion taking place in their preschools and their perceptions and beliefs about inclusion. There was little evidence of practices of inclusion taking place. Both regular and special educators agreed that SEN should be educated alongside their peers in a school but were unlikely to agree that the SEN students should be in the same classroom. Factors identified as influencing inclusion included school culture, skills and competency, guidance and information, workload and students' disabilities. More guidelines and support are required for successful inclusion in Malaysian integrated preschools.     

Dissecting the role of sessional anatomy teachers: A systematic literature review

Worldwide there is a growing reliance on sessional teachers in universities. This has impacted all disciplines in higher education including medical anatomy programs. The objective of this review was to define the role and support needs of sessional anatomy teachers by reporting on the (1) qualifications, (2) teaching role, (3) training, and (4) performance management of this group of educators. A systematic literature search was conducted on the 27 July 2017 in Scopus, Web of Science, and several databases on the Ovid, ProQuest and EBSCOhost platforms. The search retrieved 5,658 articles, with 39 deemed eligible for inclusion. The qualifications and educational distance between sessional anatomy teachers and their students varied widely. Reports of cross‐level, near‐peer and reciprocal‐peer teaching were identified, with most institutes utilizing recent medical graduates or medical students as sessional teachers. Sessional anatomy teachers were engaged in the full spectrum of teaching‐related duties from assisting students with cadaveric dissection, to marking student assessments and developing course materials. Fourteen institutes reported that training was provided to sessional anatomy teachers, but the specific content, objectives, methods and effectiveness of the training programs were rarely defined. Evaluations of sessional anatomy teacher performance primarily relied on subjective feedback measures such as student surveys (n = 18) or teacher self‐assessment (n = 3). The results of this systematic review highlight the need for rigorous explorations of the use of sessional anatomy teachers in medical education, and the development of evidence‐based policies and training programs that regulate and support the use of sessional teachers in higher education. Anat Sci Educ 11: 410–426. © 2017 American Association of Anatomists.     

Is the supply of continuing education in the anatomical sciences keeping up with the demand? Results of a national survey

Continuing education (CE) is an essential element in the life‐long learning of health care providers and educators. Despite the importance of the anatomical sciences in the training and practice of clinicians, no studies have examined the need/state of anatomy‐related CE nationally. This study assessed the current landscape of CE in the anatomical sciences to contextualize preferences for CE, identify factors that influence the perceived need for CE, and examine the association between supply and demand. Surveys were distributed to educators in the anatomical sciences, practicing physical therapists (PTs), and anatomy training programs across the United States. Twenty‐five percent (9 of 36) of training programs surveyed offered CE, certificates, or summer series programs related to anatomy. The majority of PTs (92%) and anatomy educators (81%) felt they had a potential or actual need for anatomy related CE with the most popular formats being online videos/learning modules and intensive, hands‐on workshops. The most commonly perceived barriers to participating in CE for both groups were program location, cost, and duration, while educators also perceived time of year as a significant factor. Logistic regression analyses revealed that no investigated factor influenced the need or desire for PTs to engage in anatomy related CE (P ≤ 0.124), while teaching experience and the highest level of learner taught significantly influenced the perceived need among anatomy educators (P < 0.001). Overall, quantitative and qualitative analyses revealed a robust need for CE that strategically integrates anatomy with areas of clinical practice and education. Anat Sci Educ 11: 225–235. © 2017 American Association of Anatomists.     

What do the public know about anatomy? Anatomy education to the public and the implications

Public knowledge of the anatomical “self” is lacking and evidence points towards a growing need for anatomy education to the wider public. The public were offered the opportunity to learn human anatomy and complete an anatomical knowledge survey afterwards. Sixty‐three participants volunteered to attempt to place 20 anatomical structures on a blank human body template. Responses were scored independently and then collated. A mixed effects logistic model was used to examine any associations with participants’ as a random effect and all other factors as fixed effects. Results showed a statistically significant quadratic trend with age. Participants in health‐related employment scored significantly higher than those not in health‐related employment. There was a significant interaction between gender and organ type with males scoring higher than females in identifying muscles, but not in identifying internal organs. The current study demonstrates the general public's eagerness to learn anatomy despite their limited knowledge of the human body, and the need for widening participation. Furthermore, it raises an awareness of the anatomical literacy needs of the general public, especially in school children and young adults. Furthermore, it emphasizes the value of health literacy as a focus in undergraduate medical education. Anatomy literacy appears to be neglected, and this experience provides an example of a possible mode of public engagement in anatomy. Anat Sci Educ 11: 117–123. © 2017 American Association of Anatomists.     

A preliminary survey of professionalism teaching practices in anatomy education among Indian Medical Colleges

Professionalism and ethics have gained widespread recognition as competencies to be fulfilled, taught, and assessed within medical education. The role of the anatomy course in developed nations has evolved over time and now encompasses multiple domains, including knowledge, skills, and the inculcation of professionalism and ethics. The Medical Council of India recently recommended the integration of professionalism teaching in undergraduate medical curricula. The authors investigated whether the initial orientation lectures and instructions given by faculty at the outset of undergraduate medical anatomy courses throughout India served a “hidden curriculum” regarding professionalism practices, and whether these orientation messages could serve as an early exposure to medical professionalism and ethics for medical students. An online survey was carried out among 102 anatomy faculty members across India requesting details about specific professionalism protocols and instructions regarding behavior in the dissection hall that are routinely given to preclinical students, as well as the importance that they placed on professional behavior. It was found that most faculty members regularly instruct students regarding expected behavior during the anatomy course, including dissection practices. These instructions stress attributes of professionalism like humanism, accountability, and honesty. However, there needs to be a more concentrated effort by educators to prohibit such unprofessional practices like dissection hall photography, and better information is required regarding biomedical waste disposal. Despite the absence of clear guidelines for professionalism teaching in medical education in India, the existing framework of anatomy education provides an opportunity to introduce the concept of professionalism to the first‐year medical student. This opportunity may provide an early foundation for designing a professionalism‐integrated curriculum. Anat Sci Educ 10: 433–443. © 2017 American Association of Anatomists.     

Factors influencing students' decisions to participate in a short “dissection experience” within a systemic anatomy course

Changes in medical education have affected both curriculum design and delivery. Many medical schools now use integrated curricula and a systemic approach, with reduced hours of anatomy teaching. While learning anatomy via dissection is invaluable in educational, professional, and personal development, it is time intensive and supports a regional approach to learning anatomy; the use of prosections has replaced dissection as the main teaching method in many medical schools. In our graduate‐entry medical degree, we use an integrated curriculum, with prosections to teach anatomy systemically. However, to not exclude dissection completely, and to expose students to its additional and unique benefits, we implemented a short “Dissection Experience” at the beginning of Year 2. Students attended three two‐hour anatomy sessions and participated in dissection of the clinically relevant areas of the cubital fossa, femoral triangle, and infraclavicular region. This activity was voluntary and we retrospectively surveyed all students to ascertain factors influencing their decision of whether to participate in this activity, and to obtain feedback from those students who did participate. The main reasons students did not participate were previous dissection experience and time constraints. The reasons most strongly affecting students' decisions to participate related to experience (lack of previous or new) and new skill. Students' responses as to the most beneficial component of the dissection experience were based around practical skills, anatomical education, the learning process, and the body donors. We report here on the benefits and practicalities of including a short dissection experience in a systemic, prosection‐based anatomy course. Anat Sci Educ 6: 225–231. © 2013 American Association of Anatomists.     

Land of misfit toys: Mothers’ perceptions of educational environments for their children with Down syndrome

Inclusive education is defined as educating students with disabilities in general education programmes with their non‐disabled peers. In order to create a successful learning environment for all children, general and special educators must be responsive to all students’ needs. Although inclusive education practices were developed over 15 years ago, some educators may be unwilling or unprepared to employ this model. A total of 546 teachers from 54 schools in southern New Jersey in the United States completed surveys to determine whether they displayed the dispositions, knowledge and skills necessary to implement inclusive education. Results of the surveys were analysed to determine whether significant differences in attitude and skill levels exist between special and general educators and the impact of their years of teaching on their readiness for inclusion. The analysis yielded an agreement that children with disabilities profit from interactions with non‐disabled peers. Although special educators appear more knowledgeable of inclusive practices, they are more likely to see the benefit of a segregated environment. Teachers with greater than seven years of experience voiced the continued need for administrative support, planning time and professional development opportunities.     

Peer teaching among physical therapy students during human gross anatomy: Perceptions of peer teachers and students

Despite nearly 200 accredited entry‐level physical therapist education programs in the United States that culminate in a doctoral degree, only a paucity of reports have been published regarding the efficacy of peer teaching in gross anatomy. No one has described the usefulness of peer teaching from the viewpoint of the peer teacher. An organized peer teaching method provided by four second‐year doctors of physical therapy (DPT) students in a semester course in gross anatomy had a positive impact on the academic performance in gross anatomy of first‐year DPT students. The unique feature of the weekly peer teaching sessions was a packet assembled by the second‐year peer teachers, which contained diagrams, fill‐in‐the blank questions, and helpful mnemonic devices. This study surveyed perceptions of first‐year DPT students in response to a peer teaching method, using a structured 10‐item questionnaire and a five‐point Likert scale. Second‐year DPT peer teachers provided written reflections about the benefits and challenges of serving as a peer teacher. Results revealed that 13 planned peer‐teaching experiences provided by four second‐year DPT students were valuable and promoted a firm understanding of anatomical relationships important for the clinical competence of physical therapist students. Moreover, peer teachers acknowledged acquiring clinically desirable teaching, academic, organizational, and time management skills from the experience. As a result, physical therapist educators may wish to consider this model of peer teaching to augment their teaching strategies for a class in gross human anatomy. Anat Sci Ed 1:199–206, 2008. © 2008 American Association of Anatomists.     

The Case Anatomical Knowledge Index (CAKI): A novel method used to assess anatomy content in clinical cases

There are concerns in the literature that the use of case‐based teaching of anatomy could be compromising the depth and scope of anatomy learned by students in a problem‐based learning curriculum. Poor selection of clinical cases that are used as vehicles for teaching/learning anatomy may be the root problem because some clinical cases do not provide enough opportunities to learn anatomy and are, therefore, inappropriate for case‐based teaching. Although anatomy educators are expected to respond to the identified deficiencies of case‐based anatomy teaching, making sure that students acquire sufficient anatomical knowledge to practice safely and successfully, there are no tools available that can help improve the selection of clinical cases for case‐based teaching. The author proposes a composite index, which incorporates considerations of anatomical knowledge for evaluating clinical cases/conditions for suitability in case‐based anatomy teaching. The development of the case anatomical knowledge index (CAKI) using a modified Guttman procedure is described. The scalability of the index was measured using the coefficient of reproducibility. A total of 47 clinicians participated in the validation activities that measured interrater and intraclass reliability. The CAKI was able to consistently discriminate between clinical cases/conditions with higher demand for anatomical knowledge than those with lower demand for anatomical knowledge. A review of the literature suggests that such an index has not been previously reported. Given the concerns about the depth and scope of anatomy learning in case‐based teaching, these findings have international relevance. Anat Sci Ed 2:9–18, 2009. © 2009 American Association of Anatomists.     

Anatomists debate the value of a teaching credential

Fewer and fewer programs are training graduate students and postdoctoral fellows in the classical anatomical disciplines. Nonetheless, there remains a need at all levels of clinical and basic science education for skilled instructors of anatomy, histology, and embryology. Two sessions at the 2006 annual meeting of the American Association of Anatomists (AAA) explored whether a system of accreditation would benefit students, institutions, and training programs. Although the value of accreditation was controversial, three challenges for the various anatomical societies emerged from these discussions: (1) To identify the skills and knowledge that should be shared among all anatomists, and the more specific skills and knowledge needed for the diverse settings in which anatomists work. (2) To address the historical inattention of institutions to the training of educators. (3) To develop strategies to lobby institutions and national organizations to support the training and work of educators in the anatomical sciences. One approach to meeting these challenges would be to develop guidelines for training programs. These guidelines would help graduate students seek the training they need, provide institutions with a benchmark to assess or develop training programs, and provide the basis for focusing lobbying efforts targeted at institutions or existing accreditation bodies. Anat Sci Ed 1:60–67, 2008. © 2008 American Association of Anatomists.     

Preparing early childhood educators for global education: the implications of prior learning

This paper outlines the increasing cultural diversity of Australia’s education settings and explicates the global education movement and the new Australian Early Years Learning Framework. It discusses the implication of these factors for early childhood education practice and early childhood teacher education. The key research question considered in this paper is what prior learnings do early childhood educators utilise to consider global education? Data are presented on a research project that explores the prior learning of pre‐service early childhood educators at a major Australian university. The paper shows that, unlike primary and secondary pre‐service teachers, most early childhood education pre‐service teachers have significant professional experiences in educational settings. These prior experiences have a significant impact on pre‐service early childhood educators’ knowledge, beliefs and attitudes in the area of global education and align strongly with the global education curriculum movement and new national curriculum.     

Physician opinions about an anatomy core curriculum: A case for medical imaging and vertical integration

Pre‐clinical anatomy curricula must provide medical students with the knowledge needed in a variety of medical and surgical specialties. But do physicians within specialties agree about what anatomical knowledge is most important in their practices? And, what is the common core of anatomical knowledge deemed essential by physicians in different specialties? Answers to these questions would be useful in designing pre‐clinical anatomy courses. The primary aim of this study was to assess the importance of a human gross anatomy course by soliciting the opinions of physicians from a range of specialties. We surveyed 93 physicians to determine the importance of specific anatomical topics in their own practices. Their responses were analyzed to assess variation in intra‐ and inter‐departmental attitudes toward the importance of anatomy. Nearly all of the topics taught in the course were deemed important by the clinicians as a group, but respondents showed little agreement on the rank order of importance of anatomical topics. Overall, only medical imaging received high importance by nearly all respondents, and lower importance was attached to embryology and lymphatic anatomy. Our survey data, however, also suggested distinct hierarchies in the importance assigned to anatomical topics within specialties. Given that physicians view the importance of anatomy differently, we suggest that students revisit anatomy through a vertically integrated curriculum tailored to provide specialty‐specific anatomical training to advanced students based on their areas of clinical interest. Integration of medical imaging into pre‐clinical anatomy courses, already underway in many medical schools, is of high clinical relevance. Anat Sci Educ 7: 251–261. © 2013 American Association of Anatomists.     

Anatomy as a Model Environment for Acquiring Professional Competencies in Medicine: Experiences at Harvard Medical School

Anatomy education provides students with opportunities to learn structure and function of the human body, to acquire professional competencies such as teamwork, interpersonal skills, self-awareness, and to reflect on and practice medical ethics. The fulfillment of this wide potential can present challenges in courses that are part of an integrated curriculum and shorter than traditional courses. This new reality, together with students' increasing concern about the stresses within medical education, led to efforts at Harvard Medical School to implement practical steps toward an optimal learning environment in anatomy. These were based on core elements of ethical anatomy education and principles of trauma-informed care. Anatomy is conceptualized here as the “first clinical discipline,” with relational interactions between anatomical educators, medical students, and body donors/patients. Essential prerequisites for the implementation of this work were support by the medical school leadership, open partnership between engaged students and faculty, faculty coordination, and peer-teaching. Specific interventions included pre-course faculty development on course philosophy and invitations to students to share their thoughts on anatomy. Student responses were integrated in course introductions, combined with a pre-dissection laboratory visit, an introductory guide, and a module on the history and ethics of anatomy. During the course, team-building activities were scheduled, and self-reflection encouraged, for example, through written exercises, and elective life-body drawing. Students' responses to the interventions were overall positive, but need further evaluation. This first attempt of a systematic implementation of an optimal learning environment in anatomy led to the identification of areas in need of adjustment.     

Curriculum of gross anatomy education in Korean dental hygiene programs: Perceptions of clinical dental hygienists

It is essential for dental hygienists to have basic knowledge of gross anatomy to provide efficient treatment. However, gross anatomy course is relatively neglected due to their disparity from actual clinical dental practice. This study aimed to propose an effective dental hygiene gross anatomy curriculum that reflects the opinions of professional clinical dental hygienists. The study had an online-based cross-sectional design and the survey was distributed to clinical dental hygienists via social networks (n = 200). The questionnaire consisted of questions on the utilization of anatomical knowledge in clinical practice, opinions on the contents and methods of gross anatomy education, and general characteristics. The present study found that 186 (93%) used anatomical knowledge at an above-average level. Qualitative analysis indicated that dental implant surgery, radiography, and extraction were the clinical procedures that required the most anatomical knowledge. The clinical dental hygienists answered that the most-necessary knowledge is that of the mandibular nerve, followed by that on the temporomandibular joint, mandible, maxilla, maxillary nerve, and masticatory muscle. The methods proposed to improve gross anatomy education were (in decreasing order of importance) using videos or photographs (X-rays, CT, MRI, etc.), integrating education with clinical subjects, and using a three-dimensional visualization program. Higher education levels of respondents have increased their tendency to believe that the contents and methods of the presented education were necessary. Dental hygienists who utilized anatomical knowledge more often tended to be had a greater appreciation of the necessity of all educational contents and methods.