Assessing Anatomy Education: A Perspective from Design

Medical and healthcare practice is likely to see fundamental changes in the future that will require a different approach to the way in which we educate, train, and assess the next generation of healthcare professionals. The anatomical sciences will need to be part of that challenge so they continue to play a full role in preparing students with the knowledge and ever increasingly the skills and competencies that will contribute to the fundamentals of their future capacity to practice effectively. Although there have been significant advances in anatomical science pedagogy, by reviewing learning and assessment in an apparently unrelated field, provides an opportunity to bring a different perspective and enable appropriate challenge of the current approaches in anatomy. Design learning has had to continually reimagine itself in response to the shifting landscape in design practice and the threats associated with technology and societal change. Design learning has also long used a student-centric active pedagogy and allied authentic assessment methods and, therefore, provides an ideal case study to help inform future changes required in anatomical learning and assessment.     

Learning in Stereo: The Relationship Between Spatial Ability and 3D Digital Anatomy Models

Three-dimensional (3D) digital anatomical models show potential to demonstrate complex anatomical relationships; however, the literature is inconsistent as to whether they are effective in improving the anatomy performance, particularly for students with low spatial visualization ability (Vz). This study investigated the educational effectiveness of a 3D stereoscopic model of the pelvis, and the relationship between learning with 3D models and Vz. It was hypothesized that participants learning with a 3D pelvis model would outperform participants learning with a two-dimensional (2D) visualization or cadaveric specimen on a spatial anatomy test, particularly when comparing those with low Vz. Participants (n = 64) were stratified into three experimental groups, who each attended a learning session with either a 3D stereoscopic model (n = 21), 2D visualization (n = 21), or cadaveric specimen (n = 22) of the pelvis. Medical and pre-medical student participants completed a multiple-choice pre-test and post-test during their respective learning session, and a long-term retention (LTR) test 2 months later. Results showed no difference in anatomy test improvement or LTR performance between the experimental groups. A simple linear regression analysis showed that within the 3D group, participants with high Vz tended to retain more than those with low Vz on the LTR test (R² = 0.31, P = 0.01). The low Vz participants may be cognitively overloaded by the complex spatial cues from the 3D stereoscopic model. Results of this study should inform resource selection and curriculum design for health professional students, with attention to the impact of Vz on learning.     

Three-Dimensional Tooth Models with Pulp Cavity Enhance Dental Anatomy Education

Dental anatomy is an integrated, core fundamental dental course, which prepares students for all future clinical dental courses. This study aimed to build up an online dental learning platform of micro-computed tomography-based three-dimensional (3D) tooth models with pulp cavity, and to further evaluate its effectiveness for dental anatomy education using a cohort study. First, ninety-six extracted permanent teeth were scanned by micro-computed tomography and the enamel, dentine, and pulp cavity of each was distinguished by different grey-scale intensities using Mimics software. Three-dimensional images allowed further discrimination and insights into permanent three-rooted premolars, central tip, and dental diseases including deep caries and wedge-shaped defects. Furthermore, a second mesiobuccal canal (MB2) in maxillary permanent molar teeth and Vertucci type III root canal configuration in mandibular anterior teeth could be detected using the 3D analytical tool. A digitized 3D tooth model learning platform was implemented. Last, two groups of dental students were assessed to evaluate the effect of 3D models on dental anatomy education. Participants in the Digital group were allowed to use the online dental learning platform freely after class, while the participants in the Traditional group were not. Assessment quizzes showed that participants' scores improved in the Digital group with the use of the learning platform compared with scores in the Traditional group. A questionnaire survey indicated that the participants had a positive attitude toward the 3D models. Thus, adding digital 3D resources to a traditional curriculum may have a positive effect on academic achievements.     

Making the Ethical Transition in South Africa: Acquiring Human Bodies for Training in Anatomy

While dissection remains the method of choice for teaching human anatomy, ethical requirements for obtaining cadavers has made the process of acquiring human bodies more strenuous for institutions. In Africa and at the School of Anatomical Sciences in South Africa, dependence on unclaimed bodies has been prevalent. The aim of the present study was to determine whether more rigorous application of ethical consent has altered the provenance of the cadavers in the School of Anatomical Sciences, University of the Witwatersrand. The numbers of bequeathed/donated/unclaimed cadavers received over the period 2013–2017, as well as their sex and population affinity were analyzed. The majority (96.8%) of the cadavers dissected over the period were from bequests/donations. Marginally more females than males were available. In addition, the population affinity of the cadavers had changed from a majority of South African African (unclaimed) bodies to a majority of South African White (bequest/donated) bodies. The study shows that even with ethical constraints it is possible to transition from the use of mainly unclaimed bodies to the acquisition of bequeathed/donor bodies. However, there may be challenges in relation to anatomical collections in the School as few of the bequest/donated cadavers remain in the School to be added to the collections. These changes also affect the demographics of the Schools' collections.     

The Role of History and Ethics of Anatomy in Medical Education

While time spent on anatomical education in medical school curricula has been diminishing over the last decades, the recognized role of anatomical dissection has expanded. It is perceived by many students and faculty not only as the means of learning the structure and function of the human body, but also as an opportunity for the acquisition of professional competencies such as team work, patient–doctor interaction, medical epistemology, self-awareness, and an understanding of medical ethics. This viewpoint article proposes that this learning process can be supported effectively through studying examples from the history of anatomy, as insights from this history can help illuminate contemporary ethical issues in anatomy and medicine. Anatomical education can thus provide not only the opportunity of gaining awareness of ethical questions, but also a chance to practice these new insights within the protected environment of the laboratories, in interaction with the dead and the living. Consequently, a new role has developed for anatomists, which includes the interweaving of the scholarly exploration of the history and ethics of anatomy with the practical application of research results into a reframed concept of anatomical education. Anatomy, as a foundational discipline in the medical curriculum, can thus provide a first step on the educational path of empathetic and humane medical caregivers.     

Take away body parts! An investigation into the use of 3D‐printed anatomical models in undergraduate anatomy education

Understanding the three‐dimensional (3D) nature of the human form is imperative for effective medical practice and the emergence of 3D printing creates numerous opportunities to enhance aspects of medical and healthcare training. A recently deceased, un‐embalmed donor was scanned through high‐resolution computed tomography. The scan data underwent segmentation and post‐processing and a range of 3D‐printed anatomical models were produced. A four‐stage mixed‐methods study was conducted to evaluate the educational value of the models in a medical program. (1) A quantitative pre/post‐test to assess change in learner knowledge following 3D‐printed model usage in a small group tutorial; (2) student focus group (3) a qualitative student questionnaire regarding personal student model usage (4) teaching faculty evaluation. The use of 3D‐printed models in small‐group anatomy teaching session resulted in a significant increase in knowledge (P = 0.0001) when compared to didactic 2D‐image based teaching methods. Student focus groups yielded six key themes regarding the use of 3D‐printed anatomical models: model properties, teaching integration, resource integration, assessment, clinical imaging, and pathology and anatomical variation. Questionnaires detailed how students used the models in the home environment and integrated them with anatomical learning resources such as textbooks and anatomy lectures. In conclusion, 3D‐printed anatomical models can be successfully produced from the CT data set of a recently deceased donor. These models can be used in anatomy education as a teaching tool in their own right, as well as a method for augmenting the curriculum and complementing established learning modalities, such as dissection‐based teaching. Anat Sci Educ 11: 44–53. © 2017 American Association of Anatomists.     

The Effects of a Functional Three-dimensional (3D) Printed Knee Joint Simulator in Improving Anatomical Spatial Knowledge

In recent decades, three-dimensional (3D) printing as an emerging technology, has been utilized for imparting human anatomy knowledge. However, most 3D printed models are rigid anatomical replicas that are unable to represent dynamic spatial relationships between different anatomical structures. In this study, the data obtained from a computed tomography (CT) scan of a normal knee joint were used to design and fabricate a functional knee joint simulator for anatomical education. Utility of the 3D printed simulator was evaluated in comparison with traditional didactic learning in first-year medical students (n = 35), so as to understand how the functional 3D simulator could assist in their learning of human anatomy. The outcome measure was a quiz comprising 11 multiple choice questions based on locking and unlocking of the knee joint. Students in the simulation group (mean score = 85.03%, ±SD 10.13%) performed significantly better than those in the didactic learning group, P < 0.05 (mean score = 70.71%, ±SD 15.13%), which was substantiated by large effect size, as shown by a Cohen’s d value of 1.14. In terms of learning outcome, female students who used 3D printed simulators as learning aids achieved greater improvement in their quiz scores as compared to male students in the same group. However, after correcting for the modality of instruction, the sex of the students did not have a significant influence on the learning outcome. This randomized study has demonstrated that the 3D printed simulator is beneficial for anatomical education and can help in enriching students’ learning experience.     

An Approach to Economic Evaluation in Undergraduate Anatomy Education

Medical education research is becoming increasingly concerned with the value (defined as “educational outcomes per dollar spent”) of different teaching approaches. However, the financial costs of various approaches to teaching anatomy are under-researched, making evidence-based comparisons of the value of different teaching approaches impossible. Therefore, the aims of this study were to report the cost of six popular anatomy teaching methods through a specific, yet generalizable approach, and to demonstrate a process in which these results can be used in conjunction with existing effectiveness data to undertake an economic evaluation. A cost analysis was conducted to report the direct and indirect costs of six anatomy teaching methods, using an established approach to cost-reporting. The financial information was then combined with previously published information about the effectiveness of these six teaching methods in increasing anatomy knowledge, thereby demonstrating how estimations of value can be made. Dissection was reported as the most expensive teaching approach and computer aided instruction/learning (CAI/L) was the least, based on an estimation of total cost per student per year and assuming a student cohort size of just over 1,000 (the United Kingdom average). The demonstrated approach to economic evaluation suggested computer aided instruction/learning as the approach that provided the most value, in terms of education outcomes per dollar spent. The study concludes by suggesting that future medical education research should incorporate substantially greater consideration of cost, in order to draw important conclusions about value for learners.     

Assessing the Impact of a Ceremony in Honor of the Body Donors in the Development of Ethical and Humanistic Attitudes among Medical Students

Activities related to body donation programs, such as donor memorial ceremonies, provide the opportunity to complement student training, especially with regard to the ethical and humanistic elements involved in medical training. This study sought to assess the impact of a ceremony in honor of the body donors has on ethical and humanistic attitudes in medical students. Medical students were surveyed about their perceptions of changes in themselves, respect for donors and donor families, and their relationship with patients. The effect of the students' contact with the family of the donor was analyzed in students who had contact with the cadaver in the dissection room and had either participated or not participated in the donor memorial ceremony. A total of 370 questionnaires were answered by first-, second-, and third-year medical students at the Federal University of Health Sciences of Porto Alegre in 2017. The students who participated in the ceremony presented more positive responses in relation to commitment to their studies, reflection on death, and positive development of empathy when compared to those who did not attend the ceremony. Most of the students that attended the ceremony suggested the event led to an improvement in the doctor–patient relationship. These results suggest that cadaver dissection with accompanied memorial ceremony involving contact with donor families is an effective means of fostering ethical and humanistic attitudes among medical students from the beginning of the course.     

Ethical Responses to the Covid-19 Pandemic: Implications for the Ethos and Practice of Anatomy as a Health Science Discipline

The move of much anatomy teaching online in response to the Covid-19 pandemic has been successfully implemented within very short time frames. This has necessitated a high degree of dependence upon the use of digitized cadaveric resources, has entailed immense workload demands on staff, and has disrupted students' studies. These educational exigencies have been accompanied by ethical uncertainties for a discipline centered on study of the dead human body. An ethical framework for anatomy is suggested based on the principles of equal concern and respect, minimization of harm, fairness, and reciprocity, in which all staff and students are to be treated with respect and as moral equals. A series of ethical obligations are proposed as a means of maintaining the ethos of anatomy, coping with the suspension of body donation, providing adequate resources, and responding to increased dependence upon external providers. Good academic practice raises more general obligations stemming from the welfare of students, the increased workload of staff, and checking on online assessment and invigilation. As anatomists respond to the educational and ethical lessons prompted by this pandemic, they should plan for future disruptions to normal work patterns by adopting a sustainable and equitable course of action.     

Spatial Abilities Training in Anatomy Education: A Systematic Review

Spatial abilities have been correlated to anatomy knowledge assessment and spatial training has been found to improve spatial abilities in previous systematic reviews. The objective of this systematic review was to evaluate spatial abilities training in anatomy education. A literature search was done from inception to 3 August 2017 in Scopus^® and several databases on the EBSCOhost platform. Citations were reviewed and those involving anatomy education, an intervention, and a spatial abilities test were retained and the corresponding full-text articles were reviewed for inclusion. Before and after training studies, as well as comparative training programs, relating a spatial training intervention to spatial abilities were eligible. Of the 2,405 citations obtained, 52 articles were identified and reviewed, yielding eight eligible articles. Instruction in anatomy and mental rotations training were found to improve spatial abilities. For the seven studies retained for the meta-analysis that included the effect of interventions on spatial abilities test scores, the pooled treatment effect difference was 0.49 (95% CI [0.17; 0.82]; n = 11) improvement. For the two studies that included the practice effect on spatial abilities test scores in a control group, the pooled treatment effect difference was 0.47 (95% CI [−0.03; 0.97]; n = 2) improvement. In these two studies, the impact of the intervention on spatial abilities test scores was found despite the practice effect. Evidence was found for improvement of spatial abilities in anatomy education using instruction in anatomy and mental rotations training.     

Dual‐extrusion 3D printing of anatomical models for education

Two material 3D printing is becoming increasingly popular, inexpensive and accessible. In this paper, freely available printable files and dual extrusion fused deposition modelling were combined to create a number of functional anatomical models. To represent muscle and bone FilaFlex^3D flexible filament and polylactic acid (PLA) filament were extruded respectively via a single 0.4 mm nozzle using a Big Builder printer. For each filament, cubes (5 mm³) were printed and analyzed for X, Y, and Z accuracy. The PLA printed cubes resulted in errors averaging just 1.2% across all directions but for FilaFlex^3D printed cubes the errors were statistically significantly greater (average of 3.2%). As an exemplar, a focus was placed on the muscles, bones and cartilage of upper airway and neck. The resulting single prints combined flexible and hard structures. A single print model of the vocal cords was constructed which permitted movement of the arytenoids on the cricoid cartilage and served to illustrate the action of intrinsic laryngeal muscles. As University libraries become increasingly engaged in offering inexpensive 3D printing services it may soon become common place for both student and educator to access websites, download free models or 3D body parts and only pay the costs of print consumables. Novel models can be manufactured as dissectible, functional multi‐layered units and offer rich possibilities for sectional and/or reduced anatomy. This approach can liberate the anatomist from constraints of inflexible hard models or plastinated specimens and engage in the design of class specific models of the future. Anat Sci Educ 11: 65–72. © 2017 American Association of Anatomists.     

Anatomy education in Namibia: balancing facility design and curriculum development

The anatomy curriculum at Namibia's first, and currently only, medical school is clinically oriented, outcome-based, and includes all of the components of modern anatomical sciences i.e., histology, embryology, neuroanatomy, gross, and clinical anatomy. The design of the facilities and the equipment incorporated into these facilities were directed toward simplification of work flow and ease of use by faculty, staff, and students. From the onset, the integration of state of the art technology was pursued to facilitate teaching and promote a student-centered pedagogical approach to dissections. The program, as realized, is comprised of three 16-week semesters with seven hours of contact time per week, namely three hours of lectures and four hours of dissection laboratory and microscopy time. Set outcomes were established, each revolving around clinical cases with integrated medical imaging. The design of the facility itself was not constrained by a legacy structure, allowing the School of Medicine, in collaboration with architects and contractors, to design the building from scratch. A design was implemented that allows for the sequential processing of cadaveric material in a unidirectional flow from reception, to preparation, embalming, storage, dissection, and maceration. Importantly, the odor of formaldehyde typically associated with anatomy facilities was eliminated outside of the dissection areas and minimized within via a high-performance ventilation system. By holistically incorporating an integrated curriculum, facility design, and teaching at an early stage, the authors believe they have created a system that might serve as a model for new anatomy programs.     

Cinematic Rendering in Anatomy: A Crossover Study Comparing a Novel 3D Reconstruction Technique to Conventional Computed Tomography

Integration of medical imaging into preclinical anatomy courses is already underway in many medical schools. However, interpretation of two-dimensional grayscale images is difficult and conventional volume rendering techniques provide only images of limited quality. In this regard, a more photorealistic visualization provided by Cinematic Rendering (CR) may be more suitable for anatomical education. A randomized, two-period crossover study was conducted from July to December 2018, at the University Hospital of Erlangen, Germany to compare CR and conventional computed tomography (CT) imaging for speed and comprehension of anatomy. Sixteen students were randomized into two assessment sequences. During each assessment period, participants had to answer 15 anatomy-related questions that were divided into three categories: parenchymal, musculoskeletal, and vascular anatomy. After a washout period of 14 days, assessments were crossed over to the respective second reconstruction technique. The mean interperiod differences for the time to answer differed significantly between the CR–CT sequence (−204.21 ± 156.0 seconds) and the CT–CR sequence (243.33 ± 113.83 seconds; P < 0.001). Overall time reduction by CR was 65.56%. Cinematic Rendering visualization of musculoskeletal and vascular anatomy was higher rated compared to CT visualization (P < 0.001 and P = 0.003), whereas CT visualization of parenchymal anatomy received a higher scoring than CR visualization (P < 0.001). No carryover effects were observed. A questionnaire revealed that students consider CR to be beneficial for medical education. These results suggest that CR has a potential to enhance knowledge acquisition and transfer from medical imaging data in medical education.     

Anatomy 3.0: Rediscovering Theatrum Anatomicum in the wake of Covid-19

The Covid-19 pandemic has challenged medical educators internationally to confront the challenges of adapting their present educational activities to a rapidly evolving digital world. In this article, the authors use anatomy education as proxy to reflect on and remap the past, present, and future of medical education in the face of these disruptions. Inspired by the historical Theatrum Anatomicum (Anatomy 1.0), the authors argue replacing current anatomy dissection laboratory (Anatomy 2.0) with a prototype anatomy studio (Anatomy 3.0). In this studio, anatomists are web-performers who not only collaborate with other foundational science educators to devise meaningful and interactive content but who also partner with actors, directors, web-designers, computer engineers, information technologists, and visual artists to master online interactions and processes in order to optimize students' engagement and learning. This anatomy studio also offers students opportunities to create their own online content and thus reposition themselves digitally, a step into developing a new competency of stage presence within medical education. So restructured, Anatomy 3.0 will prepare students with the skills to navigate an emergent era of tele and digital medicine as well as help to foreshadow forthcoming changes in medical education.     

3D打印技术在中小学教学中的应用研究

2013年伊始,3D打印技术突然成为人们关注的热点,由工业、建筑、军事等应用领域逐渐走向民用领域.教育领域,特别是基础教育领域应用3D打印技术还处于起步、探索阶段.文章介绍了什么是3D打印技术;3D打印技术在本质上是多媒体技术的延伸,是虚拟现实技术的延伸,它拓展了人的感觉和知觉,促进了人的思维能力的进一步发展;列举了3D打印技术在中小学学科教学中应用的几个案例;3D打印技术目前面临的一些诸如普及慢、成本高、速度慢等局限性.最后指出,3D打印技术作为第三次工业革命的重要标志之一,未来4～5年,必将普遍走进中小学课堂,必将对现有教学产生深刻的影响和变革.     

Criss-cross heart three-dimensional printed models in medical education: A multicenter study on their value as a supporting tool to conventional imaging

The utility of three-dimensional (3D) printed models for medical education in complex congenital heart disease (CHD) is sparse and limited. The purpose of this study was to evaluate the utility of 3D printed models for medical education in criss-cross hearts covering a wide range of participants with different levels of knowledge and experience, from medical students, clinical fellows up to senior medical personnel. Study participants were enrolled from four dedicated imaging workshops developed between 2016 and 2019. The study design was a non-randomized cross-over study to evaluate 127 participants' level of understanding of the criss-cross heart anatomy. This was evaluated using the scores obtained following teaching with conventional images (echocardiography and magnetic resonance imaging) versus a 3D printed model learning approach. A significant improvement in anatomical knowledge of criss-cross heart anatomy was observed when comparing conventional imaging test scores to 3D printed model tests [76.9% (61.5%–87.8%) vs. 84.6% (76.9%–96.2%), P < 0.001]. The increase in the questionnaire marks was statistically significant across all academic groups (consultants in pediatric cardiology, fellows in pediatric cardiology, and medical students). Ninety-four percent (120) and 95.2% (121) of the participants agreed or strongly agreed, respectively, that 3D models helped them to better understand the medical images. Participants scored their overall satisfaction with the 3D printed models as 9.1 out of 10 points. In complex CHD such as criss-cross hearts, 3D printed replicas improve the understanding of cardiovascular anatomy. They enhanced the teaching experience especially when approaching medical students.