“Let's Get Physical”: Advantages of a physical model over 3D computer models and textbooks in learning imaging anatomy

Three‐dimensional (3D) information plays an important part in medical and veterinary education. Appreciating complex 3D spatial relationships requires a strong foundational understanding of anatomy and mental 3D visualization skills. Novel learning resources have been introduced to anatomy training to achieve this. Objective evaluation of their comparative efficacies remains scarce in the literature. This study developed and evaluated the use of a physical model in demonstrating the complex spatial relationships of the equine foot. It was hypothesized that the newly developed physical model would be more effective for students to learn magnetic resonance imaging (MRI) anatomy of the foot than textbooks or computer‐based 3D models. Third year veterinary medicine students were randomly assigned to one of three teaching aid groups (physical model; textbooks; 3D computer model). The comparative efficacies of the three teaching aids were assessed through students' abilities to identify anatomical structures on MR images. Overall mean MRI assessment scores were significantly higher in students utilizing the physical model (86.39%) compared with students using textbooks (62.61%) and the 3D computer model (63.68%) (P < 0.001), with no significant difference between the textbook and 3D computer model groups (P = 0.685). Student feedback was also more positive in the physical model group compared with both the textbook and 3D computer model groups. Our results suggest that physical models may hold a significant advantage over alternative learning resources in enhancing visuospatial and 3D understanding of complex anatomical architecture, and that 3D computer models have significant limitations with regards to 3D learning. Anat Sci Educ 6: 216–224. © 2013 American Association of Anatomists.     

Application of flipped classroom pedagogy to the human gross anatomy laboratory: Student preferences and learning outcomes

To improve student preparedness for anatomy laboratory dissection, the dental gross anatomy laboratory was transformed using flipped classroom pedagogy. Instead of spending class time explaining the procedures and anatomical structures for each laboratory, students were provided online materials to prepare for laboratory on their own. Eliminating in‐class preparation provided the opportunity to end each period with integrative group activities that connected laboratory and lecture material and explored clinical correlations. Materials provided for prelaboratory preparation included: custom‐made, three‐dimensional (3D) anatomy videos, abbreviated dissection instructions, key atlas figures, and dissection videos. Data from three years of the course (n = 241 students) allowed for analysis of students' preferences for these materials and detailed tracking of usage of 3D anatomy videos. Students reported spending an average of 27:22 (±17:56) minutes preparing for laboratory, similar to the 30 minutes previously allocated for in‐class dissection preparation. The 3D anatomy videos and key atlas figures were rated the most helpful resources. Scores on laboratory examinations were compared for the three years before the curriculum change (2011–2013; n = 242) and three years after (2014–2016; n = 241). There was no change in average grades on the first and second laboratory examinations. However, on the final semi‐cumulative laboratory examination, scores were significantly higher in the post‐flip classes (P = 0.04). These results demonstrate an effective model for applying flipped classroom pedagogy to the gross anatomy laboratory and illustrate a meaningful role for 3D anatomy visualizations in a dissection‐based course. Anat Sci Educ 11: 385–396. © 2017 American Association of Anatomists.     

Seventh grade students' mental models of the greenhouse effect

This constructivist study investigates 225 student drawings and explanations from three different schools in the midwest in the US, to identify seventh grade students' mental models of the greenhouse effect. Five distinct mental models were derived from an inductive analysis of the content of the students' drawings and explanations: Model 1, a ‘greenhouse’ for growing plants; Model 2, greenhouse gases cause ozone depletion or formation, causing the Earth to warm; Model 3, greenhouse gases, but no heating mechanism, simply gases in the atmosphere; Model 4, greenhouse gases ‘trap’ the sun's rays, heating the Earth; and Model 5, the sun's rays are ‘bounced’ or reflected back and forth between the Earth's surface and greenhouse gases, heating the Earth. Science textbooks are critiqued in light of the students' mental models and curricular and instructional implications are explored.     

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.     

Does Augmented Visual Feedback from Novel,Multicolored, Three-Dimensional-Printed Teeth Affect Dental Students' Acquisition of Manual Skills?

Although three-dimensional (3D) printing technology is increasingly used in dental education, its application regarding the provision of online visual augmented feedback has not been tested. Thus, this study aimed to: (1) develop two generations of multicolored 3D-printed teeth that provide visual augmented feedback for students conducting the cavity preparation process, (2) assess students' clinical performance after training on the 3D models, and (3) acquire student feedback. For the first-generation model, augmented feedback was obtained from five 3D-printed teeth models for five cavity preparation procedures. Each model comprised three layers printed in green, yellow, and red indicating whether preparation was acceptable, limited, or unacceptable, respectively. The study used a crossover design in which the experimental group trained on five multicolored models and 10 standard plastic teeth, and the control group trained on 15 standard plastic teeth. Students gave positive feedback of the methodology but complained about the printed material's hardness. Therefore, a second-generation model was developed: the model's occlusal plane was replaced with a harder printed acrylic material, and the experiment was repeated. During training, instructors provided external terminal feedback only for performance on standard plastic teeth. Manual grades for cavity preparations on standard plastic teeth were compared. No significant differences were found between the control and experimental groups in both generations' models. However, less instructor time was needed, and similar clinical results were obtained after training with both generations. Thus, multicolored 3D-printed teeth models promote self-learning during the process of acquiring manual skills and reduce student dependency on instructors.     

The place of surface anatomy in the medical literature and undergraduate anatomy textbooks

The aims of this review were to examine the place of surface anatomy in the medical literature, particularly the methods and approaches used in teaching surface and living anatomy and assess commonly used anatomy textbooks in regard to their surface anatomy contents. PubMed and MEDLINE databases were searched using the following keywords “surface anatomy,” “living anatomy,” “teaching surface anatomy,” “bony landmarks,” “peer examination” and “dermatomes”. The percentage of pages covering surface anatomy in each textbook was calculated as well as the number of images covering surface anatomy. Clarity, quality and adequacy of surface anatomy contents was also examined. The search identified 22 research papers addressing methods used in teaching surface anatomy, 31 papers that can help in the improvement of surface anatomy curriculum, and 12 anatomy textbooks . These teaching methods included: body painting, peer volunteer surface anatomy, use of a living anatomy model, real time ultrasound, virtual (visible) human dissector (VHD), full body digital x‐ray of cadavers (Lodox^® Statscan^® images) combined with palpating landmarks on peers and the cadaver, as well as the use of collaborative, contextual and self‐directed learning. Nineteen of these studies were published in the period from 2006 to 2013. The 31 papers covered evidence‐based and clinically‐applied surface anatomy. The percentage of surface anatomy in textbooks' contents ranged from 0 to 6.2 with an average of 3.4%. The number of medical illustrations on surface anatomy varied from 0 to 135. In conclusion, although there has been a progressive increase in publications addressing methods used in teaching surface anatomy over the last six to seven years, most anatomy textbooks do not provide students with adequate information about surface anatomy. Only three textbooks provided a solid explanation and foundation of understanding surface anatomy. Anat Sci Educ 6: 415–432. © 2013 American Association of Anatomists.     

Students' Understandings of Human Organs and Organ Systems

How do people develop their understanding of what is inside them? This study looks at students' understandings of their internal structure. A cross-sectional approach was used involving a total of 158 students in England from six different age groups (ranging from four year old students to first year undergraduates). Students were given a blank piece of A4-sized paper and asked to draw what they thought was inside themselves. Repeated inspections of the completed drawings allowed us to construct a seven point scale of these representations. Our analysis shows the extent to which student understanding increases with age and the degree to which students know more about some organs and organ systems than others. While gender differences in the drawings were generally not large there were some intriguing differences in the ways males and females drew reproductive organs.

     

How does Donor Dissection Influence Medical Students' Perceptions of Ethics? A Cross-Sectional and Longitudinal Qualitative Study

The contribution of donor dissection to modern anatomy pedagogy remains debated. While short-term anatomy knowledge gains from dissection are questionable, studies suggest that donor dissection may have other impacts on students including influencing medical students' professional development, though evidence for such is limited. To improve the understanding of how anatomy education influences medical student professional development, the cross-sectional and longitudinal impacts of donor dissection on medical students' perceptions of ethics were explored. A cross-sectional and longitudinal qualitative study was undertaken at an Australian university where student responses to online discussion forums and in-person interviews were analyzed. Data were collected across the 1.5 years that undergraduate medical students received anatomy instruction (three semesters during first and second years). A total of 207 students participated in the online discussion forums, yielding 51,024 words; 24 students participated in at least 1 of 11 interviews, yielding over 11 hours of interview data. Framework analysis identified five themes related to ethics in an anatomical education context: (1) Dignity, (2) Beneficence, (3) Consent, (4) Justification for versus the necessity of dissection, and (5) Dichotomy of objectification and personification. The dominant themes of students' ethical perceptions changed with time, with a shift from focusing on donors as people, toward the utility of donors in anatomy education. Additionally, themes varied by student demographics including gender, ancestry, and religiosity. Together this study suggests a strong impact of donor dissection on priming students' focus on medical ethics and provides further advocacy for formal and purposeful integration of medical ethics with anatomy education.     

Observing Interprofessional Collaboration: Impact on Attitude and Knowledge Acquisition

Interprofessional collaboration (IPC) in the medical field is an important factor for good clinical outcomes and should be taught as early as in undergraduate medical education. Since implementing IPC training is an organizational challenge, students are often limited in their opportunities to experience real-life IPC. Therefore, an approach where students observe successful IPC activities of role models in an applied anatomical format was proposed. It was studied whether observing IPC activities in undergraduate anatomical education has an impact on both students' attitude toward IPC and on knowledge acquisition. Further, it was examined whether the attitudes and knowledge of students from different medical disciplines were influenced in different ways. Therefore, 75 medical students and thirty-eight physiotherapy students participated in a study with the task of observing a live broadcast of an interprofessional teaching session. Participants were asked about their attitudes toward interprofessional learning, their evaluation of professional responsibilities, and their profession-specific knowledge before and after observing the IPC session. The participants' attitude toward interprofessional learning improved for both groups of students. Moreover, students of physiotherapy adjusted their evaluation of their own and others' professional responsibilities after observing IPC. In both student groups, knowledge increased, in particular, with respect to the field of knowledge in other professions. So, observing IPC can modify students' attitudes and support knowledge acquisition. The implementation of IPC observations provides students from various healthcare disciplines with a clearer impression of professionals' responsibilities and gives learners the opportunity to acquire knowledge from healthcare fields unfamiliar to them.     

Visualization of stereoscopic anatomic models of the paranasal sinuses and cervical vertebrae from the surgical and procedural perspective

Recent improvements in three‐dimensional (3D) virtual modeling software allows anatomists to generate high‐resolution, visually appealing, colored, anatomical 3D models from computed tomography (CT) images. In this study, high‐resolution CT images of a cadaver were used to develop clinically relevant anatomic models including facial skull, nasal cavity, septum, turbinates, paranasal sinuses, optic nerve, pituitary gland, carotid artery, cervical vertebrae, atlanto‐axial joint, cervical spinal cord, cervical nerve root, and vertebral artery that can be used to teach clinical trainees (students, residents, and fellows) approaches for trans‐sphenoidal pituitary surgery and cervical spine injection procedure. Volume, surface rendering and a new rendering technique, semi‐auto‐combined, were applied in the study. These models enable visualization, manipulation, and interaction on a computer and can be presented in a stereoscopic 3D virtual environment, which makes users feel as if they are inside the model. Anat Sci Educ 10: 598–606. © 2017 American Association of Anatomists.     

Exploring the validity of assessment in anatomy: Do images influence cognitive processes used in answering extended matching questions?

Assessment is an important aspect of medical education because it tests students' competence and motivates them to study. Various assessment methods, with and without images, are used in the study of anatomy. In this study, we investigated the use of extended matching questions (EMQs). To gain insight into the influence of images on the validity of test items, we focused on students' cognitive processes while they answered questions with and without images. Seventeen first‐year medical students answered EMQs about gross anatomy, combined with either labeled images or answer lists, while thinking aloud. The participants' verbal reports were transcribed verbatim and then coded. Initial codes were based on a task analysis and were adapted into final codes during the coding process. Results showed that students used more cues from EMQs with images and visualized more often in EMQs with answer lists. Ready knowledge and verbal reasoning were used equally often in both conditions. In conclusion, EMQs with and without images elicit different results in this think aloud experiment, indicating different cognitive processes. They seem to measure different skills, making them valid for different testing purposes. The take‐home message for anatomy teachers is that questions without images seem to test the quality of students' mental images while questions with images test their ability to interpret visual information. It makes sense to use both response formats in tests. Using images from clinical practice instead of anatomical drawings will help to improve test validity. Anat Sci Educ 7: 107–116. © 2013 American Association of Anatomists.     

Musculoskeletal ultrasound training encourages self-directed learning and increases confidence for clinical and anatomical appreciation of first-year medical students

Best-practice guidelines have incorporated ultrasound in diagnostic and procedural medicine. Due to this demand, the Arizona College of Osteopathic Medicine initiated a comprehensive integration of ultrasound into its first-year anatomy course attended by more than 280 students. Ultrasound workshops were developed to enhance student conceptualization of musculoskeletal (MSK) anatomy through visualizing clinically important anatomical relationships, a simulated lumbar puncture during the back unit, carpal tunnel and shoulder evaluations during the upper limb unit, and plantar fascia, calcaneal tendon, and tarsal tunnel evaluations during the lower limb unit. A 5-point Likert scale survey evaluated if ultrasound improved students' self-perceived anatomical and clinical comprehension of relevant anatomy, improved students' ability to orient to ultrasound imagery, and prompted further independent investigation of the anatomical area. Ultrasound examination questions were added to the anatomy examinations. Two-tailed one-sample t-tests for the back, upper limb, and lower limb units were found to be significant across all Likert survey categories (P < 0.001). Positive student responses to the Likert survey in conjunction with examination question average of 84.3% (±10.3) demonstrated that the ultrasound workshops are beneficial to student education. Ultrasound enhances medical students' clinical and anatomical comprehension and ability to orient to ultrasound imagery for MSK anatomy. This study supports early ultrasound education as a mechanism to encourage students' independent learning as evidenced by many undertaking voluntary investigation of clinical concerns associated with MSK anatomy. This study establishes the successful integration of MSK ultrasound into a large medical school program and its benefit to student clinical education.     

Student‐centered integrated anatomy resource sessions at Alfaisal University

Alfaisal University is a new medical school in Riyadh, Kingdom of Saudi Arabia that matriculates eligible students directly from high school and requires them to participate in a hybrid problem‐based learning (PBL) curriculum. PBL is a well‐established student‐centered approach, and the authors have sought to examine if a student‐centered, integrated approach to learn human structures leads to positive perceptions of learning outcomes. Ten students were divided into four groups to rotate through wet and dry laboratory stations (integrated resource sessions, IRSs) that engaged them in imaging techniques, embryology, histology, gross anatomy (dissections and prosections), surface anatomy, and self‐directed learning questions. All IRSs were primarily directed by students. During two second‐semester organ system blocks, forty students responded to a structured questionnaire designed to poll students' perceptions of changes in their knowledge, skills, and attitudes as a result of IRS. The majority (60%) of students felt that the student‐centered approach to learning enhanced their medical knowledge. Most students also felt that the IRS approach was advantageous for formulating clear learning objectives (55%) and in preparing for examinations (65%). Despite their positive feelings toward IRS, students did not view this learning approach as an adequate replacement for the knowledge gained from lectures and textbooks. Students' performance on objective structured practical examinations improved significantly for the two curricular blocks that included IRS compared with earlier non‐IRS blocks. A student‐centered approach to teach human structure in a hybrid PBL curriculum may enhance understanding of the basic sciences in first‐year medical students. Anat Sci Educ 3:272–275, 2010. © 2010 American Association of Anatomists.     

Alternative vocational schooling for the dropped‐out: students' perceptions of the Activity School of East Finland

Dropping out of school is a universal problem, concerning fairly similar target groups in all countries. Several action plans to prevent dropping out and to activate the dropouts have been developed worldwide. The object of this study, the Activity School of East Finland, is an exceptionally comprehensive entity, within which alternative pedagogical models are applied during the entire three‐year course of vocational education. In this paper, we will review the key figures for the most important variables related to the experiences on the Activity School during the three years studied. The evaluation is based on the students' assessment of the impact of the activity. The added value generated by the Activity School, and compared to comparison group data from traditional vocational education, is most clearly seen as the general satisfaction experienced by the students with the Activity School's operating model and their satisfaction with the student–teacher interaction.     

Assessment drives learning: An unavoidable truth?

The debate around which factors drive medical students' learning is ongoing and controversial. What is the influence of an assessment's weighting on the motivation of students to study the particular subject? One medical school in London is in a unique position to investigate this question. At our institution, the weighting of Anatomy within the overall scheme of assessment has changed twice in recent years, a trend of increased weighting. This enabled a comparative investigation into the effect these changes have had on the students' motivation to learn Anatomy. A five‐point Likert‐scale questionnaire survey was used to evaluate students. A section within a broad survey of Anatomy teaching and learning at our institution was dedicated to the evaluation of the amount of weighting Anatomy received within the assessment structure and the effect this had on students' motivation toward learning the subject. Increasing Anatomy's weighting within the scheme of assessment produced a dramatic increasing trend toward students' motivation to learn Anatomy. The weighting of Anatomy has a profound effect on students' motivation to learn it. Although multifactorial and complex in nature, medical students' self‐reported drive to study a subject is directly influenced by the weighting of the subject in the overall scheme of assessment. Anat Sci Educ 2:199–204, 2009. © 2009 American Association of Anatomists.     

Effects of training experienced teachers in the use of the one‐minute preceptor technique in the gross anatomy laboratory

The one‐minute preceptor (OMP) is a time‐efficient, learner‐centered teaching method used in a busy ambulatory care setting. This project evaluated the effects of training experienced anatomy teachers in the use of the OMP in the gross anatomy laboratory on students' perceived learning. Second‐year medical students from a five‐year, undergraduate‐entry, system‐ and problem‐based medical program were divided randomly into two groups of 76 students each. The groups took part in the same gross anatomy laboratory session on different dates, supervised by the same two teachers (both with over 25 years of teaching experience). The teachers attended a workshop on the use of the OMP between the two sessions. Students were given a questionnaire at the end of the two sessions to indicate their agreements to statements regarding their learning experiences. Semistructured interviews were conducted with the two teachers after the second session. Results showed that training experienced anatomy teachers in the use of the OMP did not result in improvement of student learning perception in the gross anatomy laboratory. The experienced teachers have developed their own approaches with elements similar to those in the OMP: being learner centered and adaptable to individual student's needs, providing feedback, and enhancing teacher immediacy. They do not have an explicit structure such as the OMP, and are thus flexible and adaptive. Confining the teachers' teaching behaviors to the OMP structure could limit their performance. Although there are theoretical advantages for novice teachers in adopting the OMP technique, these advantages still need to be supported by further studies. Anat Sci Educ 7: 124–129. © 2013 American Association of Anatomists.     

Effects of Knowledge Maps and Prior Knowledge on Recall of Science Lecture Content

The effects of three types of lecture aids on students' recall of two college-level biology lectures were compared. Students heard audiotaped lectures while viewing either knowledge maps, outlines, or lists of the key terms presented on overhead transparencies. Free-recall tests revealed that listeners with low prior knowledge of biology learned the most when knowledge maps accompanied the lecture and the least when key terms were listed. For listeners with high prior knowledge, however, the opposite was true. An analysis of recall coherence revealed that learners recalled significantly fewer fragmented facts after viewing maps or outlines than after viewing lists. Prior knowledge was a significant factor in all analyses. Results are interpreted in terms of Mayer's cognitive model of assimilation encoding.     

Improving Physics Teaching through Collaborative Research

For one semester a team of researchers observed, recorded and discussed the manner in which physics knowledge was being transmitted by the teacher and acquired by a class of Year 11 students (aged 15‐16 years) and the role of the students' textbooks in this process. The collaboration provided an environment in which the teacher, as a member of the research team, could reflect on practice and initiate changes in his teaching. The results of the study are presented as two assertions. First, the collaborative approach enhanced the teacher's philosophical basis for his physics teaching and created an environment in which changes in teaching could occur. Secondly, deficiencies in students' use of the required textbooks were identified, and more effective means for student learning from text were adopted and evaluated.     

Web‐based interactive 3D visualization as a tool for improved anatomy learning

Despite a long tradition, conventional anatomy education based on dissection is declining. This study tested a new virtual reality (VR) technique for anatomy learning based on virtual contrast injection. The aim was to assess whether students value this new three‐dimensional (3D) visualization method as a learning tool and what value they gain from its use in reaching their anatomical learning objectives. Several 3D vascular VR models were created using an interactive segmentation tool based on the “virtual contrast injection” method. This method allows users, with relative ease, to convert computer tomography or magnetic resonance images into vivid 3D VR movies using the OsiriX software equipped with the CMIV CTA plug‐in. Once created using the segmentation tool, the image series were exported in Quick Time Virtual Reality (QTVR) format and integrated within a web framework of the Educational Virtual Anatomy (EVA) program. A total of nine QTVR movies were produced encompassing most of the major arteries of the body. These movies were supplemented with associated information, color keys, and notes. The results indicate that, in general, students' attitudes towards the EVA‐program were positive when compared with anatomy textbooks, but results were not the same with dissections. Additionally, knowledge tests suggest a potentially beneficial effect on learning. Anat Sci Ed 2:61–68, 2009. © 2009 American Association of Anatomists.