Enhancement of anatomical learning and developing clinical competence of first‐year medical and allied health profession students

Hands‐on educational experiences can stimulate student interest, increase knowledge retention, and enhance development of clinical skills. The Lachman test, used to assess the integrity of the anterior cruciate ligament (ACL), is commonly performed by health care professionals and is relatively easy to teach to first‐year health profession students. This study integrated teaching the Lachman test into a first‐year anatomy laboratory and examined if students receiving the training would be more confident, competent, and if the training would enhance anatomical learning. First‐year medical, physician assistant and physical therapy students were randomly assigned into either the intervention (Group A) or control group (Group B). Both groups received the course lecture on knee anatomy and training on how to perform the Lachman test during a surface anatomy class. Group A received an additional 15 minutes hands‐on training for the Lachman test utilizing a lightly embalmed cadaver as a simulated patient. One week later, both groups performed the Lachman test on a lightly embalmed cadaver and later completed a post‐test and survey. Students with hands‐on training performed significantly better than students with lecture‐only training in completing the checklist, a post‐test, and correctly diagnosing an ACL tear. Students in Group A also reported being more confident after hands‐on training compared to students receiving lecture‐only training. Both groups reported that incorporating clinical skill activities facilitated learning and created excitement for learning. Hands‐on training using lightly embalmed cadavers as patient simulators increased confidence and competence in performing the Lachman test and aided in learning anatomy. Anat Sci Educ 7: 181–190. © 2013 American Association of Anatomists.     

Bringing anatomy to life: Evaluating a novel ultrasound curriculum in the anatomy laboratory

As point-of-care ultrasound (POCUS) invades medical specialties, more students covet earlier ultrasound (US) training programs in medical school. Determining the optimal placement and format in the curriculum remains a challenge. This study uses student perceptions and confidence in interpreting and acquiring images to evaluate the effectiveness of an US curriculum and assesses their performance on US content. A unique US curriculum was incorporated into first-year clinical anatomy at Tufts University School of Medicine (TUSM). Students completed surveys evaluating changes in US confidence and perceptions. Mean ratings on pre- and post-surveys were compared using Mann–Whitney U tests. Performance on US examination questions was evaluated. Two independent evaluators coded narrative responses and NVivo software was used to identify common themes. Two hundred eleven students completed the US curriculum. Students reported higher post-curriculum mean confidence ratings on US comprehension, operation, image acquisition, artifact recognition, and normal image interpretation (P < 0.0001). US reinforced anatomy concepts and clinical correlates (9.56, ±0.97 SD; 9.60, ±1.05). Students disagreed with items stating learning US is too difficult (1.2, ±2.2) and that it interferes with learning anatomy (0.68, ±1.7). Students scored above passing on practical US knowledge questions, supporting survey data, and the relation to learning spatial relationships. Qualitative analysis identified seven major themes and additional subthemes. Limited integration of US breaks barriers in students' perceptions and confidence in performing POCUS. The TUSM US curriculum is a natural marriage of anatomy and POCUS applications, serving as a template for medical schools.     

No cuts,no buts: Satisfaction of first-year medical students with a hybrid prosection-based model for learning gross anatomy during the Covid-19 pandemic

Few realized the extent of disruption that the Covid-19 global pandemic would impose upon higher anatomical education. While many institutions were obliged to adopt a fully-remote online model, the New York Institute of Technology College of Osteopathic Medicine strove to develop a curriculum that would allow medical students to receive an in-person anatomy education. A hybrid model that emphasized learning from prosected cadavers and self-study stations was implemented, with the remainder of the students' time directed toward studying at home. Through an anonymous survey aimed at gleaning student satisfaction, this study demonstrates that this hybrid prosection-based anatomy course aligned with student preferences both assuming no health risk (64.6% agreed) and given the current risk of contracting Covid-19 (78.5% agreed). Generally, students felt that their education was equal to that of previous years (Likert scale = 3.24 ± 1.05), fostered an appreciation for anatomy (4.56 ± 0.59), promoted teamwork (4.13 ± 0.85), and prepared them for practical examinations (4.18 ± 0.74). Linear mixed-effect models demonstrated that specific differences in results could be attributed to students' preconceived preferences toward student-led dissections and to past medical training. Importantly, most students “disagree” (1.97 ± 1.00) that they were concerned about the risk of exposure to Covid-19 during in-person anatomy laboratory sessions. Areas requiring improvement were identified by the model, including the provision of access to the cadavers outside of the regularly scheduled laboratory times (3.89 ± 1.08). These findings should be utilized when designing future gross anatomy courses in response to the “new normal”.     

Development of a supported self-directed learning approach for anatomy education

The ability to deliver sufficient core anatomical knowledge and understanding to medical students with limited time and resources remains a major challenge for anatomy educators. Here, we report the results of switching from a primarily didactic method of teaching to supported self-directed learning for students studying anatomy as part of undergraduate medicine at the University of Edinburgh. The supported self-directed approach we have developed makes use of an integrated range of resources, including formal lectures and practical sessions (incorporating gross anatomy specimens, medical imaging technologies, anatomical models, clinical scenarios, and surface anatomy workstations). In practical sessions, students are provided with a custom-made workbook that guides them through each session, with academic staff, postgraduate tutors, and near-peer teaching assistants present to deal with misunderstandings and explain more complicated topics. This approach retains many of the best attributes of didactic teaching but blends them with the advantages associated with self-directed learning approaches. The switch to supported self-directed learning-initially introduced in 2005-resulted in a significant improvement in anatomy examination scores over the subsequent period of five years, manifesting as an increase in the average anatomy practical spot examination mark, less students failing to obtain the pass mark and more students passing with distinction. We conclude that the introduction of supported self-directed learning improved students' engagement, leading to deeper learning and better understanding and knowledge of anatomy.     

Interactive radiological anatomy eLearning solution for first year medical students: Development,integration, and impact on learning

A technology enhanced learning and teaching (TELT) solution, radiological anatomy (RA) eLearning, composed of a range of identification‐based and guided learning activities related to normal and pathological X‐ray images, was devised for the Year 1 nervous and locomotor course at the Faculty of Medicine, University of Southampton. Its effectiveness was evaluated using a questionnaire, pre‐ and post‐tests, focus groups, summative assessment, and tracking data. Since introduced in 2009, a total of 781 students have used RA eLearning, and among them 167 Year 1 students in 2011, of whom 116 participated in the evaluation study. Students enjoyed learning (77%) with RA eLearning, found it was easy to use (81%) and actively engaged them in their learning (75%), all of which were associated to the usability, learning design of the TELT solution and its integration in the curriculum; 80% of students reported RA eLearning helped their revision of anatomy and 69% stated that it facilitated their application of anatomy in a clinical context, both of which were associated with the benefits offered by the learning and activities design. At the end of course summative assessment, student knowledge of RA eLearning relevant topics (mean 80%; SD ±16) was significantly better as compared to topics not relevant to RA eLearning (mean 63%; SD ±15) (mean difference 18%; 95% CI 15% to 20%; P < 0.001). A well designed and integrated TELT solution can be an efficient method for facilitating the application, integration, and contextualization of anatomy and radiology to create a blended learning environment. Anat Sci Educ 7: 350–360. © 2013 American Association of Anatomists.     

Longitudinal retention of anatomical knowledge in second‐year medical students

The Radboud University Medical Center has a problem‐based, learner‐oriented, horizontally, and vertically integrated medical curriculum. Anatomists and clinicians have noticed students’ decreasing anatomical knowledge and the disability to apply knowledge in diagnostic reasoning and problem solving. In a longitudinal cohort, the retention of anatomical knowledge gained during the first year of medical school among second‐year medical students was assessed. In May 2011, 346 medical students applied for the second‐year gastro‐intestinal (GI) tract course. The students were asked to participate in a reexamination of a selection of anatomical questions of an examination from October 2009. The examination consisted of a clinical anatomy case scenario and two computed tomography (CT) images of thorax and abdomen in an extended matching format. A total of 165 students were included for analysis. In 2011, students scored significantly lower for the anatomy examination compared to 2009 with a decline in overall examination score of 14.7% (±11.7%). Decrease in knowledge was higher in the radiological questions, compared to the clinical anatomy cases 17.5% (±13.6%) vs. 7.9% (±10.0%), respectively, d = 5.17. In both years, male students scored slightly better compared to female students, and decline of knowledge seems somewhat lower in male students (13.1% (±11.1%) vs. 15.5% (±12.0%), respectively), d = ?0.21. Anatomical knowledge in the problem‐oriented horizontal and vertical integrated medical curriculum, declined by approximately 15% 1.5 year after the initial anatomy course. The loss of knowledge in the present study is relative small compared to previous studies. Anat Sci Educ 10: 242–248. © 2016 American Association of Anatomists.     

Improved medical student perception of ultrasound using a paired anatomy teaching assistant and clinician teaching model

This study describes a new teaching model for ultrasound (US) training, and evaluates its effect on medical student attitudes toward US. First year medical students participated in hands‐on US during human gross anatomy (2014 N = 183; 2015 N = 182). The sessions were facilitated by clinicians alone in 2014, and by anatomy teaching assistant (TA)‐clinician pairs in 2015. Both cohorts completed course evaluations which included five US‐related items on a four‐point scale; cohort responses were compared using Mann‐Whitney U tests with significance threshold set at 0.05. The 2015 survey also evaluated the TAs (three items, five‐point scale). With the adoption of the TA‐clinician teaching model, student ratings increased significantly for four out of five US‐items: “US advanced my ability to learn anatomy” increased from 2.91 ± 0.77 to 3.35 ± 0.68 (P < 0.0001), “Incorporating US increased my interest in anatomy” from 3.05 ± 0.84 to 3.50 ± 0.71 (P < 0.0001), “US is relevant to my current educational needs” from 3.36 ± 0.63 to 3.54 ± 0.53 (P = 0.015), and “US training should start in Phase I” from 3.36 ± 0.71 to 3.56 ± 0.59 (P = 0.010). Moreover, more than 84% of students reported that TAs enhanced their understanding of anatomy (mean 4.18 ± 0.86), were a valuable part of US training (mean 4.23 ± 0.89), and deemed the TAs proficient in US (mean 4.24 ± 0.86). By using an anatomy TA‐clinician teaching team, this study demonstrated significant improvements in student perceptions of the impact of US on anatomy education and the relevancy of US training to the early stages of medical education. Anat Sci Educ 11: 175–184. © 2017 American Association of Anatomists.     

Ultrasound imaging in medical student education: Impact on learning anatomy and physical diagnosis

Ultrasound use has expanded dramatically among the medical specialties for diagnostic and interventional purposes, due to its affordability, portability, and practicality. This imaging modality, which permits real‐time visualization of anatomic structures and relationships in vivo, holds potential for pre‐clinical instruction of students in anatomy and physical diagnosis, as well as providing a bridge to the eventual use of bedside ultrasound by clinicians to assess patients and guide invasive procedures. In many studies, but not all, improved understanding of anatomy has been demonstrated, and in others, improved accuracy in selected aspects of physical diagnosis is evident. Most students have expressed a highly favorable impression of this technology for anatomy education when surveyed. Logistic issues or obstacles to the integration of ultrasound imaging into anatomy teaching appear to be readily overcome. The enthusiasm of students and anatomists for teaching with ultrasound has led to widespread implementation of ultrasound‐based teaching initiatives in medical schools the world over, including some with integration throughout the entire curriculum; a trend that likely will continue to grow. Anat Sci Educ 10: 176–189. © 2016 American Association of Anatomists.     

Negotiation of learning and identity among first-year medical students

The demand for medical schools to produce competent doctors to meet health needs in South Africa has increased. In response to this challenge, the Faculty of Health Sciences at a relatively elite university introduced a problem-based, socially relevant curriculum in 2002. The classroom environment is designed to facilitate a learning context where students from diverse backgrounds engage critically and learn from each other. This study draws on data from a larger qualitative case study to describe how a group of ‘black’ students who failed their first semester experienced the school–university transition. Drawing on post-structuralist theory, this article analyses how the students negotiated learning and identity. The argument is made that the students re-positioned themselves in deficit, outsider subject positions in order to survive their first year. This article ends with a consideration of the implications for developing a learning environment which recognises difference and fosters diversity.     

自我导向学习及其与成人教育发展述评

自我导向学习孕育于成人教育,又推动成人教育的发展。自我导向学习对成人教育的发展影响巨大,奠定了成人教育学的学科基础,形成了成人学习的基本模式;澄清了成人学习认识上的误区,促进了成人学习研究的深化;推动了成人学习流派、学说的涌现和实践模式的建构。拓展理论基础、建构基本原理、加强课程领导和开发有效策略是自我导向学习在我国成人教育研究领域的发展趋势。     

Evaluation of an innovative hands‐on anatomy‐centered ultrasound curriculum to supplement graduate gross anatomy education

Ultrasound (US) can enhance anatomy education, yet is incorporated into few non‐medical anatomy programs. This study is the first to evaluate the impact of US training in gross anatomy for non‐medical students in the United States. All 32 master's students enrolled in gross anatomy with the anatomy‐centered ultrasound (ACUS) curriculum were recruited. Mean Likert ratings on pre‐ and post‐course surveys (100% response rates) were compared to evaluate the effectiveness of the ACUS curriculum in developing US confidence, and gauge its impact on views of US. Post‐course, students reported significantly higher (P < 0.001) mean confidence ratings in five US skills (pre‐course versus post‐course mean): obtaining scans (3.13 ±1.04 versus 4.03 ±0.78), optimizing images (2.78 ±1.07 versus 3.75 ±0.92), recognizing artifacts (2.94 ±0.95 versus 3.97 ±0.69), distinguishing tissue types (2.88 ±0.98 versus 4.09 ±0.69), and identifying structures (2.97 ±0.86 versus 4.03 ±0.59), demonstrating the success of the ACUS curriculum in students with limited prior experience. Views on the value of US to anatomy education and to students' future careers remained positive after the course. End‐of‐semester quiz performance (91% response rate) provided data on educational outcomes. The average score was 79%, with a 90% average on questions about distinguishing tissues/artifacts, demonstrating positive learning outcomes and retention. The anatomy‐centered ultrasound curriculum significantly increased confidence with and knowledge of US among non‐medical anatomy students with limited prior training. Non‐medical students greatly value the contributions that US makes to anatomy education and to their future careers. It is feasible to enhance anatomy education outside of medical training by incorporating US. Anat Sci Educ 10: 348–362. © 2016 American Association of Anatomists.     

Interactive anatomical and surgical live stream lectures improve students' academic performance in applied clinical anatomy

Tuebingen's Sectio Chirurgica (TSC) is an innovative, interactive, multimedia, and transdisciplinary teaching method designed to complement dissection courses. The Tuebingen's Sectio Chirurgica (TSC) allows clinical anatomy to be taught via interactive live stream surgeries moderated by an anatomist. This method aims to provide an application‐oriented approach to teaching anatomy that offers students a deeper learning experience. A cohort study was devised to determine whether students who participated in the TSC were better able to solve clinical application questions than students who did not participate. A total of 365 students participated in the dissection course during the winter term of the 2012/2013 academic year. The final examination contained 40 standard multiple‐choice (S‐MC) and 20 clinically‐applied multiple‐choice (CA‐MC) items. The CA‐MC items referred to clinical cases but could be answered solely using anatomical knowledge. Students who regularly participated in the TSC answered the CA‐MC questions significantly better than the control group (75% and 65%, respectively; P < 0.05, Mann‐Whitney U test). The groups exhibited no differences on the S‐MC questions (85% and 82.5%, respectively; P > 0.05). The CA‐MC questions had a slightly higher level of difficulty than the S‐MC questions (0.725 and 0.801, respectively; P = 0.083). The discriminatory power of the items was comparable (S‐MC median Pearson correlations: 0.321; CA‐MC: 0.283). The TSC successfully teaches the clinical application of anatomical knowledge. Students who attended the TSC in addition to the dissection course were able to answer CA‐MC questions significantly better than students who did not attend the TSC. Thus, attending the TSC in addition to the dissection course supported students' clinical learning goals. Anat Sci Educ 10: 46–52. © 2016 American Association of Anatomists.     

A dissecting competition for medical students

After repeated requests from medical students for more cadaver dissection opportunities, a voluntary dissecting "competition" was initiated for the third year medical students in 2006. This has been held annually on five occasions since, offering up to 30 dissection stations and accommodating an average of 53 students (range 40-66) per year, representing about 20-25% of the total class. Material is standardized to distal upper or lower limb specimens, each of which is dissected by one or two students during a single weekend day. Participants are required to complete their dissection in about six hours and present an appropriately labeled display together with a 300 word abstract, emphasizing clinical relevance. Dissections are judged on presentation, accuracy of identification and labeling, and relevance to the clinical abstract, taking into account the technical difficulty of the particular dissection. Judging from successive annual uptake of places and informal feedback, this is not only a popular event allowing students to focus creatively on producing a clinically relevant dissection in a relaxed learning environment but also of educational value. An unexpected outcome has been the production of many specimens suitable as prosections for future classes. A dissecting competition may be a useful method of stimulating learning for medical students interested in undertaking further dissection but it requires appropriate staff commitment and a supply of suitable cadaver specimens.     

Anatomy education for medical students in the United Kingdom and Republic of Ireland in 2019: A 20-year follow-up

Anatomical education in the United Kingdom (UK) and Ireland has long been under scrutiny, especially since the reforms triggered in 1993 by the General Medical Council's “Tomorrow's Doctors.” The aim of the current study was to investigate the state of medical student anatomy education in the UK and Ireland in 2019. In all, 39 medical schools completed the survey (100% response rate) and trained 10,093 medical students per year cohort. The teachers comprised 760 individuals, of these 143 were employed on full-time teaching contracts and 103 were employed on education and research contracts. Since a previous survey in 1999, the number of part-time staff has increased by 300%, including a significant increase in the number of anatomy demonstrators. In 2019, anatomy was predominantly taught to medical students in either a system-based or hybrid curriculum. In all, 34 medical schools (87%) used human cadavers to teach anatomy, with a total of 1,363 donors being used per annum. Gross anatomy teaching was integrated with medical imaging in 95% of medical schools, embryology in 81%, living anatomy in 78%, neuroanatomy in 73%, and histology in 68.3%. Throughout their five years of study, medical students are allocated on average 85 h of taught time for gross anatomy, 24 h for neuroanatomy, 24 h for histology, 11 h for living anatomy, and 10 for embryology. In the past 20 years, there has been an average loss of 39 h dedicated to gross anatomy teaching and a reduction in time dedicated to all other anatomy sub-disciplines.     

Ultrasound and cadaveric prosections as methods for teaching cardiac anatomy: a comparative study

This study compared the efficacy of two cardiac anatomy teaching modalities, ultrasound imaging and cadaveric prosections, for learning cardiac gross anatomy. One hundred and eight first-year medical students participated. Two weeks prior to the teaching intervention, students completed a pretest to assess their prior knowledge and to ensure that groups were equally randomized. Students, divided into pre-existing teaching groups, were assigned to one of two conditions; "cadaver" or "ultrasound." Those in the cadaver group received teaching on the heart using prosections, whereas the ultrasound group received teaching using live ultrasound images of the heart. Immediately after teaching, students sat a post-test. Both teaching modalities increased students' test scores by similar amounts but no significant difference was found between the two conditions, suggesting that both prosections and ultrasound are equally effective methods for teaching gross anatomy of the heart. Our data support the inclusion of either cadaveric teaching or living anatomy using ultrasound within the undergraduate anatomy curriculum, and further work is needed to compare the additive effect of the two modalities.     

An exploration of anatomists’ views toward the use of body painting in anatomical and medical education: An international study

Previous research has explored the experiences of medical students using body painting as a learning tool. However, to date, faculty experiences and views have not been explored. This international qualitative study utilized a grounded theory approach with data collection through interviews with academics and clinicians who utilized body painting as part of their anatomical teaching. Twenty‐six anatomists participated in the study from 14 centers worldwide. Three themes emerged from the data: (1) the efficacy of body painting, (2) the promotion of knowledge retention and recall, (3) considerations and practicalities regarding the use of body painting as a teaching tool. Subthemes show that body painting is used as an adjunct to the curriculum for teaching surface anatomy and peer examination. Benefits included diffusing the formal curricula, high student engagement and learning for future clinical practice. Body painting was advocated for promoting knowledge retention and recall, particularly learning through the process of cognitive load due to combining the use of color and kinesthetic learning with anatomical theory. Critical discussions surfaced on the topic of undressing in the classroom due to cultural and personal considerations possibly leading to unequal involvement and different learning experiences. Overall results support previous research showing that anatomists appreciate body painting as an effective, enjoyable, engaging and cost efficient adjunct to the multimodal anatomy curriculum. The role of cognitive load theory in learning anatomy through body painting emerged from the data as a possible theoretical framework supporting learning benefits from body painting and is suggested for further investigation. Anat Sci Educ 11: 146–154. © 2017 American Association of Anatomists.     

Collaborative development of anatomy workshops for medical and dental students in Cambodia

After Phnom Penh was liberated from the Khmer Rouge in 1979, health science education in Cambodia had to be completely rebuilt. In this article, the authors report the results of a teaching collaboration between the University of Melbourne (Australia), the International University (Cambodia), and the University of Health Sciences (Cambodia). The main objectives in this collaboration were to provide the opportunity for dental and medical students in Cambodia to attend resourced anatomy workshops and to provide an opportunity for anatomy teachers in Cambodia to gain experience in implementing anatomy workshops of the style that are routinely used in the medical and dental curricula at the University of Melbourne. Experienced anatomy educators from the Department of Anatomy and Cell Biology, University of Melbourne, designed and resourced a series of workshops and then delivered these in collaboration with Cambodian teaching staff in Phnom Penh. The Cambodian students who participated in the workshops were incredibly engaged and enthusiastic. The students' evaluations (by questionnaire) indicated a very positive response to the workshops. All of the workshop resources were donated to the two universities so that the staff could continue to implement similar workshops, and plans were developed to continue our collaboration by developing more resourced workshops for this purpose in the future. Two staff members from Cambodia will travel to Melbourne to participate in anatomy workshops and dissection classes at the University of Melbourne. We hope that this extension of the collaboration provides further support and impetus for the development of anatomy education in Cambodia in the future.