HistoViewer: An interactive e‐learning platform facilitating group and peer group learning

Understanding tissue architecture and the morphological characteristics of cells is a central prerequisite to comprehending the basis of physiological tissue function in healthy individuals and relating this to disease states. Traditionally, medical curricula include courses where students examine glass slides of cytological or tissue samples under a light microscope. However, it is challenging to implement group and peer group learning in these courses and to give students sufficient time to study specimens. An increasing number of medical schools have thus started to implement digital slide viewers, so‐called virtual microscopes, in histology and histopathology. These websites are mostly based on standard commercial software and offer limited adaptation to the special needs of first‐year students. An e‐learning platform has therefore been developed for use in cytology and histology courses. This virtual microscopy tool is coupled to a central database in which students can label and store the positions of individual structures for later repetition. As learning in pairs and peer groups has been shown to provide a high learning outcome, identified structures can be shared and discussed with students' peers or faculty via a built‐in communication module. This website has the possibility of opening an arbitrary number of frames which all can actively be moved and changed in magnification to enable the comparison of specimens and thus encourage a more global understanding of related tissues. HistoViewer is thus suggested as an e‐learning tool combining several modern teaching concepts. © 2013 American Association of Anatomists.     

A “Do‐It‐Yourself” interactive bone structure module: Development and evaluation of an online teaching resource

A stand‐alone online teaching module was developed to cover an area of musculoskeletal anatomy (structure of bone) found to be difficult by students. The material presented in the module was not formally presented in any other way, thus providing additional time for other curriculum components, but it was assessed in the final examination. The module was developed using “in‐house” software designed for academics with minimal computer experience. The efficacy and effectiveness of the module was gauged via student surveys, testing student knowledge before and after module introduction, and analysis of final examination results. At least 74% of the class used the module and student responses were positive regarding module usability (navigation, interaction) and utility (learning support). Learning effectiveness was demonstrated by large significant improvements in the post‐presentation test scores for “users” compared with “non‐users” and by the percentage of correct responses to relevant multiple choice questions in the final examination. Performance on relevant short answer questions in the final examination was, on average, comparable to that for other components. Though limited by study structure, it was concluded that the module produced learning outcomes equivalent to those generated by more traditional teaching methods. This “Do‐It‐Yourself” e‐learning approach may be particularly useful for meeting specific course needs not catered for by commercial applications or where there are cost limitations for generation of online learning material. The specific approaches used in the study can assist in development of effective online resources in anatomy. Anat Sci Educ 6: 107–113. © 2012 American Association of Anatomists.     

An enriched multimedia eBook application to facilitate learning of anatomy

This pilot study compared the use of an enriched multimedia eBook with traditional methods for teaching the gross anatomy of the heart and great vessels. Seventy‐one first‐year students from an Australian medical school participated in the study. Students' abilities were examined by pretest, intervention, and post‐test measurements. Perceptions and attitudes toward eBook technology were examined by survey questions. Results indicated a strongly positive user experience coupled with increased marks; however, there were no statistically significant results for the eBook method of delivery alone outperforming the traditional anatomy practical session. Results did show a statistically significant difference in the final marks achieved based on the sequencing of the learning modalities. With initial interaction with the multimedia content followed by active experimentation in the anatomy lab, students' performance was improved in the final test. Obtained data support the role of eBook technology in modern anatomy curriculum being a useful adjunct to traditional methods. Further study is needed to investigate the importance of sequencing of teaching interventions. Anat Sci Educ. 7: 19–27. © 2013 American Association of Anatomists.     

Use of interactive live digital imaging to enhance histology learning in introductory level anatomy and physiology classes

Histology is one of the main subjects in introductory college-level Human Anatomy and Physiology classes. Institutions are moving toward the replacement of traditional microscope-based histology learning with virtual microscopy learning amid concerns of losing the valuable learning experience of traditional microscopy. This study used live digital imaging (LDI) of microscopic slides on a SMART board to enhance Histology laboratory teaching. The interactive LDI system consists of a digital camera-equipped microscope that projects live images on a wall-mounted SMART board via a computer. This set-up allows real-time illustration of microscopic slides with highlighted key structural components, as well as the ability to provide the students with relevant study and review material. The impact of interactive LDI on student learning of Histology was then measured based on performance in subsequent laboratory tests before and after its implementation. Student grades increased from a mean of 76% (70.3-82.0, 95% CI) before to 92% (88.8-95.3, 95% CI) after integration of LDI indicating highly significant (P < 0.001) enhancement in students' Histology laboratory performance. In addition, student ratings of the impact of the interactive LDI on their Histology learning were strongly positive, suggesting that a majority of students who valued this learning approach also improved learning and understanding of the material as a result. The interactive LDI technique is an innovative, highly efficient and affordable tool to enhance student Histology learning, which is likely to expand knowledge and student perception of the subject and in turn enrich future science careers.     

Loosely‐guided,self‐directed learning versus strictly‐guided,station‐based learning in gross anatomy laboratory sessions

Anatomy students studying dissected anatomical specimens were subjected to either a loosely‐guided, self‐directed learning environment or a strictly‐guided, preformatted gross anatomy laboratory session. The current study's guiding questions were: (1) do strictly‐guided gross anatomy laboratory sessions lead to higher learning gains than loosely‐guided experiences? and (2) are there differences in the recall of anatomical knowledge between students who undergo the two types of laboratory sessions after weeks and months? The design was a randomized controlled trial. The participants were 360 second‐year medical students attending a gross anatomy laboratory course on the anatomy of the hand. Half of the students, the experimental group, were subjected without prior warning to station‐based laboratory sessions; the other half, the control group, to loosely‐guided laboratory sessions, which was the course's prevailing educational method at the time. The recall of anatomical knowledge was measured by written reproduction of 12 anatomical names at four points in time: immediately after the laboratory experience, then one week, five weeks, and eight months later. The strictly‐guided group scored higher than the loosely‐guided group at all time‐points. Repeated ANOVA showed no interaction between the results of the two types of laboratory sessions (P = 0.121) and a significant between‐subject effect (P ≤ 0.001). Therefore, levels of anatomical knowledge retrieved were significantly higher for the strictly‐guided group than for the loosely‐guided group at all times. It was concluded that gross anatomy laboratory sessions with strict instructions resulted in the recall of a larger amount of anatomical knowledge, even after eight months. Anat Sci Educ. © 2012 American Association of Anatomists.     

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.     

A survey of student perceptions of team‐based learning in anatomy curriculum: Favorable views unrelated to grades

Team‐based learning (TBL) combines independent out of class preparation with in class small group discussion. We adopted TBL in teaching first year medical gross anatomy. In this study, we evaluated student perceptions of TBL by using a survey that elicited perceptions of both pedagogy and mode of learning. Anatomy lectures were replaced with required preclass readings, self‐assessment quizzes, small group discussions of assignments, and groups retaking the same quizzes for deeper learning. At the course conclusion, students were surveyed to assess their preference for TBL, their perceptions of TBL effectiveness, and their perceptions of successful interpersonal relationships within groups. Respondents (n = 317; 89% response) were asked to rate the extent that they agreed (?2 = strongly disagree; ?1 = disagree; 0 = neutral; 1 = agree; and 2 = strongly agree). A principal components factor analysis with varimax rotation identified two 8‐item factors: “perceptions of TBL” and “perceptions of teamwork.” Internal consistency for each was high [Cronbach's alpha = 0.908 (preference for TBL); 0.884 (preference of teamwork)]. Results of one‐way analysis of variance between Honors/High Pass/Pass/Fail students indicated that Honors (n = 73) tended to rate perceptions of TBL higher than Pass (n = 54) [mean difference = 2.92; 95% CI (0.05, 5.79)], and also higher than Fail (n = 11) [mean difference = 6.30; 95% CI (1.13, 11.47)]. However, each had overallpositive ratings. No difference was noted between mean ratings of teamwork, which were also, overall, positive. We conclude that medical students view TBL favorably irrespective of their grades. Anat Sci Educ 2:150–155, 2009. © 2009 American Association of Anatomists.     

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.     

Near‐peer teaching in anatomy: An approach for deeper learning

Peer teaching has been recognized as a valuable and effective approach for learning and has been incorporated into medical, dental, and healthcare courses using a variety of approaches. The success of peer teaching is thought to be related to the ability of peer tutors and tutees to communicate more effectively, thereby improving the learning environment. Near‐peer teaching involves more experienced students acting as tutors who are ideally placed to pass on their knowledge and experience. The advantage of using near‐peer teachers is the opportunity for the teacher to reinforce and expand their own learning and develop essential teaching skills. This study describes the design and implementation of a program for fourth year medical students to teach anatomy to first‐ and second‐year medical students and evaluates the perceptions of the near‐peer teachers on the usefulness of the program, particularly in relation to their own learning. Feedback from participants suggests that the program fulfills its aims of providing an effective environment for developing deeper learning in anatomy through teaching. Participants recognize that the program also equips them with more advanced teaching skills that will be required as they move nearer toward taking on supervisory and teaching duties. The program has also provided the school with an additional valuable and appropriate resource for teaching anatomy to first‐ and second‐year students, who themselves view the inclusion of near‐peer teachers as a positive element in their learning. Anat Sci Educ 2:227–233, 2009. © 2009 American Association of Anatomists.     

Improving near‐peer teaching quality in anatomy by educating teaching assistants: An example from Sweden

Peer‐assisted learning has gained momentum in a variety of disciplines, including medical education. In Gothenburg, Sweden, medical students who have finished their compulsory anatomy courses have the option of working as teaching assistants (TAs). Teaching assistants provide small group teaching sessions as a complement to lectures given by faculty. Previously, TAs were left to handle the role as junior teachers by themselves, but since 2011, a continuation course in anatomy has been developed with the aim of providing the TAs better anatomy knowledge and guidance for teaching. The course was designed to comprise 7.5 ECTS credits (equivalent to 5 weeks of full‐time studies), and today all TAs are required to take this course before undertaking their own teaching responsibilities. This study aims to compare course evaluations of TA teaching before and after the introduction of the anatomy continuation course, in order to understand how students perceived teaching performed by self‐learned versus trained TAs. The results of this study demonstrate that there was a trend towards better teaching performed by trained TAs. The variability in rankings decreased significantly after the introduction of the continuation course. This was mainly due to an improvement among the TAs with the lowest levels of performance. In addition to comparing student rankings, TAs were interviewed regarding their experiences and perceptions within the continuation course. The course was generally positively regarded. The TAs described a sense of cohesion and appreciation since the institute invested in a course dedicated specifically for them. Anat Sci Educ 11: 403–409. © 2018 American Association of Anatomists.     

Perceptions among occupational and physical therapy students of a nontraditional methodology for teaching laboratory gross anatomy

This pilot study was designed to assess the perceptions of physical therapy (PT) and occupational therapy (OT) students regarding the use of computer-assisted pedagogy and prosection-oriented communications in the laboratory component of a human anatomy course at a comprehensive health sciences university in the southeastern United States. The goal was to determine whether student perceptions changed over the course of a summer session regarding verbal, visual, tactile, and web-based teaching methodologies. Pretest and post-test surveys were distributed online to students who volunteered to participate in the pilot study. Despite the relatively small sample size, statistically significant results indicated that PT and OT students who participated in this study perceived an improved ability to name major anatomical structures from memory, to draw major anatomical structures from memory, and to explain major anatomical relationships from memory. Students differed in their preferred learning styles. This study demonstrates that the combination of small group learning and digital web-based learning seems to increase PT and OT students' confidence in their anatomical knowledge. Further research is needed to determine which forms of integrated instruction lead to improved student performance in the human gross anatomy laboratory.     

Use of the one-minute preceptor as a teaching tool in the gross anatomy laboratory

The one-minute preceptor (OMP) is a time-efficient technique used for teaching in busy clinical settings. It consists of five microskills: (1) get a commitment from the student, (2) probe for supporting evidence, (3) reinforce what was done right, (4) correct errors and fill in omissions, and (5) teach a general rule. It can also be used to address structure-identification questions in gross anatomy laboratory small-group settings. The OMP is an active learner-centered teaching approach that prepares students for a style of learning that they need to master in clinical settings, provides novice anatomy teachers with an efficient and effective teaching strategy, and moves anatomy learning beyond mere name tagging to active knowledge construction.     

Evaluation of computer‐aided instruction in a gross anatomy course: A six‐year study

Web‐based computer‐aided instruction (CAI) has become increasingly important to medical curricula. This multi‐year study investigated the effectiveness of CAI and the factors affecting level of individual use. Three CAI were tested that differed in specificity of applicability to the curriculum and in the level of student interaction with the CAI. Student personality preferences and learning styles were measured using the Meyers Briggs Type Indicator (MBTI) and Kolb's Learning Style Inventory (LSI). Information on “computer literacy” and use of CAI was collected from student surveys. Server logs were used to quantify individual use of respective CAI. There was considerable variability in the level of utilization of each CAI by individual students. Individual use of each CAI differed and was associated with gender, MBTI preferences and learning style, but not with “computer literacy.” The majority of students found the CAI useful for learning and used the CAI by themselves. Students who accessed the CAI resources most frequently scored significantly higher on exams compared with students who never accessed the resources. Our results show that medical students do not uniformly use CAI developed for their curriculum and this variability is associated with various attributes of individual students. Our data also provide evidence of the importance of understanding student preferences and learning styles when implementing CAI into the curriculum. Anat Sci Ed 2:2–8, 2009. © 2009 American Association of Anatomists.     

Constructive,collaborative, contextual,and self‐directed learning in surface anatomy education

Anatomy education often consists of a combination of lectures and laboratory sessions, the latter frequently including surface anatomy. Studying surface anatomy enables students to elaborate on their knowledge of the cadaver's static anatomy by enabling the visualization of structures, especially those of the musculoskeletal system, move and function in a living human being. A recent development in teaching methods for surface anatomy is body painting, which several studies suggest increases both student motivation and knowledge acquisition. This article focuses on a teaching approach and is a translational contribution to existing literature. In line with best evidence medical education, the aim of this article is twofold: to briefly inform teachers about constructivist learning theory and elaborate on the principles of constructive, collaborative, contextual, and self‐directed learning; and to provide teachers with an example of how to implement these learning principles to change the approach to teaching surface anatomy. Student evaluations of this new approach demonstrate that the application of these learning principles leads to higher student satisfaction. However, research suggests that even better results could be achieved by further adjustments in the application of contextual and self‐directed learning principles. Successful implementation and guidance of peer physical examination is crucial for the described approach, but research shows that other options, like using life models, seem to work equally well. Future research on surface anatomy should focus on increasing the students' ability to apply anatomical knowledge and defining the setting in which certain teaching methods and approaches have a positive effect. Anat Sci Educ 6: 114–124. © 2012 American Association of Anatomists.     

Improvements in anatomy knowledge when utilizing a novel cyclical “Observe‐Reflect‐Draw‐Edit‐Repeat” learning process

Innovative educational strategies can provide variety and enhance student learning while addressing complex logistical and financial issues facing modern anatomy education. Observe‐Reflect‐Draw‐Edit‐Repeat (ORDER), a novel cyclical artistic process, has been designed based on cognitivist and constructivist learning theories, and on processes of critical observation, reflection and drawing in anatomy learning. ORDER was initially investigated in the context of a compulsory first year surface anatomy practical (ORDER‐SAP) at a United Kingdom medical school in which a cross‐over trial with pre‐post anatomy knowledge testing was utilized and student perceptions were identified. Despite positive perceptions of ORDER‐SAP, medical student (n = 154) pre‐post knowledge test scores were significantly greater (P < 0.001) with standard anatomy learning methods (3.26, SD = ±2.25) than with ORDER‐SAP (2.17, ±2.30). Based on these findings, ORDER was modified and evaluated in the context of an optional self‐directed gross anatomy online interactive tutorial (ORDER‐IT) for participating first year medical students (n = 55). Student performance was significantly greater (P < 0.001) with ORDER‐IT (2.71 ± 2.17) when compared to a control tutorial (1.31 ± 2.03). Performances of students with visual and artistic preferences when using ORDER were not significantly different (P > 0.05) to those students without these characteristics. These findings will be of value to anatomy instructors seeking to engage students from diverse learning backgrounds in a research‐led, innovative, time and cost‐effective learning method, in the context of contrasting learning environments. Anat Sci Educ 10: 7–22. © 2016 American Association of Anatomists.     

Measuring learning gain: Comparing anatomy drawing screencasts and paper‐based resources

The use of technology‐enhanced learning (TEL) resources is now a common tool across a variety of healthcare programs. Despite this popular approach to curriculum delivery there remains a paucity in empirical evidence that quantifies the change in learning gain. The aim of the study was to measure the changes in learning gain observed with anatomy drawing screencasts in comparison to a traditional paper‐based resource. Learning gain is a widely used term to describe the tangible changes in learning outcomes that have been achieved after a specific intervention. In regard to this study, a cohort of Year 2 medical students voluntarily participated and were randomly assigned to either a screencast or textbook group to compare changes in learning gain across resource type. Using a pre‐test/post‐test protocol, and a range of statistical analyses, the learning gain was calculated at three test points: immediate post‐test, 1‐week post‐test and 4‐week post‐test. Results at all test points revealed a significant increase in learning gain and large effect sizes for the screencast group compared to the textbook group. Possible reasons behind the difference in learning gain are explored by comparing the instructional design of both resources. Strengths and weaknesses of the study design are also considered. This work adds to the growing area of research that supports the effective design of TEL resources which are complimentary to the cognitive theory of multimedia learning to achieve both an effective and efficient learning resource for anatomical education. Anat Sci Educ 10: 307–316. © 2016 American Association of Anatomists.     

Effects of image‐based and text‐based active learning exercises on student examination performance in a musculoskeletal anatomy course

Research on the benefits of visual learning has relied primarily on lecture‐based pedagogy, but the potential benefits of combining active learning strategies with visual and verbal materials on learning anatomy has not yet been explored. In this study, the differential effects of text‐based and image‐based active learning exercises on examination performance were investigated in a functional anatomy course. Each class session was punctuated with an average of 12 text‐based and image‐based active learning exercises. Participation data from 231 students were compared with their examination performance on 262 questions associated with the in‐class exercises. Students also rated the helpfulness and difficulty of the in‐class exercises on a survey. Participation in the active learning exercises was positively correlated with examination performance (r = 0.63, P < 0.001). When controlling for other key demographics (gender, underrepresented minority status) and prior grade point average, participation in the image‐based exercises was significantly correlated with performance on examination questions associated with image‐based exercises (P < 0.001) and text‐based exercises (P < 0.01), while participation in text‐based exercises was not. Additionally, students reported that the active learning exercises were helpful for seeing images of key ideas (94%) and clarifying key course concepts (80%), and that the image‐based exercises were significantly less demanding, less hard and required less effort than text‐based exercises (P < 0.05). The findings confirm the positive effect of using images and active learning strategies on student learning, and suggest that integrating them may be especially beneficial for learning anatomy. Anat Sci Educ 10: 444–455. © 2017 American Association of Anatomists.     

Reflections as near‐peer facilitators of an inquiry project for undergraduate anatomy: Successes and challenges from a term of trial‐and‐error

Near‐peer facilitators (senior students serving as facilitators to their more junior peers) bring a unique student‐based perspective to teaching. With fewer years of teaching experience however, students who become involved in a facilitator role typically develop related skills quickly through a process of trial‐and‐error within the classroom. The aim of this paper is to report on the authors' own experiences and reflections as student near‐peer facilitators for an inquiry‐based project in an undergraduate anatomy course. Three areas of the facilitator experience are explored: (1) offering adequate guidance as facilitators of inquiry, (2) motivating students to engage in the inquiry process, and (3) fostering creativity in learning. A practical framework for providing guidance to students is discussed which offers facilitators a scaffold for asking questions and assisting students through the inquiry process. Considerations for stimulating intrinsic motivations toward inquiry learning are made, paying attention to ways in which facilitators might influence feelings of motivation towards learning. Also, the role of creativity in inquiry learning is explored by highlighting the actions facilitators can take to foster a creative learning environment. Finally, recommendations are made for the development of formalized training programs that aid near‐peer facilitators in the acquisition of facilitation skills before entering into a process of trial‐and‐error within the classroom. Anat Sci Educ. 7: 64–70. © 2013 American Association of Anatomists.