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

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

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.     

Spatial abilities and anatomy knowledge assessment: A systematic review

Anatomy knowledge has been found to include both spatial and non‐spatial components. However, no systematic evaluation of studies relating spatial abilities and anatomy knowledge has been undertaken. The objective of this study was to conduct a systematic review of the relationship between spatial abilities test and anatomy knowledge assessment. A literature search was done up to March 20, 2014 in Scopus and in several databases on the OvidSP and EBSCOhost platforms. Of the 556 citations obtained, 38 articles were identified and fully reviewed yielding 21 eligible articles and their quality were formally assessed. Non‐significant relationships were found between spatial abilities test and anatomy knowledge assessment using essays and non‐spatial multiple‐choice questions. Significant relationships were observed between spatial abilities test and anatomy knowledge assessment using practical examination, three‐dimensional synthesis from two‐dimensional views, drawing of views, and cross‐sections. Relationships between spatial abilities test and anatomy knowledge assessment using spatial multiple‐choice questions were unclear. The results of this systematic review provide evidence for spatial and non‐spatial methods of anatomy knowledge assessment. Anat Sci Educ 10: 235–241. © 2016 American Association of Anatomists.     

Three‐dimensional printing of X‐ray computed tomography datasets with multiple materials using open‐source data processing

Advances in three‐dimensional (3D) printing allow for digital files to be turned into a “printed” physical product. For example, complex anatomical models derived from clinical or pre‐clinical X‐ray computed tomography (CT) data of patients or research specimens can be constructed using various printable materials. Although 3D printing has the potential to advance learning, many academic programs have been slow to adopt its use in the classroom despite increased availability of the equipment and digital databases already established for educational use. Herein, a protocol is reported for the production of enlarged bone core and accurate representation of human sinus passages in a 3D printed format using entirely consumer‐grade printers and a combination of free‐software platforms. The comparative resolutions of three surface rendering programs were also determined using the sinuses, a human body, and a human wrist data files to compare the abilities of different software available for surface map generation of biomedical data. Data shows that 3D Slicer provided highest compatibility and surface resolution for anatomical 3D printing. Generated surface maps were then 3D printed via fused deposition modeling (FDM printing). In conclusion, a methodological approach that explains the production of anatomical models using entirely consumer‐grade, fused deposition modeling machines, and a combination of free software platforms is presented in this report. The methods outlined will facilitate the incorporation of 3D printed anatomical models in the classroom. Anat Sci Educ 10: 383–391. © 2017 American Association of Anatomists.     

Coupled physical and digital cadaver dissection followed by a visual test protocol provides insights into the nature of anatomical knowledge and its evaluation

This research effort compared and contrasted two conceptually different methods for the exploration of human anatomy in the first‐year dissection laboratory by accomplished students: “physical” dissection using an embalmed cadaver and “digital” dissection using three‐dimensional volume modeling of whole‐body CT and MRI image sets acquired using the same cadaver. The goal was to understand the relative contributions each method makes toward student acquisition of intuitive sense of practical anatomical knowledge gained during “hands‐on” structural exploration tasks. The main instruments for measuring anatomical knowledge under this conceptual model were questions generated using a classification system designed to assess both visual presentation manner and the corresponding response information required. Students were randomly divided into groups based on exploration method (physical or digital dissection) and then anatomical region. The physical dissectors proceeded with their direct methods, whereas the digital dissectors generated and manipulated indirect 3D digital models. After 6 weeks, corresponding student anatomical assignment teams compared their results using photography and animated digital visualizations. Finally, to see whether each method provided unique advantages, a visual test protocol of new visualizations based on the classification schema was administered. Results indicated that all students, regardless of gender, dissection method, and anatomical region dissected performed significantly better on questions presented as rotating models requiring spatial ordering or viewpoint determination responses in contrast to requests for specific lexical feature identifications. Additional results provided evidence of trends showing significant differences in gender and dissection method scores. These trends will be explored with further trials with larger populations. Anat Sci Ed 1:27–40, 2008. © 2007 American Association of Anatomists.     

Interprofessional education in gross anatomy: Experience with first‐year medical and physical therapy students at Mayo Clinic

Interprofessional education (IPE) in clinical practice is believed to improve outcomes in health care delivery. Integrating teaching and learning objectives through cross discipline student interaction in basic sciences has the potential to initiate interprofessional collaboration at the early stages of health care education. Student attitudes and effectiveness of IPE in the context of a combined gross anatomy course for first‐year students in Doctor of Physical Therapy (DPT) and Doctor of Medicine (MD) degrees curricula were evaluated. Integrated teams of MD and DPT students participated in part of the gross anatomy dissection course at Mayo Medical School. A survey was administered to 42 MD and 28 DPT students that assessed their attitudes toward IPE and cooperation among health care professionals. Pre‐ and post‐experience surveys were evaluated. Positive comments were related to opportunities for developing a better understanding of the nature and scope of each other's programs, encouraging teamwork and communication, mutual respect, and reducing the perceptual divide between disciplines. Ninety‐two percent of the students agreed that interprofessional learning would help them in becoming a more effective member of the health care team. This initial experience with IPE in gross anatomy provides a basis for continued development of interdisciplinary educational strategies. Anat Sci Ed 1:258–263, 2008. © 2008 American Association of Anatomists.     

Transforming clinical imaging data for virtual reality learning objects

Advances in anatomical informatics, three‐dimensional (3D) modeling, and virtual reality (VR) methods have made computer‐based structural visualization a practical tool for education. In this article, the authors describe streamlined methods for producing VR “learning objects,” standardized interactive software modules for anatomical sciences education, from newer high‐resolution clinical imaging systems data. The key program is OsiriX, a free radiological image processing workstation software capable of directly reformatting and rendering volumetric 3D images. The transformed image arrays are then directly loaded into a commercial VR program to produce a variety of learning objects. Multiple types or “dimensions” of anatomical information can be embedded in these objects to provide different kinds of functions, including interactive atlases, examination questions, and complex, multistructure presentations. The use of clinical imaging data and workstation software speeds up the production of VR simulations, compared with reconstruction‐based modeling from segmented cadaver cross‐sections, while providing useful examples of normal structural variation and pathological anatomy. Anat Sci Ed 1:50–55, 2008. © 2008 American Association of Anatomists.     

Validation of clay modeling as a learning tool for the periventricular structures of the human brain

Visualizing anatomical structures and functional processes in three dimensions (3D) are important skills for medical students. However, contemplating 3D structures mentally and interpreting biomedical images can be challenging. This study examines the impact of a new pedagogical approach to teaching neuroanatomy, specifically how building a 3D‐model from oil‐based modeling clay affects learners’ understanding of periventricular structures of the brain among undergraduate medical students in Colombia. Students were provided with an instructional video before building the models of the structures, and thereafter took a computer‐based quiz. They then brought their clay models to class where they answered questions about the structures via interactive response cards. Their knowledge of periventricular structures was assessed with a paper‐based quiz. Afterward, a focus group was conducted and a survey was distributed to understand students’ perceptions of the activity, as well as the impact of the intervention on their understanding of anatomical structures in 3D. Quiz scores of students that constructed the models were significantly higher than those taught the material in a more traditional manner (P < 0.05). Moreover, the modeling activity reduced time spent studying the topic and increased understanding of spatial relationships between structures in the brain. The results demonstrated a significant difference between genders in their self‐perception of their ability to contemplate and rotate structures mentally (P < 0.05). The study demonstrated that the construction of 3D clay models in combination with autonomous learning activities was a valuable and efficient learning tool in the anatomy course, and that additional models could be designed to promote deeper learning of other neuroanatomy topics. Anat Sci Educ 11: 137–145. © 2017 American Association of Anatomists.     

A psychometric evaluation of the anatomy learning experiences questionnaire and correlations with learning outcomes

The Anatomy Learning Experiences Questionnaire (ALEQ) was designed by Smith and Mathias to explore students' perceptions and experiences of learning anatomy. In this study, the psychometric properties of a slightly altered 34‐item ALEQ (ALEQ‐34) were evaluated, and correlations with learning outcomes investigated, by surveying first‐ and second‐year undergraduate medical students; 181 usable responses were obtained (75% response rate). Psychometric analysis demonstrated overall good reliability (Cronbach's alpha of 0.85). Exploratory factor analysis yielded a 27‐item, three‐factor solution (ALEQ‐27, Cronbach's alpha of 0.86), described as: (Factor 1) (Reversed) challenges in learning anatomy, (Factor 2) Applications and importance of anatomy, and (Factor 3) Learning in the dissection laboratory. Second‐year students had somewhat greater challenges and less positive attitudes in learning anatomy than first‐year students. Females reported slightly greater challenges and less confidence in learning anatomy than males. Total scores on summative gross anatomy examination questions correlated with ALEQ‐27, Pearson's r = 0.222 and 0.271, in years 1 and 2, respectively, and with Factor 1, r = 0.479 and 0.317 (all statistically significant). Factor 1 also had similar correlations across different question types (multiple choice; short answer or essay; cadaveric; and anatomical models, bones, or radiological images). In a retrospective analysis, Factor 1 predicted poor end‐of‐semester anatomy examination results in year 1 with a sensitivity of 88% and positive predictive value of 33%. Further development of ALEQ‐27 may enable deeper understanding of students' learning of anatomy, and its ten‐item Factor 1 may be a useful screening tool to identify at‐risk students. Anat Sci Educ 10: 514–527. © 2017 American Association of Anatomists.     

National survey on anatomical sciences in medical education

The drivers for curricular change in medical education such as the addition of innovative approaches to teaching, inclusion of technology and adoption of different assessment methods are gaining momentum. In an effort to understand how these changes are impacting and being implemented in gross anatomy, microscopic anatomy, neuroanatomy/neuroscience, and embryology courses, surveys were sent out to course directors/discipline leaders at allopathic Medical Schools in the United States during the 2016‐2017 academic year. Participants in the study were asked to comment on course hours, student experiences in the classroom and laboratory, amount of faculty participation, the use of peers as teachers in both the classroom and laboratory, methods used for student assessment and identification of best practices. Compared to data published from a similar survey in 2014, a number of changes were identified: (1) classroom hours in gross anatomy increased by 24% and by 29% in neuroanatomy/neuroscience; (2) laboratory hours in gross anatomy decreased by 16%, by 33% in microscopic anatomy, and by 38% in neuroanatomy/neuroscience; (3) use of virtual microscopy in microscopic anatomy teaching increased by 129%; and (4) the number of respondents reporting their discipline as part of a partially or fully integrated curriculum increased by greater than 100% for all four disciplines. Anat Sci Educ 11: 7–14. © 2017 American Association of Anatomists.