The Spectrum of Learning and Teaching: The Impact of a Fourth-Year Anatomy Course on Medical Student Knowledge and Confidence

There is growing demand from accrediting agencies for improved basic science integration into fourth-year medical curricula and inculcation of medical students with teaching skills. The objective of this study was to determine the effectiveness of a fourth-year medical school elective course focused on teaching gross anatomy on anatomical knowledge and teaching confidence. Fourth-year medical student “teacher” participants' gross anatomy knowledge was assessed before and after the course. Students rated their overall perceived anatomy knowledge and teaching skills on a scale from 0 (worst) to 10 (best), and responded to specific knowledge and teaching confidence items using a similar scale. First-year students were surveyed to evaluate the effectiveness of the fourth-year student teaching on their learning. Thirty-two students completed the course. The mean anatomy knowledge pretest score and posttest scores were 43.2 (±22.1) and 74.1 (±18.4), respectively (P < 0.001). The mean perceived anatomy knowledge ratings before and after the course were 6.19 (±1.84) and 7.84 (±1.30), respectively (P < 0.0001) and mean perceived teaching skills ratings before and after the course were 7.94 (±1.24) and 8.53 (±0.95), respectively (P = 0.002). Student feedback highlighted five themes which impacted fourth-year teaching assistant effectiveness, including social/cognitive congruence and improved access to learning opportunities. Together these results suggest that integrating fourth-year medical students in anatomy teaching increases their anatomical knowledge and improves measures of perceived confidence in both teaching and anatomy knowledge. The thematic analysis revealed that this initiative has positive benefits for first-year students.     

The Quality and Readability of English Wikipedia Anatomy Articles

Forty anatomy articles were sampled from English Wikipedia and assessed quantitatively and qualitatively. Quantitatively, each article’s edit history was analyzed by Wikipedia X-tools, references and media were counted manually, and two readability indices were used to evaluate article readability. This analysis revealed that each article was updated 8.3 ± 6.8 times per month, and referenced with 33.5 ± 24.3 sources, such as journal articles and textbooks. Each article contained on average 14.0 ± 7.6 media items. The readability indices including: (1) Flesch–Kincaid Grade Level Readability Test and (2) Flesch Reading Ease Readability Formula demonstrated that the articles had low readability and were more appropriate for college students and above. Qualitatively, the sampled articles were evaluated by experts using a modified DISCERN survey. According to the modified DISCERN, 13 articles (32.5%), 24 articles (60%), 3 articles (7.5%), were rated as “good,” “moderate,” and “poor,” respectively. There were positive correlations between the DISCERN score and the number of edits (r = 0.537), number of editors (r = 0.560), and article length (r = 0.536). Strengths reported by the panel included completeness and coverage in 11 articles (27.5%), anatomical details in 10 articles (25%), and clinical details in 5 articles (12.5%). The panel also noted areas which could be improved, such as providing missing information in 28 articles (70%), inaccuracies in 10 articles (25%), and lack or poor use of images in 17 articles (42.5%). In conclusion, this study revealed that many Wikipedia anatomy articles were difficult to read. Each article’s quality was dependent on edit frequency and article length. Learners and students should be cautious when using Wikipedia articles for anatomy education due to these limitations.     

The anatomy of anatomy: A review for its modernization

Anatomy has historically been a cornerstone in medical education regardless of nation or specialty. Until recently, dissection and didactic lectures were its sole pedagogy. Teaching methodology has been revolutionized with more reliance on models, imaging, simulation, and the Internet to further consolidate and enhance the learning experience. Moreover, modern medical curricula are giving less importance to anatomy education and to the acknowledged value of dissection. Universities have even abandoned dissection completely in favor of user‐friendly multimedia, alternative teaching approaches, and newly defined priorities in clinical practice. Anatomy curriculum is undergoing international reformation but the current framework lacks uniformity among institutions. Optimal learning content can be categorized into the following modalities: (1) dissection/prosection, (2) interactive multimedia, (3) procedural anatomy, (4) surface and clinical anatomy, and (5) imaging. The importance of multimodal teaching, with examples suggested in this article, has been widely recognized and assessed. Nevertheless, there are still ongoing limitations in anatomy teaching. Substantial problems consist of diminished allotted dissection time and the number of qualified anatomy instructors, which will eventually deteriorate the quality of education. Alternative resources and strategies are discussed in an attempt to tackle these genuine concerns. The challenges are to reinstate more effective teaching and learning tools while maintaining the beneficial values of orthodox dissection. The UK has a reputable medical education but its quality could be improved by observing international frameworks. The heavy penalty of not concentrating on sufficient anatomy education will inevitably lead to incompetent anatomists and healthcare professionals, leaving patients to face dire repercussions. Anat Sci Educ 3: 83–93, 2010. © 2010 American Association of Anatomists.     

Incorporating radiology into medical gross anatomy: Does the use of cadaver CT scans improve students' academic performance in anatomy?

Radiological images show anatomical structures in multiple planes and may be effective for teaching anatomical spatial relationships, something that students often find difficult to master. This study tests the hypotheses that (1) the use of cadaveric computed tomography (CT) scans in the anatomy laboratory is positively associated with performance in the gross anatomy course and (2) dissection of the CT‐scanned cadaver is positively associated with performance on this course. One hundred and seventy‐nine first‐year medical students enrolled in gross anatomy at Boston University School of Medicine were provided with CT scans of four cadavers, and students were given the opportunity to choose whether or not to use these images. The hypotheses were tested using logistic regression analysis adjusting for student demographic characteristics. Students who used the CT scans were more likely to score greater than 90% as an average practical examination score (odds ratio OR 3.6; 95% CI 1.4, 9.2), final course grade (OR 2.6; 95% CI 1.01, 6.8), and on spatial anatomy examination questions (OR 2.4; 95% CI 1.03, 5.6) than were students who did not use the CT scans. There were no differences in performance between students who dissected the scanned cadavers and those who dissected a different cadaver. These results demonstrate that the use of CT scans in medical gross anatomy is predictive of performance in the course and on questions requiring knowledge of anatomical spatial relationships, but it is not necessary to scan the actual cadaver dissected by each student. Anat Sci Educ 3: 56–63, 2010. © 2010 American Association of Anatomists.     

An integrated teaching method of gross anatomy and computed tomography radiology

It is essential for medical students to learn and comprehend human anatomy in three dimensions (3D). With this in mind, a new system was designed in order to integrate anatomical dissections with diagnostic computed tomography (CT) radiology. Cadavers were scanned by CT scanners, and students then consulted the postmortem CT images during cadaver dissection to gain a better understanding of 3D human anatomy and diagnostic radiology. Students used handheld digital imaging and communications in medicine viewers at the bench‐side (OsiriX on iPod touch or iPad), which enabled “pixel‐to‐tissue” direct comparisons of CT images and cadavers. Students had lectures and workshops on diagnostic radiology, and they completed study assignments where they discussed findings in the anatomy laboratory compared with CT radiology findings. This teaching method for gross and radiological anatomy was used beginning in 2009, and it yielded strongly positive student perspectives and significant improvements in radiology skills in later clinical courses. Anat Sci Educ 7: 438–449. © 2014 American Association of Anatomists.     

陕西黄土高原34种豆科植物根瘤的比较形态解剖学研究

通过对生长在陕西黄土高原的豆科21属34种植物根瘤的形态结构观察研究表明，其根瘤生长在主根和侧根上或仅生在侧根上，外表白色、粉红色或浅棕色，呈圆形、长圆形或扇形，多不分又，少数分技。其根瘤结构都由4部分组成，由外向内依次为：保护层、皮层、鞘细胞层和中心组织(侵染组织)。据统计，不同种植物的根瘤中上述各部分细胞的层数不同，其中，中心组织内侵染细胞所占的百分比在种间也存在差异。研究结果为这些植物的分类和开发利用提供了一定的依据。     

Anatomy integration blueprint: A fourth‐year musculoskeletal anatomy elective model

Current undergraduate medical school curricular trends focus on both vertical integration of clinical knowledge into the traditionally basic science‐dedicated curricula and increasing basic science education in the clinical years. This latter type of integration is more difficult and less reported on than the former. Here, we present an outline of a course wherein the primary learning and teaching objective is to integrate basic science anatomy knowledge with clinical education. The course was developed through collaboration by a multi‐specialist course development team (composed of both basic scientists and physicians) and was founded in current adult learning theories. The course was designed to be widely applicable to multiple future specialties, using current published reports regarding the topics and clinical care areas relying heavily on anatomical knowledge regardless of specialist focus. To this end, the course focuses on the role of anatomy in the diagnosis and treatment of frequently encountered musculoskeletal conditions. Our iterative implementation and action research approach to this course development has yielded a curricular template for anatomy integration into clinical years. Key components for successful implementation of these types of courses, including content topic sequence, the faculty development team, learning approaches, and hidden curricula, were developed. We also report preliminary feedback from course stakeholders and lessons learned through the process. The purpose of this report is to enhance the current literature regarding basic science integration in the clinical years of medical school. Anat Sci Educ 7: 379–388. © 2014 American Association of Anatomists.     

Developing an audiovisual notebook as a self‐learning tool in histology: Perceptions of teachers and students

Videos can be used as didactic tools for self‐learning under several circumstances, including those cases in which students are responsible for the development of this resource as an audiovisual notebook. We compared students' and teachers' perceptions regarding the main features that an audiovisual notebook should include. Four questionnaires with items about information, images, text and music, and filmmaking were used to investigate students' (n = 115) and teachers' perceptions (n = 28) regarding the development of a video focused on a histological technique. The results show that both students and teachers significantly prioritize informative components, images and filmmaking more than text and music. The scores were significantly higher for teachers than for students for all four components analyzed. The highest scores were given to items related to practical and medically oriented elements, and the lowest values were given to theoretical and complementary elements. For most items, there were no differences between genders. A strong positive correlation was found between the scores given to each item by teachers and students. These results show that both students' and teachers' perceptions tend to coincide for most items, and suggest that audiovisual notebooks developed by students would emphasize the same items as those perceived by teachers to be the most relevant. Further, these findings suggest that the use of video as an audiovisual learning notebook would not only preserve the curricular objectives but would also offer the advantages of self‐learning processes. Anat Sci Educ 7: 209–218. © 2013 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.     

Measuring change in professionalism attitudes during the gross anatomy course

By design or default, anatomy educators are often responsible for introducing students to medical professionalism. Although much has been said about the role of anatomical education, there are no published reports suggesting how to measure change. This study investigated what professionalism attitudes, if any, change during a gross anatomy course. Additionally, the influence of four dichotomous variables related to student identity and preparation for medical school were analyzed for their effect on professionalism attitudes. A cross‐sectional time‐one (T1; beginning of the course), time‐two (T2; end of the course) study using the Penn State College of Medicine Survey of Professionalism was conducted. A multivariate analysis of variance identified the main effects and interaction effects of categorical variables. A Mann Whitney U test verified significant differences. This study found a reprioritization of professionalism attitudes in favor of altruism (P = 0.04 with a Cohen's d = 0.26) at T2. Female students (P = 0.03, Cohen's d = 0.38) and students from a science background (P = 0.04, Cohen's d = 0.36) changed the most in favor of altruism. Interestingly, though several factors correlated with dissimilarities in professionalism values at T1, gender was the only factor to show a significant difference in professionalism attitudes at T2. This cohort of students reported a statistically significant increase in altruism and no significant decreases in other professionalism attitudes concurrent with the gross anatomy course. Anat Sci Educ 3:12–16, 2010. © 2009 American Association of Anatomists