Factors influencing students' decisions to participate in a short “dissection experience” within a systemic anatomy course

Changes in medical education have affected both curriculum design and delivery. Many medical schools now use integrated curricula and a systemic approach, with reduced hours of anatomy teaching. While learning anatomy via dissection is invaluable in educational, professional, and personal development, it is time intensive and supports a regional approach to learning anatomy; the use of prosections has replaced dissection as the main teaching method in many medical schools. In our graduate‐entry medical degree, we use an integrated curriculum, with prosections to teach anatomy systemically. However, to not exclude dissection completely, and to expose students to its additional and unique benefits, we implemented a short “Dissection Experience” at the beginning of Year 2. Students attended three two‐hour anatomy sessions and participated in dissection of the clinically relevant areas of the cubital fossa, femoral triangle, and infraclavicular region. This activity was voluntary and we retrospectively surveyed all students to ascertain factors influencing their decision of whether to participate in this activity, and to obtain feedback from those students who did participate. The main reasons students did not participate were previous dissection experience and time constraints. The reasons most strongly affecting students' decisions to participate related to experience (lack of previous or new) and new skill. Students' responses as to the most beneficial component of the dissection experience were based around practical skills, anatomical education, the learning process, and the body donors. We report here on the benefits and practicalities of including a short dissection experience in a systemic, prosection‐based anatomy course. Anat Sci Educ 6: 225–231. © 2013 American Association of Anatomists.     

Reduction of mental distress in the dissection course by introducing the body donor experience through anatomical demonstrations of organ systems

The practice of dissection teaches students not only the foundations of anatomical knowledge but also encourages the development of professional competencies. Yet, the dissection of cadavers in the gross anatomy course can be a stress factor for medical students. There are a minor proportion of students who demonstrate strong emotional reactions in anticipation of being confronted with a cadaver. Therefore, in 2008, the authors implemented a voluntary course entitled, “Anatomical demonstrations of organ systems” (AD‐OS) in advance of the dissection course to ease this psychological burden. The question of whether attendees of AD‐OS showed less mental distress at the start of the dissection course compared with those that had not or only infrequently visited AD‐OS was addressed. AD‐OS attendees assessed their expected mental distress using a five‐point Likert scale before starting the dissection course and a second time at the end of their first day, after they had been confronted with a cadaver. AD‐OS was evaluated as excellent and the majority of students participated actively during teaching sessions. Overall, female students showed higher levels of mental distress. AD‐OS attendees assessed themselves as being less burdened by mental distress than members of the control group. Longitudinal analysis revealed that students who visited AD‐OS showed a marked decrease of their mental distress level, comparing prospective and retrospective ratings. This was significantly (P < 0.001; Z = ?6.061) different from nonattendees or those who visited AD‐OS only infrequently. AD‐OS satisfied its intended teaching goals and proved that a step‐by‐step introduction of dissection through anatomical demonstrations helped to reduce the mental distress of students. Future studies are planned to measure mental distress with objective instruments. Anat Sci Educ © 2012 American Association of Anatomists.     

Anatomy Learning from Prosected Cadaveric Specimens Versus Plastic Models: A Comparative Study of Upper Limb Anatomy

Human cadaveric prosections are a traditional, effective, and highly appreciated modality of anatomy learning. Plastic models are an alternative teaching modality, though few studies examine their effectiveness in learning of upper limb musculoskeletal anatomy. The purpose of this study is to investigate which modality is associated with a better outcome, as assessed by students' performance on examinations. Overall, 60 undergraduate medical students without previous knowledge of anatomy participated in the study. Students were assigned into two groups. Group 1 attended lectures and studied from cadaveric prosections (n = 30) and Group 2 attended lectures and used plastic models in the laboratory (n = 30). A knowledge assessment, including examination with tag questions (spot test) and written multiple-choice questions, was held after the end of the study. Students' perceptions were also investigated via an anonymous questionnaire. No significant difference in students' performance was observed between the group using prosections and the group using plastic models (32.2 ± 14.7 vs 35.0 ± 14.8, respectively; P = 0.477). Similarly, no statistically significant difference was found regarding students' satisfaction from using each learning modality (P = 0.441). Plastic models may be a valuable supplementary modality in learning upper limb musculoskeletal anatomy, despite their limitations. Easy to use and with no need for maintaining facilities, they are highly appreciated by students and can be useful when preparing for the use of cadaveric specimens.     

Anatomical Sciences Education Vol. 5, Issue 1, 2012 Cover Image

Medical students at Durham University, United Kingdom receive instructions using ultrasound echocardiography . In this issue of ASE Dr. Finn and her colleagues compare the efficacy of ultrasound and cadaveric prosections for teaching gross anatomy of the heart.     

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”.     

Prosection or Dissection: Which is Best for Teaching the Anatomy of the Hand and Foot?

Due to the current trend of decreasing contact hours and less emphasis being given to the basic science courses in the pre-clinical years of medical education, it is essential that new approaches to teaching gross anatomy are investigated to ensure medical students are being adequately exposed to anatomical content. This study retrospectively analyzed practical examination data from four medical gross anatomy classes (N = 569) to ascertain which pedagogical approach, student participation in the dissection process, or interaction with prosected specimens is best for teaching the anatomy of the hand and foot. Data analysis involved the use of propensity score matching, a nonparametric preprocessing statistical approach which ensures accurate representation of the true treatment effect by balancing cohorts prior to statistical analysis. Statistical analysis indicated that those students who were exposed to the anatomy of the hand through interactions with prosected specimens performed 5.6% better (P = 0.012) while for the foot, students who interacted with prosections performed 13.0% better (P < 0.001). Although limited, data from this study suggest that utilizing prosections of the hand and foot seems to be a more advantageous pedagogical approach for teaching these regions than requiring students to dissect them.     

Effects of Alternating Dissection with Peer Teaching and Faculty Prosected Cadaver Demonstrations in a Physical Therapy and Occupational Therapy Gross Anatomy Course

The most effective method to teach gross anatomy is largely unknown. This study examined two teaching methods utilized in a physical therapy and occupational therapy gross anatomy course, (1) alternating dissection with peer teaching every other laboratory session and (2) faculty demonstrations during laboratory sessions. Student (n = 57) subgroup (A or B) academic performance was determined using written, laboratory practical, and palpation practical examinations. Subgroup A performed significantly better on laboratory practical examination questions pertaining to dissected, in comparison to peer-taught structures (67.1% vs. 60.2%, P = 0.008). Subgroup B performed significantly better on laboratory practical examination questions pertaining to peer-taught, in comparison to dissected structures (64.1% vs. 57.9%, P = 0.001). When Subgroup A was compared to Subgroup B, there were no statistically significant differences on laboratory practical examination question types, whether the subgroup learned the structure through dissection or peer teaching. Based on within and between subgroup comparisons, faculty demonstrations had no effect on written, laboratory practical, or palpation practical examination scores. Although limited, data suggest that the student roles when alternating dissection with peer teaching every other laboratory session appear to be equally effective for learning gross anatomy. The benefits of this method include decreased student/faculty ratio in laboratory sessions and increased time for independent study. Faculty demonstrations during laboratory sessions do not seem to improve student academic performance.     

Importance of adequate gross anatomy education: the impact of a structured pelvic anatomy course during gynecology fellowship

Medical education underwent standardization at the turn of the 20th century and remained fairly consistent until recently. Incorporation of a patient-centered or case-based curriculum is believed to reinforce basic science concepts. One negative aspect is a reduction in hours spent with cadaveric dissection in the gross anatomy laboratory. For those entering a surgical career, limited anatomical exposure leaves knowledge deficits that must be corrected during further education during residency training. The benefit of providing formal anatomy education to residents and surgical fellows is described in the literature, specifically noting improvement in written test scores and surgical application.     

A randomized trial comparing cadaveric dissection and examination of prosections as applied surgical anatomy teaching pedagogies

Anatomy is an important component in the vertical integration of basic science and clinical practice. Two common pedagogies are cadaveric dissection and examination of prosected specimens. Comparative studies mostly evaluate their immediate effectiveness. A randomized controlled trial design was employed to compare both the immediate and long-term effectiveness of dissection and prosection. Eighty third-year medical students undergoing their surgical rotation from the Yong Loo Lin School of Medicine were randomized into two groups: dissection and prosection. Each participated in a one-day hands-on course following a similar outline that demonstrated surgical anatomy in the context of its clinical relevance. A pre-course test was conducted to establish baseline knowledge. A post-course test was conducted immediately after and at a one-year interval to evaluate learner outcome and knowledge retention. A post-course survey was conducted to assess participant perception. Thirty-nine and thirty-eight participants for the dissection and prosection groups, respectively, were included for analysis. There was no significant difference between mean pre-course test scores between the dissection and prosection groups [12.6 (3.47) vs. 12.7 (3.16), P > 0.05]. Both the mean immediate [27.9 (4.30) vs. 24.9 (4.25), P < 0.05] and 1 year [23.9 (4.15) vs. 19.9 (4.05), P < 0.05] post-course test scores were significantly higher in the dissection group. However, when adjusted for course duration [dissection group took longer than prosection group (mean 411 vs. 265 min)], these findings were negated. There is no conclusive evidence of either pedagogy being superior in teaching surgical anatomy. Based on learner surveys, dissection provides a greater learner experience.     

Changes in anatomy instruction and USMLE performance: Empirical evidence on the absence of a relationship

Anatomy instruction has evolved over the past two decades as many medical schools have undergone various types of curricular reform. To provide empirical evidence about whether or not curricular changes impact the acquisition and retention of anatomy knowledge, this study investigated the effect of variation in gross anatomy course hours, curricular approach (stand‐alone versus integrated), and laboratory experience (dissection versus dissection and prosection) on USMLE Steps 1 and 2 Clinical Knowledge (CK) scores. Gross anatomy course directors at 54 United States schools provided information about their gross anatomy courses via an online survey (response rate of 42%). Survey responses were matched with USMLE scores for 6,411 examinees entering LCME‐accredited schools in 2007 and taking Step 1 for the first time in 2009. Regression analyses were conducted to examine relationships between gross anatomy instructional characteristics and USMLE performance. Step 1 total scores, Step 1 gross anatomy sub‐scores, and Step 2 CK scores were unrelated to instructional hours, controlling for MCAT scores. Examinees from schools with integrated curricula scored slightly lower on Steps 1 and 2 CK than those from stand‐alone courses (effect sizes of 2.1 and 1.9 on score scales with SDs of 22 and 20, respectively). Examinees with dissection and prosection experience performed slightly better on Step 2 CK than examinees in courses with dissection only laboratories (effect size of 1.2). Results suggest variation in course hours is unrelated to performance on Steps 1 and 2 CK. Although differences were observed in relation to curricular approach and laboratory experience, effect sizes were small. Anat Sci Educ 6: 3–10. © 2012 American Association of Anatomists.