An update on the status of anatomical sciences education in United States medical schools

The attitudes of European medical students towards the clinical importance of neuroanatomy

The attitudes of medical students towards the clinical importance of neuroanatomy have been little studied. Because it has been reported that medical students find neuroanatomy difficult and can have 'neurophobia', here we test the hypothesis that early-stage medical students across Europe have a low regard for neuroanatomy's clinical relevance. The work was conducted under the auspices of the Trans-European Pedagogic Research Group (TEPARG), with just over 1500 students from 12 European medical schools providing responses to a survey (52% response rate) that assessed their attitudes using Thurstone and Chave methodologies. Regardless of the university surveyed, and of the teaching methods employed for neuroanatomy, our findings were not consistent with our hypothesis. However, the students had a less favourable opinion of neuroanatomy's importance compared to gross anatomy; although their attitudes were more positive than previously reported for histology and embryology. The extent to which neuroanatomy plays a significant role in the early years of medical education is moot. Nevertheless, we conclude that in addition to newly recruited medical students being informed of the subject's role in a healthcare profession, we advocate the use of modern imaging technologies to enhance student understanding and motivation and cognisance of the core syllabus for the subject being developed by the International Federation of Associations of Anatomists (IFAA).

Efficacy of an intensive 2-week musculoskeletal anatomy course in a medical education setting

There is little consistency in student contact hours and teaching activities used in medical curriculums across North America, and controversy exists regarding the most efficient or effective way to teach musculoskeletal (MSK) anatomy in medical school. The purpose of this investigation was to retrospectively examine academic performance and levels of course satisfaction among first year medical students who had completed an intensive 2-week MSK anatomy course during the pre-clerkship portion of their Association of Faculties of Medicine in Canada accredited undergraduate medical program. Course data from formative and summative student evaluations, as well as end-of-course satisfaction surveys were analyzed for a homogenous group of 549 first-year medical students over a 5-year period. Data indicated that student's academic performance on both formative and summative evaluations for the 2-week MSK anatomy course were consistently high, and not significantly different from the results for other system-based 1^st year anatomy courses delivered over longer durations. Likert data from end-of-course surveys also suggested that student feedback regarding the course was overwhelmingly positive, and that the 2-week MSK anatomy course had the highest level of overall satisfaction when compared to all other first-year anatomy courses. These results can be used to help in the design and implementation of MSK anatomy courses within medical curriculums, and contribute to a growing body of literature which is focused on examining the effect of curricular design on MSK anatomy learning in a medical education setting.

Mexican Educators Survey on Anatomical Sciences Education and a Review of World Tendencies

Anatomical sciences curricula have been under constant reform over the years, with many countries having to reduce course hours while trying to preserve laboratory time. In Mexico, schools have historically been autonomous and unregulated, and data regarding structure and methods are still lacking. A national survey was sent by the Mexican Society of Anatomy to 110 anatomical sciences educators. The questionnaire consisted of 50 items (open and multiple choice) for gross anatomy, microscopic anatomy, neuroanatomy, and embryology courses in medical schools across Mexico. A clinical approach was the most common course approach in all disciplines. Contact course hours and laboratory hours were higher in Mexican anatomy education compared to other countries, with the highest reported contact hours for embryology (133.4 ± 44.1) and histology (125 ± 33.2). There were similar contact hours to other countries for gross anatomy (228.5 ± 60.5). Neuroanatomy course hours (43.9 ± 13.1) were less than reported by the United States and similar to Saudi Arabia and higher than the United Kingdom. Dissection and microscopy with histological slides predominate as the most common laboratory activities. Traditional methods prevail in most of the courses in Mexico and only a few educators have implemented innovative and technological tools. Implementation of new methods, approaches, and curricular changes are needed to enhance anatomical sciences education in Mexico.

Personal formaldehyde exposure during the transportation of embalmed cadavers

Occupational exposure to the known carcinogen formaldehyde during embalming (the preservation of cadavers) has been well documented. Cadavers may be transported to universities on loan for training medical professionals in human anatomy courses. However, occupational formaldehyde exposure levels associated with the transportation of cadavers have not previously been published. Therefore, the current pilot study examined formaldehyde exposure during this process. Preserved intact cadavers (room temperature or cooled) were loaded into cargo vans at the source (lending) lab, driven to the destination (borrowing) lab, and unloaded. Dissected cadavers (room temperature) were picked up and loaded into the cargo vans at the destination lab and driven to and unloaded at the source lab. Formaldehyde samples were collected in the breathing zone of employees engaged in cadaver transportation and handling. The number of intact cadavers or dissected cadavers in each cargo van ranged from 4 to 13 bodies. Sample collection times associated with cadaver transportation and handling tasks ranged from 15 to 216 min per sample with formaldehyde concentrations up to 1.6 ppm. Median exposure levels during cadaver transportation tasks were (1) 1.4 ppm (intact room temperature cadavers); (2) 0.13 ppm (dissected room temperature cadavers); and (3) 0.018 ppm (intact cooled cadavers). The median exposure during cadaver handling (loading/unloading) was 0.05 ppm. The 8-hr time-weighted averages during cadaver transportation and handling ranged from 0.030 ppm (intact cooled cadavers and dissected room temperature cadavers) to 0.51 ppm (intact room temperature cadavers, and dissected room temperature cadavers), the latter of which exceeded the American Conference of Governmental Industrial Hygienists recommended time-weighted average threshold limit value of 0.1 ppm. It is recommended that cadavers be transported cooled, however not all facilities may have access to or utilize specialized cadaver storage such as a walk-in cooler. Therefore, alternate exposure prevention approaches should also be identified and implemented.

Are Anatomy PhDs Nearing Extinction or Adapting to Change? United States Graduate Education Trends in the Anatomical Sciences

Faculty qualified to teach in the anatomical sciences are growing scarce just as the need for trained anatomists is greater than ever. Enrollments are surging in anticipation of a large physician shortfall; meanwhile, many anatomists are reaching retirement age. Who will fill the teaching gap? This study assessed trends in doctorates awarded in Anatomy and related fields within the United States (US) since 1969 and evaluated modern graduate education in the anatomical sciences. Data were compiled from the National Science Foundation Survey of Earned Doctorates. The total number of doctorates in the anatomical sciences and number of doctorates by sex and race/ethnicity were plotted for trend analysis. The number of PhD anatomy training programs within US medical schools was also assessed. Curricula and major characteristics of all active programs were evaluated through website searches and program director interviews. While doctorates in cell biology, developmental biology, and neuroscience have grown, the number of PhDs awarded in Anatomy has declined, on average, by 3.1 graduates per year to a 50-year low of only 8 graduates in 2017. Currently, 21 active doctoral programs in anatomy operate within US medical schools and fall into three general categories: anatomy education (n = 8), classic anatomy (n = 8), and anthropology/evolutionary anatomy (n = 5). Without a concerted effort by stakeholders to address the shortage, anatomists may face extinction. Expansion of the anatomy education doctoral degree may represent a necessary evolution of the field to meet job market needs and to thwart the extinction threat.

Virtual Reality Bell-Ringer: The Development and Testing of a Stereoscopic Application for Human Gross Anatomy

As post-secondary education migrates online, developing and evaluating new avenues for assessment in anatomy is paramount. Three-dimensional (3D) visualization technology is one area with the potential to augment or even replace resource-intensive cadaver use in anatomical education. This manuscript details the development of a smartphone application, entitled "Virtual Reality Bell-Ringer (VRBR)," capable of displaying monoscopic two-dimensional (2D) or stereoscopic 3D images with the use of an inexpensive cardboard headset for use in spot examinations. Cadaveric image use, creation, and pinning processes are explained, and the source code is provided. To validate this tool, this paper compares traditional laboratory-based spot examination assessment stations against those administered using the VRBR application to test anatomical knowledge. Participants (undergraduate, n = 38; graduate, n = 13) completed three spot examinations specific to their level of study, one in each of the modalities (2D, 3D, laboratory) as well as a mental rotation test (MRT), Stereo Fly stereotest, and cybersickness survey. Repeated measures ANCOVA suggested participants performed significantly better on laboratory and 3D stations compared to 2D stations. Moderate to severe cybersickness symptoms were reported by 63% of participants in at least one category while using the VRBR application. Highest reported symptoms included: eye strain, general discomfort, difficulty focusing, and difficulty concentrating. Overall, the VRBR application is a promising tool for its portability, affordability, and accessibility. Due to reported cybersickness and other technical limitations, the use of VRBR as an alternative to cadaveric specimens presents several challenges when testing anatomy knowledge that must be addressed before widespread adoption.

Rethinking Assessment Design: Evidence-Informed Strategies to Boost Educational Impact in the Anatomical Sciences

University assessment is in the midst of transformation. Assessments are no longer designed solely to determine that students can remember and regurgitate lecture content, nor in order to rank students to aid with some future selection process. Instead, assessments are expected to drive, support, and enhance learning and to contribute to student self-assessment and development of skills and attributes for a lifetime of learning. While traditional purposes of certifying achievement and determining readiness to progress remain important, these new expectations for assessment can create tensions in assessment design, selection, and deployment. With the recognition of these tensions, three contemporary approaches to assessment in medical education are described. These approaches include careful consideration of the educational impact of assessment-before, during (test or recall enhanced learning) and after assessments; development of student (and staff) assessment literacy; and planning of cohesive systems of assessment (with a range of assessment tools) designed to assess the various competencies demanded of future graduates. These approaches purposefully straddle the cross purposes of assessment in modern health professions education. The implications of these models are explored within the context of medical education and then linked with contemporary work in the anatomical sciences in order to highlight current synergies and potential future innovations when using evidence-informed strategies to boost the educational impact of assessments.

Initiating Students' Reflections on Life's Passing in the Anatomy Course - an International Observation at 14 Universities

BACKGROUND

Medical and dental students' feelings and thoughts about the topic of death and life's passing are often associated with learning in the gross anatomy course, when students begin working with a deceased body donor in order to study human anatomy. Little is known of whether the format of anatomy teaching has an impact on these experiences. An observational study was performed to capture the initiation of students' sentiments on the topic of life's passing during the anatomy course at 14 international universities, identify common themes regarding these thoughts, and to study the connection to variations in anatomy course formats and included elements.

METHOD

Preclinical anatomy students reflected on one question (i.e., "How did your experience in the anatomy laboratory bring about your reflections on the meaning of life and human existence as well as the sanctity of one's passing?"). Written assignments were collected and anonymously coded. Information on anatomy courses was obtained via faculty questionnaires.

RESULT

A variety of themes were identified at the different schools, correlated with different anatomy formats and elements. Results indicate that the courses that offer hands-on cadaveric dissections may play an important role in triggering these sentiments.

DISCUSSION

The initiation of students' sentiments about the topic of death varies and includes several themes. There can be a connection to the way anatomy is taught, particularly if hands-on comprehensive cadaveric dissection or prosections are included.

CONCLUSION

In summary, anatomy courses can initiate students' thinking about life's passing - particularly in schools that offer hands-on cadaveric dissections or prosections.

eNEUROANAT-CF: a Conceptual Instructional Design Framework for Neuroanatomy e-Learning Tools

In an era which is witnessing a significant rise in incidence of neurological diseases, there is also a rise in neurophobia: the diminished confidence of clinical practitioners and students to manage patients with neurological conditions. In this context, the perceived nexus between neuroanatomy-phobia (the challenges and fear associated with learning neuroanatomy) and neurophobia highlighted the need to revisit the neuroanatomy pedagogies and their instructional designs. e-Learning can be effectively employed to enhance students' learning of neuroanatomy. This perspective describes a conceptual framework for online neuroanatomy learning (e-neuroanatomy learning conceptual framework (eNEUROANAT-CF)), which provides a theoretical grounding to newly developed neuroanatomy e-learning resources, by offering a set of instructional design principles. The framework is rooted in the theories of adult learning, cognitive load, and Mayer's theory of multimedia learning. eNEUROANAT-CF was validated by imparting user opinion regarding the best perceived instructional design features for learning neuroanatomy. Furthermore, it was effectively employed to inform the pedagogical construct of an e-tool to help students learn the spinal pathways. The perspective highlights the theoretical underpinnings of the eNEUROANAT-CF under seven categories, namely "avoidance of cognitive overload," "learning style preferences," "contextualization," "motivation," "social learning," "feedback/reflection," and "active learning." In addition, elaborative examples are provided, which explains how eNEUROANAT-CF informed the instructional design features of the abovementioned e-tool. The authors propose that any novel, interactive neuroanatomy e-learning resource rooted in the instructional design principles outlined by the eNEUROANAT-CF will improve users' learning and understanding of neuroanatomy. The research shows promise to help break the perceived nexus between neuroanatomy-phobia and neurophobia.

A Novel Model for a Student-Led Surgical Anatomy Seminar

OBJECTIVE

We describe a novel educational model for a student-led anatomy interest group that utilizes an efficient method of knowledge sharing among peers in order to supplement the standard gross anatomy curriculum and expose medical students to advanced, surgically relevant anatomy.

DESIGN

Student leaders of the Advanced Anatomy Interest Group compile a list of advanced anatomy "tidbits" related to a topic within a particular surgical specialty. Each medical student participant signs up for a different "tidbit" and prepares a short presentation. On meeting day, students present to the group. After each presentation, a surgical faculty moderator offers feedback and provides additional surgical perspective.

SETTING

Duke University School of Medicine, Durham, NC, USA.

PARTICIPANTS

Three third year medical student interest group leaders, 20 first through fourth year medical student participants, and 1 surgical faculty moderator.

RESULTS

Twelve students presented an advanced anatomy tidbit, and 15 students responded to a 10-question postmeeting survey. Over 90% of respondents either agreed or strongly agreed that their understanding of surgically relevant anatomy had improved. Of those students who presented, 100% agreed or strongly agreed that their preparedness to briefly teach complex medical topics to colleagues had improved. Additionally, students reported increased interest in surgery and an improved perception of surgeons.

CONCLUSIONS

This novel educational model appears to be an effective and efficient way to supplement the standard gross anatomy curriculum and expose medical students to advanced, surgically relevant anatomy. In addition, this model enables students to hone their presentation skills, gain experience teaching advanced medical concepts to peers, and develop relationships with surgical faculty. Surgical faculty are also not burdened with any preparatory responsibilities, making their participation more feasible. This model can serve as a template for medical students, house staff, and faculty interested in expanding anatomy education at their own institutions.

The Effectiveness of an Augmented Reality Head-Mounted Display in Learning Skull Anatomy at a Community College

Despite an increase in the use of technology in undergraduate anatomy education, and the rising popularity of online anatomy courses at community colleges in the United States, there have been no reports on the efficacy of augmented reality on anatomy education in this population. The purpose of this study was to test the hypothesis that augmented reality is an effective and engaging tool for learning anatomy in community college students. Participants recruited from Cuyahoga Community College (Cleveland, OH) studied skull anatomy using either traditional tools (i.e., textbook and plastic skull model) or an augmented reality head-mounted display with an interactive virtual skull application. Comparison of knowledge before and following the study period revealed that augmented reality was an effective tool for learning skull anatomy: pre-quiz = 32.7% (± 25.2); mean (± SD), post-quiz = 61.8% (± 19.5); n = 15; t₍₂₈₎ = 3.53; P = 0.001. The traditional tools were equally effective: pre-quiz = 44.9 % (± 18.6), post-quiz = 67.9 % (± 17.3); n = 17; t₍₃₂₎ = 3.73; P = 0.0007. Students rated the augmented reality device as 9.6 (± 1.0); mean (± SD) when asked if it fit the statement "fun to use" on a semantic differential scale from 1 (poor) to 10 (excellent). In conclusion, this study found that augmented reality is an effective and engaging tool for the instruction of skull anatomy at a community college.

The Cadaver Conundrum: Sourcing and Anatomical Embalming of Human Dead Bodies by Medical Schools during and after COVID-19 Pandemic: Review and Recommendations

COVID-19 pandemic has posed a new challenge for medical schools across the world regarding the acceptance of donated and unclaimed dead bodies for academic purpose. Uncertainty of the COVID-19 status among the donated bodies poses a health risk for embalming personnel and medical students who handle the embalmed cadavers. There is a paucity of literature delineating the criteria for accepting or rejecting the bodies during COVID-19 pandemic. Similarly, there is no recommended standard operating procedure for anatomical embalming during COVID-19. We propose certain criteria for accepting and rejecting the human dead bodies for anatomical embalming. And we propose some technical modifications to the conventional procedure of formalin-based anatomical embalming. A guarded approach and diligent screening of donated bodies is the way forward during the COVID-19 pandemic.

Examining the Short-, Medium-, and Long-Term Success of an Embodied Learning Activity in the Study of Hand Anatomy for Clinical Application

A student's own body provides an often disregarded site of knowledge production and corporeal wisdom. Learning via cognitive processes anchored in physical movement and body awareness, known as embodied learning, may aid students to visualize structures and understand their functions and clinical relevance. Working from an embodied learning perspective, the current article evaluates the use of an offline physical learning tool (Anatomical Glove Learning System; AGLS) for teaching hand anatomy for clinical application in medical students. Two student samples (N₁  = 105; N₂  = 94) used the AGLS in two different ways. In the first sample, the AGLS was compared to a traditional approach using hand bones, models and prosected specimens. Secondly, the AGLS and traditional approach were combined. The evaluation consisted of three outcomes: short-term learning (post-test), medium-term applications (mock-objective structured clinical examination, MOSCE), and longer-term assessment (objective structured clinical examination, OSCE). Findings from the first sample indicated no significant differences between the AGLS and traditional laboratory groups on short- (F_(1,78) = 0.036, P = 0.849), medium- (F_(1,50) = 0.743, P = 0.393), or longer-term (F_(1,82) = 0.997, P = 0.321) outcomes. In the second sample using the AGLS in combination with a traditional approach was associated with significantly better short-term post-test scores (F_(2,174) = 5.98, P = 0.003) than using the AGLS alone, but demonstrated no effect for long-term OSCE scores. These results suggest an embodied learning experience alone does not appear to be advantageous to student learning, but when combined with other methods for studying anatomy there are learning gains.

Neuroanatomy Teaching in Australian and New Zealand Medical Schools

BACKGROUND

Graduate doctors' knowledge of central and peripheral nervous system anatomy is below an acceptable level. New technologies have been introduced to enhance education in the context of integrated curricula and reduced anatomy teaching hours in medical schools. However, it is unknown how varied this instruction has become between universities. This mixed methods study aimed to describe neuroanatomy teaching in medicine across Australia and New Zealand.

METHODS

An electronic survey was sent to Australian (n = 22) and New Zealand (n = 2) medical schools, endorsed by the Royal Australasian College of Surgeons. Academics were asked to comment on the course, content, instruction, and assessment of neuroanatomy for the 2019 academic year.

RESULTS

Ninety-two percent (22/24) of medical schools responded. Neuroanatomy content and instructional methodology was highly variable between institutions. The average time dedicated to teaching neuroanatomy was 46.0 hours (±38.1) with a range of 12-160 hours. Prosections (77%) and models (77%) were used at most universities. Dissection was utilized at 13 of 22 (59%) universities. Incorporation of new technologies was highly variable, the most common being 3-dimensional software (59%) and eBook (55%). Adoption of any virtual reality technologies was low (36%). Seven universities used an established curriculum (29%), whereas most did not (61%). Academics indicated anxiety and motivation were key elements of student engagement.

CONCLUSIONS

Results demonstrate widespread heterogeneity in the way neuroanatomy is taught to medical students. A standardized curriculum may improve collaboration between universities and facilitate translation of future research in the area into practice.

A core syllabus for histology within the medical curriculum-The cell and basic tissues

The International Federation of Associations of Anatomists (IFAA) are developing core syllabuses for the anatomical sciences by means of Delphi panels. In this article, we provide the core subject matter for the teaching of the cell and of basic tissues within a medical histology course. The goal is to set an international standard providing guidelines for such a core syllabus. The Delphi panel, composed of members across multiple countries, required two rounds to evaluate 257 relevant items/topics approved by the IFAA. Based on the perception of the core knowledge of histology, the items were to be rated by each member of the Delphi panel as being "Essential," "Important," "Acceptable," or "Not required." Topics that were rated by over 60% of the panelists as being "Essential" and "Important" are provided in this article and are recommended for the teaching of medical histology.

Musculoskeletal anatomy: evaluation and comparison of common teaching and learning modalities

Anatomy teaching has traditionally been based on dissection. However, alternative teaching modalities constantly emerge, the use of which along with a decrease in teaching hours has brought the anatomy knowledge of students and young doctors into question. In this way, the goal of the present study is to a. compare the efficacy of the most common teaching modalities and b. investigate students' perceptions on each modality. In total, 313 medical students were taught gross anatomy of the upper limb, using four different learning modalities: dissection (n = 80), prosections (n = 77), plastic models (n = 84) and 3D anatomy software (n = 72). Students' knowledge was examined by 100 multiple-choice and tag questions followed by an evaluation questionnaire. Regarding performance, the dissection and the 3D group outperformed the prosection and the plastic models group in total and multiple-choice questions. The performance of the 3D group in tag questions was also statistically significantly higher compared to the other three groups. In the evaluation questionnaire, dissection outperformed the rest three modalities in questions assessing students' satisfaction, but also fear or stress before the laboratory. Moreover, dissection and 3D software were considered more useful when preparing for clinical activities. In conclusion, dissection remains first in students' preferences and achieves higher knowledge acquisition. Contemporary, 3D anatomy software are considered equally important when preparing for clinical activities and mainly favor spatial knowledge acquisition. Prosections could be a valuable alternative when dissection is unavailable due to limited time or shortage of cadavers. Plastic models are less effective in knowledge acquisition but could be valuable when preparing for cadaveric laboratories. In conclusion, the targeted use of each learning modality is essential for a modern medical curriculum.

Exploring students' understanding of structured practical anatomy

Objectives

The shift from the traditional curriculum to an integrated organ and system-based one has fragmented anatomy courses. Thus, it has become necessary to implement a structured active learning process for the practical teaching of anatomy. We achieved this goal by using an innovative teaching strategy for practical sessions called structured practical anatomy (SPA). We aimed to document the use of SPA for teaching practical anatomy and to evaluate students’ perceptions of it.

Methods

We subdivided the students into 10 small groups, which we then assigned to structured stations with different teaching modalities. Finally, we administered the Dundee Ready Education Environment Measure (DREEM) questionnaire to assess the students’ perceptions of their learning.

Results

Out of 48 items, our study showed a mean total score of 32 ± 7 (out of 48). We classified the students into four categories according to each student's total score; 56.76% of the students had a score of 25–36 in the ‘positive’ category range, 27% in the ‘excellent’ category (37–48), 15% in the ‘negative’ category (13–24) and 0.5% in the ‘very poor’ category (below 12). Two items on the questionnaire (13–47) were strongly positive items (greater than 3 out of 4), whereas other items were in the positive medium range (2–3 out of 4).

Conclusions

SPA is an effective tool that plays a vital role in enhancing the teaching of practical anatomy. This teaching pedagogy offers an innovation in teaching and learning anatomy. Additionally, the results of the students’ perceptions of their learning reflect areas that require further exploration to boost the effectiveness of teaching methods.

The Universal Design for Learning Framework in Anatomical Sciences Education

Over the past decades, teaching and learning within the discipline of anatomy has undergone significant changes. Some of these changes are due to a reduction in the number of teaching hours, while others are related to advancements in technology. Faced with these many choices for change, it can be difficult for faculty to decide on which new developments in anatomical education need or indeed can be integrated into their course to enhance student learning. This article presents the universal design for learning (UDL) framework-an informed, evidence-based, and robust approach to underpin new course design and pedagogical reform in anatomy education. Universal design for learning is not a theory but a framework grounded in cognitive neuroscience that focuses on engaging multiple brain networks. The guidelines for UDL are organized into three core principles: (1) provide multiple means of representation, (2) provide multiple means of action and expression, and (3) provide multiple means of engagement. The learning space within the anatomy laboratory provides an excellent opportunity in which to apply this framework. This article also describes current trends employed in the teaching of anatomy. The principles of UDL are then outlined, followed by a description of how UDL approaches have been applied in the design and delivery of anatomy practical teaching to first year medical students at University College Cork. Future implications for this work are a consideration and investigation of how a course designed with the principles of UDL at its heart ultimately benefits student learning.

A Surgical View of Anatomy: Perspectives from Students and Instructors

As curricular emphasis on anatomy in undergraduate medical education continues to evolve, new approaches to anatomical education are urgently needed to prepare medical students for residency. A surgical anatomy class was designed for third- and fourth-year medical students to explore important anatomical relationships by performing realistic surgical procedures on anatomical donors. Under the guidance of both surgeons and anatomists, students in this month-long elective course explored key anatomical relationships through performing surgical approaches, with the secondary benefit of practicing basic surgical techniques. Procedures, such as left nephrectomy, first rib resection for thoracic outlet syndrome, and carotid endarterectomy, were adapted from those used clinically by multiple surgical subspecialties. This viewpoint commentary highlights perspectives from students and instructors that suggest the value of a surgical approach to anatomical education for medical students preparing for procedure-oriented residencies, with the goals of: (1) describing the elective at the authors' institution, (2) promoting similar efforts across different institutions, and (3) encouraging future qualitative and quantitative studies of similar pedagogic efforts.

A review of anatomy education during and after the COVID-19 pandemic: Revisiting traditional and modern methods to achieve future innovation

The coronavirus disease 2019 (COVID-19) pandemic has had enormous effects on anatomy education. During the pandemic, students have had no access to cadavers, which has been the principal way to learn anatomy since the 17th century. As it is difficult to predict future access to cadavers for students or in-person classes, anatomy educators are encouraged to revisit all possible teaching methods in order to develop innovations. Here, we review anatomy education methods to apply to current and future education.

Student-Authored Autopsy Reports of Anatomical Donors: Their First Patients

The preparation of student-authored autopsy reports of anatomical donors was added to the Gross Anatomy course to integrate the basic and clinical sciences and determine whether students considered this early clinical exposure to be a valuable experience. All donors were scanned using computerized tomography (CT) and student groups received the scan of their donor and a report written by a radiologist. As students dissected, they took photographs and biopsies of pathological findings that were processed for microscopic evaluation. Following consultation with pathologists and radiologists, each group prepared an autopsy report that proposed a cause of death supported with macroscopic, microscopic, and CT images. Cardiovascular events and cancer were the most common. Autopsy reports were evaluated by the faculty and each student group received feedback with respect to content, accuracy, and completeness and whether faculty agreed with students' proposed cause of death. A majority of students answering an anonymous survey indicated that this exercise was valuable or somewhat valuable, but did not agree that preparation of the autopsy report resulted in their being more engaged during the course. Students agreed or somewhat agreed that the exercise should be repeated next year, that they gained insight into the clinical manifestations of disease, that they were able to interpret the CT scan themselves, that meeting with a pathologist was interesting, and that the time required to prepare the report was adequate. Since autopsy reports prepared by students are feasible and students found it to be a valuable experience, we suggest that medical schools add this to Gross Anatomy courses to introduce clinical material and increase clinical relevance.

Does spatial awareness training affect anatomy learning in medical students?

Spatial ability (SA) is the cognitive capacity to understand and mentally manipulate concepts of objects, remembering relationships among their parts and those of their surroundings. Spatial ability provides a learning advantage in science and may be useful in anatomy and technical skills in health care. This study aimed to assess the relationship between SA and anatomy scores in first- and second-year medical students. The training sessions focused on the analysis of the spatial component of objects' structure and their interaction as applied to medicine; SA was tested using the Visualization of Rotation (ROT) test. The intervention group (n = 29) received training and their pre- and post-training scores for the SA tests were compared to a control group (n = 75). Both groups improved their mean scores in the follow-up SA test (P < 0.010). There was no significant difference in SA scores between the groups for either SA test (P = 0.31, P = 0.90). The SA scores for female students were significantly lower than for male students, both at baseline and follow-up (P < 0.010). Anatomy training and assessment were administered by the anatomy department of the medical school, and examination scores were not significantly different between the two groups post-intervention (P = 0.33). However, participants with scores in the bottom quartile for SA performed worse in the anatomy questions (P < 0.001). Spatial awareness training did not improve SA or anatomy scores; however, SA may identify students who may benefit from additional academic support.

A Hands-On Organ-Slicing Activity to Teach the Cross-Sectional Anatomy

The presentation of pre-sliced specimens is a frequently used method in the laboratory teaching of cross-sectional anatomy. In the present study, a new teaching method based on a hands-on slicing activity was introduced into the teaching of brain, heart, and liver cross-sectional anatomy. A randomized, controlled trial was performed. A total of 182 third-year medical students were randomized into a control group taught with the prosection mode (pre-sliced organ viewing) and an experimental group taught with the dissection mode (hands-on organ slicing). These teaching methods were assessed by testing the students' knowledge of cross-sectional specimens and cross-sectional radiological images, and analyzing students' feedback. Using a specimen test on three organs (brain, heart, and liver), significant differences were observed in the mean scores of the control and experimental groups: for brain 59.6% (±14.2) vs. 70.1% (±15.5), (P < 0.001, Cohen's d = 0.17); for heart: 57.6% (±12.5) vs. 75.6% (±15.3), (P < 0.001, d = 0.30); and for liver: 60.4% (±14.5) vs. 81.7% (±14.2), (P < 0.001, d = 0.46). In a cross-sectional radiological image test, better performance was also found in the experimental group (P < 0.001). The mean scores of the control vs. experimental groups were as follows: for brain imaging 63.9% (±15.1) vs. 71.1% (±16.1); for heart imaging 64.7% (±14.5) vs. 75.2% (±15.5); and for liver imaging 61.1% (±15.5) vs. 81.2% (±14.6), respectively. The effect sizes (Cohen's d) were 0.05, 0.23, and 0.52, respectively. Students in the lower tertile benefited the most from the slicing experiences. Students' feedback was generally positive. Hands-on slicing activity can increase the effectiveness of anatomy teaching and increase students' ability to interpret radiological images.

Changing Study Strategies with Revised Anatomy Curricula: a Move for Better or Worse?

Investigations into medical student study strategies have seen an increase in recent years, but we have also seen a move to more integrated medical curricula during this time. This manuscript endeavors to assess the changes in study plans and students' reported study strategies that are associated with a move from a traditional stand-alone anatomy curriculum to an integrated, standardized curriculum. Previously validated study strategy surveys were given to medical students at the beginning of their anatomy course and again at the end of the course. These responses were then correlated with basic demographic information and outcomes in anatomy. Results indicate that this change in curriculum does correlate with changes to students' study plans and reported study strategies. In particular, the plans for and use of web-based resources appear higher in the new curriculum while the use of self-quizzing and attendance appear lower, with potentially negative implications for understanding and long-term retention. Differences were also seen between genders and student ages. Finally, a few associations with outcomes are also noted for increased use of web-based resources and student confidence going into the exam.

A Novel Approach to Gross Dissection of the Human Pelvis and Perineum

Progressive curricular changes in medical education over the past two decades have resulted in the diaspora of gross anatomy content into integrated curricula while significantly reducing total contact hours. Despite the development of a wide range of alternative teaching modalities, gross dissection remains a critical component of medical education. The challenge posed to modern anatomists is how to maximize and integrate the time spent dissecting under the current curricular changes. In this study, an alternative approach to the dissection of the pelvis and perineum is presented in an effort to improve content delivery and student satisfaction. The approach involves removal of the perineum en bloc from the cadaver followed by excision of the pubic symphysis, removal and examination of the bladder and associated structures, examination and bisection of the midline pelvic organs in situ, and midsagittal hemisection of the pelvis for identification of the neurovasculature. Results indicate that this novel dissecting approach increases the number of structures identified by 46% ± 14% over current dissecting methods. Survey results indicate that students were better able to integrate lecture and laboratory concepts, understand the concepts, and successfully identify more structures using the new approach (P < 0.05). The concept of anatomic efficiency is introduced and proposed as a standard quantitative measure of gross dissection proficiency across programs and institutions. These findings provide evidence that innovative solutions to anatomy education can be found that help to maintain critical content and student satisfaction in a modern medical curriculum.

Use of a Digital, Profession-Specific Dissection Guide Is Associated with Improved Examination Performance and Student Satisfaction

Anatomical knowledge is requisite for effective physical therapy (PT) practice. Cadaver dissection is a popular teaching method employed in PT anatomy courses. Limited time in the laboratory requires effective dissection instructions. Several limitations of a printed, non-discipline specific dissection guide have been identified by students and instructors in anatomy curricula. The objective of this project was to evaluate the effect of using a digital, PT specific dissection guide on examination performance and student satisfaction. A digital guide was developed that incorporated improvements based on observations of student experiences using a printed guide. The digital guide covered two lower extremity regional dissections and was distributed for use during the summer 2017 course. Enhancements included clarification of dissection procedures, formative quizzes, image galleries, embedded videos, and a glossary of terms. Students used a printed guide for all other dissections in the course. The percentage of correct answers from practical examinations was calculated and compared between summer of 2015 (print) and 2017 (digital) courses. A survey consisting of nineteen five-point Likert items was distributed. The percentage of correct answers was significantly higher for the digital guide (91.7 ± 7.11%) compared with the print guide (84.2 ± 9.51%, P < 0.0001). On the survey, the median item rating was strongly agree for two, agree for fifteen, and neither agree or disagree for two. These results suggest that developing a curriculum specific, digital guide was effective in improving student knowledge and satisfaction. These results encourage development of additional content specific guides in a digital format.

Curricular and pedagogical aspects of gross anatomy education for undergraduate physiotherapy students: a scoping review

OBJECTIVE

The objective of this review was to collate and map gross anatomy curricular and pedagogical approaches for physiotherapy students.

INTRODUCTION

Knowledge of anatomy is essential for physiotherapy clinical diagnosis, treatment effectiveness and safe practice. The information on this topic is sparse, and what does exist is diverse. This scoping review describes anatomy educational approaches for physiotherapy students and provides needed insight into this topic.

INCLUSION CRITERIA

No limits were applied on the date of the database search or age of participants. Languages were limited to English, French, German and Spanish. Studies had to include information on gross anatomy curricula or pedagogy for physiotherapy students, or information from qualified physiotherapists or those teaching gross anatomy to physiotherapy students.

METHODS

Included studies were mainly sourced from EBSCOhost (CINAHL, ERIC and MEDLINE), PubMed and Scopus databases. Perusal of reference lists facilitated further retrievals. Studies published from inception up to 21 July 2019 were included. Studies were identified and screened, and the process was reported in a PRISMA flow diagram. JBI methodology for scoping reviews was followed. Selected studies were charted according to a template created and published in a JBI scoping review protocol.

RESULTS

Fifty-four studies satisfied the inclusion criteria. Various studies gave calculable length of intervention in weeks (n=14, 26%), hours (n = 7, 13%) or both (n = 21, 39%). The majority of studies (n = 50, 93%) were cross-sectional studies; three were randomized controlled trials (6%). Mean sample sizes varied from 55.3 ± 30.4 (professional behaviors, ethical and humanistic aspects) to 323.2 ± 219.7 participants (multi-modal and blended learning). Overall, 29 studies (54%) included physiotherapy students or personnel in physiotherapy anatomy programs exclusively in the sample. Other disciplines with physiotherapy students included medical students (n = 12, 22%), and occupational therapy students (n = 10, 19%). The interprofessional education category (n = 8) determined that interdisciplinary teamwork led to increased anatomical learning and awareness of future clinical roles. Computer-assisted learning (n = 9) was effective as a stand-alone or adjunct pedagogy, useful for self-study and helped anatomical knowledge retention. Team-based learning (n = 2), peer teaching (n = 6) and clinical input incorporating case-based learning and horizontal and vertical integration (n = 4) resulted in anatomical knowledge retention and were associated with mastery of anatomical understanding, an increase in examination confidence and higher examination grades. Contradictory learning outcomes resulted from the use of online videos in blended and multi-model learning studies (n = 7). Increased student participation in asynchronous online discussion forums benefitted academic learning outcomes. The category of curriculum, pedagogy and materials (n = 15) identified and compared different survey results pertaining to the curricular aspect of the objectives of this review. One study investigated the flipped classroom concept. The use of anatomy content to encourage professional, ethical and humanistic aspects (n = 3) of physiotherapy students' behavior resulted in positive outcomes.

CONCLUSIONS

This scoping review revealed a multi-faceted topic with many types of interventions and outcomes recorded. It identified variations in pedagogies, curricular content and learning approaches integral to the subject and their impact on gross anatomy education for this population. Beneficial behavioral, anatomical learning, knowledge retention and academic outcomes were identified.

Web Browsing Habits of Healthcare Professions Students in Gross Anatomy Laboratory

Personal computer use for educational purposes by the healthcare professions students has become ubiquitous. Although the effect of computer-based dissection instructions has been studied, there is a paucity of information regarding student browsing habits of information available on the Internet. Although current students have favorable attitudes toward accessing anatomical information online, web browsing habits have not yet been investigated specifically in the dissection laboratory setting. The purpose of this study was to describe the browsing habits of the healthcare professions students in the gross anatomy setting using a retrospective analysis. Files containing web browser history were retrieved from desktop computers in the gross anatomy laboratory and custom code was written to parse them into comma separated value files. Each web address was categorized and descriptive statistics was calculated. Browser history for 24 computers was analyzed from June 2013 to January 2015. During this period, students accumulated 100,857 webpage visits. Most often, students performed a Google search for anatomy (22.0% of all visits) and non-anatomy related (20.6% of all visits) information. Students also used the web browser to access various entertainment (16.4% of all visits) and productivity related services (15.9% of all visits). This analysis revealed a large volume of webpage visits by the healthcare professions students in the gross anatomy laboratory. A wide diversity of anatomy and non-anatomy related webpages were visited. Future analyses could be directed at examination of when in relation to class time students accessed the information, how browsing habits change over time, and what anatomical structures were most commonly searched for.

A comparison of the effectiveness of dissection and prosection on short-term anatomic knowledge retention in a reciprocal peer-teaching program

Few discussions regarding instructional methods incite as much passion as the debate over dissection versus prosection. Despite numerous analyses, few studies have isolated the impact of dissection versus prosection from the numerous variables that are involved in anatomy education. This study used a retrospective design to assess the effect of peer teaching with dissection or prosection on anatomical knowledge retention of the peer teachers. Exam scores were analyzed from three cohorts of students (N = 184) who were enrolled in a Musculoskeletal System course in an allopathic medical school between academic years 2014-2017. Students in the first 2 yr learned anatomy of an assigned region through traditional dissection, whereas students in the third year learned anatomy of the same regions on prosected specimens. The effect of these instructional methods on anatomical knowledge retention was measured by student performance on a teaching-readiness quiz, written exam, and practical examination. One advantage of this study is the stability of variables between cohorts. Student groups peer taught the same objectives; course sequencing and content remained consistent between years; students spent the same amount of time learning their material, regardless of learning modality (dissection or prosection); and students were tested in the same manner. Comparisons of student performance data suggest that anatomy knowledge was equivalent, regardless of the instructional method (dissection or prosected cadavers) but is strongly associated with prior anatomy experience. Findings from this study support previous studies that conclude that there are no disparities in the effectiveness of learning anatomy via dissection or prosection.

National Survey on Canadian Undergraduate Medical Programs: The Decline of the Anatomical Sciences in Canadian Medical Education

The anatomical sciences have always been regarded as an essential component of medical education. In Canada, the methodology and time dedicated to anatomy teaching are currently unknown. Two surveys were administered to course directors and discipline leaders to gain a comprehensive view of anatomical education in Canadian medical schools. Participants were queried about contact hours (classroom and laboratory), content delivery and assessment methods for gross anatomy, histology, and embryology. Twelve schools responded to both surveys, for an overall response rate of 64%. Overall, Canadian medical students spend 92.8 (± 45.4) hours (mean ± SD) studying gross anatomy, 25.2 (± 21.0) hours for histology, and 7.4 (± 4.3) hours for embryology. Gross anatomy contact hours statistically significantly exceeded those for histology and embryology. Results show that most content is delivered in the first year of medical school, as anatomy is a foundational building block for upper-year courses. Laboratory contact time for gross anatomy was 56.8 (± 30.7) hours, histology was 11.4 (± 16.2) hours, and embryology was 0.25 (± 0.6) hours. Additionally, 42% of programs predominantly used instructor/technician-made prosections, another 33% used a mix of dissection and prosections and 25% have their students complete cadaveric dissections. Teaching is either completely or partially integrated into all Canadian medical curricula. This integration trend in Canada parallels those of other medical schools around the world where programs have begun to decrease contact time in anatomy and increase integration of the anatomical sciences into other courses. Compared to published American data, Canadian schools offer less contact time. The reason for this gap is unknown. Further investigation is required to determine if the amount of anatomical science education within medical school affects students' performance in clerkship, residency and beyond.

Survey of Gross Anatomy Education in China: The Past and the Present

Medical education in mainland China has undergone massive expansion and reforms in the past decades. A nation-wide survey of the five-year clinical medicine programs aimed to examine the course hours, pedagogies, learning resources and teaching staff of anatomy both at present and over the past three decades (1990-1999, 2000-2009, and 2010-2018). The directors or senior teachers from 90 out of the 130 five-year clinical medicine programs were invited to fill out a factual questionnaire by email. Ultimately, sixty-five completed questionnaires were received from 65 different schools. It was found that the total number of gross anatomy course hours has decreased by 11% in the past 30 years and that systematic and regional anatomy have been increasingly taught separately among the surveyed medical schools. Problem-based learning has been adopted in thirty-five (54%) of the surveyed schools, and team-based learning is used in ten (15%) of the surveyed schools. The surveyed schools reported receiving more donated cadavers in recent years, with the average number increasing from 20.67 ± 20.29 in 2000-2009 to 36.10 ± 47.26 in 2010-2018. However, this has not resulted in a decrease in the number of students who needed to share one cadaver (11.85 ± 5.03 in 1990-1999 to 14.22 ± 5.0 in 2010-2018). A decreasing trend regarding the teacher-student ratio (1:25.5 in 2000-2009 to 1:33.2 in 2010-2018) was also reported. The survey demonstrated the historical changes in gross anatomy education in China over the past thirty years.

Dissection in the Modern Medical Curriculum: An Exploration into Student Perception and Adaptions for the Future

For centuries cadaveric dissection has been a cornerstone of medical anatomy education. However, time and financial limitations in modern, compressed medical curricula, coupled with the abundance of alternate modalities, have raised questions about the role of dissection. This study was designed to explore student perceptions of the efficacy of a dissection program for learning musculoskeletal anatomy, and possible adaptations for appropriate inclusion of dissection in the modern medical curricula. A paper-based questionnaire was used to collect data from 174 medical students after completion of cadaveric dissections. Data were analyzed using both quantitative and qualitative methods. Students strongly believed that cadaver-based learning is essential to anatomy education and modern teaching modalities only complement this. Moreover, most students reported that dissection provided an additional, immersive learning experience that facilitated active learning and helped in developing manual competencies. Students with previous dissection experience or an interest in anatomy-related specialties were significantly more likely to attend dissection sessions. Students found that the procedural dissection components enhanced the knowledge of applied anatomy and is beneficial for the development of clinical skills. They welcomed the idea of implementing more procedure-based dissections alongside lectures and prosections-based practical (PBP) sessions. Cadaveric dissection plays an integral role in medical anatomy education. Time restraints and an increased focus on clinical significance, however, demand carefully considered adaptations of existing dissection protocols. The introduction of procedure-based dissection offers an innovative, highly engaging and clinically relevant package that would amalgamate skills essential to medical practice while retaining the benefits that have allowed dissection to stand the test of time.

Time Spent in Practicing Dissection Correlated with Improvement in Anatomical Knowledge of Students: Experimental Study in an Integrated Learning Program

Introduction and aim

Cadaveric dissection has long been used as the main domain for teaching anatomy in medical schools. However, recently with a limited number of cadavers and time for practicing dissection, prosections and anatomical models are widely used and may replace traditional dissection. We aimed to explore the possible association between practicing dissection and test results among medical students and to determine whether there are differences in achievements between students who studied anatomy by cadaveric dissection and those who used prosections and anatomical models.

Methods

The study was conducted at the University of Bisha, College of Medicine, Saudi Arabia, during the period from March to August 2017. Students were randomly assigned to one of two groups (50 in each). The first group studied anatomy (upper limb course) by practicing dissection while the other studied it by using prosections and anatomical models. Both groups were subjected to the same final assessments. Scores of both groups were compared by using the Student’s t-test. Correlation analysis between time spent in practicing dissection (carefully registered using a predesigned portfolio and an attendance logbook) and assessment grades was implemented using the rank-based Pearson correlation coefficient.

Results

Students practicing dissection achieved higher grades (169 ± 1.99) than those who studied anatomy by only using prosections and anatomical models (142 ± 1.78, p<0.001). There was an association between the time spent in practicing dissections and overall anatomy summative assessments (r²=0.841, p<0.001). Students expressed positive responses towards the effectiveness and value of practicing dissection.

Conclusions

We concluded that practicing dissection helps students to achieve higher results than learning using only models and prosections. Time spent in practicing dissection correlated with final assessment results. Further research is required to measure not only the statistical significance of results but also their educational effectiveness and long term learning outcomes.

An International Partnership of 12 Anatomy Departments - Improving Global Health through Internationalization of Medical Education

Background

At a time of global interconnectedness, the internationalization of medical education has become important. Anatomy as an academic discipline, with its close connections to the basic sciences and to medical education, can easily be connected with global health and internationalization of medical education. Here the authors present an international program based on a partnership between twelve anatomy departments in ten countries, on four continents. Details of a proposed plan for the future direction of the program are also discussed.

Objective

The aim is to improve global healthcare by preparing future global healthcare leaders via early international networking, international collaboration and exchange, intercultural experience, and connecting two seemingly distant academic disciplines - anatomy and global health - via internationalization of medical education.

Methods

Based in the anatomy course, the program involved early international collaboration between preclinical medical and dental students. The program provided a stepwise progression for learning about healthcare and intercultural topics beyond pure anatomy education - starting with virtual small groups of international students, who subsequently presented their work to a larger international audience during group videoconferences. The above progressed to in-person visits for research internships in the basic sciences within industrialized countries.

Findings

Students appreciated the international and intercultural interaction, learned about areas outside the scope of anatomy (e.g., differences in healthcare education and delivery systems, Public and Global Health challenges, health ethics, and cultural enrichment), and valued the exchange travel for basic sciences research internships and cultural experience.

Conclusions

This unique collaboration of international anatomy departments can represent a new role for the medical anatomy course beyond pure anatomy teaching - involving areas of global health and internationalization of medical education - and could mark a new era of international collaboration among anatomists.

Anatomical Sciences Education Among Biological Anthropology Graduates: a Solution to the Dearth of Anatomy Educators?

The need for anatomical knowledge is increasingly in demand as new medical and allied-health professions programs continue to open, but there is a growing dearth of educators with formal training in the anatomical sciences. Several sources for anatomy faculty have been suggested, including surgeons, but few have considered a more obvious, alternative approach to this shortage: hiring qualified faculty from other PhD departments/programs whose graduates receive formal training in anatomy, including biological anthropologists. This study surveyed 305 biological anthropology graduates to assimilate information about the nature and extent of training among biological anthropology graduates in the core anatomy disciplines (anatomy, histology, embryology, histology, neuroanatomy), and to determine whether biological anthropology graduates value and apply anatomy training. Only 36% of PhDs reported that anatomy was a required course, but 72% of PhD graduates took an anatomy course (usually gross anatomy with a human cadaveric dissection laboratory). Histology, embryology, and neuroanatomy also were not required to obtain a PhD, though some of this material was covered during the anatomy course, and some students opted to take these courses as electives. Forty-five percent of PhD students reported teaching experience in gross anatomy courses with cadaveric dissection. Ninety-four percent of biological anthropology PhD graduates are prepared to teach human osteology, and 48% are comfortable teaching gross anatomy. Biological anthropology graduates bring unique expertise, training, and research experience to medical education programs, and many are well-suited to fill the growing number of anatomy faculty positions.

Uncovering Hidden Curricula: Use of Dark Humor in Anatomy Labs and its Implications for Basic Sciences Education

Humor is subjective within most settings, but within the anatomy laboratory, it is likely to be significantly more contentious. While humor may be considered a component of the hidden curriculum of medical education, it has yet to be studied specifically from a basic sciences perspective. This study sought to understand if, when, how, and why humor may be used in anatomy labs and the implications this may have in basic sciences education. A survey consisting of demographic and qualitative items was designed to sample widely from academics, students, and health professionals with anatomy laboratory experience. A total of 185 respondents, representing 9 countries participated following purposive sampling and snowball recruitment. Findings of significance were 72% of respondents who had experienced dark humor within the anatomy lab. Themes identified from free-text pertained to the use of internal and external barometers to ascertain the appropriateness of humorous remarks and the use of humor as a mechanism for diffusing stress. Polarity in responses concerning the acceptability of dark humor and rude mnemonics was also observed. This study highlighted that while dark humor may be a perceived tension release, many individuals make use of very specific internalized gauges to determine when and what humor may be appropriate. The data emphasized the need for not only future humanistic-focused anatomy but also basic sciences, education research, to better understand and have ideal educational experiences for all. Finally, this study provided further evidence of the impact of the hidden curriculum associated with the use of humor within educational and professional settings.

An anatomy workshop for improving anatomy self-efficacy and competency when transitioning into a problem-based learning, Doctor of Physical Therapy program

First-year Doctor of Physical Therapy (DPT) students entering a problem-based learning (PBL) program are faced with a number of pedagogical challenges, including the development of self-directed learning skills, resource unfamiliarity, and group dynamics. These challenges can make learning anatomy in a self-directed manner less efficient. Prematriculation introduction of strategies to improve anatomy learning may help prepare students for a rigorous DPT program and improve anatomy learning efficiency. The present study describes a 2-day anatomy workshop offered to incoming students before a DPT program was initiated. Knowledge acquired during both days of the workshop resulted in statistically significant improvements in anatomy postquiz scores for each corresponding prequiz (P < 0.001 for lower and upper limb quizzes). Workshop participants survey responses demonstrated that anatomy confidence and PBL preparedness increased at distinct intervals following the workshop and was significantly higher than controls after the first semester (P < 0.01 for anatomy confidence and PBL preparedness). Multivariate regression analyses demonstrated statistically significant relationships between semester anatomy practical scores and workshop participation (P = 0.03 for practical 1 and P = 0.049 for practical 2) and undergraduate grade point average (P < 0.001 for practical 1 and P = 0.03 for practical 2). First-year DPT students reported the anatomy workshop to be a valuable experience for learning strategies to improve anatomy self-efficacy. An introductory anatomy workshop is an effective strategy to improve self-directed anatomy learning efficiency before the start of a rigorous DPT program.

Evaluation of Neuroanatomy Web Resources for Undergraduate Education: Educators' and Students' Perspectives

Despite the development of novel teaching strategies and the abundance of adjunct teaching web resources, students and early career physicians have continuously reported difficulties in learning and clinically applying neuroanatomy. Differences in instructional design of these resources, the lack of assessment of their capacity to meet intended educational goals, and a poor understanding of the user's perspective may have hindered their success in increasing understanding and retention of neuroanatomical knowledge. To decipher the limitations of existing web resources, an online search for neuroanatomy web resources was performed and distilled through a strict filtration rubric. A selection of resources were analyzed by a panel of educators and rated using Likert scales, focusing on the identification of features influencing their usefulness in learning the anatomy of the spinal pathways. The top three ranked web resources were subsequently evaluated by a panel of medical and neuroscience students to assess how specific features aided in their learning of the subject. This detailed analysis has identified features of neuroanatomy web resources that are valued by both educators and users with regard to instructional design. One resource was rated highest by end users and educators on a series of Likert scale questions in terms of clarity of explanation, step-wise teaching design, summarization of information, control of instructional-pace, integration with neurophysiology, neuroradiology and clinical correlates, deployment of a wide array of pedagogical tools, and factors for visualizing neuroanatomical inter-relationships. These results have provided a novel user perspective on the influence of specific elements of neuroanatomy web resources to improve instructional design and enhance learner performance.

Musculoskeletal Anatomy Knowledge Retention in the Macquarie University Chiropractic Program: A Cross-Sectional Study

Attrition of anatomy knowledge has been an area of concern in health professions curricula. To ensure safe and effective clinical practice, the study of chiropractic requires a good knowledge of musculoskeletal anatomy. In this study, musculoskeletal limb knowledge retention was investigated among students in the 5-year chiropractic program at Macquarie University, Australia. A test of 20 multiple-choice questions, categorized into low-order (LO) and high-order (HO) cognitive ability according to Bloom's Taxonomy, was developed. Students enrolled in the program were invited to participate with 257 of the 387 choosing to participate, (response rate ranging 56%-72% per year level). No attrition of knowledge across the years was observed, instead, a significant increase in knowledge, measured by total LO and HO scores (P < 0.0005), throughout the program. There were significant increases in both low and high cognitive scores which were not uniform, with high-order scores increasing significantly in the last two year levels. The increase of knowledge, may be explained, at least partially, by the vertical and horizontal integrated curriculum. Retrieval of knowledge, especially in clinically applied formats, may have led to an enhanced ability to apply anatomy knowledge and account for the increased scores in the high-order knowledge seen in the later clinical years. Evaluating anatomy knowledge retention at different cognitive levels seems to provide a better assessment and is worth considering in future anatomy educational research.

Integrating Specialty-Specific Clinical Anatomy Education into the Post-Clerkship Curriculum

Anatomy is a foundational science mainstay of undergraduate medical school education, particularly in the pre-clerkship curriculum. During the post-clerkship curriculum, students closer to graduate medical education may benefit from a focused concentration on human anatomy related to their specific clinical interests. Here, we describe a course for post-clerkship students that uniquely incorporates a multimodal approach of dissection, didactics, and clinical correlation to radiologic imaging, with the opportunity to personalize student learning on a specialty-specific anatomic region. The course increased students' confidence of anatomical knowledge and its clinical relevance. Other institutions may benefit from establishing a similar multimodal integrated post-clerkship anatomy curriculum.

From Scope to Screen: The Evolution of Histology Education

Histology, the branch of anatomy also known as microscopic anatomy, is the study of the structure and function of the body's tissues. To gain an understanding of the tissues of the body is to learn the foundational underpinnings of anatomy and achieve a deeper, more intimate insight into how the body is constructed, functions, and undergoes pathological change. Histology, therefore, is an integral element of basic science education within today's medical curricula. Its development as a discipline is inextricably linked to the evolution of the technology that allows us to visualize it. This chapter takes us on the journey through the past, present, and future of histology and its education; from technologies grounded in ancient understanding and control of the properties of light, to the ingenuity of crafting glass lenses that led to the construction of the first microscopes; traversing the second revolution in histology through the development of modern histological techniques and methods of digital and virtual microscopy, which allows learners to visualize histology anywhere, at any time; to the future of histology that allows flexible self-directed learning through social media, live-streaming, and virtual reality as a result of the powerful smart technologies we all carry around in our pockets. But, is our continuous pursuit of technological advancement projecting us towards a dystopian world where machines with artificial intelligence learn how to read histological slides and diagnose the diseases in the very humans that built them?

Table Quizzes as an Assessment Tool in the Gross Anatomy Laboratory

Using cadaveric instruction in a graduate-level anatomy course is an expensive and time-consuming undertaking. While this is a worthwhile endeavor, most first-year medical students and students in the health fields struggle with the independent, self-directed learning approach in the cadaveric laboratory, and going beyond rote memorization of the material. As such, effective assessment tools that maximize student learning in the cadaveric laboratory are critical, especially if no lecture component is present. Dissection quality often reflects student attention to detail and therefore may be tied to overall performance in the course. The aim of this study was to investigate the relationship between weekly table quizzes and the overall student outcomes in a graduate biomedical human dissection class as well as examining the benefits and implications of this approach. In this course, a uniquely structured weekly quiz assessed dissection quality and probed student understanding in human anatomy. Student data compiled from 5 years of dissection courses were analyzed to evaluate the relationship between performance in the weekly assessment and on the unit examinations. The results showed a statistically significant relationship between the weekly quizzes and the student examinations at the end of each dissection block in 2013, 2015, 2016, and 2017. The data suggest a potential correlation between performance on weekly quizzes and on unit examinations. The unique nature of the table quizzes provides the students with the opportunity to practice the retrieval of their knowledge, feel more guided throughout their dissection, and receive immediate feedback on their performance. This assessment tool also provides a way to predict student outcomes and an opportunity for early intervention to help at-risk students. The analysis of this research study contributes to the need for more data on the usage of assessment tools in a graduate human dissection class.

Voice in Digital Education: The Impact of Instructor's Perceived Age and Gender on Student Learning and Evaluation

Instructor evaluations are influenced by implicit age and gender bias, with lower ratings and negative feedback given to instructors believed to stray from stereotypical age and gender norms. Female instructors exhibiting typically male-associated qualities such as leadership and authority, are often negatively impacted. Implicit bias also influences evaluation of digital resources and instructors, regardless of students' positive learning outcomes. As digital learning resources become the norm in education, it is crucial to explore the impact of implicit bias at various educational levels. In this study, undergraduate and graduate students were randomly exposed to one of five digital tutorials; four experimental tutorials presenting identical anatomy content with narrators of different gender and age, and a control tutorial featuring origami (paper folding) instructions without audio. Learning outcomes were measured by pre-quiz vs. post-quiz comparisons using repeated measures MANOVA. Implicit bias was analyzed by evaluation response comparisons using repeated measures MANOVA and three-way MANOVA. Post-quiz scores increased significantly in the four experimental groups (P < 0.05) but not in the control (P = 0.99). The increased performance was not statistically different across the four experimental groups (P > 0.26), suggesting that learning occurred irrespective of the instructor gender and age. Students' evaluations were consistently higher for the experimental resources than the control. There was no significant difference in evaluations across the four experimental groups but compared to the control, younger male and younger female narrators received significantly higher ratings for approachability, acceptance, inclusivity, and care for student learning. The study highlights important considerations for digital resources development and interpretation of student evaluations.

A Look at the Anatomy Educator Job Market: Anatomists Remain in Short Supply

In 2002, a widely publicized report projected an anatomy educator shortage based on department chairpersons' perceptions. Now, 17 years later, the question lingers: "Does an anatomy educator shortage persist and, if so, how severe is the shortage?" Trends in the number, type, and fill rate of anatomy educator job openings were explored by analyzing job posting in the United States over the past two years. A survey was distributed to leaders of anatomy-related departments in the United States, Canada, and European Union. Most departmental leaders who responded (65% or more) from the United States/Canada (n = 81) and the European Union (n = 52) anticipate they will have "moderate" to "great" difficulty hiring anatomy educators in gross anatomy, histology, and embryology over the next five years. Within the United States, the number of anatomy educator job postings at medical schools more than doubled from at least 21 postings in 2017 to 52 postings in 2018. Twenty-one percent of postings between 2017 and 2018 were never filled. While the number of anatomy educator openings within the United States/Canada is perceived to remain in a steady state for the next five years, the European Union estimates a five-fold increase in the number of openings. Departmental leaders prioritize anatomy educator applicants who have teaching experience (mean ± SD = 4.64 ± 0.84 on five-point Likert scale), versatility in teaching multiple anatomy disciplines (3.93 ± 1.07), and flexibility in implementing various teaching pedagogies (3.69 ± 1.17). Collectively, these data suggest the shortage of anatomy educators continues in the United States/Canada and the European Union.

Anatomical Sciences in Chiropractic Education: A Survey of Chiropractic Programs in Australia

Human anatomy knowledge is a core requirement for all health care clinicians. There is a paucity of information relating to anatomy content and delivery in Australian chiropractic programs. The aim of this study was to describe anatomy teaching in Australian chiropractic programs, utilizing a survey which was distributed to all four programs, requesting information on: anatomy program structure, delivery methods, assessment, teaching resources, and academic staff profile at their institution. The survey was undertaken in 2016 and documented practices in that academic year. All four institutions responded. There was a reported difference in the teaching hours, content, delivery and assessment of anatomy utilized in Australian chiropractic programs. Anatomy was compulsory at all four institutions with the mean total of 214 (SD ± 100.2) teaching hours. Teaching was undertaken by permanent ongoing (30%) and sessional academic staff, and student to teacher ratio varied from 15:1 to 12:1. A variety of teaching resources were utilized, including human tissue access, either as prosected cadavers or plastinated body parts. The results of this survey confirm that anatomy has an established place in chiropractic education programs in Australia and while curricular variations exist, all programs had similar course design, delivery, and assessment methods. This study confirmed the provision of a strong foundation in topographical anatomy and neuroanatomy, while other anatomical sciences, such as histology and embryology were not consistently delivered. Formalization of a core anatomy curriculum together with competency standards is needed to assist program evaluation and development, and for accreditation purposes.

Learning Cardiac Embryology-Which Resources Do Students Use, and Why?

With increasing class sizes, small group activities for learning embryology are present in few institutions. How then do students supplement their lectures in order to ask and answer questions, or delve into concepts in detail? Arguably, animations and videos are ideal for visualizing four-dimensional anatomy, but how do students find and filter these? First-year medical students were surveyed with respect to the cardiac embryology component of their course and asked their opinions regarding the clinical relevance of this content and the resources they used to enhance learning. Students indicated that they considered cardiac embryology to be of relevance to clinical practice and that videos are a useful resource in helping them to learn this material. However, when seeking videos or resources, it emerged that students tended to Google information in preference to accessing online resources (or textbooks) specifically recommended by their instructor, despite students' recognition that "accuracy of information" was paramount when choosing what resource to use. While all students seemed reluctant to contact a staff member with questions, those with less proficiency in English were less likely to approach faculty for assistance. While acknowledging students as adult learners, self-regulated learning skills do not develop automatically and the development of these skills should be viewed as a "shared responsibility" between students and staff. Likewise, students also need to be taught critical appraisal of learning resources, especially in the complex online environment, with design of their bespoke institutional virtual learning environment facilitating easy identification and access of recommended resources.

A core syllabus for the teaching of gross anatomy of the thorax to medical students

Discussion is ongoing concerning the need to ensure the clinical relevance of the biomedical sciences. However, clinical relevance within health care courses presupposes that there is internationally agreed core material to be taught and learned. For anatomy, by the initial use of Delphi Panels that comprise anatomists, scientists, and clinicians, the International Federation of Associations of Anatomists (IFAAs) is developing internationally accepted core syllabuses for all anatomical sciences disciplines in the health care professions. In this article, the deliberations of a Delphi Panel for the teaching of thoracic anatomy in the medical curriculum are presented, prior to their publication on the IFAA's website. To develop the syllabus further, it is required that anatomical societies, as well as individual anatomists and clinicians, comment upon, elaborate, and amend this draft recommended syllabus. The aim is to set internationally recognized standards and thus to provide guidelines concerning the knowledge of the human thorax expected of graduating medical professionals. Such information should be borne in mind by those involved in the development of medical courses. Clin. Anat. 33:300-315, 2020. © 2019 Wiley Periodicals, Inc.

An Expert Derived Feedforward Histology Module Improves Pattern Recognition Efficiency in Novice Students

Histology is a visually oriented, foundational anatomical sciences subject in professional health curricula that has seen a dramatic reduction in educational contact hours and an increase in content migration to a digital platform. While the digital migration of histology laboratories has transformed histology education, few studies have shown the impact of this change on visual literacy development, a critical competency in histology. The objective of this study was to assess whether providing a video clip of an expert's gaze while completing leukocyte identification tasks would increase the efficiency and performance of novices completing similar identification tasks. In a randomized study, one group of novices (n = 9) was provided with training materials that included expert eye gaze, while the other group (n = 12) was provided training materials with identical content, but without the expert eye gaze. Eye movement parameters including fixation rate and total scan path distance, and performance measures including time-to-task-completion and accuracy, were collected during an identification task assessment. Compared to the control group, the average fixation duration was 13.2% higher (P < 0.02) and scan path distance was 35.0% shorter in the experimental group (P = 0.14). Analysis of task performance measures revealed no significant difference between the groups. These preliminary results suggest a more efficient search performed by the experimental group, indicating the potential efficacy of training using an expert's gaze to enhance visual literacy development. With further investigation, such feedforward enhanced training methods could be utilized for histology and other visually oriented subjects.