Student performance in and perceptions of a high structure undergraduate human anatomy course

Inverted Classroom Teaching of Physiology in Basic Medical Education: Bibliometric Visual Analysis

Background

Over the last decade, there has been growing interest in inverted classroom teaching (ICT) and its various forms within the education sector. Physiology is a core course that bridges basic and clinical medicine, and ICT in physiology has been sporadically practiced to different extents globally. However, students' and teachers' responses and feedback to ICT in physiology are diverse, and the effectiveness of a modified ICT model integrated into regular teaching practice in physiology courses is difficult to assess objectively and quantitatively.

Objective

This study aimed to explore the current status and development direction of ICT in physiology in basic medical education using bibliometric visual analysis of the related literature.

Methods

A bibliometric analysis of the ICT-related literature in physiology published between 2000 and 2023 was performed using CiteSpace, a bibliometric visualization tool, based on the Web of Science database. Moreover, an in-depth review was performed to summarize the application of ICT in physiology courses worldwide, along with identification of research hot spots and development trends.

Results

A total of 42 studies were included for this bibliometric analysis, with the year 2013 marking the commencement of the field. University staff and doctors working at affiliated hospitals represent the core authors of this field, with several research teams forming cooperative relationships and developing research networks. The development of ICT in physiology could be divided into several stages: the introduction stage (2013-2014), extensive practice stage (2015-2019), and modification and growth stage (2020-2023). Gopalan C is the author with the highest citation count of 5 cited publications and has published 14 relevant papers since 2016, with a significant surge from 2019 to 2022. Author collaboration is generally limited in this field, and most academic work has been conducted in independent teams, with minimal cross-team communication. Authors from the United States published the highest number of papers related to ICT in physiology (18 in total, accounting for over 43% of the total papers), and their intermediary centrality was 0.24, indicating strong connections both within the country and internationally. Chinese authors ranked second, publishing 8 papers in the field, although their intermediary centrality was only 0.02, suggesting limited international influence and lower overall research quality. The topics of ICT in physiology research have been multifaceted, covering active learning, autonomous learning, student performance, teaching effect, blended teaching, and others.

Conclusions

This bibliometric analysis and literature review provides a comprehensive overview of the history, development process, and future direction of the field of ICT in physiology. These findings can help to strengthen academic exchange and cooperation internationally, while promoting the diversification and effectiveness of ICT in physiology through building academic communities to jointly train emerging medical talents.

Body painting, ultrasound, clinical examination, and peer-teaching: A student-centered approach to enhance musculoskeletal anatomy learning

The presented course, established 2016 as a compulsory elective for 22nd-year bachelor medical students, aimed to enhance deep learning of upper and lower limb anatomy from a clinical perspective by a maximum of student-centered activities combining hands-on skills training with team-learning. Three cohorts (in total 60 students) participated in this study. Students rotated through body painting, ultrasound, and clinical investigation supervised by faculty or an experienced clinician. Teams of 3-4 students prepared presentations on clinical anatomy and pathological conditions, which by teacher- and peer assessments on average achieved >85% (mean 17.8/20 points ± 1.06). After each activity session, the students reported their learning experience through a reflective diary. Fifty students (83%) evaluated the course by a voluntary anonymous questionnaire combining Likert-type scale and free-text questions to assess, predominantly, perception of course activities and their perceived influence on learning anatomy. Journal reports and questionnaires revealed that the students highly valued the course, and 92% (29 females, 17 males) rated group work satisfying or well-perceived. The highest appreciation achieved ultrasound followed by clinical examination and body painting, which one third proposed to integrate into the regular dissection course. All students recommended the course to their younger peers. This course was feasible to integrate in the pre-existing curriculum. Limiting factors to offer this elective course to more students are availability of clinical teachers, technical equipment, and education rooms. Being student-directed tasks, body painting and reflective diary-writing would be feasible to implement without additional faculty, which we recommend to educators for student engagement activation.

Artwork in anatomy education: A way to improve undergraduate students' self-efficacy and attitude

Anatomy is one of the leading subjects in health science, and students need a strong anatomy background in these fields. Traditional lecturer-oriented anatomy education is based predominantly on passive learning methods. In recent years, alternative educational methods like hands-on art and 3D atlas-based education methods have become more popular as competitive alternatives to traditional approaches. This is a prospective, randomized, longitudinal, interventional study, and a total of 181 undergraduate students participated in this study. A comparative design was used with two groups: Artwork and Atlas. This study aims to evaluate the effectiveness of creative and artistic approaches in improving undergraduate students' attitudes and self-efficacy toward anatomy courses. A Pearson correlation, an independent t-test, and a paired t-test were used to analyze the results. Both groups experienced a negative mean score on the anatomy self-efficacy scale, suggesting an increase in anatomy self-efficacy, and showed significant self-efficacy improvements (p < 0.005). An independent t-test analysis found no statistically significant difference between the Atlas group and the Artwork group on the anatomy self-efficacy scales (pretest and posttest) and the anatomy attitudes scale (p > 0.005). Artwork-based education and learning methods can be used as active learning methods to improve students' self-efficacy toward anatomy. This method allows learners to employ their creative abilities in order to express their ideas visually, making complex concepts easier to comprehend. It can also help students develop practical, problem-solving, critical thinking, and teamwork skills. It is cost-effective and engaging since it does not need any expensive equipment.

Using Test Question Templates to teach physiology core concepts

The past ∼15 years have seen increasing interest in defining disciplinary core concepts. Within the field of physiology, Michael, McFarland, Modell, and colleagues have published studies that defined physiology core concepts and have elaborated many of these as detailed conceptual frameworks. With such helpful definitions now in place, attention is turning to the related issue of how to maximize student understanding of the core concepts by linking these "big ideas" to concrete student-facing resources for active learning and assessment. Our practitioner-based view begins with the recognition that in many if not most undergraduate physiology courses assessment drives learning. We have therefore linked published conceptual frameworks to Test Question Templates (TQTs), whose structure promotes transparent assessments as well as the active learning needed to prepare for such assessments. We provide examples of conceptual framework-linked TQTs for the physiology core concepts of Homeostasis, Flow Down Gradients, the Cell Membrane, and Cell-Cell Communication. We argue that this deployment of TQTs has at least two distinct benefits for the teaching and learning of core concepts. First, documenting the connections between conceptual frameworks and TQTs may clarify coverage and assessment of the core concepts for both instructors and students. Second, misconceptions about core concepts may be directly targeted and dispelled via thoughtful construction, arrangement, and iteration of TQTs. We propose that the TQT framework or similar approaches may be applied fruitfully to any sufficiently articulated physiology core concept for high school, undergraduate, or graduate students.NEW & NOTEWORTHY Our students often focus on the grades they need to advance through academic programs. How can instructors harness this understandable interest in grades to help students gain a true understanding of core concepts? The new framework of Test Question Templates (TQTs) shows promise in linking student priorities like test scores to instructor priorities like core concepts.

Using videos in active learning: An experience in veterinary anatomy

Examination failure rate is high in veterinary anatomy in Brazilian universities. We report here our active learning experience in which students recorded video reports on veterinary anatomical specimens of locomotor apparatus to support classic learning. Eighteen students were divided into 2 groups, case group (V3) and control (E). Case group students individually recorded video reports of prosected specimens weekly. Acceptance and efficacy of the strategy were assessed with a Likert scale anonymous questionnaire and students' scores in theoretical exams. The method was highly accepted and the performance test proved that recording videos is an effective strategy for active learning in anatomy.

Effect of flipped classroom approach in the teaching of a hematology course

The flipped classroom is a teaching strategy used to enhance the engagement of students in the learning process. Replacing didactic lectures with active learning strategies through flipped classroom sessions fosters independence and the opportunity for students to engage in different passive learning styles. Although many studies of the flipped classroom approach have been conducted with medical students, few have focused on the effect of flipped classroom sessions on students in other medical professional fields. The aim of this study was to assess the effect of the flipped classroom approach on the performance of medical laboratory science students in a hematology course and their perception of the flipped classroom as an active learning strategy. In addition, students' perceptions regarding the flipped classroom as an active learning strategy were assessed. Of two cohorts in hematology courses, cohort 2 attended flipped classroom sessions, whereas cohort 1 underwent traditional class sessions. Students' learning outcomes, achievements and performance on examinations in hematology courses were assessed. In addition, a satisfaction survey was distributed to the students to evaluate their perception of the flipped classroom as a student-centred learning strategy. Students in cohort 2 performed significantly better in the knowledge and cognitive domains than did those in cohort 1 (p < 0.001). Cohort 2 students completed the course successfully with an average grade of 81%, and few students received low grades; in comparison, cohort 1 students completed the course with an average grade of 73%, and 7 students received a grade of F. Of students in cohort 2, 83% believed that the flipped classroom provided a better understanding of the subject matter and appropriate knowledge and skills. The results indicate the effectiveness of flipped classrooms as an active learning style in enabling students to obtain desirable knowledge and improve their academic performance. Moreover, students zrecognized that the flipped classroom as an active learning style was more beneficial than the traditional teaching approach.

Practice and exploration of the "student-centered" multielement fusion teaching mode in human anatomy

Purpose

Human anatomy is a core course of basic medicine and the first professional course for medical students. Traditional teaching includes "teacher-centered" instruction, passive learning, and a lack of interaction between teachers and students as well as between students. The aim of this study was to develop a "student-centered" multielement fusion teaching mode to address the mentioned drawbacks.

Methods

A total of 141 clinical medical students from grades 2016 and 2017 of Chengde Medical University participated in this study. The students were randomly divided into four classes: two experimental classes and two control classes. The experimental classes experienced a "student-centered" multielement fusion teaching mode, while the control classes experienced a traditional teaching method. Formative assessments and questionnaires were used to assess the students' preferences and obtain feedback. Theoretical and experimental tests were carried out to detect the students' scores at the end of the semester.

Results

The results of the questionnaires demonstrated that 100% of the students agreed that the multielement teaching mode was better. In the experimental test, the students in the experimental group achieved a mean score of 16.50 ± 0.3203, which was significantly higher than that of the control group 12.65 ± 0.4731 (P < 0.01). In the theoretical test, the average score of the experimental group was 45.86 ± 0.6273 and that of the control group was 46.59 ± 0.6636; thus, there was no significant difference between the two groups (P > 0.05).

Conclusion

The application of a "student-centered" multielement fusion teaching mode obtained strong approval from the students. This teaching mode not only improved students' interest in learning and increased the interaction between teachers and students as well as between students but also enhanced students' competence and will lay a solid foundation for their future careers.

An Adaptive Blended Learning Model for the Implementation of an Integrated Medical Neuroscience Course During the Covid-19 Pandemic

The implementation of an integrated medical neuroscience course by technologically pivoting an in-person neuroscience course to online using an adaptive blended method may provide a unique approach for teaching a medical neuroscience course during the Covid-19 pandemic. An adaptive blended learning method was developed in response to the requirements necessitated by the Covid-19 pandemic. This model combined pedagogical needs with digital technology using online learning activities to implement student learning in a medical neuroscience course for year one medical students. This approach provided medical students with an individually customized learning opportunity in medical neuroscience. The students had the complete choice to engage the learning system synchronously or asynchronously and learn neuroscience materials at different locations and times in response to the demands required to deal with the pandemic. Students' performance in summative and formative examinations of the adaptive blended learning activities were compared with the previous performance obtained the previous year when the contents of the medical neuroscience course were implemented using the conventional "face-to-face" learning approach. While the cohort of our students in 2019 and 2020 changed, the contents, sessions, volume of material, and assessment were constant. This enabled us to compare the results of the 2019 and 2020 classes. Overall, students' performance was not significantly different between the adaptive blended learning and the in-person approach. More students scored between 70% and 79% during the adaptive blended learning compared with in-class teaching, while more students scored between 80% and 89% during the in-person learning than during the adaptive blended learning. Finally, the percentage of students that scored >90% was not significantly different for both Years 2019 and 2020. The adaptive blended learning approach was effective in enhancing academic performance for high-performing medical students. It also permitted the early identification of underachieving students, thereby serving as an early warning sign to permit timely intervention.

An Analysis of Anatomy Education Before and During Covid-19: May-August 2020

Coronavirus disease 2019 (Covid-19) created unparalleled challenges to anatomy education. Gross anatomy education has been particularly impacted given the traditional in-person format of didactic instruction and/or laboratory component(s). To assess the changes in gross anatomy lecture and laboratory instruction, assessment, and teaching resources utilized as a result of Covid-19, a survey was distributed to gross anatomy educators through professional associations and listservs. Of the 67 survey responses received for the May-August 2020 academic period, 84% were from United States (US) institutions, while 16% were internationally based. Respondents indicated that in-person lecture decreased during Covid-19 (before: 76%, during: 8%, P < 0.001) and use of cadaver materials declined (before: 76 ± 33%, during: 34 ± 43%, P < 0.001). The use of cadaver materials in laboratories decreased during Covid-19 across academic programs, stand-alone and integrated anatomy courses, and private and public institutions (P ≤ 0.004). Before Covid-19, cadaveric materials used in laboratories were greater among professional health programs relative to medical and undergraduate programs (P ≤ 0.03) and among stand-alone relative to integrated anatomy courses (P ≤ 0.03). Furthermore, computer-based assessment increased (P < 0.001) and assessment materials changed from cadaveric material to images (P < 0.03) during Covid-19, even though assessment structure was not different (P > 0.05). The use of digital teaching resources increased during Covid-19 (P < 0.001), with reports of increased use of in-house created content, BlueLink, and Complete Anatomy software (P < 0.05). While primarily representing US institutions, this study provided evidence of how anatomy educators adapted their courses, largely through virtual mediums, and modified laboratory protocols during the initial emergence of the Covid-19 pandemic.

Investigating Student Perceptions of a Dissection-Based Undergraduate Gross Anatomy Course Using Q Methodology

The demand for upper-level undergraduate dissection-based anatomy courses is growing, as professional programs require more advanced anatomy training prior to matriculation. To address this need, Indiana University School of Medicine (IUSM) partnered with Indiana University-Purdue University Indianapolis-a large, urban, life science-focused campus nearby to IUSM-to offer an undergraduate, dissection-based course in regional gross anatomy. Because this is a new course, a deeper post-course evaluation of student perceptions was conducted using Q methodology. In this study, Q methodology was used to evaluate student views of the overall course structure, pre-laboratory materials and activities, assessments, and quality of instruction. Of the 15 students in the spring semester 2018 cohort, 80% (n = 12) participated in the evaluation, and 10 of those students followed up with written explanations for their rationale in selecting the four statements with which they most strongly agreed and disagreed. The Q methodology sorted the students into one of three statistically significant groups: Motivated Dissectors (n = 6), Traditional Students (n = 3), and Inspired Learners (n = 3). Motivated Dissectors and Inspired Learners felt strongly that the course did not encourage self-directed learning and that the pre-laboratory materials were not adequate to prepare them for quizzes. Traditional Students, however, disagreed, having a favorable opinion of the pre-laboratory materials, even though this group felt most strongly that the amount of material covered in the course was overwhelming. This study demonstrates the utility of Q methodology to evaluate courses to elucidate student perspectives and inform future course modifications.

A Quantitative Analysis of Four Undergraduate Human Anatomy Laboratory Curricula: Approaches, Identified Structures, Concepts, and Thematic Emphases

Human anatomy is a foundational course thatserves diverse pre-professional health care majors. However, limited information is available on the teaching approaches, content, and thematic emphases of this course at the undergraduate level when compared with that of medical and other graduate schools. Herein, we document and quantitatively evaluate the laboratory curriculum of four undergraduate human anatomy courses in the USA. For each course, we assess the total number of structures (terms requiring identification during an exam), concepts (terms requiring an explanation), and clinical applications. To facilitate further assessments, we also compare the content distribution of each course with that recommended by the American Association of Clinical Anatomists (AACA). Two courses followed a regional approach emphasizing the use of human cadavers, while the other two followed a system-based approach and used plastic models and non-human cadaveric materials (e.g., cats and sheep). The total amount of information presented to students differed significantly among curricula. The majority of terms (65-88%) taught to students referred to the identification of anatomical structures whereas clinical applications were rare (< 1.3%). Courses using a regional approach expected students to learn as much as twice the number of terms than those following a system-based approach. Functions, innervations, origins, and insertions of muscles are only included in the curriculum of the courses following a regional approach. The proportion of terms devoted to each anatomical module in all curricula was significantly different from each other, as well as from that of AACA recommendation. We discuss these differences in the curriculum, the challenges and limitations inherent with each teaching approach, as well as in the teaching materials used among the curricula. These quantitative analyses aim to provide insightful information about the structure of the undergraduate human anatomy laboratory curriculum and may prove useful when redesigning a course.

Impact and educational outcomes of a small group self-directed teaching strategy in a clinical neuroscience curriculum

The complexity of the material being taught in clinical neuroscience within the medical school curriculum requires creative pedagogies to teach medical students effectively. Many clinical teaching strategies have been developed and are well described to address these challenges. However, only a few have been evaluated to determine their impact on the performance of students studying clinical neuroscience. Interactive, 2-hour, self-directed small-group interactive clinical case-based learning sessions were conducted weekly for 4 weeks to integrate concepts learned in the corresponding didactic lectures. Students in the small groups analyzed cases of patients suffering from neurological disease that were based on eight learning objectives that allowed them to evaluate neuroanatomical data and clinical findings before presenting their case analysis to the larger group. Students' performances on the formative quizzes and summative tests were compared to those of first-year medical students in the previous year for whom the self-directed, small-group interactive clinical sessions were not available. There was a significant improvement in the summative performance of first-year medical students with self-directed clinical case learning in the second year (Y2) of teaching clinical neuroscience (P < 0.05) when compared with first-year students in the first year (Y1) for whom the self-directed learning approach was not available. Student performance in the formative assessments between Y1 and Y2 was not significantly different (P = 0.803). A target of ≥70% student scoring above 80% in the final summative examination was met. The current study revealed evidence for the impact and educational outcomes of a self-directed, clinical teaching strategy in a clinical neuroscience curriculum for first-year medical students. Anat Sci Educ 11: 478-487. © 2017 American Association of Anatomists.

Influence of study approaches and course design on academic success in the undergraduate anatomy laboratory

Many pre-health professional programs require completion of an undergraduate anatomy course with a laboratory component, yet grades in these courses are often low. Many students perceive anatomy as a more challenging subject than other coursework, and the resulting anxiety surrounding this perception may be a significant contributor to poor performance. Well-planned and deliberate guidance from instructors, as well as thoughtful course design, may be necessary to assist students in finding the best approach to studying for anatomy. This article assesses which study habits are associated with course success and whether course design influences study habits. Surveys (n = 1,274) were administered to students enrolled in three undergraduate human anatomy laboratory courses with varying levels of cooperative learning and structured guidance. The surveys collected information on potential predictors of performance, including student demographics, educational background, self-assessment ability, and study methods (e.g., flashcards, textbooks, diagrams). Compared to low performers, high performers perceive studying in laboratory, asking the instructor questions, quizzing alone, and quizzing others as more effective for learning. Additionally, students co-enrolled in a flipped, active lecture anatomy course achieve higher grades and find active learning activities (e.g., quizzing alone and in groups) more helpful for their learning in the laboratory. These results strengthen previous research suggesting that student performance is more greatly enhanced by an active classroom environment that practices successful study strategies rather than one that simply encourages students to employ such strategies inside and outside the classroom. Anat Sci Educ 11: 496-509. © 2018 American Association of Anatomists.

Experience from an optional dissection course in a clinically-orientated concept to complement system-based anatomy in a reformed curriculum

Profound anatomical knowledge is the basis for modern demands in medicine and surgery, but many countries worldwide including Australia and New Zealand have discontinued offering dissection courses to medical and dental students during the past decades. This educational project done in Australia aimed at enhancing basic and advanced anatomy teaching by engaging a sub-group of second-year undergraduate students of a compulsory prosection- and model-based anatomy course (n = 54/170) in an optional multimodal course, which should easily articulate with a vertical curriculum. With topographical cadaver dissections as core, peer student-teams prepared and peer-assessed anatomy lectures based on clinical topics, which were rated highly by the peers and teachers. Anatomical knowledge was tested by quizzes and a multiple-choice examination. Individual dissection skills were self- and teacher-assessed. A final course grade was assigned based on these assessments. The grades in the system-based compulsory course achieved by the attendees of the paralleling dissection course were compared with their peers attending other optional courses. After beginning of the semester, the students in the dissection course performed similar, significantly (P < 0.005) improved during the semester (78.5% vs. 69.9%, 70.1% vs. 64.1%), but in the integrated (including anatomy, biochemistry, physiology) final examination at the end of the year only tended to higher scores. As assessed through interviews and a voluntary questionnaire, all students of the optional dissection course liked these activities, which enhanced their learning experience. Thus, this concept elegantly integrates anatomical dissection with modern teaching demands and is feasible for implementation in modernized curricula. Anat Sci Educ 11: 32-43. © 2017 American Association of Anatomists.

Cadaveric dissection as an educational tool for anatomical sciences in the 21st century

Anatomical education has been undergoing reforms in line with the demands of medical profession. The aim of the present study is to assess the impact of a traditional method like cadaveric dissection in teaching/learning anatomy at present times when medical schools are inclining towards student-centered, integrated, clinical application models. The article undertakes a review of literature and analyzes the observations made therein reflecting on the relevance of cadaveric dissection in anatomical education of 21st century. Despite the advent of modern technology and evolved teaching methods, dissection continues to remain a cornerstone of anatomy curriculum. Medical professionals of all levels believe that dissection enables learning anatomy with relevant clinical correlates. Moreover dissection helps to build discipline independent skills which are essential requirements of modern health care setup. It has been supplemented by other teaching/learning methods due to limited availability of cadavers in some countries. However, in the developing world due to good access to cadavers, dissection based teaching is central to anatomy education till date. Its utility is also reflected in the perception of students who are of the opinion that dissection provides them with a foundation critical to development of clinical skills. Researchers have even suggested that time has come to reinstate dissection as the core method of teaching gross anatomy to ensure safe medical practice. Nevertheless, as dissection alone cannot provide uniform learning experience hence needs to be complemented with other innovative learning methods in the future education model of anatomy. Anat Sci Educ 10: 286-299. © 2016 American Association of Anatomists.

Improving Exam Performance in Introductory Biology through the Use of Preclass Reading Guides

High-structure courses or flipped courses require students to obtain course content before class so that class time can be used for active-learning exercises. While textbooks are used ubiquitously in college biology courses for content dissemination, studies have shown that students frequently do not read their textbooks. To address this issue, we created preclass reading guides that provided students with a way to actively engage with the required reading for each day of class. To determine whether reading guide completion before class is associated with increased performance, we surveyed students about their use of reading guides in two sections of a large-enrollment (400+ students) introductory biology course and used multiple linear regression models to identify significant correlations. The results indicated that greater than 80% of students completed the reading guides before class and that full completion of the reading guides before class was significantly positively correlated with exam performance. Reading guides in most cases were used similarly between different student groups (based on gender, ethnicity, and aptitude). These results suggest that optional preclass reading guides may help students stay on track to acquire course content in introductory biology and thus result in improved exam performance.