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Schweikert A, Kenny S, Oglesby I, Glasgow A, de Santi C, Gensch I, Lachmann N, Desroziers T, Fletcher C, Snijders D, Nathan N, Hurley K. An evaluation of an open access iPSC training course: "How to model interstitial lung disease using patient-derived iPSCs". Stem Cell Res Ther 2023; 14:377. [PMID: 38124115 PMCID: PMC10734099 DOI: 10.1186/s13287-023-03598-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 12/04/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND Interstitial lung diseases (ILD) are a group of rare lung diseases with severe outcomes. The COST Innovator Grant aims to establish a first-of-a-kind open-access Biorepository of patient-derived induced pluripotent stem cells (iPSC) and to train researchers in the skills required to generate a robust preclinical model of ILD using these cells. This study aims to describe and evaluate the effectiveness of a training course designed to train researchers in iPSC techniques to model ILD. METHODS 74 researchers, physicians and stakeholders attended the training course in Dublin in May 2022 with 31 trainees receiving teaching in practical iPSC culturing skills. The training course learners were divided into the Hands-on (16 trainees) and Observer groups (15 trainees), with the Observers attending a supervised live-streamed experience of the laboratories skills directly delivered to the Hands-on group. All participants were asked to participate in an evaluation to analyse their satisfaction and knowledge gained during the Training Course, with means compared using t-tests. RESULTS The gender balance in both groups was predominantly females (77.4%). The Hands-on group consisted mainly of researchers (75%), whereas all participants of the Observer group described themselves as clinicians. All participants in the Hands-on group were at least very satisfied with the training course compared to 70% of the participants in the Observer group. The knowledge assessment showed that the Hands-on group retained significantly more knowledge of iPSC characteristics and culturing techniques compared to the Observers (* < 0.05; p = 0.0457). A comprehensive learning video detailing iPSC culturing techniques was produced and is included with this manuscript. CONCLUSIONS The majority of participants were highly or very satisfied with the training course and retained significant knowledge about iPSC characteristics and culturing techniques after attending the training course. Overall, our findings demonstrate the feasibility of running hybrid Hands-on and Observer teaching events and underscore the importance of this type of training programme to appeal to a broad spectrum of interested clinicians and researchers particularly in rare disease. The long-term implications of this type of training event requires further study to determine its efficacy and impact on adoption of iPSC disease modelling techniques in participants' laboratories.
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Affiliation(s)
- Anja Schweikert
- Department of Medicine, Royal College of Surgeons in Ireland, Education and Research Centre, Beaumont Hospital, Dublin 9, Ireland
- Tissue Engineering Research Group, Royal College of Surgeons in Ireland, Dublin 2, Ireland
| | - Sarah Kenny
- School of Medicine, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin 2, Ireland
| | - Irene Oglesby
- Department of Medicine, Royal College of Surgeons in Ireland, Education and Research Centre, Beaumont Hospital, Dublin 9, Ireland
- Tissue Engineering Research Group, Royal College of Surgeons in Ireland, Dublin 2, Ireland
| | - Arlene Glasgow
- Department of Clinical Microbiology, Royal College of Surgeons in Ireland, Dublin 9, Ireland
| | - Chiara de Santi
- School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland, Dublin 2, Ireland
| | - Ingrid Gensch
- Department for Pediatric Pneumology, Allergology and Neonatology, Hannover Medical School, Hannover, Germany
- Cluster of Excellence - Resolving Infection Susceptibility (RESIST, EXC 2155), Hannover Medical School, Hannover, Germany
- Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), German Center for Lung Research, Hannover, Germany
- Regenerative Biology to Reconstructive Therapy (REBIRTH) Center for Translational and Regenerative Medicine, Hannover Medical School, Hannover, Germany
| | - Nico Lachmann
- Department for Pediatric Pneumology, Allergology and Neonatology, Hannover Medical School, Hannover, Germany
- Cluster of Excellence - Resolving Infection Susceptibility (RESIST, EXC 2155), Hannover Medical School, Hannover, Germany
- Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), German Center for Lung Research, Hannover, Germany
- Regenerative Biology to Reconstructive Therapy (REBIRTH) Center for Translational and Regenerative Medicine, Hannover Medical School, Hannover, Germany
| | - Tifenn Desroziers
- Laboratory of Childhood Genetic Disorders Inserm UMR_S933, Armand Trousseau Hospital, Sorbonne University, Paris, France
| | - Camille Fletcher
- Laboratory of Childhood Genetic Disorders Inserm UMR_S933, Armand Trousseau Hospital, Sorbonne University, Paris, France
| | - Deborah Snijders
- Department of Woman and Child Health (SDB), Primary Ciliary Dyskinesia Centre, University of Padova, Padua, Italy
| | - Nadia Nathan
- Laboratory of Childhood Genetic Disorders Inserm UMR_S933, Armand Trousseau Hospital, Sorbonne University, Paris, France
- Pediatric Pulmonology Department and Reference Centre for Rare Lung Diseases RespiRare, Armand Trousseau Hospital, APHP Sorbonne University, Paris, France
| | - Killian Hurley
- Department of Medicine, Royal College of Surgeons in Ireland, Education and Research Centre, Beaumont Hospital, Dublin 9, Ireland.
- Tissue Engineering Research Group, Royal College of Surgeons in Ireland, Dublin 2, Ireland.
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Seddon IA, Rahimy E, Miller JB, Charles S, Kitchens J, Houston SK. Feasibility and Potential for Real-Time 3D Vitreoretinal Surgery Telementoring. Retina 2023; 43:2162-2165. [PMID: 36731001 DOI: 10.1097/iae.0000000000003656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
PURPOSE To demonstrate the potential for real-time, three-dimensional (3D) surgical telementoring to enhance vitreoretinal surgical education. METHODS The 3D video feed from a high dynamic range surgical camera (NGENUITY) was run through a 4K video capture device (Magewell USB 4K) and set as the video input for a video conferencing application (Zoom). Remote surgical viewing was then performed in two-dimensions (2D) on a computer or in 3D with a virtual reality headset (Oculus Quest 2). RESULTS Ten surgical cases were successfully live streamed in real time to two separate surgeons in the United States. Specific details of the case were visualized with low latency and interaction with the operating surgeon was possible without affecting the surgical display quality. Excluding the NGENUITY system and personal computers, ancillary equipment costs (video capture card and virtual reality headset) were kept to below $1,000. CONCLUSION Our study demonstrates that 3D surgical video streaming can be achieved in real time with minimal latency through the use of low-cost video capture equipment and video conferencing/streaming software. The use of this technology gives educators the ability to mentor trainees without the traditional geographic and physical constraints of in-person surgical viewing.
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Affiliation(s)
- Ian A Seddon
- College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, Florida
- Florida Retina Institute, Orlando, Florida
| | - Ehsan Rahimy
- Department of Ophthalmology, Palo Alto Medical Foundation, Palo Alto, California
- Retina Service, Stanford University, Palo Alto, California
| | - John B Miller
- Retina Service, Massachusetts Eye and Ear Institute, Boston, Massachusetts
| | - Steve Charles
- Charles Retina Institute, Germantown, Tennessee; and
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Prakash A. Role of live streaming surgical video in CVTS residency program in India: a strategy to improve learning curve of surgical residents. Indian J Thorac Cardiovasc Surg 2023; 39:646-650. [PMID: 37885944 PMCID: PMC10597936 DOI: 10.1007/s12055-023-01607-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 08/16/2023] [Accepted: 09/07/2023] [Indexed: 10/28/2023] Open
Abstract
Recording surgical video is not new in medicine. But not many surgical residency programs in India have this facility. The coronavirus disease (COVID) pandemic made us search for new ways to progress ahead in our surgical careers. We present a way to record surgical videos and live stream them to a select audience comprising surgical residents and faculty, wherever they may be. This may become a standard of teaching once adopted by all top surgical residency programs across the country.
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Livestreaming Can Augment the Observation of Veterinary Post-mortem Examinations. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2023; 1397:113-134. [DOI: 10.1007/978-3-031-17135-2_7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Koh ZJ, Yeow M, Srinivasan DK, Ng YK, Ponnamperuma GG, Chong CS. A randomized trial comparing cadaveric dissection and examination of prosections as applied surgical anatomy teaching pedagogies. ANATOMICAL SCIENCES EDUCATION 2023; 16:57-70. [PMID: 34968002 DOI: 10.1002/ase.2166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 12/21/2021] [Accepted: 12/28/2021] [Indexed: 06/14/2023]
Abstract
Anatomy is an important component in the vertical integration of basic science and clinical practice. Two common pedagogies are cadaveric dissection and examination of prosected specimens. Comparative studies mostly evaluate their immediate effectiveness. A randomized controlled trial design was employed to compare both the immediate and long-term effectiveness of dissection and prosection. Eighty third-year medical students undergoing their surgical rotation from the Yong Loo Lin School of Medicine were randomized into two groups: dissection and prosection. Each participated in a one-day hands-on course following a similar outline that demonstrated surgical anatomy in the context of its clinical relevance. A pre-course test was conducted to establish baseline knowledge. A post-course test was conducted immediately after and at a one-year interval to evaluate learner outcome and knowledge retention. A post-course survey was conducted to assess participant perception. Thirty-nine and thirty-eight participants for the dissection and prosection groups, respectively, were included for analysis. There was no significant difference between mean pre-course test scores between the dissection and prosection groups [12.6 (3.47) vs. 12.7 (3.16), P > 0.05]. Both the mean immediate [27.9 (4.30) vs. 24.9 (4.25), P < 0.05] and 1 year [23.9 (4.15) vs. 19.9 (4.05), P < 0.05] post-course test scores were significantly higher in the dissection group. However, when adjusted for course duration [dissection group took longer than prosection group (mean 411 vs. 265 min)], these findings were negated. There is no conclusive evidence of either pedagogy being superior in teaching surgical anatomy. Based on learner surveys, dissection provides a greater learner experience.
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Affiliation(s)
- Zong Jie Koh
- Department of General Surgery, University Surgical Cluster, National University Health System, Singapore, Singapore
| | - Marcus Yeow
- Department of Internal Medicine, Singapore General Hospital, Singapore, Singapore
| | - Dinesh Kumar Srinivasan
- Department of Anatomy, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Yee Kong Ng
- Department of Anatomy, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Gominda G Ponnamperuma
- Department of Medical Education, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
| | - Choon Seng Chong
- Division of Colorectal Surgery, Department of General Surgery, University Surgical Cluster, National University Health System, Singapore, Singapore
- Dean's office, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
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Evidence-based Guidelines on the Use of Virtual Surgical Education Pertaining to the Domains of Cognition and Curriculum, Psychomotor Skills Training, and Faculty Development and Mentorship. Ann Surg 2022; 276:e6-e15. [PMID: 34171862 DOI: 10.1097/sla.0000000000005014] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To identify, categorize, and evaluate the quality of literature, and to provide evidence-based guidelines on virtual surgical education within the cognitive and curricula, psychomotor, and faculty development and mentorship domains. SUMMARY OF BACKGROUND DATA During the coronavirus disease 2019 pandemic, utilizing virtual learning modalities is expanding rapidly. Although the innovative methods must be considered to bridge the surgical education gap, a framework is needed to avoid expansion of virtual education without proper supporting evidence in some areas. METHODS The Association for Surgical Education formed an ad-hoc research group to evaluate the quality and methodology of the current literature on virtual education and to build evidence-based guidelines by utilizing the SiGN methodology. We identified patient/problem-intervention-comparison-outcome-style questions, conducted systematic literature reviews using PubMed, EMBASE, and Education Resources information Center databases. Then we formulated evidence-based recommendations, assessed the quality of evidence using Grading of Recommendations, Assessment, Development, and Evaluation, Newcastle-Ottawa Scale for Education, and Kirkpatrick ratings, and conducted Delphi consensus to validate the recommendations. RESULTS Eleven patient/problem-intervention-comparison-outcome-style questions were designed by the expert committees. After screening 4723 articles by the review committee, 241 articles met inclusion criteria for full article reviews, and 166 studies were included and categorized into 3 domains: cognition and curricula (n = 92), psychomotor, (n = 119), and faculty development and mentorship (n = 119). Sixteen evidence-based recommendations were formulated and validated by an external expert panel. CONCLUSION The evidence-based guidelines developed using SiGN methodology, provide a set of recommendations for surgical training societies, training programs, and educators on utilizing virtual surgical education and highlights the area of needs for further investigation.
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Skadorwa T. Anatomy podcasts for Medical Education. Clin Anat 2022; 35:580-591. [PMID: 35363384 DOI: 10.1002/ca.23865] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 03/28/2022] [Accepted: 03/28/2022] [Indexed: 11/09/2022]
Abstract
INTRODUCTION The implementation of podcasts as a complementary educational activity increased over the past year due to the Covid-19 pandemic. Being an alternative channel for transmission of anatomical knowledge, the on-demand audio broadcasts became an intriguing medium for both students and educators. MATERIALS AND METHODS This paper presents the results of a questionnaire study on the evaluation of an audio podcast designed specifically for the first-year medical students as an innovative and optional component of the human anatomy course. The audience expressed their opinions in four categories: engagement in listening to the podcast, content and preferences, technical level and perspectives of using the podcast in further years of medical studies. RESULTS Despite the non-compulsory nature of the podcast, the listenership reached the level of 45%. In the study, 1608 listeners had access to the survey and the overall response rate was 35.9%. On the basis of the analysis, the attitude and preferences of the listeners were demonstrated, including the preferred time of listening, length of the episodes, selection of topics, format of the broadcast, or the method of its delivery. Students also commented on the influence of the podcast on passing the final exam in anatomy and a concept of recording broadcasts in a foreign language. CONCLUSIONS The presented data allowed the recognition of the needs of medical students and contributed to the improvement of the ongoing project. The paper presents the technical data and guidelines for educators willing to include this medium in the students' anatomical curriculum. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Tymon Skadorwa
- Department of Descriptive and Clinical Anatomy, Center for Biostructure Research, Medical University of Warsaw, 5 Chałubińskiego St., Warsaw, Poland
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OUP accepted manuscript. Arch Clin Neuropsychol 2022; 37:1103-1117. [DOI: 10.1093/arclin/acac033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 04/18/2022] [Accepted: 05/03/2022] [Indexed: 11/13/2022] Open
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Georgakarakos E, Fiska A. Issues in Teaching Vascular Anatomy: Thoughts and Suggestions from the Clinician's Point of View. ANATOMICAL SCIENCES EDUCATION 2022; 15:210-216. [PMID: 33320424 DOI: 10.1002/ase.2040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 08/19/2020] [Accepted: 12/10/2020] [Indexed: 06/12/2023]
Abstract
The role of anatomy in modern curricula is under reform due to competency of other rapidly evolving subjects and the rapid evolution of several practical aspects and applications dictating modernization of teaching methods as well as of teaching demands. Moreover, modern practice of medicine has put the arterial and vascular system in the center of numerous minimally invasive techniques. Therefore, regardless of their specialty, most doctors should have a very clear and precise knowledge of the vascular anatomy and the basic access techniques from the early years. This viewpoint commentary reflects the experience of the two authors in applying the principles and content of surgical vascular anatomy in undergraduate anatomy teaching and discusses the rationale of this. Moreover, it is suggested that cadaveric dissections should be modified with emphasis on standard surgical vascular exposures and the multidisciplinary teaching of vascular anatomy as a means not only to gain optimal long-term knowledge retention, but also to emphasize through realistic examples on the practical clinical value of vascular anatomy.
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Affiliation(s)
- Efstratios Georgakarakos
- Department of Vascular Surgery, University Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece
| | - Aliki Fiska
- Department of Anatomy, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
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Abu-Rmaileh M, Osborn T, Gonzalez SR, Yuen JC. The Use of Live Streaming Technologies in Surgery: A Review of the Literature. Ann Plast Surg 2022; 88:122-127. [PMID: 34270473 DOI: 10.1097/sap.0000000000002909] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Live streaming surgery is a developing communication platform in medicine. To maximize the technological advances that allow for the live streaming of surgery, it is crucial to have an understanding of the various video-capturing devices that are available and their pros and cons of implementation. Possible barriers to the widespread use of live streaming surgery include cost, concerns about patient safety and privacy, and limited understanding of the current available resources. In this article, we present the results of our literature review of techniques for live streaming of surgery as a means to inform readers and promote their implementation. METHODS We conducted a literature review of the literature to identify previous articles indexed in PubMed and Ovid. We used the following search terms: [Surgery AND Streaming], which generated 32 articles for initial review. References were reviewed within each document to find similar articles that were not captured by the initial search. The article selection criteria were peer-reviewed publications, case reports, and case series describing the use of live surgical streaming technologies. RESULTS Literature review showed enhanced surgeon interaction with viewers and improved anatomy scores with the widespread use of live streaming. Surgeons reported positive feedback and wished to engage in more sessions in the future. The largest barriers to implementation of streaming technology are video quality through the Internet and patient information protection. CONCLUSIONS Live streaming of surgery for educational purposes has not been widely accepted in surgical training programs to date. Streaming accessibility has advanced over the past 2 decades with the availability of handheld mobile devices. However, little has been done to allow for live streaming of surgery to trainees in a manner compliant with the Health Portability Insurance and Accountability Act.
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Affiliation(s)
| | - Tamara Osborn
- Department of Surgery, University of Arkansas for Medical Sciences, Little Rock, AR
| | - Santiago R Gonzalez
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of California San Francisco, San Francisco, CA
| | - James C Yuen
- Division of Plastic Surgery, Department of Surgery, University of Arkansas for Medical Sciences, Little Rock, AR
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Eggeling M, Bientzle M, Korger S, Kimmerle J. The impact of patient narratives on medical students' perceptions of shared decision making: A randomized controlled trial. MEDICAL EDUCATION ONLINE 2021; 26:1886642. [PMID: 33588696 PMCID: PMC7894447 DOI: 10.1080/10872981.2021.1886642] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 01/12/2021] [Accepted: 02/02/2021] [Indexed: 06/12/2023]
Abstract
Successful shared decision making (SDM) in clinical practice requires that future clinicians learn to appreciate the value of patient participation as early as they can in their medical training. Narratives, such as patient testimonials, have been successfully used to support patients' decision-making process. Previous research suggests that narratives may also be used for increasing clinicians' empathy and responsiveness in medical consultations. However, so far, no studies have investigated the benefits of narratives for conveying the relevance of SDM to medical students. In this randomized controlled experiment, N = 167 medical students were put into a scenario where they prepared for medical consultation with a patient having Parkinson disease. After receiving general information, participants read either a narrative testimonial of a Parkinson patient or a fact-based information text. We measured their perceptions of SDM, their control preferences (i.e., their priorities as to who should make the decision), and the time they intended to spend for the consultation. Participants in the narrative patient testimonial condition referred more strongly to the patient as the one who should make decisions than participants who read the information text. Participants who read the patient narrative also considered SDM in situations with several equivalent treatment options to be more important than participants in the information text condition. There were no group differences regarding their control preferences. Participants who read the patient testimonial indicated that they would schedule more time for the consultation. These findings show that narratives can potentially be useful for imparting the relevance of SDM and patient-centered values to medical students. We discuss possible causes of this effect and implications for training and future research. Trial registration: The study was pre-registered on the pre-registration platform AsPredicted (aspredicted.org) before data collection began (registration number: #29,342). Date of registration: 17 October 2019.
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Affiliation(s)
- Marie Eggeling
- Knowledge Construction Lab, Leibniz-Institut Fuer Wissensmedien, Tuebingen, Germany
| | - Martina Bientzle
- Knowledge Construction Lab, Leibniz-Institut Fuer Wissensmedien, Tuebingen, Germany
| | - Simone Korger
- Knowledge Construction Lab, Leibniz-Institut Fuer Wissensmedien, Tuebingen, Germany
| | - Joachim Kimmerle
- Knowledge Construction Lab, Leibniz-Institut Fuer Wissensmedien, Tuebingen, Germany
- Department of Psychology, University of Tuebingen, Tuebingen, Germany
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Fives C, Lone M, Nolan YM. Motivation and learning methods of anatomy: Associations with mental well-being. Clin Anat 2021; 35:26-39. [PMID: 34482575 DOI: 10.1002/ca.23781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 08/31/2021] [Accepted: 08/31/2021] [Indexed: 11/10/2022]
Abstract
Appropriate anatomy education for speech and language therapists is a crucial part of preparation for clinical practice. While much research has been conducted regarding the anatomical education of medical students, there is a paucity of evidence for speech and language therapy students. This study assessed the methods employed by a cohort of first-year speech and language therapy students to learn anatomy, their perceptions of the clinical importance of anatomy and motivation to learn anatomy (using a modified version of the motivation strategies for learning questionnaire) and how this related to potential barriers to motivation such as mental well-being (using the Warwick-Edinburgh Mental Well-Being Scale [WEMWBS]). Analysis revealed that 92% of students agreed or strongly agreed that a sound knowledge of anatomy is important for clinical practice, 74% agreed or strongly agreed that listening at lectures was how they primarily learned anatomy, and 91% of students agreed or strongly agreed that they worried a great deal about tests. The latter statement was negatively correlated with a number of statements on the WEMWBS. Overall, the data revealed that first-year speech and language therapy students place importance on anatomy and its role in their future clinical practice, that they have different preferences for learning anatomy compared to medical students, and also have significant anxiety surrounding anatomy examinations. Multiple significant correlations between responses to the motivation and mental well-being questionnaires suggest that there is a significant relationship between first-year student motivation to learn anatomy and well-being.
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Affiliation(s)
- Cassie Fives
- Department of Anatomy and Neuroscience, School of Medicine, University College Cork, Cork, Ireland
| | - Mutahira Lone
- Department of Anatomy and Neuroscience, School of Medicine, University College Cork, Cork, Ireland
| | - Yvonne M Nolan
- Department of Anatomy and Neuroscience, School of Medicine, University College Cork, Cork, Ireland
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Grosser J, Bientzle M, Shiozawa T, Hirt B, Kimmerle J. Observing Interprofessional Collaboration: Impact on Attitude and Knowledge Acquisition. ANATOMICAL SCIENCES EDUCATION 2021; 14:452-459. [PMID: 32735751 DOI: 10.1002/ase.2007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 07/24/2020] [Accepted: 07/24/2020] [Indexed: 05/24/2023]
Abstract
Interprofessional collaboration (IPC) in the medical field is an important factor for good clinical outcomes and should be taught as early as in undergraduate medical education. Since implementing IPC training is an organizational challenge, students are often limited in their opportunities to experience real-life IPC. Therefore, an approach where students observe successful IPC activities of role models in an applied anatomical format was proposed. It was studied whether observing IPC activities in undergraduate anatomical education has an impact on both students' attitude toward IPC and on knowledge acquisition. Further, it was examined whether the attitudes and knowledge of students from different medical disciplines were influenced in different ways. Therefore, 75 medical students and thirty-eight physiotherapy students participated in a study with the task of observing a live broadcast of an interprofessional teaching session. Participants were asked about their attitudes toward interprofessional learning, their evaluation of professional responsibilities, and their profession-specific knowledge before and after observing the IPC session. The participants' attitude toward interprofessional learning improved for both groups of students. Moreover, students of physiotherapy adjusted their evaluation of their own and others' professional responsibilities after observing IPC. In both student groups, knowledge increased, in particular, with respect to the field of knowledge in other professions. So, observing IPC can modify students' attitudes and support knowledge acquisition. The implementation of IPC observations provides students from various healthcare disciplines with a clearer impression of professionals' responsibilities and gives learners the opportunity to acquire knowledge from healthcare fields unfamiliar to them.
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Affiliation(s)
- Johannes Grosser
- Knowledge Construction Laboratory, Knowledge Media Research Center (Leibniz-Institut fuer Wissensmedien), Tuebingen, Germany
| | - Martina Bientzle
- Knowledge Construction Laboratory, Knowledge Media Research Center (Leibniz-Institut fuer Wissensmedien), Tuebingen, Germany
| | - Thomas Shiozawa
- Department of Anatomy, Institute of Clinical Anatomy and Cell Analysis, Faculty of Medicine, Eberhard Karls University of Tuebingen, Tuebingen, Germany
| | - Bernhard Hirt
- Department of Anatomy, Institute of Clinical Anatomy and Cell Analysis, Faculty of Medicine, Eberhard Karls University of Tuebingen, Tuebingen, Germany
| | - Joachim Kimmerle
- Knowledge Construction Laboratory, Knowledge Media Research Center (Leibniz-Institut fuer Wissensmedien), Tuebingen, Germany
- Department of Psychology, Faculty of Science, Eberhard Karls University of Tuebingen, Tuebingen, Germany
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Implementation and evaluation of eight virtual surgical electives for medical students during the COVID-19 pandemic. Am J Surg 2021; 222:248-253. [PMID: 33558060 PMCID: PMC7857999 DOI: 10.1016/j.amjsurg.2021.01.032] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Revised: 11/29/2020] [Accepted: 01/23/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND Eight novel virtual surgery electives (VSEs) were developed and implemented in April-May 2020 for medical students forced to continue their education remotely due to COVID-19. METHODS Each VSE was 1-2 weeks long, contained specialty-specific course objectives, and included a variety of teaching modalities. Students completed a post-course survey to assess changes in their interest and understanding of the specialty. Quantitative methods were employed to analyze the results. RESULTS Eighty-three students participated in the electives and 67 (80.7%) completed the post-course survey. Forty-six (68.7%) respondents reported "increased" or "greatly increased" interest in the course specialty completed. Survey respondents' post-course understanding of each specialty increased by a statistically significant amount (p-value = <0.0001). CONCLUSION This initial effort demonstrated that VSEs can be an effective tool for increasing medical students' interest in and understanding of surgical specialties. They should be studied further with more rigorous methods in a larger population.
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Altenbernd TW. Relationship between Didactic Attendance and Average Ophthalmic Knowledge Assessment Program Performance. JOURNAL OF ACADEMIC OPHTHALMOLOGY 2020. [DOI: 10.1055/s-0040-1718567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
Abstract
Background The Accreditation Council for Graduate Medical Education's ophthalmology-specific program requirements indicate that a resident must participate in 360 hours of educational activities over the course of residency. The requirements allow a variety of options by which this educational process may occur. Furthermore, the current generation of learners has used a large array of learning tools in their careers: digital media, online resources, question banks, flipped classrooms, problem-based learning, and asynchronous lectures in addition to the traditional face-to-face didactic lectures.
Objectives This article determines if the traditional face-to-face didactic lectures play a significant role in the education of ophthalmology residents, attempts to quantitate this role, and estimates the relative importance of this method.
Methods Lecture hours beginning immediately after an Ophthalmic Knowledge Assessment Program (OKAP) examination and up to the subsequent exam was tabulated for 40 residents over 8 years. From 2012 through 2019 each of the residents took the OKAP exam one to three times. The average overall OKAP score for each resident was then regressed against his or her logged hours of didactics that year. This rate of average OKAP score to lecture hours was then evaluated for significant differences on the basis of postgraduate year (PGY). “STATA 13.1 IC,” was used for all statistical analysis.
Conclusion Traditional synchronous didactic lectures play a statistically significant role in the education of ophthalmology residents. For each 3.5 hours of lectures per year there is a 1% increase in the average OKAP score, p = 0.0064. However, the amount of variability explained by this single factor is low, R
2 = 0.067, and other factors are presumed to play a large part in learning. PGY subgroup analysis showed significant difference in the OKAP performance to lecture hour relationship, the number of lecture hours attended, and the OKAP performance.
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Affiliation(s)
- Todd W. Altenbernd
- Department of Ophthalmology, University of Arizona School of Medicine, Tucson, Arizona
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16
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Grosser J, Bientzle M, Kimmerle J. A Literature Review on the Foundations and Potentials of Digital Teaching Scenarios for Interprofessional Health Care Education. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E3410. [PMID: 32422876 PMCID: PMC7277820 DOI: 10.3390/ijerph17103410] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 05/08/2020] [Accepted: 05/13/2020] [Indexed: 01/05/2023]
Abstract
The health care system is increasingly complex and specialized, but it presents the actors involved with the challenge of working together in interprofessional teams. One way to meet this challenge is through interprofessional training approaches, where representatives of different professions learn together with learners of other professions. This article contributes to the question of how interprofessional teaching in health care education can be designed with a low threshold by using digital media. We focus on learning with digital learning platforms and learning with videos. Based on existing empirical findings, these approaches are discussed in terms of their potential and limitations for interprofessional teaching. In particular, we examine how these approaches influence the core competence domains of interprofessional collaborative practice. Digital collaborative learning platforms are suitable for teaching interprofessional competences, since they enable social and professional exchange among learners of different professions. Videos are suitable for imparting medical declarative and procedural knowledge. Based on these considerations, the use of videos in combination with interaction possibilities is presented as a didactic approach that can combine the aspect of knowledge transfer with the possibility of interprofessional computer-based collaboration.
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Affiliation(s)
- Johannes Grosser
- Knowledge Construction Lab, Leibniz-Institut fuer Wissensmedien, 72076 Tuebingen, Germany; (J.G.); (M.B.)
| | - Martina Bientzle
- Knowledge Construction Lab, Leibniz-Institut fuer Wissensmedien, 72076 Tuebingen, Germany; (J.G.); (M.B.)
| | - Joachim Kimmerle
- Knowledge Construction Lab, Leibniz-Institut fuer Wissensmedien, 72076 Tuebingen, Germany; (J.G.); (M.B.)
- Department for Psychology, Eberhard Karls University, 72076 Tuebingen, Germany
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Zhao J, Xu X, Jiang H, Ding Y. The effectiveness of virtual reality-based technology on anatomy teaching: a meta-analysis of randomized controlled studies. BMC MEDICAL EDUCATION 2020; 20:127. [PMID: 32334594 PMCID: PMC7183109 DOI: 10.1186/s12909-020-1994-z] [Citation(s) in RCA: 105] [Impact Index Per Article: 26.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 03/04/2020] [Indexed: 05/20/2023]
Abstract
BACKGROUND Virtual reality (VR) is an innovation that permits the individual to discover and operate within three-dimensional (3D) environment to gain practical understanding. This research aimed to examine the general efficiency of VR for teaching medical anatomy. METHODS We executed a meta-analysis of randomized controlled studies of the performance of VR anatomy education. We browsed five databases from the year 1990 to 2019. Ultimately, 15 randomized controlled trials with a teaching outcome measure analysis were included. Two authors separately chose studies, extracted information, and examined the risk of bias. The primary outcomes were examination scores of the students. Secondary outcomes were the degrees of satisfaction of the students. Random-effects models were used for the pooled evaluations of scores and satisfaction degrees. Standardized mean difference (SMD) was applied to assess the systematic results. The heterogeneity was determined by I2 statistics, and then was investigated by meta-regression and subgroup analyses. RESULTS In this review, we screened and included fifteen randomized controlled researches (816 students). The pooled analysis of primary outcomes showed that VR improves test scores moderately compared with other approaches (standardized mean difference [SMD] = 0.53; 95% Confidence Interval [CI] 0.09-0.97, p < 0.05; I2 = 87.8%). The high homogeneity indicated that the studies were different from each other. Therefore, we carried out meta-regression as well as subgroup analyses using seven variables (year, country, learners, course, intervention, comparator, and duration). We found that VR improves post-intervention test score of anatomy compared with other types of teaching methods. CONCLUSIONS The finding confirms that VR may act as an efficient way to improve the learners' level of anatomy knowledge. Future research should assess other factors like degree of satisfaction, cost-effectiveness, and adverse reactions when evaluating the teaching effectiveness of VR in anatomy.
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Affiliation(s)
| | - Xinliang Xu
- Department of Traumatic Surgery, Jining No.1 Peoples Hospital, Jining, China
| | - Hualin Jiang
- Health Science Center, Xi'an Jiaotong University, Xian, China.
| | - Yi Ding
- Department of Pharmacy, Xijing Hospital, Fourth Military Medical University, Xian, China.
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Kulisch C, Langheinrich J, Heuckendorf E, Vida I, Brunk I. Challenges and implementation of the German maternity protection act for female medical students in macroscopic anatomical education. GMS JOURNAL FOR MEDICAL EDUCATION 2020; 37:Doc17. [PMID: 32328519 PMCID: PMC7171363 DOI: 10.3205/zma001310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Figures] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Revised: 11/27/2019] [Accepted: 01/07/2020] [Indexed: 06/11/2023]
Abstract
Background: Recent decades have seen controversial discussions on the validity of dissection courses in medical education, with alternative programs tested for various reasons. On April 1, 2015 the classification of formaldehyde as a hazardous substance was upgraded by the EU, leding to some universities precluding the participation of pregnant and breastfeeding students in dissection course. However, the revision to the Maternity Protection Act, implemented in Germany on January 1, 2018, now protects student mothers from being disadvantaged in their studies as a consequence of their pregnancy or breastfeeding. Therefore, universities must offer alternatives to dissection courses using formaldehyde to these female students. Project description: As an alternative to regular dissection courses, which use the abovementioned chemical, the Centre for Anatomy at Charité has opted for developing dedicated courses for student mothers. These new courses use plastinated prosection material instead of formalin-treated cadavers of body donors. As the core of the anatomical education takes place during the third and fourth semester in the current curriculum of human medicine at Charité the alternative courses are limited to those two semesters. Additionally, alternative exams at the end of both semesters had to be developed. The alternative courses were designed to offer pregnant and breastfeeding students a study program as close as possible to the one in which their peers learn human anatomy. Results: For the new courses, plastinates had to be produced and further specimens are still needed. Additionally required sets of bones, models and radiological images were readily available at the Centre for Anatomy. The planning and conceptualization of the courses took half a year of intense preparation. The courses for the third and fourth semester were first running during summer semester 2017. There is a clear demand for courses among pregnant and breastfeeding students. At least 5 student participants per course were registered, corresponding to every fortieth female student in their semester cohorts. The highest number of student participants was 13 in one course so far. The performances of the participants in the anatomical examinations were matching that of students attending the regular courses. Discussion: The alternative macroscopic anatomy courses enable the implementation of the revised Maternity Protection Act. The targeted student group is highly satisfied with the offered alternative courses. Considering the number of participants and their examination performance so far, the Centre for Anatomy regards the efforts involved in planning and implementing the courses as justified. The courses allow pregnant and breastfeeding students to address the same anatomical themes at the same time as their fellow students. However, due to restricted flexibility of plastinates and because students cannot prepare specific anatomical structures independently the scope of topographic learning is limited. That being said, well-produced plastinates can display anatomical structures which often cannot be dissected in regular courses. The alternative macroscopic anatomy courses using plastinates constitute suitable alternatives to the regular dissection courses with formalin-treated cadavers for pregnant and breastfeeding students.
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Affiliation(s)
- Christoph Kulisch
- Charité - Universitätsmedizin Berlin, Institut für Integrative Neuroanatomie, Berlin, Germany
| | - Jana Langheinrich
- Charité - Universitätsmedizin Berlin, Institut für Funktionelle Anatomie, Berlin, Germany
| | - Evelyn Heuckendorf
- Charité - Universitätsmedizin Berlin, Institut für Integrative Neuroanatomie, Berlin, Germany
| | - Imre Vida
- Charité - Universitätsmedizin Berlin, Institut für Integrative Neuroanatomie, Berlin, Germany
| | - Irene Brunk
- Charité - Universitätsmedizin Berlin, Institut für Integrative Neuroanatomie, Berlin, Germany
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19
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Grosser J, Bientzle M, Shiozawa T, Hirt B, Kimmerle J. Acquiring Clinical Knowledge from an Online Video Platform: A Randomized Controlled Experiment on the Relevance of Integrating Anatomical Information and Clinical Practice. ANATOMICAL SCIENCES EDUCATION 2019; 12:478-484. [PMID: 30347523 DOI: 10.1002/ase.1841] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Revised: 10/10/2018] [Accepted: 10/13/2018] [Indexed: 06/08/2023]
Abstract
Basic subjects in medical education, such as anatomy, are often taught through teaching formats that do not always sufficiently demonstrate the relevance of this basic information for clinical practice. Accordingly, it is a recent trend in anatomy education to link anatomical information more explicitly to clinical practice. This article presents an online video platform (Tuebingen's Sectio Chirurgica [TSC]) as one means of explicitly integrating preclinical anatomical knowledge and clinical application. The purpose of the study presented here was to examine the effects of videos through which medical students were educated about Anterior Cruciate Ligament reconstruction. A TSC video about this surgical procedure was compared to a video with a traditional lecture providing the identical information. Participants (n = 114) perceived the TSC video to be superior in comprehensibility of the presentation (P = 0.003) and conceivability of the surgical procedure (P = 0.027), and to be more entertaining (P < 0.001). Moreover, participants in the TSC condition acquired more clinical knowledge than in the lecture condition (P = 0.043) but did not differ in their acquisition of anatomical knowledge. Mediation analyses indicated that the effect on the acquisition of clinical knowledge was mediated by comprehensibility, conceivability, and entertainment. These findings are discussed regarding their implications for medical education in terms of contributing to the general trend of linking preclinical anatomical knowledge to clinical application. A discussion about the limitations of the study and suggestions for future research are also provided.
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Affiliation(s)
- Johannes Grosser
- Knowledge Construction Laboratory, Knowledge Media Research Center (Leibniz-Institut fuer Wissensmedien), Tuebingen, Germany
| | - Martina Bientzle
- Knowledge Construction Laboratory, Knowledge Media Research Center (Leibniz-Institut fuer Wissensmedien), Tuebingen, Germany
| | - Thomas Shiozawa
- Department of Anatomy, Institute of Clinical Anatomy and Cell Analysis, Faculty of Medicine, Eberhard Karls University of Tuebingen, Tuebingen, Germany
| | - Bernhard Hirt
- Department of Anatomy, Institute of Clinical Anatomy and Cell Analysis, Faculty of Medicine, Eberhard Karls University of Tuebingen, Tuebingen, Germany
| | - Joachim Kimmerle
- Knowledge Construction Laboratory, Knowledge Media Research Center (Leibniz-Institut fuer Wissensmedien), Tuebingen, Germany
- Department of Psychology, Faculty of Science, Eberhard Karls University of Tuebingen, Tuebingen, Germany
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20
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Bordage G, Page G. The key-features approach to assess clinical decisions: validity evidence to date. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2018; 23:1005-1036. [PMID: 29777464 DOI: 10.1007/s10459-018-9830-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/04/2017] [Accepted: 05/07/2018] [Indexed: 06/08/2023]
Abstract
The key-features (KFs) approach to assessment was initially proposed during the First Cambridge Conference on Medical Education in 1984 as a more efficient and effective means of assessing clinical decision-making skills. Over three decades later, we conducted a comprehensive, systematic review of the validity evidence gathered since then. The evidence was compiled according to the Standards for Educational and Psychological Testing's five sources of validity evidence, namely, Content, Response process, Internal structure, Relations to other variables, and Consequences, to which we added two other types related to Cost-feasibility and Acceptability. Of the 457 publications that referred to the KFs approach between 1984 and October 2017, 164 are cited here; the remaining 293 were either redundant or the authors simply mentioned the KFs concept in relation to their work. While one set of articles reported meeting the validity standards, another set examined KFs test development choices and score interpretation. The accumulated validity evidence for the KFs approach since its inception supports the decision-making construct measured and its use to assess clinical decision-making skills at all levels of training and practice and with various types of exam formats. Recognizing that gathering validity evidence is an ongoing process, areas with limited evidence, such as item factor analyses or consequences of testing, are identified as well as new topics needing further clarification, such as the use of the KFs approach for formative assessment and its place within a program of assessment.
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Affiliation(s)
- G Bordage
- Department of Medical Education, College of Medicine, University of Illinois at Chicago, Chicago, USA.
| | - G Page
- Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, Canada
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Triepels CPR, Koppes DM, Van Kuijk SMJ, Popeijus HE, Lamers WH, van Gorp T, Futterer JJ, Kruitwagen RFPM, Notten KJB. Medical students' perspective on training in anatomy. Ann Anat 2018; 217:60-65. [PMID: 29501634 DOI: 10.1016/j.aanat.2018.01.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Revised: 01/02/2018] [Accepted: 01/23/2018] [Indexed: 11/17/2022]
Abstract
Gaining sufficient knowledge of anatomy is an important part of medical education. Factors that influence how well students learn anatomical structures include available sources, learning time and study assistance. This study explores the attitude of medical students with regard to studying anatomy and evaluates possibilities for improvement of training in anatomy. Twenty medical students participated in a focus group meeting. Based on this focus group, an online survey consisting of 27 questions was developed and distributed amongst medical students of Maastricht University, the Netherlands. A total of 495 medical students (both Bachelor and Master level) participated in this survey. Master students found studying anatomy less attractive than Bachelor students (36.8% of the Master students vs. 47.9% of the Bachelor students (p=.024)). Although most students responded that they thought it is important to study anatomy, 48% of all students studied anatomy less than 10h per study block of 8 weeks. Only 47.9% of the students rated their knowledge of anatomy as adequate. Students suggested that three-dimensional techniques would help improve their knowledge of anatomy. Therefore investing in three-dimensional tools could prove beneficial in the future.
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Affiliation(s)
- C P R Triepels
- Department of Obstetrics and Gynaecology, Maastricht University Medical Centre(+), The Netherlands.
| | - D M Koppes
- Department of Obstetrics and Gynaecology, Maastricht University Medical Centre(+), The Netherlands
| | - S M J Van Kuijk
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre(+), Maastricht, The Netherlands
| | - H E Popeijus
- Department of Human Biology, Maastricht University, The Netherlands
| | - W H Lamers
- Department of Anatomy and Embryology, Maastricht University, The Netherlands
| | - T van Gorp
- Department of Obstetrics and Gynaecology, Maastricht University Medical Centre(+), The Netherlands; GROW - School for Oncology and Developmental Biology, Maastricht University Medical Centre(+), Maastricht, The Netherlands
| | - J J Futterer
- Department of Radiology and Nuclear Medicine, Radboud UMC, Nijmegen, The Netherlands
| | - R F P M Kruitwagen
- Department of Obstetrics and Gynaecology, Maastricht University Medical Centre(+), The Netherlands; GROW - School for Oncology and Developmental Biology, Maastricht University Medical Centre(+), Maastricht, The Netherlands
| | - K J B Notten
- Department of Obstetrics and Gynaecology, Maastricht University Medical Centre(+), The Netherlands; GROW - School for Oncology and Developmental Biology, Maastricht University Medical Centre(+), Maastricht, The Netherlands
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22
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Ko LN, Rana J, Burgin S. Teaching & Learning Tips 5: Making lectures more “active”. Int J Dermatol 2017; 57:351-354. [DOI: 10.1111/ijd.13701] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Revised: 06/05/2017] [Accepted: 06/14/2017] [Indexed: 12/01/2022]
Affiliation(s)
| | | | - Susan Burgin
- Harvard Medical School; Boston MA USA
- Department of Dermatology; Beth Israel Deaconess Medical Center; Boston MA USA
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