A preliminary survey of professionalism teaching practices in anatomy education among Indian Medical Colleges

A modified Delphi approach to nurturing professionalism in postgraduate medical education in Singapore

INTRODUCTION

Nurturing professional identities instils behavioural standards of physicians, and this in turn facilitates consistent professional attitudes, practice and patient care. Identities are socioculturally constructed efforts; therefore, we must account for the social, cultural and local healthcare factors that shape physicians' roles, responsibilities and expectations. This study aimed to forward a programme to nurture professionalism among physicians in Singapore.

METHODS

A three-phase, evidenced-based approach was used. First, a systematic scoping review (SSR) was conducted to identify professionalism elements. Second, a questionnaire was created based on the findings of the SSR. Third, a modified Delphi approach, which involved local experts to identify socioculturally appropriate elements to nurture professionalism, was used.

RESULTS

A total of 124 articles were identified from the SSR; these articles revealed definitions, knowledge, skills and approaches to nurturing professionalism. Through the modified Delphi approach, we identified professional traits, virtues, communication, ethical, self-care, teaching and assessment methods, and support mechanisms.

CONCLUSION

The results of this study formed the basis for a holistic and longitudinal programme focused on instilling professional traits and competencies over time through personalised and holistic support of physicians. The findings will be of interest to medical communities in the region and beyond.

The Attitude of Medical Students Toward Voluntary Body Donation: A Single Institute Survey and Narrative Review of Global Trends

INTRODUCTION

Voluntary body donation (VBD) programs form the backbone of cadaveric teaching and learning in medical schools. It benefits the medical fraternity the most. Yet, there is a dearth of VBD practice among medical students. We aimed to understand the knowledge and attitude of first-year medical students in a tertiary institute with a systematic review of willingness toward VBD among undergraduate students worldwide.

METHODS

 The first-year medical undergraduates were given a 12-item questionnaire to assess their knowledge and attitude toward VBD. Statistical tests were applied to analyze the difference between the variables. We systematically searched Google Scholar, PubMed, and SCOPUS databases until October 15, 2022. Data concerning knowledge, awareness, and attitude toward VBD among undergraduates of medical backgrounds were extracted and analyzed qualitatively.

RESULTS

A total of 82.5% of students returned the completed responses. A significant association was seen between their attitudes toward whole body donation by strangers (p=0.043) and family members (p=0.035). The religion of the participants significantly affected their opinions on VBD and their willingness to pledge themselves (p=0.034). For the review, 20 studies were selected to be analyzed qualitatively. These studies included 4232 undergraduate students globally who were assessed for knowledge, awareness, and attitude toward VBD. Around 50% of the studies were published in India. The first study included was published in 2008. Seven studies were exclusively conducted on medical undergraduates, while the rest consisted of a mixed cohort. The attitude and knowledge of medical undergraduates on VBD were assessed via questionnaires containing both open-ended and closed-ended questions.

CONCLUSION

Based on observations from our survey and review, we concluded that while undergraduate students have a highly positive attitude toward VBD, their rate of pledging is low. The most prominent barrier to this attitude is their experience with cadavers in the dissection hall. Hence, we recommend a revisit of cadaver handling practices and the establishment of appropriate protocols for safe and deferential cadaver handling.

Latin American Anatomists' views on human body dissection and donation

BACKGROUND

Studies abound regarding the medical students' views on the importance of anatomy and the dissection of human bodies, but little is known about the views of Latin American Anatomists.

METHODS

A survey was carried out to test several hypotheses among anatomists of the Americas about how they perceive their professional identity, the use and role of dissection in their undergraduate courses, and the approval degree of bequeathing their body for anatomical teaching/research; another goal was ascertaining to what extent their attitude on these topics depended on gender, length of teaching experience and belief in the afterlife.

RESULTS

One hundred and forty-five anatomists from thirteen Latin American and Caribbean Countries took the survey; 79% stated the main role of an anatomist is teaching; 34% recorded their undergraduate students dissected human cadavers as part of their anatomy lab course-undergraduates dissecting less in the less experienced anatomists' courses (p = 0.0002). Most anatomists said dissection was a training tool for undergraduate students, a tool for developing professional skills, and a tool to help control emotions-most experienced anatomists stood out from the rest saying dissection is only to teach anatomy (p < 0.001), even if such response was the least valued by them among all replies. Men differed from women in valuing dissection as a tool to help control emotions (p = 0.006); less experienced anatomists held the opposite (p < 0.0001). Approval of a close doctor-patient relationship diverged, being different between the most and the least experienced anatomists (p = 0.01). Anatomists said they would donate only their organs (44%), whole body (9%) and both organs and body (46%). Undecided anatomists about the belief in life after death were the least in favor of donation (p = 0.05).

Teaching Cellular Architecture: The Global Status of Histology Education

Histology or microanatomy is the science of the structure and function of tissues and organs in metazoic organisms at the cellular level. By definition, histology is dependent on a variety of microscope techniques, usually light or more recently virtual, as well as electron microscopy. Since its inception more than two centuries ago, histology has been an integral component of biomedical education, specifically for medical, dental, and veterinary students. Traditionally, histology has been taught in two sequential phases, first a didactic transfer of information to learners and secondly a laboratory segment in which students develop the skill of analyzing micrographic images. In this chapter, the authors provide an overview of how histology is currently taught in different global regions. This overview also outlines which educational strategies and technologies are used, and how the local and cultural environment influences the histology education of medical and other students in different countries and continents. Also discussed are current trends that change the teaching of this basic science subject.

The Anatomy Course During COVID-19: The Impact of Cadaver-Based Learning on the Initiation of Reflection on Death

BACKGROUND

During the COVID-19 pandemic, in-person cadaveric dissection laboratories for teaching anatomy were omitted by many schools around the world. While knowledge domains can be easily evaluated via remote exams, non-traditional discipline-independent skills such as those encouraged through reflection on the topic of death are often overlooked. This study investigated how different anatomy course formats played a role in initiating students' reflections on death during the COVID-19 pandemic.

METHOD

In fall 2020, 217 medical, dental, premedical, and health sciences students from 13 international universities discussed differences in their anatomy courses online. Formats of anatomy courses ranged from dissection-based, prosection-based, hybrid (combination of dissection and prosection) to no laboratory exposure at all. Students' responses to the question, "Did/does your anatomy course initiate your thinking about life's passing?" were collected, and they self-reported themes that were present in their reflections on death using a multiple-choice prompt. Statistical analyses to detect differences between students with and without exposure to cadavers were performed using the chi-squared test.

RESULTS

When comparing students who had exposure to human anatomical specimens to those who had no exposure, the majority of students with exposure thought that the course did initiate thoughts about life's passing, compared to students without exposure (P < 0.05). Reflection themes were consistent across groups.

DISCUSSION

These findings indicate that anatomy dissection courses are important for the initiation of students' feelings about the topic of death. Omission of cadaveric dissection- or prosection-based laboratories will decrease the likelihood that students initiate reflection on this topic and gain important transferable skills.

Teaching professionalism in cadaver dissection: medical students' perspective

This study was designed to facilitate freshman medical students’ adaptation to the dissection room and familiarize them with the related ethical codes. Single-group post-test design research was conducted at Tehran University of Medical Sciences in 2018 - 2019. The program began with a brief explanation of the necessity of the subject, and after a documentary film was shown, the principles of professional and ethical behaviors in the dissection room were discussed by a panel of experts. In the end, a valid and reliable evaluation questionnaire (Cronbach's alpha coefficient = 0.89) was distributed among the students. A total of 129 questionnaires were completed and returned. Overall, 94.4% of the students believed that the program provided an excellent opportunity to reflect on professional behaviors during practical anatomy sessions. In addition, 92.8% of the students believed that they would use the ethical points mentioned in the program in the future. Content analysis of the open questions produced three main categories: "motivating learning", "application of theory in practice" and "changing the attitude toward responsibility". The results indicate that adequate preparation for cadaver dissection sessions and learning about professional behavior codes in the first exposure can help medical students to better understand the principles of professional behaviors.

Perceptions, satisfactions, and performance of undergraduate students during Covid-19 emergency remote teaching

Due to the Covid-19 pandemic, the education system worldwide faced sudden and unforeseen challenges. Many academic institutions closed their doors, forcing both educators and students to transition to Emergency Remote Teaching (ERT) for the remainder of the semester. This transition eliminated hands-on experiences, increased workload, and altered curricula. However, these aspects, as well as students' perceptions, study habits, and performance in response to ERT remain poorly documented. This contribution describes changes in the curriculum of an undergraduate cadaver-based laboratory, and explores students' performance, self-perceived learning, and overall satisfaction during this educational crisis. Online content delivery for this course included both asynchronous instruction and synchronous discussion sessions. While formative assessments remained the same, online spotter examinations included short answer, multiple choice, multiple answer, ordering, and true and false questions. Despite examination grades improving 20% during ERT, students reported lower levels of learning, confidence, and engagement with the course materials when compared to the face-to-face portion of the class. The most prevalent challenges identified by students were those related to the loss of access to cadaver-based learning, including difficulty identifying and visualizing structures in three dimensions, and the loss of context and sensorial cues. Flexibility in taking examinations and learning the material at their own pace were recognized as positive outcomes of the ERT transition. While the resulting student perceptions and performances are unsurprising, they offer insight into the challenges of fostering a productive learning environment in a future threatened by epidemic outbreak and economic uncertainty.

Teaching Professionalism to Medical Students Using Dissection-Based Anatomy Education: a Practical Guide

Professionalism is a core competency for all healthcare professionals and is a subject of great interest within the academic community due to its vital importance in delivering the highest quality patient care. Despite this, professionalism remains difficult to define, teach and assess. The potential use of anatomy education in teaching professionalism has been increasingly highlighted within the literature, but still remains an underutilised tool in medical education. Therefore, this practical guide offers evidence-based practical points for successfully incorporating professionalism within a dissection-based anatomy course delivered to undergraduate medical students.

The "difficult" cadaver: weight bias in the gross anatomy lab

Background: The prevalence of overweight and obesity continues to rise and is associated with increased morbidity and mortality. Weight bias is common among physicians and medical students and limits the therapeutic alliance between providers and patients with overweight and obesity.Objective: The authors sought to explore the relationship between the gross anatomy course and medical student attitudes towards weight and obesity.Design: The authors employed a mixed-methods approach consisting of semi-structured interviews and anonymous web-based surveys of first-year medical students taking gross anatomy at one USA medical school. They analyzed transcripts of interviews and free-text survey responses using a grounded theory approach and performed tests of association to investigate the relationship between demographic information, responses to multiple-choice survey questions and weight bias.Results: A total of 319 (52%) first-year medical students (2015-2018) completed the survey and 33 participated in interviews. Of survey respondents, 71 (22%) responded that the course had changed how they felt about people with overweight/obesity. These respondents were also more likely to affirm that the course had affected their views toward their own bodies (p < 0.001). Qualitative data analysis identified three overarching themes within students' descriptions of the effects of the gross anatomy lab on attitudes toward bodies perceived to have excess weight: these bodies were described as 1) difficult, 2) unhealthy, and 3) evoking disgust. Students extrapolated from their experiences with cadavers to imagined interactions with future patients, relying heavily on the narrative of the difficult patient.Conclusions: At one USA medical school, students perceived their experiences in gross anatomy as shaping their attitudes toward individuals with overweight or obesity. Efforts to reduce medical student weight bias ought to target this previously unexplored potential site of weight bias.

Currículo oculto, educação médica e profissionalismo: uma revisão integrativa

O currículo oculto resulta das relações interpessoais vividas academicamente, extrapolando o currículo formal, podendo ser um facilitador e também um empecilho ao aprendizado. Essa revisão objetiva compreender a abordagem da temática na educação médica e sua relação com o profissionalismo. A revisão integrativa nos permitiu observar uma sobrecarga cognitiva e emocional do(a)s estudantes causada pelo currículo oculto. Todavia, constatamos como a educação médica tem trabalhado com a finalidade de reduzir esses prejuízos. Nesse sentido, é importante problematizar os modelos hegemônicos que influenciam valores, interesses, discursos, saberes e práticas ao longo da formação. Para isso, é fundamental o debate em torno de conceitos/ações como identidade, diversidade, inclusão, hegemonia, ideologia, poder e cultura, que pode ocorrer de forma longitudinal e integrada em unidades curriculares relacionadas às humanidades.

Profile and Motivations of Registered Whole-Body Donors in Turkey: Istanbul University Experience

Little is known regarding the profiles of whole body donors in Muslim majority countries where donation is scarce. Therefore, this study aims to profile registered donors in Turkey by means of a survey. The explored data could be used to improve ongoing campaign efforts and ethical practices such as commemoration services. Registered donors of the donation programs at the two faculties of medicine of Istanbul University were compared with the national population and a cluster analysis was performed to reveal any concealed sub-groups. Data from 188 respondents were analyzed. The majority of registered donors were married (42%), male (65.4%), aged over 50 years (76%), held a tertiary education degree (49.7%), and were irreligious (58.5%). Cluster analysis revealed two groups with significantly different educational levels, marital statuses, and religious choices. Regarding whether their bodies could be used for education or research, the majority (64.5%) of the respondents left the decision to the anatomy department. Similarly, 73.8% approved indefinite use of their organs, body parts and/or skeletons. The respondents were also willing to share their medical history (94.2%) and personal information (81.6%) if needed. Motivational themes for body donation including usefulness, impermanence, religion, awareness, and kinship were devised after a thematic analysis. Among the respondents, 56.5% were registered organ donors and 63.3% were frequent blood donors. The results of this study provide data that may help revising informed consent forms, developing and implementing thanksgiving ceremonies, and selecting additional targets for supporting body donation campaign activities such as organ and blood donation units.

How does Donor Dissection Influence Medical Students' Perceptions of Ethics? A Cross-Sectional and Longitudinal Qualitative Study

The contribution of donor dissection to modern anatomy pedagogy remains debated. While short-term anatomy knowledge gains from dissection are questionable, studies suggest that donor dissection may have other impacts on students including influencing medical students' professional development, though evidence for such is limited. To improve the understanding of how anatomy education influences medical student professional development, the cross-sectional and longitudinal impacts of donor dissection on medical students' perceptions of ethics were explored. A cross-sectional and longitudinal qualitative study was undertaken at an Australian university where student responses to online discussion forums and in-person interviews were analyzed. Data were collected across the 1.5 years that undergraduate medical students received anatomy instruction (three semesters during first and second years). A total of 207 students participated in the online discussion forums, yielding 51,024 words; 24 students participated in at least 1 of 11 interviews, yielding over 11 hours of interview data. Framework analysis identified five themes related to ethics in an anatomical education context: (1) Dignity, (2) Beneficence, (3) Consent, (4) Justification for versus the necessity of dissection, and (5) Dichotomy of objectification and personification. The dominant themes of students' ethical perceptions changed with time, with a shift from focusing on donors as people, toward the utility of donors in anatomy education. Additionally, themes varied by student demographics including gender, ancestry, and religiosity. Together this study suggests a strong impact of donor dissection on priming students' focus on medical ethics and provides further advocacy for formal and purposeful integration of medical ethics with anatomy education.

Unethical behavior and professionalism among medical students in a private medical university in Malaysia

BACKGROUND

Ethical behavior and professionalism is an ideal characteristic required of medical students and included as 'must achieve' and critical aspect of medical students' curriculum. This study proposes to determine the perceived unethical and unprofessional behavior among medical students in a private medical university from year 1 to year 5 of the medical curriculum.

METHODS

A cross-sectional study was conducted among year 1 to year 5 medical students in a private medical university. A self-administered questionnaire was used with the 3 major domains of professionalism and ethics i.e. discipline plagiarism and cheating.

RESULTS

A total of 464 respondents responded to the survey and they included medical students from year 1 and year 2 (pre-clinical) and years 3-5 (clinical years). Majority of the students, 275 (59.2%) answered that they had not seen any form of unethical behavior among other students. The females seem to have a larger number 172(63%) among the same gender compared to the males. Majority 352 (75%) of them had not heard of the 'Code of Professional Conduct by the Malaysian Medical Council'. About fifty three (53.1%) of the students answered that the training was sufficient.

CONCLUSIONS

This study showed that the perception of unethical behavior was 58.8% in the 1st year (pre-clinical) and it increased to 65.2% in the 5th year (clinical). The 3 main discipline issues were students do not show interest in class (mean 2.9/4), they are rude to other students (mean 2.8/4) and talking during class (mean 2.6/4). Despite the existence of unethical behavior among the students majority of them (71.7%) claimed that they had adequate training in ethics and professionalism. It is proposed that not only the teaching of ethics and professionalism be reviewed but an assessment strategy be introduced to strengthen the importance of professionalism and ethics.

Fostering Students' Collaborative Learning Competencies and Professional Conduct in the Context of Two Gross Anatomy Courses in Veterinary Medicine

Collaborative learning has been used in anatomy courses to support students' learning of challenging topics but the success of group work depends significantly on the students' ability to communicate in a professional manner. Veterinary students' experiences with tasks related to collaborative learning and professional conduct were studied by comparing learning collaborative competences and pedagogy, as well as perceived positive and challenging aspects, in two gross anatomy courses. Both qualitative and quantitative data were collected from students' experiences of course assignments and collaboration, as well as from self-evaluated collaboration competence development. Trying things out oneself, practical application and professional conduct were positively highlighted particularly in the first-year course (myology and arthrology) group work and learning from others more in the second year (topographical anatomy). Various group work challenges, often relating to practical matters or communication, were the key concerns for students. The main difference between the two courses in learning of collaborative knowledge work competencies appeared to relate to the nature of the group work assignment. The topography course included the element of collaboration in preparing a presentation and teaching session for the rest of the class. Interestingly, students on the myology and arthrology course gave more positive comments on professional conduct than the students on the topography course despite the fact that the latter course included more practical elements relating to their future profession.

Building Professionalism in Human Dissection Room as a Component of Hidden Curriculum Delivery: A Systematic Review of Good Practices

The core values in medical practice which are essential for the humane outlook of a physician are clubbed within the domain of medical professionalism. Professionalism along with other discipline-independent skills (human skills) is propagated implicitly in medical schools as components of a "hidden curriculum." Evidence suggests a strong association between "hidden curriculum" delivery and development of professionalism in the human dissection room. In this review article, the authors have tried to highlight a few exclusive practices adopted by medical schools which enhance the implementation of the "hidden curriculum" within the practice of human dissection and successfully inculcate the key components of professionalism such as integrity, respect, and compassion among students. These distinctive concepts are aimed at humanizing the experience of anatomical dissection by revealing the identity of the donors along with their personal details either through display of video clips of donor interviews, interactions with the family members of the donor over a meal or recognition of the donor as a mentor and organizing memorial services in honor of donors after conclusion of the dissection in the presence of their family members. The resounding success of these good practices in building professionalism among medical students from the onset of the academic curriculum has signaled a new chapter in anatomical sciences education. It has become imperative to recognize the visionary efforts of a select few medical educators and begin incorporating these recent trends into the delivery of the "hidden curriculum" within the evolving gross anatomy education model.

Can CanMEDS competencies be developed in medical school anatomy laboratories? A literature review

OBJECTIVES

The purpose of this literature review was to identify potential ways in which undergraduate medical anatomy education may be relevant to the CanMEDS Roles, a competency-based framework used throughout Canadian medical training.

METHODS

A scoping review of medical education literature was conducted in March 2017 for English language publications that included key words related to anatomy education and to key competencies formally described for each of the Roles in the CanMEDS 2015 framework. Indicated benefits were then collated, characterized, and synthesized for each CanMEDS Role.

RESULTS

There were 71 studies identified describing original findings. Perceived benefits of anatomy education were most often identified for competencies related to the Medical Expert Role. Multiple studies also cited benefits related to the Scholar, Professional and Collaborator Roles. There was a lack of literature related to the Health Advocate, Communicator, and Leader Roles. The majority of benefits defined in the literature were limited to student perceptions rather than objectively measured outcomes.

CONCLUSIONS

There is some evidence to suggest that anatomy education can facilitate the development of core competencies related to several CanMEDS Roles, outside of simply developing medical knowledge in the Medical Expert Role. Future studies need to develop methods to objectively assess outcomes related to these competencies.