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

Battle of the sections: Student outcomes and course feedback support combined prosection and dissection laboratory formats to maximize student success

Gross anatomy laboratories frequently utilize dissection or prosection formats within medical curricula. Practical examination scores are consistent across the formats, yet these examinations assessed larger anatomical structures. In contrast, a single report noted improved scores when prosection was used in the hand and foot regions, areas that are more difficult to dissect. The incorporation of prosected donors within "Head and Neck" laboratories provided an opportunity to further characterize the impact of prosection in a structurally complex area. Retrospective analysis of 21 Head and Neck practical examination questions was completed to compare scores among cohorts that utilized dissection exclusively or incorporated prosection. Mean scores of practical examination questions were significantly higher in the prosection cohort (84.27% ± 12.69) as compared with the dissection cohort (75.59% ± 12.27) (p < 0.001). Of the 12 questions that performed better in the prosection cohort (88.42% ± 8.21), 10 items mapped to deeper anatomical regions. By comparison, eight of nine questions in the dissection cohort outperformed (88.44% ± 3.34) the prosection cohort (71.74% ± 18.11), and mapped to anatomically superficial regions. Despite the mean score increase with positional location of the questions, this effect was not statically significant across cohorts (p = 1.000), suggesting that structure accessibility in anatomically complex regions impacts performance. Student feedback cited structure preservation (71.5%) and time savings (55.8%) as advantages to prosection; however, dissection was the perceived superior and preferred laboratory format (88.6%). These data support combined prosection and dissection formats for improving student recognition of deeply positioned structures and maximizing student success.

Comparison of the study performance of dental students in different subfields of neuroanatomy at the Charité - Universitätsmedizin Berlin and evaluation of the neuroanatomy course in the fourth preclinical semester

INTRODUCTION

The dentist's main working area is the head and neck region, which is innervated by the cranial nerves. On a daily basis, dentists must administer local anaesthesia to ensure pain-free treatment and differentiate between dental pain and neuropathies to avoid mistreatment. Therefore, neuroanatomical training, especially on the cranial nerves, is of immense importance for clinical practice. In order to adopt the curriculum, it is essential to constantly evaluate the quality of the training and to investigate whether there is a correlation between the students' performance and the relevance of the subfields to their work.

MATERIAL AND METHODS

To address this issue, the results of MC exams in the neuroanatomy course for dental students at Charité-Universitätsmedizin Berlin from winter semester 2014/2015 to winter semester 2019/2020 were analysed. Each question was assigned to a specific subfield of neuroanatomy. We then compared cranial nerves and cranial nerve nuclei (clinically relevant) with the remaining subfields (clinically less/not relevant) to investigate whether students performed better in anatomy subfields that are more aligned with the clinical practice of a dentist. We also conducted an anonymous survey (n=201) of the dental students.

RESULTS

From winter semester 2014/2015 to winter semester 2019/2020, students performed significantly (***, p< 0.001) better on the clinically relevant questions of the MC examination than on the less/not clinically relevant questions. However, when looking at each of the eleven semesters separately, only three semesters actually performed significantly better on the clinically relevant questions. Our survey also showed that students perceived the subfield of cranial nerves and cranial nerve nuclei to be the most relevant and studied it more intensively out of their own interest.

DISCUSSION

The study showed that students perceived the subfield of cranial nerves and cranial nerve nuclei to be the most relevant. However, there was no direct correlation between student performance and clinically relevant questions. Using student performance alone as an indicator of relevance is not optimal, as factors such as motivation to learn can have a significant impact.

CONCLUSION

Greater clinical relevance influences what students learn more intensively out of their own interest, but does not influence the results of the MC examination in favour of the subspecialty. Based on the available evidence, it is recommended that the structure of the neuroanatomy course be reconsidered.

Of mice (dogs, horses, sheep) and men: A novel comparative anatomy dissection course in a United Kingdom university

At the University of Bristol, we established a novel dissection course to complement our anatomy degree. Students enrolled in this undergraduate course are trained as comparative anatomists, with equal time given to both human and veterinary anatomy. Historically, students opted to dissect either human or veterinary donors as part of the course. To fully reflect the comparative nature of the degree, the dissection course was redesigned so students could dissect both human and veterinary specimens as part of the same course. This facilitated a wide-ranging experience of anatomy, encouraging detailed knowledge of a multitude of species and allowing for multifaceted anatomy graduates to be ready for employment in a wide and competitive job market. Across three iterations of the amended version of the course, median marks ranged from 58.7% to 62.0%, with between 22 and 39 students enrolled. In comparison to the course prior to the introduction of the change, median marks ranged from 59.8% to 62.8%, with between 16 and 24 students enrolled. There was no significant difference between marks before or after the introduction of the concurrently comparative aspect. This paper describes the course, with learning materials and assessments considered, along with some reflection on its value. The course offers benefits to students by widening their perspective on anatomical knowledge and making them more equipped for the job market. It also broadens their understanding of form-function relationships. However, student feedback implied that having the choice between human or veterinary dissection was preferable, and this may outweigh the perceived benefits of the course.

International consensus for a dissection room quality system (DRQS): A Delphi panel study

Dissection Rooms (DRs) are key facilities that allow teaching and research on human anatomy, where students and researchers work with human bodies to acquire, increase, or create new knowledge. Usually, DRs work with a Body Donation Program (BDP), where living donors bequeath their bodies for use in teaching and research after they expire. Despite DRs being part of universities worldwide, no common guidelines, regulations, or quality management systems (QMS) exist that could be applied to different countries. With that purpose in mind, we aimed to develop a QMS that could be applied to DRs globally, using a Delphi panel to achieve consensus about the items that should constitute the QMS. The panel was constituted by 20 anatomy professors from 20 different countries, and the 167 standards to create the rules or guidelines that constitute the QMS were divided in five categories: direction, body donation, students, instructors, and research. After two rounds of revisions, 150 standards were considered "essential" or "important" by more than 70% of the participants, thus being incorporated to the Dissection Room Quality System (DRQS). The results of this panel represent a minimum list of items of the DRQS for improving the functioning of DRs globally.

Needs assessment of essential anatomy: The perspective of adult primary care resident physicians

Curricular development and modification involve first identifying a problem and then performing a needs assessment, which can guide the design of curricular components. Pedagogical changes, coupled with reductions in curricular time for gross anatomy, pose challenges and impose restrictions within medical school curricula. In order to make anatomy education effective and efficient, it is important to determine the anatomy considered essential for medical education through a targeted needs assessment. In this study, 50 adult primary care resident physicians in family medicine (FM) and internal medicine (IM) were surveyed to assess the importance of 907 anatomical structures, or groups of structures, across all anatomical regions from a curated list based on the boldface terms in four primary anatomy texts. There were no statistically significant differences in the ratings of structures between the two groups for any anatomical region. In total, 17.0% of structures, or groups of structures, were classified as essential, 58.0% as more important, 24.4% as less important, and 0.7% as not important. FM residents rated tissues classified as skeleton, nerves, fasciae, anatomical spaces, blood vessels, lymphatics, and surface anatomy (p < 0.0001) significantly higher than IM residents, but there were no differences in the rating of muscles or organs (p > 0.0056). It was notable that 100.0% of cranial nerves were classified as essential, and 94.5% of surface anatomy structures were classified as essential or more important. It is proposed that results of this study can serve to inform curricular development and revision.

Prosections in Anatomy Education: Establishing a Definition and Describing Preparation, Use, and Educator Perceptions

There is an ongoing debate in anatomy education regarding the use of prosection versus student dissection in anatomy lab instruction. While there are plenty of studies comparing dissection and prosection, there are very few studies on how prosections are prepared and how they are used in anatomy instruction. Furthermore, there is no consistent definition of prosection used in the literature. This study used an anonymous questionnaire distributed to anatomy educators internationally and asked for educator views on defining, preparing, and using prosections in various course settings. One-hundred twenty-five completed responses representing fifteen countries and sixty-seven institutions underwent a thematic analysis to describe major themes in participant responses. From responses, a definition of prosection was developed, and the major perceived strengths and weaknesses of prosection use were described. Furthermore, quantitative data regarding the prevalence of prosection use as either a supplemental or primary resource and details pertaining to the perceived expertise of prosectors was collected. This study demonstrates the extensive reach of prosections in anatomy education and sets a foundation from which future studies on unique prosection preparation and use can stem from.

Do virtual dissection tables add benefit to cadaver-based anatomy education? An evaluation

PURPOSE

The anatomy education literature suggests blended-learning approaches as more effective. We performed a literature review to answer the question if virtual dissection tables can play a significant role as supplements to traditional cadaver-based anatomy education methods.

METHODS

PubMed, SCOPUS, ERIC and Cochrane databases were searched for articles with purpose to explore the outcomes of the use of virtual dissection tables in conjunction with cadaver-based anatomy education.

RESULTS

Six articles were included. Three articles were comparative and comprised evaluation of participants' anatomy examinations results. Three articles were non-comparative and comprised only evaluation of participants' opinions about the educational intervention. In all studies, the participants expressed satisfaction about the educational value of this intervention, while the data about anatomy examinations' results suggest that virtual dissection tables may also enhance students' academic performance, when they are used in conjunction with cadavers.

CONCLUSION

Virtual dissection tables seem to do have a role in modern blended-learning anatomy curricula and could essentially supplement the educational power of cadaver-based methods. Our findings may stimulate further implementation of virtual dissection tables as supplementary tools to cadaver-based anatomy education.

Impact of the COVID-19 Pandemic on Students' Motivation in Relation to Asynchronous Anatomy Video Lectures

OBJECTIVES

This study aimed to investigate medical students' motivation in relation to asynchronous anatomy video lectures, carried out during COVID-19 remote teaching.

METHODS

Repeated cross-sectional modified Instructional Materials Motivation Survey questionnaire, validated in Brazil, was applied to 255 students attending the first semester of the undergraduate medical course at the José do Rosário Vellano University, in June 2020 and November 2020. The data were analyzed considering the 95% confidence level as significant (p < 0.05).

RESULTS

The overall score of motivation attributed by the students was moderate to high (3.7/5, 74%). The same occurred in relation to all dimensions of the instrument: Interest (3.6/5, 72%), Confidence (3.7/5, 74%), Attention (3.5/5, 70%), and Expectation (3.7/5, 74%). Cluster analysis showed that 78% (n = 168) of the students had moderate (72% of the maximum score) or high (86% of the maximum score) degrees of motivation. The influence of social isolation on the students' emotional state did not affect the overall motivation scores (p = 0.217) or the dimensions of motivation: Interest (p = 0342), Confidence (p = 0.061), Attention (p = 0.625), and Expectation (p = 0.094).

CONCLUSIONS

The students showed high motivation for the asynchronous video lectures of human anatomy. Although the majority of students are highly affected regarding their emotional state, due to the social isolation imposed by the COVID-19 pandemic, this fact did not interfere with the motivation for video lectures, probably due to the high intrinsic motivation that students in the first year have in relation to anatomy. These findings alert to the importance of asynchronous video lectures as an adequate strategy for the teaching and learning of human anatomy.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s40670-022-01714-7.

Dyad pedagogy in practical anatomy: A description of the implementation and student perceptions of an adaptive approach to cadaveric teaching

Prior to the challenges imposed by the Covid-19 pandemic, anatomy practical sessions at Trinity College Dublin involved eight to 10 students per donor station, rotating between digital learning, anatomical models/osteology, and dissection activities for three hours weekly. To maintain cadaveric participation in the anatomy laboratory while adhering to distancing guidelines, a transition to dyad pedagogy was implemented. This mode of delivery allowed two students per donor station to spend one hour per week in the anatomy laboratory with all digital learning elements transferred to the virtual learning platform Blackboard as pre- and post-practical session learning activities. Dyad pedagogy has been explored in clinical settings and simulation procedural-based training but is yet to be fully verified in anatomy education. To determine the effectiveness of hybrid practical sessions and reduced donor to student ratios, the opinions of first year medical students were examined using an online questionnaire with a 51% response rate. Although students recognized the merits of more time in the anatomy laboratory, including opportunities for self-directed study and exposure to anatomical variation, they felt that having two students per station enabled sufficient hands-on time with the donor body and fostered learning opportunities that would not be possible with larger groups. Strong preferences for quality time with the donor body supported by online resources suggests this modality should be a key consideration in course design for anatomy curricula and emphasizes the importance of gauging students' preferences to optimize satisfaction and learning output when pivoting to blended learning strategies in anatomy education.

To Touch or Not to Touch: Evaluating Student Laboratory Outcomes of Hands-On versus Visual Examination of Prosected Cadavers

We utilized the physical manipulation of cadaveric donors by students to evaluate learning outcomes in two undergraduate anatomy courses. Students (n = 176) were assigned as those whom ‘manipulated’ (n = 100) or ‘did not manipulate’ (n = 76) donors, and data were compared to performance on laboratory assessments. A Fisher’s exact test was conducted within individual and combined course populations to assess if the relationship between physical touch and receiving a passing grade is more than expected by chance. BIO 201 ‘manipulating’ students received a ‘C’ or better (n = 58) vs. 6 D, F, or Withdraw grades (DFW) on lab practicals as compared to those who did not manipulate (n = 33 DFW vs. 18 C or better) (p < 0.0001). BIO 221 ‘manipulating’ students (n = 34) received a ‘C’ or better vs. DFW grades (n = 2), while ‘non-manipulating’ students were able to earn outcomes of ‘C’ or better (n = 13 vs. 12 DFW). However, students involved in donor manipulation were more likely to receive a ‘C or better’ (p = 0.0002). Analysis of the data as a single cohort indicates non-manipulating students are 7.24 times more likely to earn a ‘DFW’ on lab practicals, demonstrating that students are better prepared for laboratory assessments when encouraged to manipulate anatomical structures.

Dissection versus Prosection: A Comparative Assessment of the Course Experiences, Approaches to Learning, and Academic Performance of Non-medical Undergraduate Students in Human Anatomy

Many institutions rely upon prosection-based laboratories as more resource-efficient and time-effective alternatives to traditional cadaver dissection for human anatomy education. To facilitate growing enrollment numbers despite resource limitations, the University of Guelph (a non-medical institution) introduced a modified "stepwise" prosection-based laboratory cohort to supplement a dissection-based course. In this design, all students attended the same lectures, but those in the dissection-based cohort learned by performing regional dissections and students in the prosection-based cohort studied from those dissections. Prosection students thereby witnessed a "slow reveal" of structures throughout the course. This study compared the perceived course experiences, student approaches to learning, and academic performance between the two groups. Multiple linear regression analyses were used to isolate the effect of the laboratory environment on student approaches to learning and academic performance from demographic and situational covariates. Both groups reported positive course experience ratings and high average final grades that were not statistically dissimilar (P > 0.05), increased reliance on deep approaches to learning (P = 0.002), and decreased reliance on surface approaches to learning (P = 0.023). When controlling for covariates, participation in dissection had small but statistically significant positive associations with deep approaches to learning (P = 0.043), performance on laboratory oral assessments (P < 0.001), and average final grades (P = 0.039). Ultimately, both designs promoted meaningful learning and desirable performance outcomes, indicating that both dissection and stepwise prosection have the potential to facilitate high quality human anatomy instruction.

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

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

Changes in the learning styles and approaches of students following incorporation of drawing during cadaveric dissection

The teaching of anatomy is challenging due to the constraints of material and personnel resources. Research has established that the learning preferences of students are malleable and determined by the requirements of the course. Further, drawing has been reported to aid learning in anatomy by facilitating problem solving and reducing the cognitive overload in students. Considering these issues, the aims of the study were to investigate (a) if positive changes occur in the learning styles and approaches following the incorporation of drawing during cadaveric dissection, and (b) whether they are associated with improved learning outcomes. One cohort of students in an anatomy course received training in creating scientific drawings from dissected human cadavers, while two cohorts of students did not receive such training. The learning preferences of students and their final examination grades were assessed at the commencement and conclusion of the course. Majority of student who had training in drawing transitioned from being bimodal, to trimodal or quadrimodal learners. This was associated with efficient learning approaches and a significant (p < .05) improvement in learning outcomes in these students. There were no changes in any parameters in students who had not received training in drawing. Therefore, the modulation of learning preferences of students through drawing is a pragmatic approach in anatomy teaching.

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

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

Perceived Benefits of Anatomy Coursework Prior to Medical and Dental School

Student struggles in gross anatomy coursework at the professional level can result in hours of remediation along with a need to allot time and other resources by both the student and the faculty. Since this course typically occurs in the first semester of the first year, programs can turn to admissions data to try to determine which of these students may struggle. This study looked at two years of medical (n = 280) and dental (n = 78) students to determine if there is a relationship between pre-admissions anatomy coursework and performance in gross anatomy at the professional school level. Students provided data regarding their past anatomy coursework and final grades in professional school gross anatomy courses were obtained. In addition, students responded to questions regarding their feelings of preparation and how they valued the prior anatomy coursework as it related to the professional course. Statistical analysis showed no difference in final course grade between students with and without prior anatomy in either program. Counter to the numerical data, 96.6% of the students in the study recommended an anatomy course prior to pursuing a health science degree. The primary reasons given for this recommendation were the benefits of repeated content exposure, knowledge of the anatomy terminology, and decreased stress regarding the course. The results from this study suggest that the benefits of prior anatomy may be seen more in the students' stress and quality of life rather in the numerical performance of course grades.