Dead Body Management in Times of Covid-19 and its Potential Impact on the Availability of Cadavers for Medical Education in India

Medical school students' perspectives on virtual anatomy education in a developing country

Understanding the fundamental role anatomy education plays in medical training and taking into consideration the nascence of online education in Nigeria, this study evaluated the perceptions of medical and allied-health students toward online anatomy education both during the COVID-19 lockdown in Nigeria and for the future. For this study, Google Form questionnaires were distributed via different social and academic platforms to medical and allied-health students in Nigeria between September 28 and December 17, 2020. A total of 954 students participated in the study and 947 valid responses were recorded. The results showed that 77.6% of the students had reported computer/IT skills and 12.1% admitted that they had never attended an online class. Interestingly, 60% of the respondents disapproved of online learning approaches as effective tools for instructions in the anatomical sciences. Majority of the students (84%) agreed that their performance in anatomy would have been better if the classes were face-to-face, while 55% found the online anatomy classes uninteresting. Furthermore, 91.5% agreed that anatomy educators needed advanced skills for online education, while 94.2% agreed that anatomy online teaching needs more advanced technology to be implemented in Nigeria. This study revealed an overall negative perception about the suitability and effectiveness of online anatomy education in Nigerian medical/health training. This study recommends further investigations into the challenges that were presented during online anatomy education at the peak of the pandemic. This will help direct the development and implementation of a workable and sustainable online education model for anatomical sciences in Nigeria.

Online anatomy education during the Covid-19 pandemic: Opinions of medical, speech therapy, and BSc Anatomy students

With the emergence of the Covid-19 pandemic in 2020, it was difficult to predict if the "cadaveric-based (golden) standard" of teaching anatomy would be possible in the unforeseeable future. This forced traditional anatomical teaching and learning practices to be transitioned to remote online platforms. This study explored the opinions of anatomy students (n = 51), on their online learning experience of anatomy during the Covid-19 pandemic. A mixed methods approach using a descriptive, exploratory study design was conducted, by use of an online survey. The survey consisted of a six-point Likert scale and was assembled into four sub-categories. Likert scale options ranged from; strongly disagree, to strongly agree, and not applicable. Results obtained seem to tally with expectations, indicating an adequate theoretical course component with room to improve practical online teaching. Most participants had a positive perception of the theoretical course content, duration, and platforms of communication. Virtual classes were simple to navigate with few technical difficulties experienced by the participants. Students also noted having access to sufficient study material, videos, and additional online material. Overall, more than half of all participants reported adapting well to the remote learning environment, however, the greatest challenge experienced highlighted a sense of deprivation from the lack of cadaver exposure and hands-on instruction. This research highlighted the effects of the pandemic on the modality of anatomy education and how it affected students. Although anatomy is multi-modal, it can be concluded that it is possible to achieve academic success by using online learning methods.

Quantification and persistence of COVID-19 virus in recently deceased individuals before and after embalming

The COVID-19 pandemic severely affected the medical education worldwide. The infection risk for medical students and healthcare personnel who work with COVID-19 positive cadavers or tissues remains unclear. Moreover, COVID-19 positive cadavers have been rejected by medical schools, adversely impacting the continuum of medical education. Herein, the viral genome abundance in tissues from four COVID-19 positive donors before and after embalming were compared. Tissue samples were collected from the lungs, liver, spleen, and brain both pre- and postembalming. The possible presence of infectious COVID-19 was determined by inoculating human tissue homogenates onto a monolayer of human A549-hACE2 cells and observing for cytopathic effects up to 72 h postinoculation. A real- time quantitative reverse transcription polymerase chain reaction was performed to quantify COVID-19 present in culture supernatants. Fully intact viral genome sequence was possible to obtain in samples with higher levels of virus, even several days postmortem. The embalming procedure described above substantially reduces the abundance of viable COVID-19 genomes in all tissues, sometimes even to undetectable levels. However, in some cases, COVID-19 RNA can still be detected, and a cytopathic effect can be seen both pre- and postembalmed tissues. This study suggests that embalmed COVID-19 positive cadavers might be used safely with appropriate precautions followed in gross anatomy laboratories and in clinical and scientific research. Deep lung tissue is the best specimen to test for the virus. If the tests on the lung tissues are negative, there is a very low likelihood that other tissues will show positive results.

A Large-Scale, Multiplayer Virtual Reality Deployment: A Novel Approach to Distance Education in Human Anatomy

The arrival of COVID-19 restrictions and the increasing demand of online instruction options posed challenges to education communities worldwide, especially in human anatomy. In response, Colorado State University developed and deployed an 8-week-long large-scale virtual reality (VR) course to supplement online human anatomy instruction. Students (n = 75) received a VR-capable laptop and head-mounted display and participated in weekly synchronous group laboratory sessions with instructors. The software enabled students to remotely collaborate in a common virtual space to work with human anatomy using an artist-rendered cadaver. Qualitative data were collected on student engagement, confidence, and reactions to the new technology. Quantitative data assessed student knowledge acquisition and retention of anatomical spatial relationships. Results indicated that students performed better in the online course (mean = 82.27%) when compared to previous in-person laboratories (mean = 80.08%). The utilization of VR promoted student engagement and increased opportunities for student interaction with teaching assistants, peers, and course content. Notably, students reported benefits that focused on unique aspects of their virtual learning environment, including the ability to infinitely scale the cadaver and walk inside and around anatomical structures. Results suggested that using VR was equivalent to 2D methods in student learning and retention of anatomical relationships. Overall, the virtual classroom maintained the rigor of traditional gross anatomy laboratories without negatively impacting student examination scores and provided a high level of accessibility, without compromising learner engagement.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40670-023-01751-w.

A survey-based research of medical faculty students' experiences on anatomy education during the Covid-19 pandemic process

PURPOSE

In this study, the purpose was to uncover the views of medical students about online anatomy education adopted during the COVID-19 pandemic period. It was also aimed to determine whether medical school students found online education suitable for anatomy lectures and which materials they desired to use during teaching anatomy practice lectures in this process.

METHODS

A survey form that was prepared with the Google Survey application was administered to the Medical Faculty Term 1 and 2 students who received anatomy courses at Istanbul Yeni Yüzyıl University in the spring semester of the 2019-2020 academic year.

RESULTS

A total of 180 students, 53.89% of whom were 1st graders and 46.11% 2nd graders participated in the study, and 43.89% of the students stated that they found online education suitable for anatomy theoretical courses, and 12.78% for anatomy practice courses. Also, 43.75% of Term 1 and 41.77% of Term 2 students stated that the pandemic negatively affected the teaching of anatomy theoretical courses. It was found that students considered that anatomy practice courses were more affected by the pandemic before and during the pandemic (P<0.001).

CONCLUSIONS

This study uncovered that the pandemic process negatively affected anatomy education and students made more use of face-to-face education. We believe that the results obtained in the study will shed light on the views of anatomists on the teaching of anatomy in the online education process.

New virtual platform for teaching comparative animal neuroanatomy based on metameric slices of the central nervous system

With the limitations imposed by the COVID-19 pandemic, new technologies were used as methods to continue teaching and learning activities. This scenario brought forth the need to develop online tools for teaching. Therefore, this research aimed to develop a digital platform linking the knowledge about the central nervous system (CNS) anatomy from feline, equine, and sheep models. The platform was produced from the analysis of a collection of mesoscopic slides made from the sequenced cross-section of the CNS of a feline, an equine, and a sheep. All sections were analysed and stained using the Paul-Wiegert modified technique. The platform was organized in four modules: (1) Neuroanatomy of the Central Nervous System; (2) Neuroanatomy of Feline; (3) Neuroanatomy of Equine; and (4) Neuroanatomy of sheep. For each module, an explanatory document in PDF was developed, as well as video lectures and a descriptive atlas identifying the structures present in the encephalon and in the cervical part of the spinal cord. Even though there are numerous online platforms that allow the study of veterinary anatomy of different species and organs, the veterinary neuroanatomy platform presented here is the first platform that conjointly addresses the CNS anatomy of felines, equines, and sheep. Future research applying this platform as an aid to the study of neuroanatomy by students, teachers, and veterinary professionals should validate its use as a complementary tool for teaching and learning animal neuroanatomy.

Visualization in Anatomy Education

In the post-pandemic era, one of the significant challenges for anatomy teachers is to reciprocate the experience of practical exposure while teaching the subject to undergraduates. These challenges span from conducting cadaveric dissections to handling real human bones, museum specimens, and tissue sections in the histology lab. Such exposures help the instructors to develop interactive communication with their fellow students and thus help to enhance communication skills among them. Recently, anatomy teachers all over the world started using cutting-edge educational technologies to make teaching-learning experiences for students more engaging, interesting, and interactive. Utilizing such cutting-edge educational technologies was an "option" prior to the pandemic, but the pandemic has significantly altered the situation. What was previously an "option" is now a "compulsion." Despite the fact that the majority of medical schools have resumed their regular on-campus classes, body donation and the availability of cadavers remain extremely limited, resulting in a deadlock. Anatomy teachers must incorporate cutting-edge educational technologies into their teaching and learning activities to make the subject more visual. In this chapter, we have attempted to discuss various new technologies which can provide a near-realistic perception of anatomical structures as a complementary tool for dissection/cadaver, various visualization techniques currently available and explore their importance as a pedagogic alternative in learning anatomy. We also discussed the recent advancement in visualization techniques and the pros and cons of technology-based visualization. This chapter identifies the limitations of technology-based visualization as a supplement and discusses effective utilization as an adjunct to the conventional pedagogical approaches to undergraduate anatomy education.

"Air Anatomy" - Teaching Complex Spatial Anatomy Using Simple Hand Gestures

Spatial understanding of complex anatomical concepts is often a challenge for learners, as well as for educators. It is even more challenging for students with low mental spatial abilities. There are many options to teach spatial relationships, ranging from simple models to high-end three-dimensional (3D) virtual reality tools. Using a randomized controlled trial design, this study explored the use of a unique combination of deictic and iconic hand gestures to enhance spatial anatomical understanding, coining the term "Air Anatomy". The control group (n = 45) was given a lecture on the anatomy of extraocular muscles, while the intervention group (n = 49) received the same lecture including "Air Anatomy" hand gestures. When compared to the control group, the post-test scores for the intervention group were significantly higher for basic recall (P < 0.001; Mann-Whitney U test) and for the application of knowledge (P = 0.015; Mann-Whitney U test). Students with low to moderate spatial ability (as assessed by a mental rotation test) were found to benefit most by this technique. Students in the intervention group also reported a lower extrinsic cognitive load and higher germane load, when compared to the control group. An instructional skills questionnaire survey indicated the effectiveness of this technique in improving overall classroom experience. Feedback of the students in the intervention group was also favorable for instruction using "Air Anatomy". The study suggests that "Air Anatomy" is a useful, "no-cost", accessible method that aids spatial understanding of anatomical concepts.

Modern and synchronized clinical anatomy teaching based on the BDIE method (board-digital dissection-imaging-evaluation)

PURPOSE

Anatomy has historically been taught via traditional medical school lectures and dissection. In many countries, practical or legal issues limit access to cadaveric dissection. New technologies are favored by students and could improve learning, complementing traditional teaching.

METHODS

All students in second-year medicine at a single medical school were submitted to a novel anatomical course with digital tool exposure. We explored a new combined teaching method: a physical blackboard lesson synchronized with digital dissection, imaging and direct evaluation (BDIE). Synchronized dissection is broadcast live in the classroom and in partner medical schools. Following the course, students completed a short survey about their perception of this new anatomic clinical course.

RESULTS

The survey included 183 students whom 178 completed the questionnaire, i.e., a 97% response rate. Ninety-nine percent of students thought this synchronized method useful to improve their understanding of anatomy and 90% stated it helped them retain this learning.

CONCLUSION

This BDIE method, in conjunction with teaching guidelines and dissection, is highly appreciated by students who consider it helps them to acquire lasting knowledge.

Effectiveness of Pedagogical Tools for Teaching Medical Gross Anatomy During the COVID-19 Pandemic

Medical institutions have been forced to modify gross anatomy pedagogy to comply with the health restrictions imposed by the novel coronavirus (COVID-19). Boston University School of Medicine (BUSM) is one such institution that temporarily restructured its course. We replaced cadaveric dissection activities with prosections and placed a greater emphasis on a flipped classroom model. This study investigates the effectiveness of new course materials developed to aid these curriculum changes. Course materials were developed for three purposes: (1) preparation before laboratory sessions (orientation videos and Complete Anatomy (3D4Medical, Elsevier) screens); (2) guidance during laboratory sessions (laboratory guides); and (3) review after laboratory sessions (Zoom recitation sessions). We performed a grounded theory thematic analysis of students' responses (80/160, 50% response) to qualitative survey questions and to focus group questions (16 students who self-selected between 4 different sessions). Data from both the survey and focus groups demonstrated that the vast majority of students agreed that the materials helped them navigate through learning gross anatomy. However, laboratory guides were used mostly for post-lab review as opposed to the intended direction during laboratory sessions. Students within all focus groups overwhelmingly touted the value of Zoom recitation sessions, with many stating that they were imperative to course success. When comparing performance data between 2019 (pre-COVID) and 2020 students, we found that the students who took the anatomy course during the onset of COVID had a slightly higher overall average score in all three modules of the course than compared to the 2019 students. We propose that the utilization of course materials that students perceived as time saving and pertinent to their exam performance, when combined with cadaveric prosection, emphasized the benefits of flipped-classroom learning to help students learn gross anatomy effectively and efficiently during the pandemic and beyond.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s40670-022-01524-x.

One year of anatomy teaching and learning in the outbreak: Has the Covid-19 pandemic marked the end of a century-old practice? A systematic review

At the end of 2019, the Covid-19 pandemic spread caused restrictions in business and social spheres. Higher education was also severely affected: universities and medical schools moved online to distance learning and laboratory facilities closed. Questions arise about the long-term effects of this pandemic on anatomical education. In this systematic review, the authors investigated whether or not anatomical educators were able to deliver anatomical knowledge during this pandemic. They also discuss the challenges that anatomical education has faced over the last year. The search strategy was conducted between July 2020 and July 2021. Two hundred and one records were identified, and a total of 79 studies were finally included. How best to deliver anatomy to students remains a moot point. In the last years, the advent of new technologies has raised the question of the possible overcoming of dissection as the main instrument in anatomical education. The Covid-19 pandemic further sharpened the debate. Remote learning enhanced the use of technologies other than cadaveric dissection to teach anatomy. Moreover, from the analyzed records it appears that both from students' perspective as well as teachers' there is a clear tear between those who endorse dissection and those who believe it could be easily overcome or at least integrated by virtual reality and online learning. The authors strongly believe that the best anatomy teaching practice requires the careful adaptation of resources and methods. Nevertheless, they support cadaveric dissection and hope that it will not be replaced entirely as a result of this pandemic.

E-Learning Three-Dimensional Anatomy of the Brainstem: Impact of Different Microscopy Techniques and Spatial Ability

Polarized light imaging (PLI) is a new method which quantifies and visualizes nerve fiber direction. In this study, the educational value of PLI sections of the human brainstem were compared to histological sections stained with Luxol fast blue (LFB) using e-learning modules. Mental Rotations Test (MRT) was used to assess the spatial ability. Pre-intervention, post-intervention, and long-term (1 week) anatomical tests were provided to assess the baseline knowledge and retention. One-on-one electronic interviews after the last test were carried out to understand the students' perceptions of the intervention. Thirty-eight medical students, (19 female and 19 males, mean age 21.5 ± SD 2.4; median age: 21.0 years) participated with a mean MRT score of 13.2 ± 5.2 points and a mean pre-intervention knowledge test score of 49.9 ± 11.8%. A significant improvement in both, post-intervention and long-term test scores occurred after learning with either PLI or LFB e-learning module on brainstem anatomy (both P < 0.001). No difference was observed between groups in post-intervention test scores and long-term test scores (P = 0.913 and P = 0.403, respectively). A higher MRT-score was significantly correlated with a higher post-intervention test score (rk  = 0.321; P < 0.05, respectively), but there was not a significant association between the MRT- and the long-term scores (rk = -0.078; P = 0.509). Interviews (n = 10) revealed three major topics: Learning (brainstem) anatomy by use of e-learning modules; The "need" of technological background information when studying brainstem sections; and Mnemonics when studying brainstem anatomy. Future studies should assess the cognitive burden of cross-sectional learning methods with PLI and/or LFB sections and their effects on knowledge retention.

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.

Ethical and sociocultural challenges in managing dead bodies during epidemics and natural disasters

Background

Catastrophic natural disasters and epidemics claim thousands of lives and have severe and lasting consequences, accompanied by human suffering. The Ebola epidemic of 2014–2016 and the current COVID-19 pandemic have revealed some of the practical and ethical complexities relating to the management of dead bodies. While frontline staff are tasked with saving lives, managing the bodies of those who die remains an under-resourced and overlooked issue, with numerous ethical and practical problems globally.

Methods

This scoping review of literature examines the management of dead bodies during epidemics and natural disasters. 82 articles were reviewed, of which only a small number were empirical studies focusing on ethical or sociocultural issues that emerge in the management of dead bodies.

Results

We have identified a wide range of ethical and sociocultural challenges, such as ensuring dignity for the deceased while protecting the living, honouring the cultural and religious rituals surrounding death, alleviating the suffering that accompanies grieving for the survivors and mitigating inequalities of resource allocation. It was revealed that several ethical and sociocultural issues arise at all stages of body management: notification, retrieving, identification, storage and burial of dead bodies.

Conclusion

While practical issues with managing dead bodies have been discussed in the global health literature and the ethical and sociocultural facets of handling the dead have been recognised, they are nonetheless not given adequate attention. Further research is needed to ensure care for the dead in epidemics and that natural disasters are informed by ethical best practice.

Factors affecting management of corpses of the confirmed COVID-19 patients during pandemic: A systematic review

Introduction

The global spread of the COVID 19 disease and the concerning rise in the number of corpses of the patients dying of the disease has caused challenges in handling the corpses by the health system and relevant organizations in most countries. The aim of the present study was to investigate factors affecting the corpse management process of the patients dying of COVID 19.

Materials and methods

This study was a systematic review of literature using the PRISMA guideline. Without time limit until the end of January 2021, the studies related to corpse management in patients with COVID 19 were extracted from the data resources of Medline (PubMed), Web of Science, Google scholar, Embase, ProQuest, Scopus, Iranmedex, SID, and ISC, and also the reference lists of selected studies, as well as other systematic reviews, key journals, and proceedings of conferences and congresses. Finally, thematic analysis was used to analyze the obtained data.

Results

190 studies were identified based on the initial search, and finally 21 studies were entered into analysis. Based on the systematic review and thematic content analysis, challenges in the process of managing the corpses of COVID-19 victims were divided into three main themes and eight sub-themes. The themes included psychosocial factors, environmental factors, and resources, and the sub-themes included supporting survivors, customs, values, infection control, corpse identification and burial, corpse transferring, equipment, and governments’ capacity.

Conclusion

Implementing psychological, social, and spiritual support programs for grieving families, the observance of customs and values governing the community at the time of funeral and burial, and planning to control infection and safety in the process of maintenance, transfer to the cemetery and safe burial are the most important strategies that can be used in the process of corpse management. Utilizing and aligning religious leaders with the health system in order to inform people about the ways of disease transmission from the bodies and to use alternative solutions for holding religious and cultural ceremonies (e.g., virtual mourning), as well as providing personal protective equipment to those in close contact with corpses, the development and implementation of health protocols for managing possibly a large number of bodies, capacity building, and anticipating necessary resources are highly recommended strategies.

Evaluation of Information on Body Donation Promotion at Official Websites of Turkish Anatomy Departments

Raising public awareness of body donation is crucial for countries like Turkey that have struggling donation programs. The official websites of anatomy departments may contribute to achieving this goal. Nevertheless, previous studies reported institutional or individual reluctance of departments or anatomists, respectively, due to an expectation of adverse publicity. This study aimed to investigate whether the official websites of Turkish anatomy departments provided information on body donation and analyzed the content of these websites. Websites of anatomy departments at 100 medical faculties were evaluated. Only 12 departments (12%) provided information on body donation with varying content. A thematic analysis of the information provided revealed five main themes. These were (1) legal aspects, (2) significance, (3) acceptance/rejection criteria, (4) availability, and (5) redirection. All departments (n = 12, 100%) outlined the legal aspects of body donation, seven departments (58%) highlighted the significance of body donation, seven departments (58%) provided contact information for potential donors, five departments (41%) covered acceptance/rejection criteria, and three departments (25%) provided a link to the official website of the Turkish Society of Anatomy and Clinical Anatomy. Thus, Turkish anatomy departments were reluctant to provide information on body donation, and the content of provided information varied greatly among departments. This lack of information, coordination, and participation in existing awareness activities for body donation in anatomy department websites may be contributing to the low numbers of body donations and donor registrations seen nationally.

A unique and effective method of anatomy education: Small-group learning with prosected plastinated specimens

OBJECTIVE

At the New York University College of Dentistry, we are faced with the challenge of teaching Head and Neck Anatomy to a class of approximately 380 first-year students. We have developed an innovative anatomy curriculum that has proven effective in facilitating students' learning and long-term retention of the material. It has the added benefit of being time- and cost-efficient. Here, we share the structure of our curriculum and examine the student outcomes and student feedback.

MATERIALS AND METHODS

In this paper, we describe the evidence-based methods used in our course and present measures of student success. We also surveyed students about aspects of the anatomy curriculum.

RESULTS

Our curriculum efficiently manages cost, instructional time, and classroom space, while promoting student success. Over the last 9 years, NYU Dentistry students have achieved a mean first-time pass rate of 98.6% and an average anatomy score of 1.74 standard deviations above the national mean on the National Board Dental Examination Part I. Students agree with instructor assessments of which features of the curriculum are valuable and state that the course helps them prepare for clinical courses.

CONCLUSION

We believe that the main factors in the success of our course are the small group setting, the benefits of spaced repetition and frequent quizzes, and the use of plastinated specimens in place of wet cadavers.

How to One Up a Pandemic: University of Minnesota's Physical Medicine and Rehabilitation Virtual Clerkship-A Model for Alternative Clinical Training and Preliminary Validation Study

ABSTRACT

Drastic and rapid changes to medical education are uncommon because of regulations and restrictions designed to ensure consistency among medical school curriculums and to safeguard student well-being. As a consequence of the COVID-19 pandemic, medical education had to break away from its conventions and transition from time-honored teaching methods to innovative solutions. This article explores the anticipated and actual efficacy of the swift conversion of a specialty elective from a traditional in-person format to a fully virtual clerkship. In addition, it includes a noninferiority study to determine where a virtual classroom may excel or fall short in comparison with conventional clinical rotations.

Design, Implementation, and Evaluation of a Distance Learning Framework to Adapt to the Changing Landscape of Anatomy Instruction in Medical Education During COVID-19 Pandemic: A Proof-of-Concept Study

This study presents the design of a DL-framework to deliver anatomy teaching that provides a microfiche of the onsite anatomy learning experience during the mandated COVID-19 lockdown. First, using nominal-group technique, we identified the DL learning theories to be employed in blueprinting the DL-framework. Effectiveness of the designed DL-framework in anatomy teaching was demonstrated using the exemplar of the Head and Neck (H&N) course during COVID-19 lockdown, in the pre-clerkship curriculum at our medical school. The dissemination of the DL-framework in the anatomy course was informed by the Analyse, Design, Develop, Implement, and Evaluate (ADDIE) model. The efficiency of the DL-framework was evaluated using the first two levels of Kirkpatrick's model. Versatility of the DL-framework was demonstrated by aligning its precepts with individual domains of key learning outcomes framework. The framework's blueprint was designed amalgamating principles of: Garrison's community inquiry, Siemens' connectivism and Harasim's online-collaborative-learning; and improved using Anderson's DL-model. Following the implementation of the DL-framework in the H&N course informed by ADDIE, the framework's efficiency was evaluated. In total, 70% students responded to the survey assessing perception toward DL (Kirkpatrick's Level: 1). Descriptive analysis of the survey results showed that the DL-framework was positively received by students and attested that students had an enriched learning experience, which promoted collaborative-learning and student-autonomy. For, Kirkpatrick's Level: 2 i.e., cognitive development, we compared the summative assessment performance in the H&N course across three cohort of students. The results show that the scores of the cohort, which experienced the course entirely through DL modality was statistically higher (P < 0.01) than both the other cohorts, indicating that shift to DL did not have an adverse effect on students' learning. Using Bourdieu's Theory of Practice, we showed that the DL-framework is an efficient pedagogical approach, pertinent for medical schools to adopt; and is versatile as it attests to the key domains of students' learning outcomes in the different learning outcomes framework. To our knowledge this is the first-study of its kind where a rationale and theory-guided approach has been availed not only to blueprint a DL framework, but also to implement it in the MBBS curriculum.

Anatomy 3.0: Rediscovering Theatrum Anatomicum in the wake of Covid-19

The Covid-19 pandemic has challenged medical educators internationally to confront the challenges of adapting their present educational activities to a rapidly evolving digital world. In this article, the authors use anatomy education as proxy to reflect on and remap the past, present, and future of medical education in the face of these disruptions. Inspired by the historical Theatrum Anatomicum (Anatomy 1.0), the authors argue replacing current anatomy dissection laboratory (Anatomy 2.0) with a prototype anatomy studio (Anatomy 3.0). In this studio, anatomists are web-performers who not only collaborate with other foundational science educators to devise meaningful and interactive content but who also partner with actors, directors, web-designers, computer engineers, information technologists, and visual artists to master online interactions and processes in order to optimize students' engagement and learning. This anatomy studio also offers students opportunities to create their own online content and thus reposition themselves digitally, a step into developing a new competency of stage presence within medical education. So restructured, Anatomy 3.0 will prepare students with the skills to navigate an emergent era of tele and digital medicine as well as help to foreshadow forthcoming changes in medical education.

Body Donation, Teaching, and Research in Dissection Rooms in Spain in Times of Covid-19

The state of alarm due to Covid-19 pandemic in Spain stopped all educational and most university research activities. The Spanish Anatomical Society (SAE) Consensus Expert Group on Body Donations piloted a study based on a questionnaire to know the status of body donations and dissection activities during the lockdown, as well as the future implications of Covid-19 pandemic for body donation programs and anatomy teaching. The questionnaire results show that Spanish Universities refused body donations and stopped all dissection research and teaching. The Covid-19 expected influence on anatomy teaching was referred to the increase in teaching workforce and resources required to apply the new safety measures to future practical activities, as well as to prepare and adapt teaching material for online-only programs. The application of reinforced safety measures was expected to be perceived by the respondent's students as a gain in teaching quality, while the transformation of the anatomy courses in online-only programs will be perceived as a quality decrease. The respondent's concerns about future institutional implications of the pandemic were related to increased costs of the adaptation of the facilities and the reinforced preventive measures, as well as the eventual decrease in donations. The complete lockdown applied to dissection rooms was not justified by scientific evidence and represented a break of the confidence deposed in the institutions by the donors. A consensus is required for the adoption of a renewed, comprehensive protocol for present and future body donations including the evidence Covid-19 pandemic has contributed to create.

Emerging from emergency pandemic pedagogy: A survey of anatomical educators in the United Kingdom and Ireland

It is critical that academic opinion of pandemic pedagogy is comprehensively quantified in order to inform future practices. Thus, this study examines how anatomists in the United Kingdom (UK) and Republic of Ireland (ROI) perceive the teaching adaptations made in response to COVID-19, and how these adaptations have impacted their experiences teaching, their online work environment and community. Data was collected via a questionnaire from 24 anatomists across 15 universities in the UK (11) and ROI (4). With regards to teaching, 95.6% of academics have upskilled in new technologies to meet the demands of distance teaching. Academics (95.8%) preferred face-to-face delivery of practical sessions. Most universities (80.0%) reported that practical sessions will continue in a new form that ensures social distancing. However, 50.0% of academics are uncertain if these adaptations will improve student learning. Many anatomists believe that the new adaptations may hinder student-student (66.7%) and student-tutor (45.8%) interactions. Regarding assessment, 52.6% of academics preferred traditional methods to online. Remote online assessment was difficult to protect against collusion, but provided time saving opportunities for academics. Finally, in terms of working environment, 83.3% of academics stated that their workload increased; 54.2% preferred working on site rather than remotely and 79.2% think that staff interactions are better when working on site. These results demonstrate a widespread concern amongst anatomists regarding the pandemic-induced adaptations to teaching, assessment and working environment. However, important opportunities were also identified that could ultimately serve to benefit students and educators alike.

A 3D hologram with mixed reality techniques for better understanding the pulmonary lesions of COVID-19: Randomized Controlled Trial

Background

The COVID-19 outbreak has now become a pandemic and has had a serious adverse impact on global public health. The effect of COVID-19 on the lungs can be determined through 2D computed tomography (CT) imaging, which requires a high level of spatial imagination on the part of the medical provider.

Objective

The purpose of this study is to determine whether viewing a 3D hologram with mixed reality techniques can improve medical professionals’ understanding of the pulmonary lesions caused by COVID-19.

Methods

The study involved 60 participants, including 20 radiologists, 20 surgeons, and 20 medical students. Each of the three groups was randomly divided into two groups, either the 2D CT group (n=30; mean age 29 years [range 19-38 years]; males=20) or the 3D holographic group (n=30; mean age 30 years [range 20=38 years]; males=20). The two groups completed the same task, which involved identifying lung lesions caused by COVID-19 for 6 cases using a 2D CT or 3D hologram. Finally, an independent radiology professor rated the participants' performance (out of 100). All participants in two groups completed a Likert scale questionnaire regarding the educational utility and efficiency of 3D holograms. The National Aeronautics and Space Administration Task Load Index (NASA-TLX) was completed by all participants.

Results

The mean task score of the 3D hologram group (mean 91.98, SD 2.45) was significantly higher than that of the 2D CT group (mean 74.09, SD 7.59; P<.001). With the help of 3D holograms, surgeons and medical students achieved the same score as radiologists and made obvious progress in identifying pulmonary lesions caused by COVID-19. The Likert scale questionnaire results showed that the 3D hologram group had superior results compared to the 2D CT group (teaching: 2D CT group median 2, IQR 1-2 versus 3D group median 5, IQR 5-5; P<.001; understanding and communicating: 2D CT group median 1, IQR 1-1 versus 3D group median 5, IQR 5-5; P<.001; increasing interest: 2D CT group median 2, IQR 2-2 versus 3D group median 5, IQR 5-5; P<.001; lowering the learning curve: 2D CT group median 2, IQR 1-2 versus 3D group median 4, IQR 4-5; P<.001; spatial awareness: 2D CT group median 2, IQR 1-2 versus 3D group median 5, IQR 5-5; P<.001; learning: 2D CT group median 3, IQR 2-3 versus 3D group median 5, IQR 5-5; P<.001). The 3D group scored significantly lower than the 2D CT group for the “mental,” “temporal,” “performance,” and “frustration” subscales on the NASA-TLX.

Conclusions

A 3D hologram with mixed reality techniques can be used to help medical professionals, especially medical students and newly hired doctors, better identify pulmonary lesions caused by COVID-19. It can be used in medical education to improve spatial awareness, increase interest, improve understandability, and lower the learning curve.

Trial Registration

Chinese Clinical Trial Registry ChiCTR2100045845; http://www.chictr.org.cn/showprojen.aspx?proj=125761

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

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

Covid-19: Emerging Considerations for Body Sourcing and Handling. A Perspective View from Nigeria

The current Coronavirus disease (Covid-19) pandemic has spread to about 220 countries of the world and has resulted in a significant number of deaths globally. Infections are still on the rise, and the impact on the global death rate could be devastating. There are fears over the likely impact of a large number of deaths on body sourcing and handling of cadavers for teaching and research. Historically, epidemics come with several challenges and have often led to some level of negligence of ethical practices and health and safety regulations associated with body sourcing and handling. The authors highlighted some emerging problems in this article, focusing on Africa and Nigeria in particular. These problems include a higher risk of coronavirus exposure for body handlers, shortage of cadavers for teaching and learning, a lack of standard regulations leading to unethical body sourcing and handling, and a lack of monitoring and collaboration needed for a well-coordinated Covid-19 pandemic response strategy. If these issues are ignored, the previous gains made in anatomical ethical practices may be destroyed. Some useful recommendations for policymaking geared toward prevention or curtailing these emerging issues have been instilled in this article.

The COVID-19 pandemic and undergraduate medical student teaching/learning and assessment

This article was migrated. The article was marked as recommended. Medical colleges closed in most countries in February-March due to the coronavirus pandemic and the need to ensure physical distancing. Many rapid changes to teaching/learning and assessment were carried out. Articles published on medical education during the pandemic were analyzed to answer three questions: What changes to undergraduate medical student teaching/learning have occurred during the last six months? What modifications to undergraduate medical student assessment have occurred during the corresponding time period and what are students' perceptions regarding these changes? English language articles published during the current year till 10 th July were searched using the terms 'pandemic', 'coronavirus disease', 'COVID-19', 'undergraduate medical education', 'medical student assessment' and 'medical schools'. The online databases PubMed and Google Scholar were searched. The journal AMEE MedEdPublish was also searched. Articles dealing mainly with postgraduate education, continuing medical education, institutional preparedness, early graduation and joining the workforce were excluded. After narrowing down according to the selection criteria, and addressing duplication, a total of 62 unique articles were obtained. A total of 44 articles were on undergraduate teaching /learning during the pandemic and 10 articles mainly focused on assessment. A total of 8 articles mentioned student experiences of teaching/learning and assessment during the pandemic. Medical education migrated online during the pandemic. The transition may have been smoother for preclinical students as the content could be delivered remotely more easily. Moving clinical learning online has greater challenges. Medical students, especially in developing countries face greater challenges to learn remotely. Open book assessments have been used. E-portfolios, projects, exams with remote proctoring, online OSCE, online structured viva-voce have been carried out. Student perception about these changes were mixed. They were happy about being able to continue learning but maintaining focus and sustaining interest were challenges. Clinical learning has been particularly affected.

Simulation Centers and Simulation-Based Education during the Time of COVID 19: A Multi-Center Best Practice Position Paper by the World Academic Council of Emergency Medicine

COVID 19 struck us all like a bolt of lightning and for the past 10 months, it has tested our resilience, agility, creativity, and adaptability in all aspects of our lives and work. Simulation centers and simulation-based educational programs have not been spared. Rather than wait for the pandemic to be over before commencing operations and training, we have been actively looking at programs, reviewing alternative methods such as e-learning, use of virtual learning platforms, decentralization of training using in situ simulation (ISS) modeling, partnerships with relevant clinical departments, cross-training of staff to attain useful secondary skills, and many other alternatives and substitutes. It has been an eye-opening journey as we maximize our staff's talent and potential in new adoptions and stretching our goals beyond what we deemed was possible. This paper shares perspectives from simulation centers; The SingHealth Duke NUS Institute of Medical Simulation which is integrated with an Academic Medical Center in Singapore, The Robert and Dorothy Rector Clinical Skills and Simulation Center, which is integrated with Thomas Jefferson University, Oakhill Emergency Department, Florida State University Emergency Medicine Program, Florida, USA and The Wellington Regional Simulation and skills center. It describes the experiences from the time when COVID 19 first struck countries around the world to the current state whereby the simulation centers have stWWarting functioning in their "new norm." These centers were representative examples of those in countries which had extremely heavy (USA), moderate (Singapore) as well as light (New Zealand) load of COVID 19 cases in the nation. Whichever categories these centers were in, they all faced disruption and had to make the necessary adjustments, aligning with national policies and advisories. As there is no existing tried and tested model for the running of a simulation center during an infectious disease pandemic, this can serve as a landmark reference paper, as we continue to fine-tune and prepare for the next new, emerging infectious disease or crisis.

Human anatomy education and management of anatomic specimens during and after COVID-19 pandemic: Ethical, legal and biosafety aspects

COVID-19 is an infection caused by the SARS-CoV-2 virus, initially identified in the city of Wuhan, China, in December 2019. Since then, the virus has spread to the continents, causing a major pandemic. The impacts of this pandemic on the education of human anatomy interfere in at least two aspects: (1) receiving and managing anatomical specimens in anatomy laboratories and (2) adaptations for classes on remote virtual teaching. Therefore, this study reviewed and discussed the legal and bioethical aspects, considering the scenario of a South American Country, aiming to stimulate the debate on these two relevant themes in the international community. Because of the COVID-19 pandemic and the impossibility of mass testing, anatomists and other workers in the field must deal with the risk of receiving bodies infected with SARS-CoV-2. In this situation, additional care measures in biosafety practices are essential to protect the staff. Such measures are: the bodies must be preserved by the perfusion of formaldehyde or other fixative solutions; embalming must be performed in ventilated rooms with a good air exhaust system; to avoid excessive manipulation of bodies and procedures such as pulmonary insufflation or craniotomy; and proper use of personal protective equipment, including lab coat, gloves and masks. As for exposure of body images in online classes, this review showed that there are no legal impediments to this end. However, anatomists must adopt measures aimed at protecting the memory of the deceased, such as using secure digital platforms with restricted access; family authorization/consent and student awareness.

Gross Anatomy Education in China during the Covid-19 Pandemic: A National Survey

The Covid-19 pandemic launched the use of online courses in Chinese medical schools during February 2020. To evaluate the state of gross anatomy education in China during the pandemic, a nationwide survey was conducted through convenience sampling by email or respondent invitations on social media. A total of 359 questionnaires were received from the respondents. The first response from a given school was included in the study to represent that school, thus, 77 questionnaires were used for analyses. Schools represented were from all provinces in mainland China as well as Hong Kong and Macao. The survey found that before the pandemic, 74.0% and 33.8% of the 77 schools conducted online theoretical and practical sessions, respectively, on gross anatomy, and 36 (46.8% of 77) had temporarily suspended practical sessions at the time the survey was conducted. Body donation programs were also affected with 26.0% and 27.3% of the 77 schools having suspended donation programs or saw a decreased number of donations. During the pandemic, 40.3% of the 77 schools kept or initiated the implementation of active learning, and online assessment was continued in 49.4% of the 77 medical schools. Another 26 (33.8%) schools initiated online assessment during the pandemic. A total of 359 answers were included for the analysis of the "teachers' perception of the online teaching experience." Over half (51.0%) of the 359 responded teachers were very statisfied or satisfied with the effectiveness of online teaching during the pandemic. A total of 36.2% of these respondents preferred to implement online teaching of theoretical sessions after the pandemic, and 89 (24.8%) teachers were keen to return to traditional face-to-face anatomy education.

The place of cadaveric dissection in post-COVID-19 anatomy education

From time immemorial, cadaveric dissection has been commonly employed as a method of practical teaching and learning for anatomical education globally. Conventionally, cadaveric dissection has been embraced and widely accepted as the best fit for comprehensive and gross teaching in anatomy education, thus placing an undue rise in cadavers' demands. The emergence of the new coronavirus disease 2019 (COVID-19) has posed significant effects on medical education with substantial impacts on anatomy education, as seen in the shift from classroom to virtual learning. An essential area of anatomy education and training requiring immediate consideration is the position of cadaveric dissection in a post-COVID-19 era, which entails the safety of cadavers from possible SARS-CoV-2 infection before their use. This article explores the place of cadaveric dissection in post-COVID-19 anatomy education.

Spotlight on the Shift to Remote Anatomical Teaching During Covid-19 Pandemic: Perspectives and Experiences from the University of Malta

Covid-19 has spread globally, affecting all nations. Preventive measures were implemented by governments including the closure of universities. The aim of this study was to evaluate the student's perspectives and experiences on the shift to remote preclinical medical education while inquiring whether there has been any psychological impact on the students. A customized questionnaire utilizing Likert-scale-based questions and the Generalized Anxiety Disorder-7 assessment tool was distributed online to enrolled preclinical medical students at the Faculty of Medicine and Surgery at the University of Malta. Quantitative and qualitative analyses of the data gathered was carried out. Multivariate logistic regression analyses was performed to establish independent variables associated with anxiety symptoms. A total of 172 responded out of a cohort of 299 preclinical students (58%). The majority perceived a positive learning experience following the shift to remote lectures, however, it was not the case for small group teaching including dissection sessions. Nonetheless students reported concerns about their education, examinations, progression to next academic year and wellbeing. Less than half the students exhibited symptoms of anxiety. Students exhibiting "moderate" worry (OR:7.6; CI 95%:1.98-29.31; P < 0.01) and "severe" worry (OR: 2.0; CI 95%: 5.0-80.5; P < 0.01) on their mental, emotional, and wellbeing due to Covid-19 were associated with anxiety symptoms after adjusting for cofounders. Apart from the short-term effects, the Covid-19 pandemic may have a long-term impact on both the medical education and the students' future careers. It is important that the implemented changes in medical education are recorded and studied since such data will be essential on how to proceed post-Covid-19 pandemic.

Post-COVID-19 pandemic: Standard operating procedures for gross anatomy laboratory in the new standard

The culture of cadaver dissection remains the most commonly used method of practical teaching and learning of human anatomy. Anatomist and medical professionals considered cadaver dissection as the gold standard for teaching and learning anatomy in detail. The increase seen in the establishment of new medical training institutions globally has consequently led to a proportionate increase in the sourcing for cadavers. Moreover, the surge in mortality rates following the recent coronavirus disease 2019 (COVID-19) pandemic with no cure or approved vaccine has been a source of concern for academia, especially on the safety in the usage of cadavers for dissection. Notwithstanding, several countries continue to depend on unclaimed bodies as the primary source for cadavers, regardless of the cause of death. Besides, body donation is also usually reported to be strained during disease outbreaks thereby putting countries that depend solely on it in a dilemma. This study highlighted the recommended standard operating procedures (SOPs) to be imbibed in gross anatomy dissection halls during and post-COVID-19 pandemic.

Ethical Responses to the Covid-19 Pandemic: Implications for the Ethos and Practice of Anatomy as a Health Science Discipline

The move of much anatomy teaching online in response to the Covid-19 pandemic has been successfully implemented within very short time frames. This has necessitated a high degree of dependence upon the use of digitized cadaveric resources, has entailed immense workload demands on staff, and has disrupted students' studies. These educational exigencies have been accompanied by ethical uncertainties for a discipline centered on study of the dead human body. An ethical framework for anatomy is suggested based on the principles of equal concern and respect, minimization of harm, fairness, and reciprocity, in which all staff and students are to be treated with respect and as moral equals. A series of ethical obligations are proposed as a means of maintaining the ethos of anatomy, coping with the suspension of body donation, providing adequate resources, and responding to increased dependence upon external providers. Good academic practice raises more general obligations stemming from the welfare of students, the increased workload of staff, and checking on online assessment and invigilation. As anatomists respond to the educational and ethical lessons prompted by this pandemic, they should plan for future disruptions to normal work patterns by adopting a sustainable and equitable course of action.