Dissection Experience and Performance on a Human Gross Anatomy Written Examination: Lessons Learned During the Covid-19 Pandemic

Impact of gross anatomy laboratory on student written examination performance: A 3-year study of a large-enrollment undergraduate anatomy course

The efficacy of the various pedagogies that are used in human anatomy laboratories has been extensively debated. Nevertheless, an important question remains relatively unexamined-how the learning experience in the anatomy laboratory impacts students' mastery and application of anatomical knowledge beyond the laboratory setting. In this study, the effect of a prosection-based anatomy laboratory on overall comprehension and mastery of anatomical knowledge was evaluated in an upper division undergraduate anatomy curriculum that consists of a mandatory lecture course and an optional laboratory course. This flexible curricular structure permitted assessing the merit of laboratory learning on the written examination performance of the lecture course. In 2019 and 2022, the anatomy laboratory was taught in-person using prosections, while in 2021 due to the Covid-19 pandemic related regulations, it was taught remotely with live-streaming of prosections using document cameras. In both in-person and remote instructive formats, written examination scores of the lecture course were compared between two cohorts of students: Those enrolled in lecture only and those enrolled in both lecture and laboratory. Results showed that the cohort enrolled in both lecture and laboratory courses consistently outperformed the lecture-only cohort by one full letter grade. Furthermore, when the degrees of improvement on written examination scores were compared between the two instructive formats, in-person laboratory had a greater increase compared to remote laboratory. Altogether this study demonstrates that the prosection-based anatomy laboratory enhances students' mastery of anatomical knowledge beyond the laboratory setting by promoting comprehension of spatial relationships of anatomical structures.

The future of anatomy teaching post-pandemic: An academic viewpoint

The COVID-19 pandemic caused major disruption to anatomical teaching worldwide with both lectures and practicals being moved online. Throughout this period anatomists were able to find new and innovative ways to teach and to aid student learning via a variety of delivery modes. This study aimed to interview anatomists who were involved in teaching undergraduate medical students at UK universities to document the changes that occurred and to understand academic perceptions of pandemic delivery to comprehend how anatomy education may change in the long term. Results suggest that academics are likely to continue to deliver anatomical lectures online post-pandemic akin to a flipped classroom approach, although caution was noted regarding 'at-risk' student groups. No academics wished to see continued delivery of practical classes online, however, resources designed or invested in during the pandemic will be integrated into practical classes or pre-class preparation allowing for a more complete student experience. No clear picture emerged as to the preferred way staff and students will communicate in the current post-pandemic hybrid working environment and beyond. This will likely only be resolved when a new pattern of home working evolves in UK institutions. This report is the first to detail the academic vision of anatomy teaching in a post-pandemic world and will be useful to those adapting to these changes and for those pedagogical researchers targeting where anatomical education research should focus moving forward.

COVID-19 modifications to a first year medical human anatomy course: Effects on student performance on summative examinations

The COVID-19 (COVID) pandemic forced changes in how medical curricula are organized and delivered. In addition to disease mitigation strategies, other curricular modifications were required to maintain educational effectiveness and student and faculty safety. While these changes appear to be successful in their primary goal, their effect on learning and other important educational outcomes is less well understood. We describe changes to our anatomy course and describe their effects on summative examination scores. We compared anatomy examination scores from 4 years prior to COVID with scores from the 2 years following COVID mandated changes in an effort to determine the effectiveness of our course modifications. Examination scores for the first of four successive Blocks of instruction following the implementation of curricular changes demonstrated a lower mean score and greater range of scores than for the four pre-COVID years. Pre-COVID and post-COVID scores for Blocks II, III, and IV were comparable. Our results indicate that our changes to the anatomy curriculum did not prevent a performance decline during the first Block of instruction only. However, students were able to successfully adapt to these changes during the remainder of the course. We discuss factors that may have accounted for the Block I performance decline and call attention to changes within the larger curriculum that may have affected student performance.

Achievement of learning outcomes in non-traditional (online) versus traditional (face-to-face) anatomy teaching in medical schools: A mixed method systematic review

In recent years, the logistical challenges posed by the Covid-19 pandemic have prompted medical educators teaching gross anatomy to explore an expanded use of online instructional modalities. There is concern that this shift to online anatomy education in medical schools could affect long-term learning outcomes for future healthcare providers. In this systematic review, the educational effectiveness of online anatomy teaching is compared with traditional ("face-to-face") teaching methods, specifically in terms of students' academic performance and satisfaction. A search of four databases identified and screened 162 studies. Subsequently, 31 studies were analyzed, including both (a) teaching outcome measures (test scores) and (b) student satisfaction ratings. Authors chose studies, extracted data, assessed quality and examined risk of bias. Nineteen studies compared students' academic performances between online and face-to-face teaching methods. Twenty-six studies measured students' levels of satisfaction in both teaching methods. Both qualitative and quantitative analyses of the data revealed comparable academic performances with no statistical difference between the two teaching methods, but a higher level of satisfaction with face-to-face teaching. The findings confirm that students can learn from online teaching but are more satisfied with face-to-face teaching. The authors conclude that online teaching cannot replace traditional teaching and there is no preference for one type of modality over the other. Therefore, a multi-modal learning approach combining online with face-to-face educational modalities for medical students could be efficient and successful.

The gross anatomy course: SARS-CoV-2 pandemic-related effects on students' learning, interest in peer-teaching, and students' perception of its importance

The COVID-19 pandemic required adjustments and limitations in university teaching, thereby challenging teaching concepts in anatomy requiring in-person contact, including the gross anatomy course. Therefore, the present study investigates the impact of COVID-19-associated adjustments on students' perception of the gross anatomy course's importance and quality, students' preferred learning setting and outcome, and their motivation to involve themselves in academic activities, including becoming a future peer-teacher of the course. Using paper-based questionnaires in Ulm, Germany, 397 (response rate: 82.3%) students of the winter term of 2020/2021 were surveyed using quantitative and qualitative items, which were compared with cohorts prior to the pandemic. Students reported a higher global rating on course quality during COVID-19 (pre-COVID-19: 5.3 ± 0.9, during-COVID-19: 5.6 ± 0.7, p < 0.001; 1 = very bad, 6 = very good). Students' perceived importance of the gross anatomy course showed a small but significant increase (pre-COVID-19: 4.2 ± 0.6, during-COVID-19: 4.3 ± 0.6, p < 0.001; 1 = strongly disagree, 6 = strongly agree). Students' motivation to apply as a peer-teacher remained stable, nevertheless, they reported less interest in transferring their knowledge to junior students. Finally, students reported that they spent significantly more learning time alone and their examination grades remained unchanged during the pandemic. Astonishingly, despite radical changes of the teaching environment due to COVID-19, students appreciate the offered teaching and highly valued the gross anatomy course.

Medical student exam performance and perceptions of a COVID-19 pandemic-appropriate pre-clerkship medical physiology and pathophysiology curriculum

BACKGROUND

Medical schools were compelled to abruptly transition pre-clerkship curricula to remote learning formats due to the emergence of the Coronavirus Disease 2019 (COVID-19) pandemic. We evaluated student perceptions of remote learning, exam performance, and utilization of third-party learning resources to assess the implementation of a newly developed pandemic-appropriate physiology curriculum.

METHODS

This was an observational study based on a survey conducted in the Spring of 2021 at the University of California, Irvine, School of Medicine (UCISOM). This study aimed to assess first (MS1) and second year (MS2) medical students' perceptions of satisfaction, support, academic performance, and connectedness before and during the COVID-19 pandemic. The MS1 class began medical school during the first year of the COVID-19 pandemic, whereas the MS2 class did so prior to the start of the pandemic. A survey instrument was developed and validated to identify the impact remote learning had on student self-perceptions of the Medical Physiology and Pathophysiology course. Surveys were distributed to all students and responses were collected on a voluntary basis. Exam scores on a customized National Board of Medical Examiners (NBME) physiology shelf exam were also compared to objectively identify how the remote curriculum during the pandemic impacted academic performance.

RESULTS

Of 204 students enrolled, 74 responses were analyzed, with 42 MS1 (40% of MS1s) and 32 MS2 (31% of MS2s) responses. Overall, MS1s and MS2s were satisfied with the curriculum they received (95 and 97% respectively) and the school's support of their concerns (86 and 100% respectively). Notably, only 50% of MS1s felt connected to their peers, compared to 94% of MS2s. Lecture attendance and self-perception of their academic performance were similar between both classes. Interestingly, the intra-pandemic class's NBME exam average in 2020 (60.2% ± 8.9, n = 104) was significantly higher than the pre-pandemic class average in 2019 (56.8% ± 11.3, n = 100). Both classes primarily used course materials over third-party learning resources. An additional set of survey questions distributed only to the MS1 class found that the majority of MS1s reported minimal barriers with regards to accessibility, including internet connectivity, study-conducive environments, and balancing family commitments. Overall, pre-clerkship medical students had positive perceptions of the newly developed pandemic-appropriate physiology curriculum.

CONCLUSIONS

Changes to the pre-clerkship physiology curriculum during the COVID-19 pandemic were met with overall satisfaction from the students and an increase in NBME scores. More attention to student connectedness is needed to improve how remote learning can be best optimized into future curricula development.

Promoting more future-ready anatomy education after the Covid-19 pandemic: A scoping review

The coronavirus disease 2019 (Covid-19) pandemic caused an abrupt transition from face-to-face to online anatomy teaching, learning, and assessment. Although online education has ensured the continuity of anatomy education during the pandemic, its implementation has been challenging, and its effectiveness has been questioned. Therefore, literature pertinent to online anatomy education during the pandemic is crucial to explain Covid-19's disruptions to this field. Accordingly, this scoping review explored changes, disruptions, and gaps in anatomy teaching and assessment during Covid-19 using an enhanced version of Arksey and O'Malley's six-stage protocol. Five online databases were searched for articles that described changes and disruptions in anatomy education. Three independent researchers were involved in titles, abstracts, and full texts screening, while another four researchers were independently involved in data extraction, charting, and synthesis. This review revealed six themes: immediate strategic plans and actions, teaching and learning changes, online assessment practice, students' and educators' receptivity and adaptability, online learning and assessment effects, and future directions. It also revealed four gaps: non-future-ready curricula, learning obstacles, administrative and teaching challenges, and online education ethical issues. The results were reported in tabular and narrative forms, following the PRISMA Extension for Scoping Reviews (PRISMA-ScR guidelines). Understanding the evolution and gaps in anatomy education during the Covid-19 pandemic will help anatomists design future-ready, adaptable curricula.

A Multicentre Analysis of Approaches to Learning and Student Experiences of Learning Anatomy Online

Introduction

The approaches to learning students adopt when learning anatomy online could yield important lessons for educators. Dissection room teaching can encourage students to adopt a deep approach to learning anatomy. It was therefore hypothesized that the proportion of students adopting a deep approach to learning would be lower in a population learning anatomy online. This research aims to investigate the experiences of students learning anatomy online during the COVID-19 pandemic and the approaches to learning they adopted.

Methods

A survey was distributed to medical students at 7 universities across the UK and Ireland. The survey included two previously validated questionnaires: Approaches and Study Skills Inventory for Students and Anatomy Learning Experience Questionnaire.

Results

The analysis included 224 unique student responses. Students' approach to learning mirrored reports from previous studies conducted during face-to-face tuition with 44.3% adopting deep, 40.7% strategic, 11.4% surface, and 3.6% combined learning approaches. The university (p = 0.019) and changes to formative (p = 0.016) and summative (p = 0.009) assessments significantly impacted approach to learning. Students reported that online resources were effective but highlighted the need for clearer guidance on how to find and use them successfully.

Conclusion

It is important to highlight that students value in-person opportunities to learn from human cadaveric material and hence dissection room sessions should remain at the forefront of anatomical education. It is recommended that future online and/or blended provisions of anatomy teaching include varied resources that maximize engagement with media featuring cadaveric specimens.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40670-022-01633-7.

No cuts, no buts: Satisfaction of first-year medical students with a hybrid prosection-based model for learning gross anatomy during the Covid-19 pandemic

Few realized the extent of disruption that the Covid-19 global pandemic would impose upon higher anatomical education. While many institutions were obliged to adopt a fully-remote online model, the New York Institute of Technology College of Osteopathic Medicine strove to develop a curriculum that would allow medical students to receive an in-person anatomy education. A hybrid model that emphasized learning from prosected cadavers and self-study stations was implemented, with the remainder of the students' time directed toward studying at home. Through an anonymous survey aimed at gleaning student satisfaction, this study demonstrates that this hybrid prosection-based anatomy course aligned with student preferences both assuming no health risk (64.6% agreed) and given the current risk of contracting Covid-19 (78.5% agreed). Generally, students felt that their education was equal to that of previous years (Likert scale = 3.24 ± 1.05), fostered an appreciation for anatomy (4.56 ± 0.59), promoted teamwork (4.13 ± 0.85), and prepared them for practical examinations (4.18 ± 0.74). Linear mixed-effect models demonstrated that specific differences in results could be attributed to students' preconceived preferences toward student-led dissections and to past medical training. Importantly, most students "disagree" (1.97 ± 1.00) that they were concerned about the risk of exposure to Covid-19 during in-person anatomy laboratory sessions. Areas requiring improvement were identified by the model, including the provision of access to the cadavers outside of the regularly scheduled laboratory times (3.89 ± 1.08). These findings should be utilized when designing future gross anatomy courses in response to the "new normal".

The impact of asynchronous online anatomy teaching and smaller learning groups in the anatomy laboratory on medical students' performance during the Covid-19 pandemic

Due to the Covid-19 pandemic, National Taiwan University anatomy teachers adopted asynchronous online video teaching and reduced the size of anatomy laboratory groups in April 2020. The aim of this study was to investigate the impact of these changes on medical students' learning. Before Covid-19, the performance of the 2019-2020 cohort was significantly better than that of the 2018-2019 cohort. However, the implementation of modified teaching strategies significantly lowered the laboratory midterm score of the 2019-2020 cohort in the second semester. Conversely, the final laboratory examination score of the 2019-2020 cohort was significantly higher than that of the 2018-2019 cohort. Through correlation analysis, lecture and laboratory examination scores were highly correlated. Additionally, the difference in lecture and laboratory z-scores between two cohorts, the Likert scale survey and free-text feedback of the 2019-2020 cohort, were conducted to show the impact of modified teaching strategies. There were several important findings in this study. First, the change in teaching strategies may temporarily negatively influence medical students to learn anatomy. Besides, analyzing the performance of laboratory assessments could be a complementary strategy to evaluate online assessments. Applying lecture examination scores to predict laboratory performance was a feasible way to identify students who may have difficulty in learning practical dissection. Finally, reducing group size together with reduced peer discussion may have a negative effect on learning cadaver dissection for students with low academic performance. These findings should be taken into consideration when anatomy teachers apply new teaching strategies in anatomy courses.

Assessment of the opinions and experiences of anatomy educators regarding the distance anatomy education in medical facilities under the effect of COVID-19 in Turkey

Purpose

Methods

Results

Conclusion

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.

Evaluation of views and perceptions of the medical faculty students about distance anatomy education during the COVID-19 pandemic

Purpose

This study aimed to investigate the students’ opinions about the distance anatomy education given in our faculty at the COVID-19 pandemic and present our department’s experiences.

Methods

An online questionnaire designed for medical faculty students. The questionnaire was applied to 355 volunteer medical faculty students. The questionnaire consisted of demographics, five-point Likert items, and open-ended questions. The questionnaire was applied between August and September 2020. Distance anatomy education activities were evaluated during March and July 2020.

Results

Results showed face-to-face theoretical anatomy education was found to be more effective than distance anatomy education conducted with recorded lecture videos. Even though the positive aspects of distance anatomy education stand out in topics, such as time management, it has been stated that cadaver and laboratory education has been disrupted. Most of the students agreed that they spent more time on supplementary resources during distance anatomy education.

Conclusion

The COVID-19 pandemic has provided an unexpected experimental environment. The demand for a blended method, which consists of distance (supported by video recordings) theoretical anatomy education and face-to-face practical anatomy education for the post-pandemic period comes to the fore. Distance anatomy education brings some problems with it due to its nature, and it is essential to seek unique solutions to them. Evaluating the perceptions of the parties will play an essential role in solving the problems of distance anatomy education and in the formation of future anatomy education styles.

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.

Crashing from cadaver to computer: Covid-driven crisis-mode pedagogy spawns active online substitute for teaching gross anatomy

In early 2020, the Covid-19 crisis forced medical institutions worldwide to convert quickly to online platforms for content delivery. Although many components of medical education were adaptable to that format, anatomical dissection laboratory lost substantial content in that conversion, including features of active student participation, three-dimensional spatial relationships of structures, and the perception of texture, variation, and scale. The present study aimed to develop and assess online anatomy laboratory sessions that sought to preserve benefits of the dissection experience for first-year medical students. The online teaching package was based on a novel form of active videography that emulates eye movement patterns that occur during processes of visual identification, scene analysis, and learning. Using this video-image library of dissected materials, content was presented through asynchronous narrated laboratory demonstrations and synchronous/active video conference sessions and included a novel, video-based assessment tool. Data were obtained using summative assessments and a final course evaluation. Test scores for the online practical examination were significantly improved over those for previous in-person dissection-based examinations, as evidenced by several measures of performance (Mean: 2015-2019: 82.5%; 2020: 94.9%; P = 0.003). Concurrently, didactic test scores were slightly, but not significantly, improved (Mean: 2015-2019: 88.0%; 2020: 89.9%). Student evaluations of online sessions and overall course were highly positive. Results indicated that this innovative online teaching package can provide an effective alternative when in-person dissection laboratory is unavailable. Although this approach consumed considerable faculty time for video editing, further development will include video conference breakout rooms to emulate dissection small-group teamwork.

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.