Effects of Covid-19: The Need to Assess the Real Value of Anatomy Education

A Comparative Analysis of Physical Therapy Anatomical Knowledge and Retention: Human Donor Dissection Versus Virtual Laboratory

INTRODUCTION

Despite a long history of using human donor dissection (HDD) for physical therapy (PT) anatomy education, there are no PT guidelines that require HDD. The purpose of this quantitative causal-comparative study was to determine if Doctor of Physical Therapy students who used HDD had different grades both within anatomy and within courses that require retention and application of anatomical knowledge (kinesiology and a foundational musculoskeletal course) compared with those who used virtual 3-dimensional anatomical software (VAS).

REVIEW OF LITERATURE

Numerous factors affect the decision to use HDD within PT anatomy, and few PT studies have compared the effectiveness of VAS to HDD.

SUBJECTS

All students who took anatomy in an entry-level PT program from 2018 to 2021 (232 total students, 115 who used HDD in 2018-2019 and 117 who used VAS in 2020-2021).

METHODS

Mann-Whitney tests were used to compare anatomy grades (course, written examination, and practical examination) and future grades in kinesiology and a foundational musculoskeletal course for students who used HDD or VAS.

RESULTS

Physical therapy students who used VAS had statistically significant higher anatomy course grades (VAS 93.81% ± 4.99% to HDD 92.20% ± 4.53%) and higher practical examination grades (VAS 97.43% ± 2.91% to HDD 93.55% ± 4.39%) compared with those who used HDD. However, there were no significant differences between groups on written anatomy examinations (VAS 89.42% ± 7.21% to HDD 90.40% ± 4.94%), kinesiology grades (VAS 91.86% ± 4.52% to HDD 92.80% ± 4.27%), or foundational musculoskeletal grades (VAS 89.50% ± 3.89% to HDD 89.77% ± 3.83%).

DISCUSSION AND CONCLUSION

The causal-comparative study design prevents concluding that PT student grade differences were due exclusively to either anatomy laboratory method. It does provide preliminary evidence that the PT anatomy laboratory method did not practically affect anatomy performance or long-term application of anatomy knowledge in future coursework.

How COVID-19 elucidated challenges in the pedagogy of physiotherapy entry-level education in Brazil and directions for their remediation with special attention to digital teaching and learning

INTRODUCTION

As experienced physiotherapy educators in Brazil, we observed that COVID-19 elucidated challenges in the pedagogy of entry-level education overall, and directions for their remediation. In this commentary, we describe our observations with particular attention to the opportunity for digital and distance teaching and learning in Brazil's exemplary middle-income country.

BODY

First, the legislation in Brazil around health professional education, specifically entry-level physiotherapy education, is described concerning distanced learning. Then, we contrast such education before and during the COVID-19 pandemic, and in the aftermath of its peak. Our observations reinforce the need to preserve teaching and learning excellence in physiotherapy education with various approaches including distanced and digital learning; be aware of both advantages and disadvantages; and identify means of balancing these for optimal delivery and learner outcomes. Our collective experience and insights strongly support the need for change in the legislative document governing physiotherapy education in Brazil.

CONCLUSION

We hope our experiences will enable other educators to evaluate their contexts, reflect on how best to deliver entry-level physiotherapy education in general and during a pandemic, and reinforce the essentiality of practical face-to-face classes in achieving physiotherapy competencies. Only in this way will global standards of practice be ensured, through quality professional education and the factors that inform and govern these.

Israeli medical faculties' response to the COVID-19 crisis vis-à-vis anatomical education: The cultivation of future academic leadership-A national mixed-methods study

The COVID-19 crisis created unprecedented conditions for the medical academic system that enable it to showcase the real value of learning approaches in anatomical education. In parallel, the ongoing reassessment of the role of dissection in medical training, given the huge advances in imaging technology and science education, continued. The present study investigates the response of the six Israeli medical faculties to the pandemic vis-à-vis anatomical education. We reached out to medical students studying anatomy at the time of the crisis (N = 311), advanced medical students working as anatomy instructors (N = 55), and deans and heads of anatomy departments (N = 6). Applying a mixed-method approach, we used Likert scale questionnaires and held in-depth interviews with faculty members. Our results indicate that Israeli medical faculties were committed to a dissection-based anatomy curriculum and made substantial efforts to maintain it in the face of health restrictions. Students appreciated these efforts as this was their preferred learning method. Through a phenomenological analysis of interviews, we demonstrate how the crisis opened up a unique prism through which new insights into the debated role of dissection may be gleaned. Our analysis also reveals that anatomy instructors played a pivotal role in the crisis, not only because they carried out faculty policy, but especially because it gave them the opportunity to determine policy and show leadership. The crisis additionally enabled faculties to cultivate their leadership skills. Our research confirms donor body dissection as a mainstay of anatomical education and emphasizes its immeasurable value to the curriculum and future physicians.

"Preparing them for the profession": An interpretative phenomenological analysis of anatomy educators coping with complexity in the United Kingdom curriculum

Efforts to integrate the basic sciences into the ever-changing curriculum are a trending area of research in health professions education. Low-stakes, high-frequency assessment methods such as the progress test are now widely implemented in the United Kingdom and Northern Ireland as a means of furthering curricular integration toward contemporary goals of competency and professional identity formation. The anatomy educator's experience vis-à-vis these curricular changes is not well understood. This study aimed to explore how anatomy educators make sense of the shifting demands of their role. The interviews were semi-structured, particularly concerned with the phenomenon of teachers adapting to the complexity of their learning environment. The study used interpretative phenomenological analysis (IPA) to focus on the lived experiences of participants coping with the phenomena in question: how do anatomy educators make sense of the learning environment in the United Kingdom? Interviews were transcribed verbatim and interpreted inductively, identifying four key themes: confidence through connectedness, variations in appraisals of curricular integration, managing expectations to perform in paradoxical situations, and the emergence of innovative teaching. Results point to the learning environment as a complex system and highlight the importance of feeling support from and connection to colleagues, enabling individual educators to develop confidence, meet the top-down demands of changing curricula, and experience personal identity development and uncertainty tolerance within their role. This IPA study offers insight into the lived experiences of anatomy educators whose experiential interpretations of a complex and changing curriculum can uniquely inform stakeholders in health professions education.

Evolving strategies in whirlwind mode: The changing face of anatomy education during Covid-19 pandemic

The Covid-19 pandemic stipulated adoption of unfamiliar strategies for delivering anatomy education in online mode. The factors which determine education strategies are variable across geographical regions. It was perceived that an overview of education strategies around the globe would be useful for anatomists. Hence this narrative review was undertaken to collate observations from different geographical regions pertaining to education strategies adopted during the pandemic. Data relevant to the topic of study were extracted from 12 articles that were selected from an initial pool of 317 articles based on search criteria set for the review. Subtle differences in core education strategies implied that baseline response from anatomists was similar across regions. It was evident that online digital tools were key elements of education strategies adopted by educators for delivering online anatomy classes across the globe. Interestingly, a considerable gap in terms of number and variety of online tools used for anatomy education (those requiring commercial purchase) was noted between economically developed and developing regions. This may have an impact on learning outcome for students and may even lead to variations in anatomical knowledge by regions. It was observed that offline human dissection sessions were incorporated into online practical classes in one region as positive cases showed a declining trend. This positive development is worth emulating elsewhere based on cautious assessment of prevailing situation. From a broad perspective timely introduction of education strategies ensured delivery of anatomy education during the pandemic and gave an evolved outlook to the fabric of anatomy education.

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.

Medical students' perceptions and performance in an online regional anatomy course during the Covid-19 pandemic

The present study evaluated the students' psychological well-being, experiences, performance, and perception of learning regional anatomy remotely. A regional anatomy remote learning curriculum was designed and learning materials were delivered virtually to 120 undergraduate medical students at Jinan University, China. All the students consented and voluntarily participated in this study by completing self-administered online questionnaires including the Zung's Self-Rating Anxiety and Depression Scales at the beginning and end of the learning session. A subset participated in focus group discussions. Most of the students (90.0%) positively evaluated the current distance learning model. More than 80% were satisfied with the content arrangement and coverage. Many students preferred virtual lectures (68.2%) and videos showing dissections (70.6%) during the distance learning sessions. However, writing laboratory reports and case-based learning were the least preferred modes of learning as they were only preferred by 23.2% and 14.1% of the students, respectively. There was no significant lockdown-related anxiety or depression reported by students using depression and anxiety scales as well as feedback from focus group discussions. The surveyed students' confidence scores in distance learning were significantly higher after 5 weeks than at the beginning of the session (3.05 ± 0.83 vs. 3.70 ± 0.71, P < 0.05). Furthermore, the present results showed no significant differences between the current group's academic performance in the unit tests as well as the final overall evaluation for different parts of the course compared to that of the previous year's cohort. The findings above were congruent with focus group discussion data that the use of the online teaching platform for regional anatomy significantly improved the students' confidence in virtual and self-directed learning and did not negatively affect their academic performance.

The value of in-person undergraduate dissection in anatomical education in the time of Covid-19

While several innovative pedagogical practices have been developed and implemented in anatomy education since the onset of the coronavirus disease 2019 (Covid-19) pandemic, considering the value of in-person undergraduate dissection remains crucial. In this commentary, a human dissection course at the University of Toronto is used as an example to highlight the value of dissection for undergraduate learners in non-professional programs. In-person dissection allows for real life, anatomical variation, and supports the advancement of students' conceptual knowledge of the human body and visual-spatial abilities. Direct involvement with dissection during undergraduate training also provides students with an opportunity to practice and refine non-technical skills, such as communication and collaboration, while simultaneously promoting the development of students' professional identity formation. Further, dissection is a practical, hands-on experience that can provide students with insight into potential career aspirations related to anatomy and the health professions. It is suggested that as institutions veer from traditional pedagogical practices and evaluate how to best move forward post-pandemic, it is imperative that the value of undergraduate dissection is considered among new innovations in the field of anatomy.

Musculoskeletal anatomy knowledge in Australian chiropractors

Anatomy is a key knowledge area in chiropractic and is formally offered in the undergraduate component of chiropractic education. There is the potential for loss of anatomy knowledge before the opportunity to apply it in a clinical setting. This study aimed to determine whether chiropractic clinicians retain a level of anatomy knowledge comparable to that of chiropractic students and to compare chiropractors' self-rating of their anatomical knowledge against an objective knowledge assessment tool. A previously validated multiple-choice test was utilized to measure retention of limb musculoskeletal (MSK) knowledge in Australian chiropractors. One hundred and one registered chiropractors completed the questionnaire and responses were scored, analyzed, and compared to scores attained by undergraduate and postgraduate chiropractic students who had previously completed the same questionnaire. The results indicated that practitioners retained their anatomy knowledge, with a significantly higher total mean score than the undergraduate group [total mean score = 36.5% (±SD 13.6%); P < 0.01] but not significantly different to the postgraduate group [total mean score = 52.2% (±SD 14.1%); P = 0.74]. There was a weak positive correlation between chiropractors' self-rated knowledge and test performance scores indicating the effectiveness of this Australian chiropractic group in self-assessing their anatomy knowledge. This study found that Australian chiropractors' knowledge of MSK anatomy was retained during the transition from university to clinical practice and they accurately evaluated their own test performance.

The effect of repetition- and scenario-based repetition strategies on anatomy course achievement, classroom engagement and online learning attitude

Anatomy is known to be the oldest and most fundamental branch among medical sciences. That is the reason why it is given at the beginning of medical education to form the basis for other medical sciences. Students who newly begin medical education need to spare plenty of time outside the course hours to study Anatomy which involves different and a lot of terminology. In this study, online repetitions were done outside the class using the repetition (classical presentation) and scenario-based repetition methods and the knowledge levels, course engagement statuses and online learning attitudes of the students were compared quantitatively and qualitatively between the groups.The study was conducted with 162 medical school year 2 students. These 162 students were randomized to experimental and control groups. The data were obtained with "Anatomy Achievement Test (AAT)", "Classroom Engagement Inventory (CEI)" and "Medical School Students' Attitudes Towards Online Learning Scale (MSSATOLS)". After administering the experimental procedure to the students who were randomized to the experimental and control groups, focus group interviews were held with 16 students from the experimental group, 8 who received the highest scores and 8 who received the lowest scores from the data collecting instruments. The collected research data determined that the affective engagement (AE) and the anatomy achievement test (AAT) performed pre- and post-study were higher in the group in which the scenario-based repetition strategy was applied. AAT pre-test (mean = 27.16) and post-test (mean = 27.15) scores of the repetition group were very close to each other. However, the AAT post-test (mean = 32.33) average of the scenario-based repetition group was above the mean pre-test scores (mean = 26.79) (p < .05). Similarly, the mean AE pre-test (mean = 17.79) and post-test (mean = 17.91) scores of only the repetition group were very close to one another. However, the AE post-test (mean = 19.46) mean score of the scenario-based repetition group was above the mean pre-test score (mean = 17.82) (p < .05). In summary, pre-test and post-test scores changed the anatomy achievement and affective engagement scores, and this change was in favour of experimental group and increasing the post-test scores.The responses given to the questions in the scales and the impressions obtained from qualitative interviews indicated that the students did not find adequate the lectures given in the form of presentations alone and thought that various methods and primarily scenario-based education should be used as part of anatomy education to be able to establish a good connection with clinical sciences and Anatomy education should be provided not only at the beginning of the medical education but also in the following years.

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 the online learning of veterinary anatomy education during the Covid-19 pandemic lockdown in Egypt: Students' perceptions

The sudden shift of veterinary anatomy teaching from traditional to online mode during the coronavirus disease 2019 (Covid-19) pandemic lockdown was a major challenge used for the first time in Egyptian veterinary medical schools. This study aimed to evaluate the students' perspectives regarding the shift of veterinary anatomy teaching to online mode during the lockdown in Egypt. A total of 502 students from all veterinary medical schools in Egypt (n = 17) answered the questionnaire. The results revealed that nearly two-thirds of students felt enthusiastic about studying anatomy online during the pandemic. Moreover, approximately 63% of students were satisfied with the provided learning materials, 66% were able to understand anatomy using the online learning system during the lockdown period, 67% were comfortable with technological skills during their online study, and 47% believed that online learning of anatomy could replace face-to-face teaching. Therefore, despite the problems associated with the emergency switch to remote teaching, it appears to be a suitable alternative in teaching veterinary anatomy in Egyptian universities during this pandemic crisis in Egyptian universities. Moreover, the study provided several measurements to overcome the common problems associated with this challenging method for future application, such as providing three-dimensional virtual tools and electronic devices with either free or low-priced Internet packages, and measuring students' understanding before and after each lecture. This is the first study to solicit the early students' feedback regarding the emergency shift to online veterinary anatomy teaching which might help decision-makers in Egypt for future implementation of online learning of veterinary anatomy.

An analysis of anatomy education before and during Covid-19: August-December 2020

Coronavirus disease-2019 (Covid-19) disrupted the in-person teaching format of anatomy. To study changes in gross anatomy education that occurred during August-December, 2020 compared to before the pandemic, an online survey was distributed to anatomy educators. The 191 responses received were analyzed in total and by academic program, geographic region, and institution type. Cadaver use decreased overall (before: 74.1 ± 34.1%, during: 50.3 ± 43.0%, P < 0.0001), as well as across allopathic and osteopathic medicine, therapy, undergraduate, and veterinary programs (P < 0.05), but remained unchanged for other programs (P > 0.05). Cadaver use decreased internationally and in the US (P < 0.0001), at public and private (P < 0.0001) institutions, and among allopathic medical programs in Northeastern, Central, and Southern (P < 0.05), but not Western, US geographical regions. Laboratories during Covid-19 were delivered through synchronous (59%), asynchronous (4%), or mixed (37%) formats (P < 0.0001) and utilized digital resources (47%), dissection (32%), and/or prosection (21%) (P < 0.0001). The practical laboratory examination persisted during Covid-19 (P = 0.419); however, the setting and materials shifted to computer-based (P < 0.0001) and image-based (P < 0.0001), respectively. In-person lecture decreased during Covid-19 (before: 88%, during: 24%, P = 0.003). When anatomy digital resources were categorized, dissection media, interactive software, and open-access content increased (P ≤ 0.008), with specific increases in BlueLink, Acland's Videos, and Complete Anatomy (P < 0.05). This study provided evidence of how gross anatomy educators continued to adapt their courses past the early stages of the pandemic.

Responding to Covid-19: A thematic analysis of students' perspectives on modified learning activities during an emergency transition to remote human anatomy education

In March 2020, the coronavirus disease 2019 (Covid-19) global pandemic forced many post-secondary institutions to move their teaching online, which had a substantial impact on students enrolled in laboratory-based courses in fields like human anatomy. This descriptive study collected students' perspectives on the transition to remote education, with specific attention to the teaching activities, resources, and assessments used in an undergraduate Clinical Human Visceral Anatomy course at McGill University. Through inductive semantic thematic analysis, student-held values for effective remote education were identified and grouped into the following themes: (1) preferences for communication, (2) values for remote learning activities and resources, (3) values for remote assessment, and (4) perceived positive and negative impacts of remote education on learning. Students generally valued having clear communication, opportunities for both synchronous and asynchronous learning activities, and flexible assessment formats that maintained alignment with the course outcomes and activities. Many felt that remote education had a net-negative impact on their learning, course satisfaction, and sense of community. However, there were no significant differences in grades on laboratory quizzes administered before and after the shutdown (P = 0.443), and grades on the remote final examination were significantly higher than those on the in-person midterm examination (P < 0.001). These findings are discussed in the context of modern educational theories and practices related to remote teaching. Strategies for facilitating a student-centered environment online are also proposed. Future longitudinal research into skill development, learning outcome attainment, and the evolving perspectives of students and instructors operating in remote education contexts is warranted.

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.

Lacunae regarding dearth of dissection-based teaching during COVID-19 pandemic: how to cope with it?

Introduction

In view of the ongoing COVID-19 pandemic, anatomy education programs were amended so as to shift to primarily online mode from physical classes. In the whole process, main concern area that has emerged is regarding dearth of physical human dissection sessions. There is enough evidence available in literature to suggest that dissection room is an ideal place to cultivate and inculcate discipline independent skills or humanistic skills among the students. These include attributes in relation to ethical practice, professionalism, communication skills, empathy and compassion. Imbibing these skills are an essential element of medical education curriculum as it is desirable that students exhibit these traits when they begin medical practice. Hence deficiency in terms of exposure to physical dissection sessions can adversely affect training of medical students on a long term.

Methods

A literature search of relevant, peer-reviewed, published articles was undertaken from indexed databases (Medline and PubMed, Scopus, Embase, CINAHL Plus, Web of Science and Google Scholar) for this study.

Results

To counter the pertinent issue in online anatomy teaching program, a few measures have been suggested in this paper based on identification of actual deficit areas in terms of learning and analysis thereof. Live streaming of real time dissection, awareness sessions on human dissection, online interactive learning sessions and reflective thoughts-based exercise can contribute to building discipline independent skills in present scenario.

Conclusion

Incorporation and implementation of these interventions within the realm of online anatomy education programs during COVID-19 pandemic can possibly contribute towards desirable learning outcomes.

Digital Feast and Physical Famine: The Altered Ecosystem of Anatomy Education due to the Covid-19 Pandemic

This article explores the effects of the coronavirus disease 2019 (Covid-19) pandemic on the evolution of both physical and digital cadavers within the unique ecosystem of the anatomy laboratory. A physical cadaver is a traditional and established learning tool in anatomy education, whereas a digital cadaver is a relatively recent phenomenon. The Covid-19 pandemic presented a major disturbance and disruption to all levels and types of education, including anatomy education. This article constructs a conceptual metaphor between a typical anatomy laboratory and an ecosystem, and considers the affordances, constraints, and changing roles of physical and digital cadavers within anatomy education through an ecological lens. Adaptation of physical and digital cadavers during the disturbance is analyzed, and the resiliency of digital cadaver technology is recognized. The evolving role of the digital cadaver is considered in terms of increasing accessibility and inclusivity within the anatomy laboratory ecosystem of the future.