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

Human cerebral blood supply via circulus arteriosus cerebri: A scoping review on its variations and clinical implications

Background

Circulus arteriosus cerebri (CAC), responsible for supplying blood to the brain, presents anatomical variations that have been associated with both haemorrhagic and ischemic strokes. Therefore, it is crucial to conduct comprehensive investigations and comparisons of the diverse variant components of the CAC, published in various journals, and analyze them to identify individuals at risk of cerebrovascular pathologies, thereby ensuring enhanced and timely treatment.

Methods

A scoping review according to the five-stage protocol by Arksey and O'Malley was performed between February and June 2023. Seven hundred and seventy-seven records were initially identified, and a total of 51 studies were finally included.

Results

This scoping review focuses on the anatomical variations of the CAC and their clinical implications on cerebrovascular disease and includes more original articles than review s. Consistent with previous findings, most of the records included small populations or samples, while only three records reported larger populations. Surprisingly, the populations enclosed in the included records consisted of autopsied cadaveric specimens more than living subjects. Finally, the qualitative analysis highlighted three main themes concerning the relationship between the normal CAC morphology and the cerebrovascular disease onset as well as the variant CAC morphology and its main features that might be also involved in these diseases. Finally, techniques that can be used to measure CAC have also been assessed.

Conclusion

Variations in the CAC, more common in the posterior part, with genetic and environmental factors influencing these variations impact cerebrovascular disorders. Understanding variants components of CAC can aid in improving brain surgeries and post-stroke care.

Challenges in sourcing bodies for anatomy education and research in Ethiopia: Pre and post COVID-19 scenarios

BACKGROUND

The relevance of anatomical dissection in instructing anatomy to medical, dental, and other health science students is indisputable. Ethiopian anatomists encountered challenges in obtaining human bodies for anatomy education and research, both prior to and following the COVID-19 outbreak. The challenges intensified during the pandemic, significantly affecting anatomy education in Ethiopia. This study seeks to investigate the sources of bodies for anatomy, spanning the periods before and after COVID-19, with a particular focus on identifying the primary challenges associated with sourcing of bodies in Ethiopia.

METHODS

Fifty (50) anatomists completed a survey distributed to ten (10) randomly chosen medical institutions in Ethiopia. The survey gathered information on the body profile (number of bodies, age, sex, sources, and methods of body disposal), and the challenges faced during the sourcing of bodies in the years 2018 and 2023.

RESULTS

A total of sixty-three (63) bodies were used by the sampled medical institutions between 2018 and 2023 academic years. All (100%) of the bodies used were unclaimed human bodies. Most (66.7%) of these bodies were males. The majority (65.5%) of these bodies were sourced from Tikur Anbessa hospital in Addis Ababa. None (0%) of the sampled medical institutions had body donation programs. Disposal of human tissues encompassed various methods, including the retention of skeletons, prosection of vital organs, and burial of remaining tissues. Economic constraints and the absence of a legal framework document were the main challenges in acquiring bodies in the pre-pandemic period. The COVID-19 pandemic prevention policies and the civil war further exacerbated the challenges in sourcing of bodies for anatomy dissections during the post-pandemic period.

CONCLUSION

The reliance on unclaimed human bodies for anatomy education and research in Ethiopian medical institutions mirrors a common practice across many African countries. The authors suggest the development of a legislative framework or operational guidelines, coupled with empowering the medical institutions to outsource their own funding that will ultimately lead to an increased number of bodies available for anatomical dissection. Over time, implementation and promotion of body donation programs may also resolve body shortages for anatomy education in Ethiopia.

Immersive virtual reality and augmented reality in anatomy education: A systematic review and meta-analysis

The purpose of this review was to (1) analyze the effectiveness of immersive virtual reality (iVR) and augmented reality (AR) as teaching/learning resources (collectively called XR-technologies) for gaining anatomy knowledge compared to traditional approaches and (2) gauge students' perceptions of the usefulness of these technologies as learning tools. This meta-analysis, previously registered in PROSPERO (CRD42023423017), followed PRISMA guidelines. A systematic bibliographical search, without time parameters, was conducted through four databases until June 2023. A meta-analytic approach investigated knowledge gains and XR's usefulness for learning. Pooled effect sizes were estimated using Cohen's standardized mean difference (SMD) and 95% confidence intervals (95% CI). A single-group proportional meta-analysis was conducted to quantify the percentage of students who considered XR devices useful for their learning. Twenty-seven experimental studies, reporting data from 2199 health sciences students, were included for analysis. XR-technologies yielded higher knowledge gains than traditional approaches (SMD = 0.40; 95% CI = 0.22 to 0.60), especially when used as supplemental/complementary learning resources (SMD = 0.52; 95% CI = 0.40 to 0.63). Specifically, knowledge performance using XR devices outperformed textbooks and atlases (SMD = 0.32; 95% CI = 0.10 to 0.54) and didactic lectures (SMD = 1.00; 95% CI = 0.57 to 1.42), especially among undergraduate students (SMD = 0.41; 95% CI = 0.20 to 0.62). XR devices were perceived to be more useful for learning than traditional approaches (SMD = 0.54; 95% CI = 0.04 to 1), and 80% of all students who used XR devices reported these devices as useful for learning anatomy. Learners using XR technologies demonstrated increased anatomy knowledge gains and considered these technologies useful for learning anatomy.

Anatomical Ignorance Resulting in Iatrogenic Causes of Human Morbidity

This article discusses how inadequate anatomy education contributes to iatrogenic causes of human morbidity and mortality. Through a review of the relevant literature, high-yield clinical cases were identified in which a lack of sufficient anatomical knowledge contributed to patient morbidity, such as abscess formation and neuropathy as a result of improper intramuscular injections, superior gluteal nerve injuries due to surgical procedures, and misdiagnoses due to physicians' inability to examine and correlate clinical and radiological findings. The importance of a multimodal learning approach in anatomy education for medical students, which includes the utilization of the cadaveric dissection approach to emphasize spatial understanding, is crucial for the development of competent physicians with a deep-rooted foundational knowledge of anatomy and related concepts, such as physiology, pathology, and radiology. It cannot be understated that anatomy education and a lack of knowledge of anatomy and related concepts may influence iatrogenic causes of human morbidity and mortality. Therefore, all efforts should be made to ensure that students develop a strong foundational anatomy knowledge during their preclinical years.

Artificial intelligence and clinical anatomical education: Promises and perils

Anatomy educators are often at the forefront of adopting innovative and advanced technologies for teaching, such as artificial intelligence (AI). While AI offers potential new opportunities for anatomical education, hard lessons learned from the deployment of AI tools in other domains (e.g., criminal justice, healthcare, and finance) suggest that these opportunities are likely to be tempered by disadvantages for at least some learners and within certain educational contexts. From the perspectives of an anatomy educator, public health researcher, medical ethicist, and an educational technology expert, this article examines five tensions between the promises and the perils of integrating AI into anatomy education. These tensions highlight the ways in which AI is currently ill-suited for incorporating the uncertainties intrinsic to anatomy education in the areas of (1) human variations, (2) healthcare practice, (3) diversity and social justice, (4) student support, and (5) student learning. Practical recommendations for a considered approach to working alongside AI in the contemporary (and future) anatomy education learning environment are provided, including enhanced transparency about how AI is integrated, AI developer diversity, inclusion of uncertainty and anatomical variations within deployed AI, provisions made for educator awareness of AI benefits and limitations, building in curricular "AI-free" time, and engaging AI to extend human capacities. These recommendations serve as a guiding framework for how the clinical anatomy discipline, and anatomy educators, can work alongside AI, and develop a more nuanced and considered approach to the role of AI in healthcare education.

A comparison of pre- and post-clinical education learning preferences among medical students who elected to dissect compared to those who did not during the COVID-19 pandemic

Anatomy instructional methods varied widely during the COVID-19 pandemic and programs are assessing innovations for retention. Learning preferences were assessed among medical students dichotomized as elective dissectors (ED) or non-dissectors (ND) during the COVID-19 partial re-opening in 2020 (preclinical) and again in 2022 after clinical exposure (post-clinical) to assess the viability of elective dissection post-pandemic. A mixed-method approach was used for the assessment of test scores, learning preference surveys, learning activities rankings, and thematic analyses. No significant differences occurred in anatomy examination scores. Dissection was considered useful by both preclinical groups but significantly more so by ED, while the presence of an instructor was significantly preferred by ED although a majority of ND agreed. Elective dissection was significantly preferred by ND but also by a large minority of ED students. Pre- and post-clinical ND believed that elective dissection offered more academic flexibility, did not hinder clinical learning, and did not negatively impact medical education. The corresponding ED stated that confidence improved, clinical experiences were enhanced, and dissection was irreplaceable. Preclinical ND preferred self-learning, while ED students preferred online learning, but these differences largely disappeared post-clinically. Learning activity rankings were not significantly different among all groups (ND, ED, preclinical, and post-clinical). A hybrid laboratory with a virtual learning environment ranked highest across groups and preferences increased over time suggesting that students benefited from this instructional method during clinical exposure. The absence of laboratory experience ranked lowest, and preference decreased over time suggesting that anatomy dissection is valued.

The current state of anatomy education in United States doctor of physical therapy programs

Physical therapy education has significantly evolved over the past few decades. While gross anatomy is integral to physical therapy education curricula, the current state of anatomy education within these programs is not well understood. The primary purpose of this report was to provide an update on the current state of anatomy education across United States (US) Doctor of Physical Therapy (DPT) programs. A survey was disseminated to all 261 accredited US physical therapy programs. The survey was deployed in November 2020 with a deadline to respond by January 15, 2021. The response rate was 32.6% (85/261). When teaching anatomy, 90.5% of the responding programs used dissection, 71.4% used didactic lectures, 60.7% used computer-assisted technology, 58% used prosections, 23.8% used plastinated models, and 31% reported using other methods. DPT programs have experienced declines in PhD faculty (15.7%) and Master of Physical Therapy faculty (15.3%) and notable increases in DPT (16.5%) and physician faculty (8.2%) teaching anatomy within DPT programs. Despite greater use of computer-assisted technologies, these technologies have not replaced donor-based dissection in DPT programs.

Chinese anatomy educators' perceptions of blended learning in anatomy education: A national survey in the post-COVID-19 era

Blended learning, which combines face-to-face lectures with online learning, has emerged as a suitable teaching approach during the COVID-19 pandemic. This study used a national survey of anatomy educators in Mainland China to evaluate the changes in the implementation of blended learning in anatomical pedagogy. A total of 297 responses were collected from medical schools across all provinces. Respondents included 167 males and 130 females, with an average age of 44.94 (±8.28) and average of 17.72 (±9.62) years of professional experience. The survey showed adoption of online teaching and assessment by Chinese anatomy educators increased by 32.7% and 46.8%, respectively, compared to pre-pandemic levels. Perceptions of blended learning outcomes varied, with 32.3% and 37% educators considering it superior and inferior to traditional teaching, respectively. Faculty training programs related to blended learning increased significantly, fostering a collaborative learning environment; however, challenges remained in achieving satisfactory online assessment outcomes. Anatomy educators' attitudes reflected a strong preference for classroom learning (4.941 ± 0.856) and recognition of the importance of relevant technology (4.483 ± 0.954), whereas online learning received lower acceptance (4.078 ± 0.734). Female anatomy teachers demonstrated effective time management in online teaching. Meanwhile, educators with over 15 years of experience encountered difficulties with relevant technology, consistent with negative attitudes toward blended learning. Overall, this survey highlights the persistent challenges in implementing blended learning in anatomy education and provides insights for enhancing the pedagogical model in the post-COVID-19 era.

Blended learning in undergraduate dental education: a global pilot study

AIMS

To explore the global trends in blended learning in undergraduate dental education during the COVID pandemic and during the recovery phase by engaging with the students and faculty and evaluate the implications for dental education in the post-COVID era.

METHODS

It was a pilot cross-sectional study which employed a convenience sampling technique to recruit representatives of dental faculty and undergraduate students in 80 dental institutions globally. A previously validated questionnaire consisting of a combination of closed and open-ended items was used for data collection. Responses to these online questionnaires were processed and analysed using the R statistical computing environment.

RESULTS

A total of 320 dental students and 169 faculty members from 47 different dental institutions participated in the study. Video and Live Online Tutorials were considered to be the most effective method of online learning followed by online question banks by both groups. Significant differences were noted between faculty and students regarding time spent and effectiveness of online teaching and learning, respectively, both before and after the start of COVID. The results highlight the faculty need to engage more closely with the students to address their learning needs. Finally, the participants provided several recommendations regarding the future development of teaching and learning strategies as well as assessments in the post-pandemic era.

CONCLUSIONS

This is the first study which explores blended learning in dental education with participants from multiple institutions in different regions of the globe. Compared to the faculty, students considered online learning to be less interactive and preferred learning activities and all assessments to be delivered face-to-face. The results underscore the need to adapt teaching practices to suit the learning needs of the students.

Educator perspectives on non-technical, discipline-independent skill acquisition: An international, qualitative study

Gross anatomy education utilizing body donors and human specimens assists the acquisition of non-traditional, discipline-independent skills (NTDIS) such as teamwork, communication, and leadership. Alterations to anatomy curricula, such as those resulting from the COVID-19 pandemic, likely impact NTDIS acquisition, yet how this manifests is unclear. This study, therefore, explored anatomy educator perspectives on NTDIS acquisition as a response to changes in teaching delivery. Gross anatomy educators across different countries were recruited and took part in one-on-one, semi-structured interviews that were audio recorded and transcribed. Data were analyzed using the framework method. Basic statistical analyses were performed on demographic and categorical data. Fifteen educators from five continents were interviewed (average length 32.5 min, range 17-51 min). Educator experience ranged from 0-4 years (n = 3) to 20+ years (n = 7). Most taught using dissection (n = 14) with prosection use (n = 13) also common. Themes relating to NTDIS included expected content (respect for donors, teamwork, communication skills, humanistic values), assessable content, assessment challenges, and impact of curriculum changes; NTDIS unique to anatomy education included cultural, ethical, and social considerations around dead bodies, including boundaries, and social norms. Informed by curriculum alterations during the COVID-19 pandemic, this first empirical study of anatomy educator perspectives on NTDIS highlights the potentially adverse educational impacts of decreased interaction with body donors and human specimens on NTDIS acquisition and difficulties with NTDIS assessment. Findings support gross anatomy education as unique in providing NTDIS that cannot easily be replicated elsewhere. Recommendations around NTDIS-specific educator competencies and promoting NTDIS are provided.

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.

Distance versus face-to-face education of gross anatomy for dental hygiene students: Perceptions and academic achievements of learners

The provision of distance education has increased rapidly over the past few years owing to the COVID-19 pandemic. The core of gross anatomy distance education is three-dimensional (3D) visualization of anatomical structures, and the use of simple 3D visualization tools has increased as distance education has become more popular. The purpose of this study was to establish a more effective operation plan in dental hygiene by investigating learners' opinions about distance education of gross anatomy and 3D visualization tools, and by comparing and analyzing their academic achievements. The study involved 250 students and comprised an analysis of 120 students who took a head and neck anatomy class at the Department of Dental Hygiene at D University via distance learning during 2020-2022, and 130 graduates who had completed the class via face-to-face learning during 2015-2017. An online survey of 120 of the enrolled students comprised 10 questions asking for opinions on the head and neck anatomy distance learning classes, five questions on the 3D visualization tool, and five on general characteristics. Overall, the learners had positive perceptions of distance education for head and neck anatomy and the 3D visualization tool. Among the education methods compared, they generally preferred blended learning (n = 47, 39.2%). There was a significant preference for the distance learning method of asynchronous classes (n = 86, 94.5%). Analysis of academic achievements according to whether or not distance education was conducted revealed a significantly higher score in the face-to-face class group (P < 0.05). A blended learning method can be effective in increasing learner satisfaction and improving academic achievement in gross anatomy classes on dental hygiene. It is suggested that theoretical material should be learned through asynchronous content and knowledge expanded through small-group activities during face-to-face learning. This will help establish a standard model for teaching of gross anatomy in dental hygiene in the postpandemic era.

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.

Commentary: Is There a Lack of Insight on the Anatomy Teaching Adaptations Made by "Cadaver-Free" Medical Schools in Response to the COVID-19 Pandemic?

The COVID-19 pandemic negatively impacted anatomy education as it ceased face-to-face anatomy teaching sessions and laboratory practicals. In the past 2 years, a growing body of literature has been dedicated to the adaptations made in the teaching of anatomy predominantly by medical schools who employ cadaveric dissection and prosection-based practicals to teach anatomy. Despite this, there is dearth of evidence in terms of the challenges that medical schools who do not use cadaveric dissection or prosected specimens to teach anatomy faced as well as the adaptations they made in response to the pandemic.

Assessment of Factors That Students Perceive to Affect Their Virtual Learning of Clinical Skills for OSCE

Purpose

Objective Structured Clinical Examination (OSCE) is a vital examination that must be passed to graduate as a qualified doctor. The delivery of OSCE teaching was changed to an online format to accommodate COVID-19 restrictions. Therefore, this study evaluates factors that students perceive to affect their virtual learning of clinical skills for OSCE.

Methods

In this cross-sectional study, all medical students from across the world who attended "The Respiratory Station" session delivered by OSCEazy (a medical student organization providing free online medical education) in the academic year 2020-2021 received an online questionnaire about their perceptions of this learning opportunity. The survey was created on Google™ forms and consisted of 5-point Likert scales as well as free-text boxes.

Results

A total of 556 responses were received (mean age: 24, female: 76.6%). Most students agreed that online OSCE teaching offers more flexibility and convenience (median: 5, IQR: 4-5) but their likeliness to ask questions in either format was similar (median: 4, IQR: 3-5 vs median: 4, IQR: 3-4, p value: 0.94). The use of visual aids (median: 5, IQR: 4-5) and breakout rooms (median: 3, IQR: 2-4) were thought to enhance the quality of virtual OSCE teaching. The biggest concern about online teaching was access to a stable internet connection (69.1%).

Conclusion

The flexibility and convenience of virtual OSCE teaching enables the sharing of knowledge and skills to a wider audience and thus may be a very useful adjunct to face-to-face OSCE teaching in the future.

Online education for prosthetics and orthotics students in the era of COVID-19 pandemic in Iran: challenges, opportunities, and recommendations

INTRODUCTION

With the advent of the COVID-19 pandemic, many higher education programs in Iran, including prosthetics and orthotics (P&O), had to shift to the online environment all at once. This unanticipated transition was challenging for the educational system. However, online education is superior in some aspects to conventional methods, and this situation may offer opportunities. This study was carried out from September 2021 to March 2022 to investigate the challenges and opportunities of online education in the P&O sector in Iran based on the opinions of students and faculty members. Relevant recommendations will also be discussed.

METHODS

In this qualitative study, semi-structured interviews were conducted in both oral and written formats. Purposive and snowball sampling techniques were used to recruit undergraduate and postgraduate P&O students, as well as P&O faculty members, for this qualitative study. The data gathered from interviews with study participants were analyzed by thematic analysis.

RESULTS

Based on the data analysis, many sub-themes of the three main themes were recognized: (1) challenges: technical, socioeconomic, environmental distractors, supervision and evaluation, workload, digital competence, interactions, motivation, sessions-related issues, class time, hands-on and clinical training; (2) opportunities: technological innovations, infrastructure development, flexible learning environment, student-centered learning, availability of contents, time and cost saving, high concentration, more self-confidence; (3) recommendations: technical infrastructure, team dynamics, hybrid courses, time management, awareness.

CONCLUSION

Online education of P&O during the era of the COVID-19 pandemic was accompanied by a series of challenges. Technical issues and the gravity of hands-on training in this field were significant challenges. This era, however, provided the opportunity to facilitate the establishment of needed infrastructure and support technological innovations for online education. Considering hybrid (mixed online and on-site) courses was recommended to improve the quality of learning.

The freedom to teach (at the best)

Over the past decades, biomedical education has changed considerably, mostly by the introduction of novel didactic strategies, as well as the addition of technology. As a consequence, the centuries-old lecture-style presentation has come under criticism for providing only a one-directional transfer of information. However, the delivery of traditional lectures has also seen considerable changes such as the use of Microsoft PowerPoint slides which can be projected and serve as lecture handouts to learners. Electronic technologies and the internet now allow for the permanent recording of lectures and the distribution of video recordings to students who are unable or choose not to attend lectures in person. This off-site consumption of lecture presentations can either be synchronous or, if the recorded videos are made available online, asynchronous. At the beginning of the Covid-19 pandemic, most schools were forced to change all lecture-style instruction to an online format. With students returning to classroom teaching, schools, and educators have to make a decision whether to offer online lecture recordings permanently, reintroduce in-person lecture presentations, or compromise on a combination of both. Each solution has its own advantages and disadvantages, some of which are discussed in this article. However, there appears to be no single 'best solution' to serve all learners, educators, and educational needs.

"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.

In the eye of the beholder - how course delivery affects anatomy education

BACKGROUND

The COVID-19 pandemic caused major shifts in students' learning strategies as well as teaching environments that profoundly affected the delivery of anatomy courses in medical schools. The Department of Anatomy at the University of Zagreb School of Medicine had a unique experience where the anatomy course in 2019/2020 was first taught in-person before transferring to an online course delivery, while the inverse happened in 2020/2021. The core curriculum, course material and examination criteria were the same in both academic years. The aim of the study was to determine whether course delivery affected students' perceptions of the course and whether it impacted students' engagement and success.

METHODS

The students' perceptions of the course were assessed via an anonymous course survey (student evaluation of teaching, SET). The questions in the SET assessed the usefulness of teaching modalities rather than students' satisfaction. Most questions were in the form of statements to which students responded with their level of agreement on a five-point Likert scale. Differences between responses in 2019/2020 and 2020/2021 were analyzed using the Mann-Whitney test. Effect size was estimated using Cliff's delta and association between responses was assessed using Spearman's r coefficient.

RESULTS

Students' perceptions were significantly affected by changes in course delivery. Students' success and engagement were higher in 2019/2020 when in-person teaching preceded online teaching. Furthermore, students' views on course organization and the usefulness of continuous assessment were more positive in 2019/2020. Finally, students' perceptions of the usefulness of online materials and activities were more positive in 2019/2020. All comparisons between the two academic years were statistically significant (P ≤ 0.0001 for all comparisons, Mann-Whitney test).

CONCLUSIONS

Students' perceptions of the anatomy course were dependent on the teaching environment they were exposed to at the beginning of the course. A transfer from in-person to online course delivery was more successful than vice-versa. This has important implications for structuring hybrid courses in medical education in the future.

Evaluating the knowledge acquisition of lower limb anatomy among medical students during the post-acute COVID-19 era

Anatomy is the foundation of many medical and surgical specialties yet knowledge acquisition and retention among medical students is questionable. Over the years the anatomy teaching environment and teaching modalities have changed, even more so with the onset of the COVID-19 pandemic and the shift to a virtual environment. The aim of this study was to evaluate the knowledge acquisition of applied musculoskeletal lower limb clinical anatomy among first year medical students in Malta following the transition back to face-to-face lectures. The Kahoot online game-based quiz platform was used through a best out of four multiple-choice setting across four sessions. Scores generated by the platform along with frequencies of correctly answered questions were utilized to measure knowledge acquisition. The average scores for each question across sessions were statistically analyzed using ANOVA and student's t-test accordingly. Across the four sessions, the positive percentage response for clinical based questions remained higher than for pure anatomy questions. Anatomy knowledge acquisition appears to be subjective to clinical based knowledge rather than pure anatomy. There may be a plethora of reasons as to this outcome including the misconception that anatomy is not essential for clinical practice as well as the potential aftermath of the COVID-induced virtual learning environment. Further research is merit to ensure that students are provided with the best tools to enhance their knowledge acquisition, both as students and as future doctors.

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.

Shifting online during COVID-19: A systematic review of teaching and learning strategies and their outcomes

This systematic literature review of 36 peer-reviewed empirical articles outlines eight strategies used by higher education lecturers and students to maintain educational continuity during the COVID-19 pandemic since January 2020. The findings show that students' online access and positive coping strategies could not eradicate their infrastructure and home environment challenges. Lecturers' learning access equity strategies made learning resources available asynchronously, but having access did not imply that students could effectively self-direct learning. Lecturers designed classroom replication, online practical skills training, online assessment integrity, and student engagement strategies to boost online learning quality, but students who used ineffective online participation strategies had poor engagement. These findings indicate that lecturers and students need to develop more dexterity for adapting and manoeuvring their online strategies across different online teaching and learning modalities. How these online competencies could be developed in higher education are discussed.

Anatomy education beyond the Covid-19 pandemic: A changing pedagogy

The coronavirus disease 2019 (Covid-19) pandemic has induced multifaceted changes in anatomical education. There has been a significant increase in the employment of digital technologies coupled with the upskilling of educators' capacity and altered attitudes toward the digitalization process. While challenges remain, learners have demonstrated capabilities to adapt to digital delivery, engagement and assessment. With alternative and innovative teaching and learning strategies having been trialed and implemented for almost two years, the key question now is what the pedagogy will be for anatomy education beyond the pandemic. Here we discuss some of the changes in anatomy education that have taken place as a result of the Covid-19 pandemic and importantly present some outlooks for evidence-based anatomy pedagogy as the world enters the post-pandemic phase and beyond. The authors conclude that the anatomy discipline is ready to further modernize and has the opportunity to use digital technologies to evolve and enhance anatomy education to ensure students are provided with the learning experience which will prepare them best for the future.

Feedback from medical student on an interactive online anatomy practical using the Google Jamboard platform

Objective

The disruption caused by COVID-19 in anatomy education has forced the transition of in-person to online learning. Despite the increasing use of technology-enhanced tools in online classes, anatomy lecturers face significant difficulty in making classes interactive. Hence, this study explored the feasibility of a web-based virtual whiteboard, Google Jamboard (GJ) for two online anatomy practical classes.

Methods

This was a qualitative phenomenology study conducted on 116 second-year medical students from two Malaysian public universities via teleconferencing applications that allowed synchronous small-group activities. Each group was given a different link to 10 GJ slides that featured plain anatomy diagrams and instructions for the group task. Upon completion of the tasks, the students presented their tasks to the whole class. An online feedback form was distributed at the end of the practical session to explore the experience of the students when using the tool.

Results

Thematic analysis of student responses generated seven themes that reflected perceived learning benefits, challenges faced by the students, and suggestions for future improvement.

Conclusions

These findings suggest that GJ is a useful tool for promoting collaborative learning in virtual anatomy education. Nevertheless, the impact of this tool on the attainment of learning outcomes remains unknown. Hence, more widescale research is needed to confirm our findings.

The ethical use of digital technology in teaching anatomy: A southern African perspective

BACKGROUND

The use of 21st Century technology in anatomy teaching and the recent crisis caused by the Coronavirus pandemic has stimulated anatomists to ponder the ethics surrounding the utilisation of digital images from human bodies of known and unknown provenance in teaching.

AIM

This novel study explores the awareness of southern African anatomy educators regarding the provenance and ethical use of human material in digital resources for E-learning purposes.

MATERIALS AND METHOD

Anatomy educators (both members and non-members of the Anatomical Society of Southern Africa including postgraduate students in anatomy) located in 15 health sciences facilities in southern Africa were asked to participate in the survey which consisted of an anonymous, cross-sectional, questionnaire conducted on an online research data system, REDCap.

RESULTS

While 52% of respondents used E-learning resources sourced from their own departments for teaching, only 58% of these had knowledge of the provenance of the human material used. Of the 72% of respondents using images from external E-learning resources, 64% did not know the provenance of the human material in these resources. Some southern African anatomists considered anonymity as equivalent to informed consent. Regarding the acceptability of unclaimed bodies for online images, 37% of respondents were against the use of these bodies, while 20% indicated that it was acceptable. Personal internal moral conflict was acknowledged regarding the use of material from unclaimed bodies, particularly during crises such as the Coronavirus pandemic when digital resources were limited.

DISCUSSION AND CONCLUSIONS

Factors such as lack of awareness of provenance, the law in South Africa and using anonymity for consent, influence the ethical behaviour of southern African anatomists. Clear guiding principles would be of value for anatomists globally with respect to consent to the taking and distribution of images, and transparency on the source of the digital images provided in digital texts and online platforms. The establishment of both an oversight and ethics committee at institutions where digital imaging will be used is recommended.

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".

Life Satisfaction and Perceived Stress versus Health Promoting Behavior among Medical Students during the COVID-19 Pandemic

AIM

The aim of this study was to evaluate health-promoting behaviors as a factor supporting life satisfaction and a protective factor against stress in a group of Polish medical students during the third wave of the SARS-CoV-2 pandemic.

MATERIAL

The study was conducted in October-December 2021. There were 306 people, including 203 students in the 1st year of medicine, aged 20.42 ± 1.92 years, and 103 students in the 5th year of medicine, aged 24.88 ± 1.7 years.

METHODS

The following were used: the Satisfaction with Life Scale (SWLS), the Health Behavior Inventory (IZZ), and the Perceived Stress Scale (PSS-10). The survey was conducted online.

RESULTS

In the study group, the average result of 23.66 ± 5.97 was obtained in the life satisfaction questionnaire. In the overall assessment of health behaviors (IZZ), an average score of 80.06 ± 13.81 points was obtained. In the PSS-10 questionnaire, the respondents obtained an average of 21.10 ± 5.89 points. There were significant, negative correlations between the results obtained in the health behavior inventory with the results obtained in the stress scale and positive correlations with the results obtained in the life satisfaction scale. Moreover, in the assessment of the influence of prohealth behavior parameters on perceived stress and life satisfaction, a positive effect of PMA on life satisfaction was demonstrated, as well as a protective effect of Positive Mental Attitude (PMA) and Prohealth Activities (PhA) in relation to stress.

CONCLUSIONS

Life in the period of the third wave of the pandemic was assessed by medical students as moderately satisfactory. Significant intensity of stress negatively correlated with life satisfaction. Health-promoting behaviors, and especially positive mental attitudes, seem to play a protective role in stressful situations and improve life satisfaction.

Perspectives of online anatomy teachers: A neglected study population struggles with the invisible student

Online teachers are an under-researched population, but their perspectives are crucial to the successful implementation of online education. A fully online section of an established face-to-face (F2F) two-semester undergraduate anatomy course with a prosection laboratory commenced in 2012 at The University of Western Ontario, Canada. Professors' lectures for F2F students were broadcast in live and archived format to online students using Blackboard Collaborate (BBC) video conferencing software. Teaching assistants (TAs) delivered online laboratories using BBC and three-dimensional (3D) anatomical computer models. This study explored the common experiences and issues faced by the course teachers from 2012 to 2014. Transcripts from open-ended, individual interviews with professors (n = 4) and TAs (n = 5) were coded and analyzed thematically. The teachers' concern for their inability to see the students during sessions to assess class engagement and their teaching effectiveness, and to develop social relationships, was the main finding. However, video conferencing software and email were sufficient communication methods for the students' questions and the teachers' answers. The TAs noted usability challenges and anatomical inaccuracies in the 3D models compared to cadavers. Due to limitations of BBC's screen sharing function, live manipulation for the 3D computer models was not possible; however, the TAs found pedagogical value in using screen captures of the models for drawing activities with the students. Overall, preparation time for teaching online was longer than for F2F. The study's findings provide science educators with issues to consider when preparing for online teaching and recommendations to optimize the teaching experience.

Cadaveric and Ultrasound Validation of Percutaneous Electrolysis Approaches at the Arcade of Frohse: A Potential Treatment for Radial Tunnel Syndrome

Entrapment of the radial nerve at the arcade of Frohse could contribute to symptoms in patients with lateral epicondylalgia or radial tunnel syndrome. Our aim was to determine the validity of applying percutaneous electrolysis, targeting the supinator muscle at the Frohse’s arcade with ultrasound imaging and in a Thiel-embalmed cadaver model (not ultrasound-guiding). Percutaneous electrolysis targeting the supinator muscle was conducted in five healthy volunteers (ultrasound study) and three Thiel-embalmed cadaver forearms. Two approaches, one with the forearm supinated and other with the forearm pronated were conducted. The needle was inserted until the tip reached the interphase of both bellies of the supinator muscle. Accurate needle penetration of the supinator muscle was observed in 100% in both US-imaging and cadaveric studies. No neurovascular bundle of the radial-nerve deep branch was pierced in any insertion. The distance from the tip of the needle to the neurovascular bundle was 15.3 ± 0.6 mm with the forearm supinated, and 11.2 ± 0.6 mm with the forearm pronated. The results of the current study support that percutaneous electrolysis can properly target the supinator muscle with either the forearm in supination or in pronation. In fact, penetration of the neurovascular bundle was not observed in any approach when percutaneous needling electrolysis was performed by an experienced clinician.