Influences on anatomical knowledge: The complete arguments

The need to identify anatomy-related competencies in medical education

A profound grasp of anatomy is indispensable for shaping competent and safe medical practitioners. This knowledge acquisition is pivotal in the early stages of medical education and remains crucial throughout clinical training. However, the evolving landscape of medical education has ushered in changes to the anatomy curriculum, marked by a reduction in contact hours and a streamlined content structure to accommodate novel subjects and teaching methodologies. This transformation has precipitated a quandary in defining the essential scope and depth of anatomical knowledge to be imparted. Traditionally, surgeons assumed the role of anatomy instructors until Flexner's recommendations catalyzed the integration of trained anatomists. Nevertheless, the varied backgrounds of anatomists and the heterogeneity in anatomy curricula across institutions have introduced potential disparities in the quality of graduates. Addressing these challenges mandates the identification of key anatomy competencies tailored for undergraduate medical students. The imperative lies in ensuring that these competencies span cognitive, psychomotor, and affective domains, offering not only comprehensiveness but also direct applicability to clinical practice. Hence, this viewpoint highlights the necessity of adopting a systematic approach that includes gathering input from various stakeholders in developing and implementing a universal anatomy core competency framework, ensuring graduates are equipped for the multifaceted demands of clinical practice. Overall, the manuscript provides a comprehensive overview of the challenges and opportunities in anatomy education, with a clear call to action for a transformative approach to meet the evolving needs of medical practice.

Enhancing Anatomy Education Throu€gh Flipped Classroom and Adaptive Learning A Pilot Project on Liver Anatomy

OBJECTIVES

Anatomy education plays a critical role in medical practice, and the level of anatomical knowledge among students and physicians significantly impacts patient care. This article presents a pilot project aimed at exploring the effectiveness of the Area9's Rhapsode platform, an intelligent tutoring system that uses artificial intelligence (AI) to personalize learning and collect data on mastery acquisition.

METHODS

The study focused on liver anatomy (microscopic and macroscopic anatomy, embryology, clinical anatomy) and employed a flipped classroom approach, incorporating adaptive learning modules and an interactive in-class session. A total of 123 first-year medicine students (55 M/68F) participated to the study. Content and resources of the module were adaptable to various digital devices. Statistics were compiled based, on the one hand, on the measurement of mastery for every single learning objective provided automatically by the platform via the student interactions with the system probes (questions); on the other hand, metacognition data were worked out by crossing mastery data with the self-awareness declared in every question and learning resource by each learner.

RESULTS AND CONCLUSIONS

At the outset of the study, students displayed a 18.11% level of conscious incompetence and a 19.43% level of unconscious incompetence. Additionally, 50.86% of students demonstrated conscious competence. By the conclusion of the learning module, the level of conscious incompetence had decreased to 1.87%, and 98.73% of students exhibited conscious mastery of the materials. The results demonstrated improved learning quality, positive repurposing of study time, enhanced metacognitive awareness among students, with most students demonstrating conscious mastery of the materials and a clear understanding of their level of competence. This approach, by providing valuable insights into the potential of AI-based adaptive learning systems in anatomy education, could address the challenges posed by limited teaching hours, shortage of anatomist, and the need for individualized instruction.

Focus on evidence-based anatomy in contemporary anatomy education: Arguments in favor of a pragmatic approach

The concept of evidence-based anatomy (EBA) emerged in 2014 and has become a significant element in contemporary anatomy education. The evolving fabric of the medical education curriculum has necessitated critical changes in practice. EBA enables these changes to be incorporated seamlessly and implemented congruently into anatomy education programs. However, in parallel, non-evidence-based (classical) knowledge that has been built up through centuries of anatomical practice continues to be the core element of anatomy education in some countries/regions. Its inherent limitations hinder integration with clinical practice, leading to a rise in misadventures in the clinical setting. This viewpoint commentary highlights the strengths of EBA vis-à-vis the related attributes of classical anatomy. Appropriate arguments show that EBA helps to reduce cognitive load and enables knowledge to be delivered through innovative education tools. EBA also helps to create an inclusive learning environment in a technology-driven era. Moreover, empowered by robust resources, it is driving the pertinent amalgamation of anatomy knowledge with clinical practice. This viewpoint article endorses the adoption of EBA in contemporary anatomy education on the basis of its potential for shaping future anatomical practice.

Essential anatomy for core clerkships: A clinical perspective

Clerkships are defining experiences for medical students in which students integrate basic science knowledge with clinical information as they gain experience in diagnosing and treating patients in a variety of clinical settings. Among the basic sciences, there is broad agreement that anatomy is foundational for medical practice. Unfortunately, there are longstanding concerns that student knowledge of anatomy is below the expectations of clerkship directors and clinical faculty. Most allopathic medical schools require eight "core" clerkships: internal medicine (IM), pediatrics (PD), general surgery (GS), obstetrics and gynecology (OB), psychiatry (PS), family medicine (FM), neurology (NU), and emergency medicine (EM). A targeted needs assessment was conducted to determine the anatomy considered important for each core clerkship based on the perspective of clinicians teaching in those clerkships. A total of 525 clinical faculty were surveyed at 24 United States allopathic medical schools. Participants rated 97 anatomical structure groups across all body regions on a 1-4 Likert-type scale (1 = not important, 4 = essential). Non-parametric ANOVAs determined if differences existed between clerkships. Combining all responses, 91% of anatomical structure groups were classified as essential or more important. Clinicians in FM, EM, and GS rated anatomical structures in most body regions significantly higher than at least one other clerkship (p = 0.006). This study provides an evidence-base of anatomy content that should be considered important for each core clerkship and may assist in the development and/or revision of preclinical curricula to support the clinical training of medical students.

Anatomy in the daily practice of the gynecologist, essential or just window dressing?

Traditionally, anatomy was one of the basic pillars of medical training. However, due to the expansion of medical science and medical knowledge in general, anatomy teaching has steadily declined and the way anatomy is taught has changed. These changes go hand in hand with growing literature about a perceived and proven lack of anatomical knowledge. While anatomy is important for all doctors, these developments seem to be more worrying for surgical residents. At the same time, little is known about how clinicians use anatomy in daily practice. The primary aim of this study was to increase understanding of the role of anatomy in the daily practice of gynecologists. An explorative qualitative study was performed to answer the question "What is the tangible utility of solid anatomical knowledge in the daily practice of the gynecologist"? Semi-structured interviews with gynecologists and obstetrics and gynecology (ObGyn) residents from Belgium and the Netherlands were held and the responses were analyzed using a phenomenographic inductive coding approach. Anatomical knowledge was important and used for technical skills and non-technical achievements in the daily practice of gynecologists, and three themes were distinguished. Specifically, anatomical knowledge was important and used (1) for daily activities, (2) for the feeling of self-efficacy, and (3) to gain a respected name as a doctor. These findings are discussed in light of (perceived) insufficient anatomical knowledge, and recommendations are made for the postgraduate education of ObGyn doctors.

A core musculoskeletal anatomy syllabus for undergraduate physical therapy student education

Knowledge of musculoskeletal anatomy is fundamental to physical therapy education. Although detailed anatomy syllabi have been developed for medical and other health professional students, none are available for training physical therapists. Therefore, the aim of this project was to produce a core musculoskeletal anatomy syllabus specific to physical therapy students, utilizing a modified Delphi approach. An international Delphi panel (n = 53) composed of anatomists and clinicians involved in physical therapy education considered a total of 2193 anatomical items arranged in four categories (musculoskeletal concepts; vertebral column; pectoral girdle and upper limb; pelvic girdle and lower limb). Using specific criteria, items were rated on the basis of whether they were considered essential knowledge for a competent physical therapy student, and were categorized as core, recommended, not recommended or not core. Of the 2193 items, 1700 (77.5%) were rated as core or recommended. For musculoskeletal concepts, 70% (233/332) of items were categorized as core/recommended. Approximately 80% of items in the other three categories were considered core/recommended-vertebral column (355/440), pectoral girdle and upper limb (513/657), and pelvic girdle and lower limb (599/764). This project presents a detailed musculoskeletal anatomy syllabus which may be used within a physical therapy curriculum. A key difference compared to published musculoskeletal anatomy syllabi for medical students is that a greater number of items are considered core/recommended (approximately 80% vs. 50%). These findings will now be considered and deliberated in accordance with the International Federation of Associations of Anatomists modified Delphi approach.

Improving Medical Student Anatomy Knowledge and Confidence for the Breast Surgical Oncology Rotation

BACKGROUND

The anatomy curriculum has undergone considerable reductions in class time, resulting in decreased student anatomical knowledge retention and confidence during their surgical rotations. To counter this deficit in anatomy knowledge, a clinical anatomy mentorship program (CAMP) was developed by fourth-year medical student leaders and staff mentors in a near-peer teaching fashion prior to the surgical clerkship. This study analyzed the impact this program had on third-year medical students (MS3s) self-assessed anatomical knowledge and confidence in the operating room on the Breast Surgical Oncology rotation after this near-peer program.

METHODS

A single-center prospective survey study was performed at an academic medical center. Pre- and post-program surveys were administered to all students who participated in the CAMP and rotated on the breast surgical oncology (BSO) service during the surgery clerkship rotation. A control group of individuals who did not rotate on the CAMP was established, and this group was administered a retrospective survey. A 5-point Likert scale was used to assess surgical anatomy knowledge, confidence in the operating room, and comfort in assisting in the operating room. Control group versus post-CAMP intervention group and pre- versus post-CAMP intervention groups survey results were compared using the Student's t-test with a p-value of <0.05 statistically significant.

RESULTS

All CAMP students rated their surgical anatomy knowledge (p < 0.01), confidence in the operating room (p < 0.01), and comfort in assisting in the operating room (p < 0.01) as greater than those who did not participate in the program. Additionally, the program improved the ability of third-year medical students to prepare for operating room cases going into their third-year breast surgical oncology clerkship (p < 0.03).

CONCLUSIONS

This near-peer surgical education model appears to be an effective way to prepare third-year medical students for the breast surgical oncology rotation during the surgery clerkship by improving anatomic knowledge and student confidence. The program can serve as a template for medical students, surgical clerkship directors, and other faculty interested in efficiently expanding surgical anatomy at their institution.

An Overview of Traditional and Advanced Visualization Techniques Applied to Anatomical Instruction Involving Cadaveric Dissection

This work provides an overview of the role, basic concepts, significance, and instructional contributions of current and evolving digital visualization technologies being applied in first-year anatomy curricula. These are visualization methods that have been and are being used to support both basic science and clinical applications of gross anatomical teaching and learning to the health professions (i.e., medical, dental, physical therapy, chiropractic and nursing students). It first presents a foundation as to how this discipline has been and is being taught within the professional school environment using visualization and illustration: aspects of learning, the format of the first-year anatomy curriculum, the nature of the visual information network in support of educational excellence and newer opportunities afforded by advanced technologies placing the student at the center of the learning experience. Then, the nature of each of these new methods is presented with their individual unique characteristics, and the results that anatomy faculty running cadaveric dissection courses had with the evaluation of the new technologies.The Conclusion section lists key points found in the literature as reported. Finally, the Future Work section proposes investigations into standardizing the presentation and assessment of anatomical concepts using prominent in situ structures of viscera, their enclosures and resident compartments for more precise and reproducible measurement of then instructional effectiveness of the new techniques.

The Level of Anatomical Knowledge, Hard to Establish: a Systematic Narrative Review

OBJECTIVE

This literature review aimed to gain more insight into the level of anatomical knowledge based on published measurements among medical students, residents, fellows, and specialists.

METHODS

We performed an extensive literature search in three online databases: Medline (using PubMed), Web of Science, and Education Resources Information Centre (ERIC).

RESULTS

A total of 30 relevant studies were found. In these studies, participants took different anatomy tests, and their mean/median scaled scores range from 22.5 to 82.4% on a 0 to 100% scale.

CONCLUSION

This review provides an overview of what is known about measured anatomical knowledge. After critically reviewing the literature, we have to conclude that the existing literature confirms that anatomical knowledge is hard to establish, mainly due to the lack of standardisation.Further research should focus on ways to define and assess 'desired anatomical knowledge' in different contexts. In a next phase, we can discuss if anatomical knowledge is lacking and if interventions are needed.

The Association Between Preclinical Medical Students' Perceptions of the Anatomy Education Environment and Their Learning Approaches

This study aimed to measure medical students' perceptions of the anatomy education environment and determine its association with their learning approaches. First- and second-year undergraduate medical students (N = 234) completed the Anatomy Education Environment Measurement Inventory and the Approaches and Study Skills Inventory for Students. Results revealed that the students' perceptions of all the factors in the anatomy education environment were positive except for two areas-the anatomy learning resources and quality of histology learning facilities. The majority of students in the first year (62.3%) and second year (43.7%) adopted a deep learning approach. There was no significant association between most of the factors in the anatomy education environment and the students' learning approaches, except for the students' intrinsic interest in learning anatomy factor (p = 0.032). The anatomy education environment was positive for the medical students, and there was a prevalence of a deep learning approach among them. However, most of the factors in the anatomy education environment did not influence the students' learning approach. Given that the students' learning approach is a multifactorial construct, investigating the relationship between these two variables in longitudinal time points would provide better insight into the association between the anatomy educational climate and students' learning approaches.

Why is Anatomy Difficult to Learn? The Implications for Undergraduate Medical Curricula

The impact of the medical curricular reform on anatomy education has been inconclusive. A pervasive perception is that graduates do not possess a sufficient level of anatomical knowledge for safe medical practice; however, the reason is less well-studied. This qualitative study investigated the perceived challenges in learning anatomy, possible explanations, and ways to overcome these challenges. Unlike previous work, it explored the perceptions of multiple stakeholders in anatomy learning. Semi-structured interviews were conducted and the transcripts were analyzed by a grounded theory approach. Three main themes emerged from the data: (1) visualization of structures, (2) body of information, and (3) issues with curriculum design. The decreasing time spent in anatomy laboratories forced students to rely on alternative resources to learn anatomy but they lacked the opportunities to apply to human specimens, which impeded the "near" transfer of learning. The lack of clinical integration failed to facilitate the "far" transfer of learning. Learners also struggled to cope with the large amount of surface knowledge, which was pre-requisite to successful deep and transfer of learning. It was theorized that the perceived decline in anatomical knowledge was derived from this combination of insufficient surface knowledge and impeded "near" transfer resulting in impeded deep and "far" transfer of learning. Moving forward, anatomy learning should still be cadaveric-based coupled with complementary technological innovations that demonstrate "hidden" structures. A constant review of anatomical disciplinary knowledge with incremental integration of clinical contexts should also be adopted in medical curricula which could promote deep and far transfer of learning.

What Use is Anatomy in First Opinion Small Animal Veterinary Practice? A Qualitative Study

Despite the uncontested importance of anatomy as one of the foundational aspects of undergraduate veterinary programs, there is still limited information available as to what anatomy knowledge is most important for the graduate veterinarian in their daily clinical work. The aim of this study was therefore to gain a deeper understanding of the role that anatomy plays in first opinion small animal veterinary practice. Using ethnographic methodologies, the authors aimed to collect rich qualitative data to answer the question "How do first opinion veterinarians use anatomy knowledge in their day-to-day clinical practice?" Detailed observations and semi-structured interviews were conducted with five veterinarians working within a single small animal first opinion practice in the United Kingdom. Thematic analysis was undertaken, identifying five main themes: Importance; Uncertainty; Continuous learning; Comparative and dynamic anatomy; and Communication and language. Anatomy was found to be interwoven within all aspects of clinical practice; however, veterinarians were uncertain in their anatomy knowledge. This impacted their confidence and how they carried out their work. Veterinarians described continually learning and refreshing their anatomy knowledge in order to effectively undertake their role, highlighting the importance of teaching information literacy skills within anatomy curricula. An interrelationship between anatomy use, psychomotor, and professional skills was also highlighted. Based on these findings, recommendations were made for veterinary anatomy curriculum development. This study provides an in-depth view within a single site small animal general practice setting: further work is required to assess the transferability of these findings to other areas of veterinary practice.

Evaluation of a 3D-MC examination format in anatomy

INTRODUCTION

The quality of education in medical anatomy is a fundamental pillar of good clinical practice. Current reforms of the medical curriculum have resulted in major methodological changes in the teaching and testing of anatomy. A number of recent studies have however described a decrease in positive metrics of anatomical knowledge among students so taught. It has been suggested that the reduced anatomical knowledge measured in these studies may endanger patient safety. As proxy measures of exam quality, evaluation of the levels of students 'achievement in the examinations, assessment of the subjectively perceived level of question difficulty and analysis of exam satisfaction are each suitable parameters of investigation of medical education.

MATERIAL AND METHODS

To address these issues with regard to medical education at the Charité-Universitätsmedizin Berlin, we have analyzed students' levels of achievement in the anatomical Three Dimensional Multiple Choice (hereafter, 3D-MC)-examination of 2,015 students matriculated in medical studies from Summer Semester of 2014 through Summer Semester of 2017. We either compared students' achievement levels of identical 3D-MC questions using models or prepared anatomical specimen. Furthermore, we have analyzed the type and frequency of cognitive levels used in the anatomical questions in relation to the students' level of achievement. Finally, we conducted an anonymous survey to measure students' (n = 207) and instructors' (n = 16) satisfaction with the 3D-MC-examination in comparison to other employed anatomical testing strategies.

RESULTS

Students' achievement is significantly enhanced with anatomical questions using models relative to those utilizing anatomical specimen. Over 80% of the anatomical questions in the 3D-MC-examinations assessed the lowest cognitive levels and higher cognitive question levels were accompanied by a significant decrease of the levels of students' performance. Our survey further revealed that both, students and instructors preferred the practical examinations in anatomy and that the difficulty levels of the 3D-MC-examination was perceived as being the lowest in comparison to the other anatomical testing strategies.

DISCUSSION

Testing levels of anatomical understanding using anatomical models is not comparable to human specimen, and thus using specimen before models should be preferred to learn and test close to an authentic medical situation. The application of anatomical models and low cognitive question levels in the examination reduces the subjectively perceived level of difficulty, encourages superficial learning, and therefore decreases the retention of anatomical knowledge.

CONCLUSION

Although students and instructors prefer practical examinations in anatomy, the current development does not reflect these results. Therefore, it would be recommendable to rethink the development of anatomical testing strategies based on the existing evidence.

An Approach to Economic Evaluation in Undergraduate Anatomy Education

Medical education research is becoming increasingly concerned with the value (defined as "educational outcomes per dollar spent") of different teaching approaches. However, the financial costs of various approaches to teaching anatomy are under-researched, making evidence-based comparisons of the value of different teaching approaches impossible. Therefore, the aims of this study were to report the cost of six popular anatomy teaching methods through a specific, yet generalizable approach, and to demonstrate a process in which these results can be used in conjunction with existing effectiveness data to undertake an economic evaluation. A cost analysis was conducted to report the direct and indirect costs of six anatomy teaching methods, using an established approach to cost-reporting. The financial information was then combined with previously published information about the effectiveness of these six teaching methods in increasing anatomy knowledge, thereby demonstrating how estimations of value can be made. Dissection was reported as the most expensive teaching approach and computer aided instruction/learning (CAI/L) was the least, based on an estimation of total cost per student per year and assuming a student cohort size of just over 1,000 (the United Kingdom average). The demonstrated approach to economic evaluation suggested computer aided instruction/learning as the approach that provided the most value, in terms of education outcomes per dollar spent. The study concludes by suggesting that future medical education research should incorporate substantially greater consideration of cost, in order to draw important conclusions about value for learners.

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

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

Anatomy by Whole Body Dissection as an Elective: Student Outcomes

BACKGROUND

Anatomy education has long been considered fundamental to the medical profession. Recently, Australasian medical schools have favored prosected human material, models and medical imaging in their anatomy curriculum with only 3 medical schools offering whole-body dissection. The aim of this study was to explore the knowledge acquisition and perceptions of an elective anatomy by whole body dissection (AWBD) course for senior medical students.

METHODS

In the 2017 AWBD course, 53 self-selected senior medical students carried out dissections over an 8-week period. Students were assessed via true/false questions and practical tests involving the identification of structures on anatomical images at precourse, mid-course and end-course. In addition, at completion of the course, students completed a questionnaire using a 5-point Likert scale and 2 open-ended questions. Quantitative data analysis was conducted on test scores and questionnaire data using a paired-sample t-test and descriptive statistics. Qualitative data were coded and categorised into themes.

RESULTS

There was a significant improvement (p < 0.0001) in student test scores from pre-course (mean 34.1 ± 12.9%) to mid-course (mean 74.8 ± 9.4%) and end-course (mean 75.4 ± 9.8%). Analysis of the questionnaire data showed strongly favorable perceptions of the course, highlighting dissection, complemented by Structure, Clinical, Objective-Referenced, Problem-Based, Integrated and Organized (SCORPIO) teaching, frequent testing and senior surgeon supervision as beneficial teaching methods.

CONCLUSIONS

Dissecting in small groups has been shown to be an effective part of anatomy learning. Our study suggests complementary teaching methods as possible augmenters to a well-structed, small group AWBD course. We have presented a framework suitable for an intensive AWBD course within medical curricula, that was valued by participants, and improved students' knowledge of anatomy.

Application and evaluation of virtual technologies for anatomy education to medical students: A review

To learn anatomy, medical students need to look at body structures and manipulate anatomical structures. Simulation-based education is a promising opportunity for the upgrade and sharing of knowledge. The purpose of this review is to investigate the evaluation of virtual technologies in teaching anatomy to medical students.

Methods: In this review, we searched PubMed, Web of Sciences, Scopus, and Embase for relevant articles in November 2018. Information retrieval was done without time limitation. The search was based on the following keywords: virtual reality, medical education, and anatomy.

Results: 2483 articles were identified by searching databases. Finally, the fulltext of 12 articles was reviewed. The results of the review showed that virtual technologies had been used to train internal human anatomy, ear anatomy, nose anatomy, temporal bone anatomy, surgical anatomy, neuroanatomy, and cardiac anatomy.

Conclusion: Virtual reality, augmented reality, and games can enhance students' anatomical learning skills and are proper alternatives to traditional methods in case of no access to the cadavers and mannequin.

Musculoskeletal Anatomy Knowledge Retention in the Macquarie University Chiropractic Program: A Cross-Sectional Study

Attrition of anatomy knowledge has been an area of concern in health professions curricula. To ensure safe and effective clinical practice, the study of chiropractic requires a good knowledge of musculoskeletal anatomy. In this study, musculoskeletal limb knowledge retention was investigated among students in the 5-year chiropractic program at Macquarie University, Australia. A test of 20 multiple-choice questions, categorized into low-order (LO) and high-order (HO) cognitive ability according to Bloom's Taxonomy, was developed. Students enrolled in the program were invited to participate with 257 of the 387 choosing to participate, (response rate ranging 56%-72% per year level). No attrition of knowledge across the years was observed, instead, a significant increase in knowledge, measured by total LO and HO scores (P < 0.0005), throughout the program. There were significant increases in both low and high cognitive scores which were not uniform, with high-order scores increasing significantly in the last two year levels. The increase of knowledge, may be explained, at least partially, by the vertical and horizontal integrated curriculum. Retrieval of knowledge, especially in clinically applied formats, may have led to an enhanced ability to apply anatomy knowledge and account for the increased scores in the high-order knowledge seen in the later clinical years. Evaluating anatomy knowledge retention at different cognitive levels seems to provide a better assessment and is worth considering in future anatomy educational research.

From Scope to Screen: The Evolution of Histology Education

Histology, the branch of anatomy also known as microscopic anatomy, is the study of the structure and function of the body's tissues. To gain an understanding of the tissues of the body is to learn the foundational underpinnings of anatomy and achieve a deeper, more intimate insight into how the body is constructed, functions, and undergoes pathological change. Histology, therefore, is an integral element of basic science education within today's medical curricula. Its development as a discipline is inextricably linked to the evolution of the technology that allows us to visualize it. This chapter takes us on the journey through the past, present, and future of histology and its education; from technologies grounded in ancient understanding and control of the properties of light, to the ingenuity of crafting glass lenses that led to the construction of the first microscopes; traversing the second revolution in histology through the development of modern histological techniques and methods of digital and virtual microscopy, which allows learners to visualize histology anywhere, at any time; to the future of histology that allows flexible self-directed learning through social media, live-streaming, and virtual reality as a result of the powerful smart technologies we all carry around in our pockets. But, is our continuous pursuit of technological advancement projecting us towards a dystopian world where machines with artificial intelligence learn how to read histological slides and diagnose the diseases in the very humans that built them?

What do we need to know about anatomy in gynaecology: A Delphi consensus study

OBJECTIVE

Determination of the anatomical structures that should be taught to ensure safe and competent practice among general gynaecologists.

STUDY DESIGN

A two-round Delphi survey, face-to-face meeting in focus groups and an individual interview. Participants were medical doctors and trainees from gynaecology, surgery, urology and radiology from academic, non-academic teaching and non-academic, non-teaching hospitals in the Netherlands. Relevant structures were collected from gynaecology surgery atlas based on most common gynaecological surgeries and diseases. These structures were supplemented and critically viewed in focus groups followed by a Delphi survey. In the Delphi survey gynaecologist and trainee's gynaecology from all over the Netherlands scored the items on a Likert scale between 1 (not relevant) and 5 (highly relevant). Consensus was defined when ≥ 70 % of the panellist scored the item as relevant or very relevant and the average rating was ≥ 4. Main outcome was clinically relevant anatomical structures.

RESULTS

Consensus on 86 clinically relevant anatomical structures divided by nine categories.

CONCLUSIONS

This study identified a core list of anatomical structures that are relevant to the safe and competent practice of general gynaecologists and that can be used to guide gynaecology postgraduate education. This is the first step in a much wider and complex process of becoming a competent gynaecologist.

Undergraduate Medical Students' Usage and Perceptions of Anatomical Case-Based Learning: Comparison of Facilitated Small Group Discussions and eLearning Resources

While case-based discussions can empower students to apply knowledge to contextual clinical situations, scheduling these activities is a challenge in crowded curricula. Case-based eLearning activities, derived from existing cases discussed within anatomy small group tutorials, were created incorporating principles such as interactivity, reinforcement, and feedback. Over half of the students accessed one or more of these online cases, with 18% accessing all eight online cases provided. Access increased as the semester progressed, particularly just before summative examinations, implying students used these primarily as revision aides. Students rated both formats highly, but favored the online format with regard to enjoyment (P = 0.048), learning (P = 0.101), and feedback (P = 0.086). However, more students discussed these cases in small group tutorials within the anatomy dissecting room than completed them online (122 vs. 67) and themes emerging from free text comments included a desire to have more time dedicated to these cases during small group tutorials, and an appreciation for the opportunity for discussion with staff and learning through doing. Additionally, native English speakers rated the anatomy room discussions significantly higher in all aspects than non-native English speakers, suggesting that non-native speakers may be hesitant or reluctant to fully participate in front of peers. While online case-based learning activities are a useful adjunct to anatomy teaching, particularly for revision, assumptions that "digital natives" have an innate preference for digital resources require critical evaluation, as students still place a high value on opportunities for discussion with staff during their studies.

Anatomy integration: Effective change or change of affect?

Anatomy is fundamental to clinical practice, is considered a rite of passage in becoming a physician and is key to professional identity formation. The anatomy course that began the medical curriculum at the University of New Mexico School of Medicine was recently dissolved to address content and process gaps in the pre-clinical curriculum. Anatomy was integrated into the organ system blocks to make room for new courses to address content gaps. Previous reports of anatomy integration document more positive attitudes and perceptions to teaching anatomy in context, as compared to an independent course. The current prospective study compared two medical student cohorts to determine the effects of teaching anatomy in and out of context on the cognitive and affective domains of learning. In a pre, post, and follow-up design, methods included content assessments, confidence probes, and attitude surveys informed by focus groups. Results indicated that anatomical knowledge and student confidence was gained and mastered in both curricula. Initial acquisition of content was higher in the integrated curriculum, but not maintained. Students in the integrated curriculum displayed a different relationship to learning anatomy, appearing more concerned with their personal progression than with the connection of anatomy to medical practice or patient care. These students also agreed less with statements related to working in teams, reflective practices and professional identity formation. Further studies will determine if this difference will diminish with continued exposure to anatomy and may inform future curricular adjustments. Anat Sci Educ. © 2018 American Association of Anatomists.

How comprehensive are research studies investigating the efficacy of technology-enhanced learning resources in anatomy education? A systematic review

Anatomy education is at the forefront of integrating innovative technologies into its curricula. However, despite this rise in technology numerous authors have commented on the shortfall in efficacy studies to assess the impact such technology-enhanced learning (TEL) resources have on learning. To assess the range of evaluation approaches to TEL across anatomy education, a systematic review was conducted using MEDLINE, the Educational Resources Information Centre (ERIC), Scopus, and Google Scholar, with a total of 3,345 articles retrieved. Following the PRISMA method for reporting items, 153 articles were identified and reviewed against a published framework-the technology-enhanced learning evaluation model (TELEM). The model allowed published reports to be categorized according to evaluations at the level of (1) learner satisfaction, (2) learning gain, (3) learner impact, and (4) institutional impact. The results of this systematic review reveal that most evaluation studies into TEL within anatomy curricula were based on learner satisfaction, followed by module or course learning outcomes. Randomized controlled studies assessing learning gain with a specific TEL resource were in a minority, with no studies reporting a comprehensive assessment on the overall impact of introducing a specific TEL resource (e.g., return on investment). This systematic review has provided clear evidence that anatomy education is engaged in evaluating the impact of TEL resources on student education, although it remains at a level that fails to provide comprehensive causative evidence. Anat Sci Educ 11: 303-319. © 2017 American Association of Anatomists.

Benefits of extracurricular participation in dissection in a prosection-based medical anatomy program

The purpose of this study was to evaluate the extracurricular cadaveric dissection program available to medical students at an institution with a modern (time-compressed, student-centered, and prosection-based) approach to medical anatomy education. Quantitative (Likert-style questions) and qualitative data (thematic analysis of open-ended commentary) were collated from a survey of three medical student cohorts who had completed preclerkship. Perceived benefits of dissection included the hands-on learning style and the development of anatomy expertise, while the main barrier that limited participation was the time-intensive nature of dissection. Despite perceived benefits, students preferred that dissection remain optional. Analysis of assessments for the MD2016 cohort revealed that dissection participation was associated with enhanced performance on anatomy items in each systems-based unit examination, with the largest benefits observed on discriminating items that assessed knowledge application. In conclusion, this study revealed that there are academic and perceived benefits of extracurricular participation in dissection. While millennial medical students recognized these benefits, these students also indicated strong preference for having flexibility and choice in their anatomy education, including the choice to participate in cadaveric dissection. Anat Sci Educ 11: 294-302. © 2017 American Association of Anatomists.

Medical students' perspective on training in anatomy

Gaining sufficient knowledge of anatomy is an important part of medical education. Factors that influence how well students learn anatomical structures include available sources, learning time and study assistance. This study explores the attitude of medical students with regard to studying anatomy and evaluates possibilities for improvement of training in anatomy. Twenty medical students participated in a focus group meeting. Based on this focus group, an online survey consisting of 27 questions was developed and distributed amongst medical students of Maastricht University, the Netherlands. A total of 495 medical students (both Bachelor and Master level) participated in this survey. Master students found studying anatomy less attractive than Bachelor students (36.8% of the Master students vs. 47.9% of the Bachelor students (p=.024)). Although most students responded that they thought it is important to study anatomy, 48% of all students studied anatomy less than 10h per study block of 8 weeks. Only 47.9% of the students rated their knowledge of anatomy as adequate. Students suggested that three-dimensional techniques would help improve their knowledge of anatomy. Therefore investing in three-dimensional tools could prove beneficial in the future.

Effective methods of teaching and learning in anatomy as a basic science: A BEME systematic review: BEME guide no. 44

BACKGROUND

Anatomy is a subject essential to medical practice, yet time committed to teaching is on the decline, and resources required to teach anatomy is costly, particularly dissection. Advances in technology are a potential solution to the problem, while maintaining the quality of teaching required for eventual clinical application.

AIM

To identify methods used to teach anatomy, including those demonstrated to enhance knowledge acquisition and retention.

METHODS

PubMed, CINAHL, ERIC, Academic OneFile, ProQuest, SAGE journals and Scopus were search from the earliest entry of each database to 31 August 2015. All included articles were assessed for methodological quality and low quality articles were excluded from the study. Studies were evaluated by assessment scores, qualitative outcomes where included as well as a modified Kirkpatrick model.

RESULTS

A total of 17,820 articles were initially identified, with 29 included in the review. The review found a wide variety of teaching interventions represented in the range of studies, with CAI/CAL studies predominating in terms of teaching interventions, followed by simulation. In addition to this, CAI/CAL and simulation studies demonstrated better results overall compared to traditional teaching methods and there is evidence to support CAI/CAL as a partial replacement for dissection or a valuable tool in conjunction with dissection.

CONCLUSIONS

This review provides evidence in support of the use of alternatives to traditional teaching methods in anatomy, in particular, the use of CAI/CAL with a number of high quality, low risk of bias studies supporting this.

Understanding the current anatomical competence landscape: Comparing perceptions of program directors, residents, and fourth-year medical students

A mixed methods survey of fourth-year medical students, resident physicians, and residency program directors at the Indiana University School of Medicine gathered perceptions of anatomical competence-defined as the anatomical education necessary for effective clinical practice. The survey items explored numerous aspects of anatomical competence, including the most effective modes of instruction, perceptions of readiness for clinical practice, and specific suggestions for improving anatomical education during medical school and residency. The response rate was 46% for fourth-year medical students, 47% for residents (as graduates from 137 medical schools), and 71% for program directors. A majority of students and residents reported that their course in Gross Anatomy prepared them well for clinical practice; that cadaveric dissection was important in the early development of their anatomical competence; and that placing a greater emphasis on clinical relevance in medical school would have improved their anatomical competence even further. However, in terms of anatomical preparedness upon entering residency, the program directors rated their residents less prepared than the residents rated themselves. All three groups agreed that there is need for additional opportunities for anatomical educational during medical school and residency. Suggestions for improving anatomical education included the following: providing more opportunities for cadaveric dissection during medical school and residency; more consistent teaching of anatomy for clinical practice; more workshops that review anatomy; and better integration of anatomy with the teaching of other subjects during medical school. Anat Sci Educ 9: 307-318. © 2015 American Association of Anatomists.

Improving Medical Students' Application of Knowledge and Clinical Decision-Making Through a Porcine-Based Integrated Cardiac Basic Science Program

OBJECTIVE

Despite the concerted effort of modern undergraduate curriculum designers, the ability to integrate basic sciences in clinical rotations is an ongoing problem in medical education. Students and newly qualified doctors themselves report worry about the effect this has on their clinical performance. There are examples in the literature to support development of attempts at integrating such aspects, but this "vertical integration" has proven to be difficult. We designed an expert-led integrated program using dissection of porcine hearts to improve the use of cardiac basic sciences in clinical medical students' decision-making processes. To our knowledge, this is the first time in the United Kingdom that an animal model has been used to teach undergraduate clinical anatomy to medical students to direct wider application of knowledge.

METHODS

Action research methodology was used to evaluate the local curriculum and assess learners needs, and the agreed teaching outcomes, methods, and delivery outline were established. A total of 18 students in the clinical years of their degree program attended, completing precourse and postcourse multichoice questions examinations and questionnaires to assess learners' development.

RESULTS

Student's knowledge scores improved by 17.5% (p = 0.01; students t-test). Students also felt more confident at applying underlying knowledge to decision-making and diagnosis in clinical medicine. An expert teacher (consultant surgeon) was seen as beneficial to students' understanding and appreciation.

CONCLUSIONS

This study outlines how the development of a teaching intervention using porcine-based methods successfully improved both student's knowledge and application of cardiac basic sciences. We recommend that clinicians fully engage with integrating previously learnt underlying sciences to aid students in developing decision-making and diagnostic skills as well as a deeper approach to learning.

A brief history of topographical anatomy

This brief history of topographical anatomy begins with Egyptian medical papyri and the works known collectively as the Greco-Arabian canon, the time line then moves on to the excitement of discovery that characterised the Renaissance, the increasing regulatory and legislative frameworks introduced in the 18th and 19th centuries, and ends with a consideration of the impact of technology that epitomises the period from the late 19th century to the present day. This paper is based on a lecture I gave at the Winter Meeting of the Anatomical Society in Cambridge in December 2015, when I was awarded the Anatomical Society Medal.

Anatomical Society core regional anatomy syllabus for undergraduate medicine: the Delphi process

A modified Delphi method was employed to seek consensus when revising the UK and Ireland's core syllabus for regional anatomy in undergraduate medicine. A Delphi panel was constructed involving 'expert' (individuals with at least 5 years' experience in teaching medical students anatomy at the level required for graduation). The panel (n = 39) was selected and nominated by members of Council and/or the Education Committee of the Anatomical Society and included a range of specialists including surgeons, radiologists and anatomists. The experts were asked in two stages to 'accept', 'reject' or 'modify' (first stage only) each learning outcome. A third stage, which was not part of the Delphi method, then allowed the original authors of the syllabus to make changes either to correct any anatomical errors or to make minor syntax changes. From the original syllabus of 182 learning outcomes, removing the neuroanatomy component (163), 23 learning outcomes (15%) remained unchanged, seven learning outcomes were removed and two new learning outcomes added. The remaining 133 learning outcomes were modified. All learning outcomes on the new core syllabus achieved over 90% acceptance by the panel.

Student perceptions of independent versus facilitated small group learning approaches to compressed medical anatomy education

The purpose of this study was to compare student perceptions regarding two, small group learning approaches to compressed (46.5 prosection-based laboratory hours), integrated anatomy education at the University of Ottawa medical program. In the facilitated active learning (FAL) approach, tutors engage students and are expected to enable and balance both active learning and progression through laboratory objectives. In contrast, the emphasized independent learning (EIL) approach stresses elements from the "flipped classroom" educational model: prelaboratory preparation, independent laboratory learning, and limited tutor involvement. Quantitative (Likert-style questions) and qualitative data (independent thematic analysis of open-ended commentary) from a survey of students who had completed the preclerkship curriculum identified strengths from the EIL (promoting student collaboration and communication) and FAL (successful progression through objectives) approaches. However, EIL led to student frustration related to a lack of direction and impaired completion of objectives, whereas active learning opportunities in FAL were highly variable and dependent on tutor teaching style. A "hidden curriculum" was also identified, where students (particularly EIL and clerkship students) commonly compared their compressed anatomy education or their anatomy learning environment with other approaches. Finally, while both groups highly regarded the efficiency of prosection-based learning and expressed value for cadaveric-based learning, student commentary noted that the lack of grade value dedicated to anatomy assessment limited student accountability. This study revealed critical insights into small group learning in compressed anatomy education, including the need to balance student active learning opportunities with appropriate direction and feedback (including assessment).

Posterior approach to kidney dissection: An old surgical approach for integrated medical curricula

Integrated medical curricular changes are altering the historical regional anatomy approach to abdominal dissection. The renal system is linked physiologically and biochemically to the cardiovascular and respiratory systems; yet, anatomists often approach the urinary system as part of the abdomen and pelvic regions. As part of an integrated curriculum, the renal system must be covered relatively quickly after the thorax in the cadaver laboratory, often without the opportunity to fully appreciate the rest of the abdominal contents. This article provides dissection instructions that follow one of the historical surgical approaches for nephrectomy, including preservation of the posterior abdominal wall neurovasclature. Dissection procedures were developed for first-year medical students, intending this posterior approach to the kidneys to be their first introduction to the renal system. It has been successfully implemented with the first-year medical students at the University of New England, College of Osteopathic Medicine. Utilizing this posterior approach to the kidney enabled the study of the anatomy of the kidneys, suprarenal glands, and renal vessels, as well as the muscles of the lumbar spine, while maintaining the integrity of the anterior abdominal wall and peritoneal cavity for future gastrointestinal and reproductive system-based dissections.

Medical student perceptions of radiology use in anatomy teaching

The use of radiology in the teaching of anatomy to medical students is gaining in popularity; however, there is wide variation in how and when radiology is introduced into the curriculum. The authors sought to investigate students' perceptions regarding methods used to depict and teach anatomy and effects of integrated radiology instruction on students' abilities to correctly identify imaging modalities and anatomical structures on radiological images. First-year medical students completed questionnaires at the beginning and end of the first academic year that incorporated ten hours of radiologic anatomy teaching in the anatomy curriculum. Questions used a combination of Likert scales, rankings, and binary options. Students were tested on their ability to identify radiology modalities and anatomical structures on radiology images. Preresponse and postresponse rates were 93% (157/168) and 85% (136/160), respectively. Postmodule, 96.3% of students wanted the same or more radiology integration. Furthermore, 92.4% premodule and 96.2% postmodule agreed that "Radiology is important in medical undergraduate teaching." Modality and structure identification scores significantly increased from 59.8% to 64.3% (P < 0.001) and from 47.4% to 71.2% (P < 0.001), respectively. The top three preferred teaching formats premodule and postmodule were (1) anatomy laboratory instruction, (2) interactive sessions combining radiology with anatomy, and (3) anatomy lectures. Postmodule, 38.3% of students were comfortable reviewing radiology images. Students were positive about integrating radiology into anatomy teaching and most students wanted at least the same level of assimilation but that it is used as an adjunct rather than primary method of teaching anatomy.

To quiz or not to quiz: Formative tests help detect students at risk of failing the clinical anatomy course

Through a modified team-based learning (TBL) in the anatomy pre-clerkship curriculum, formative evaluations are utilized in the University of Ottawa Faculty of Medicine to assess and predict students' outcomes on summative examinations. The purpose of this study was to determine the efficiency of formative assessments to predict student's performance on summative examinations, during the first two semesters of medical school. Formative assessments included multiple-choice quizzes (MCQ) for each laboratory session and a practical midterm examination (MIDTERM), while the summative assessment corresponded to the final practical examination (FINAL). A moderate correlation between MCQs and FINAL (r = 0.353 and 0.301, respectively), and strong correlation between MIDTERM and FINAL assessments (r = 0.688 and 0.610, respectively) were found in the first two semesters. The MIDTERM-FINAL correlations were enhanced for students who scored under 61% in the MIDTERM (r = 0.887 and 0.717, respectively). Despite limitations, mostly related to particularities of the used tests, the analysis revealed an efficient method to identify students at risk of failing the FINAL in a TBL-based anatomy program. Future developments include the elaboration of strategies to predict and support those underperforming students.

Human cadaveric dissection: a historical account from ancient Greece to the modern era

The review article attempts to focus on the practice of human cadaveric dissection during its inception in ancient Greece in 3rd century BC, revival in medieval Italy at the beginning of 14th century and subsequent evolution in Europe and the United States of America over the centuries. The article highlights on the gradual change in attitude of religious authorities towards human dissection, the shift in the practice of human dissection being performed by barber surgeons to the anatomist himself dissecting the human body and the enactment of prominent legislations which proved to be crucial milestones during the course of the history of human cadaveric dissection. It particularly emphasizes on the different means of procuring human bodies which changed over the centuries in accordance with the increasing demand due to the rise in popularity of human dissection as a tool for teaching anatomy. Finally, it documents the rise of body donation programs as the source of human cadavers for anatomical dissection from the second half of the 20th century. Presently innovative measures are being introduced within the body donation programs by medical schools across the world to sensitize medical students such that they maintain a respectful, compassionate and empathetic attitude towards the human cadaver while dissecting the same. Human dissection is indispensable for a sound knowledge in anatomy which can ensure safe as well as efficient clinical practice and the human dissection lab could possibly be the ideal place to cultivate humanistic qualities among future physicians in the 21st century.

Outcomes of a rotational dissection system in gross anatomy

At the University of Texas Houston Medical School, a rotational dissection system was introduced to improve coordination between the Gross Anatomy and the Introduction to Clinical Medicine (ICM) courses. Six students were assigned to each cadaver and divided into two teams. For each laboratory, one team was assigned to dissect and the other to attend ICM or study independently. For the next laboratory, the assignments were reversed. At the start of the session, the team that had dissected previously spent 30 minutes teaching the other team. In 2012, the students were given three traditional practical examinations with 50 questions drawn equally from each laboratory. Students also completed three mid-course evaluations. There were no significant differences in overall performance between the two teams. Nevertheless, we wanted to determine how well individual students identified structures they had dissected compared with those they had not. For dissected structures, the mean percent correct was 80.0 ± 13.0 (mean ± standard deviation), and for undissected structures, it was 78.3 ± 14.1. The difference was small, but statistically significant (P = 0.0007). Although this result validated the concerns expressed by some students, it did not appear that a change in the system was justified. Students were generally enthusiastic about the opportunity to learn clinical skills in the first semester of medical school, and 91-96% of the students agreed that learning anatomy at the same time helped them understand the physical examination exercises in ICM.

From cadavers to clinical practice: the anatomy of lifelong learning

Background

Much has been postulated about the perceived deterioration of anatomy knowledge amongst graduates. Little is known about levels of confidence in, and educational needs concerning, clinical anatomy knowledge amongst foundation year doctors.

Aims

To establish foundation year doctors’ perceptions of anatomy related to: importance to career, confidence in anatomy knowledge and its application, preferred methods of teaching. Secondarily, to determine impact of an integrated clinical approach to anatomy teaching on foundation year doctors’ level of knowledge and confidence in its clinical application of anatomy.

Methods

A course teaching anatomy through common surgeries and related radiology was delivered to foundation year doctors. A pre- and post-course assessment based on anatomy competence score assessed holistic knowledge acquisition. Foundation year doctors’ perceptions of anatomy and course satisfaction were measured through questionnaire.

Results

Confidence in applying anatomy knowledge was low. The average pre- and post-course assessment score increased from 55% to 81%; 92.86% felt an integrated clinical approach to anatomy teaching improved their confidence on the subject and 58.62% felt it improved their clinical skills.

Conclusion

This study identified a need for ongoing educational support for foundation year doctors regarding anatomy teaching. An integrated clinical approach to teaching anatomy proved both highly relevant and popular, as well as an effective teaching approach.

Factors influencing student performance on the carpal bone test as a preliminary evaluation of anatomical knowledge retention

It has been demonstrated that a positive correlation exists between clinical knowledge and retained concepts in basic sciences. Studies have demonstrated a modest attrition of anatomy knowledge over time, which may be influenced by students' perceived importance of the basic sciences and the learning styles adopted. The aims of this study were to: (1) conduct a cross-sectional evaluation of the retention of anatomical knowledge in preclinical (second-year) and clinical (fifth-year) chiropractic students at Murdoch University; and (2) examine students' perceptions of factors that may influence their anatomy knowledge retention. Second- and fifth-year chiropractic students at Murdoch University were invited to participate in the study. Ninety-one students voluntarily participated. The Carpal Bone Test, previously utilized to determine the retention of anatomical knowledge, was utilized to determine the extent to which participants retained gross anatomy knowledge. Participants also completed a questionnaire specifically designed to identify the factors that may have influenced their retention of gross anatomy knowledge. A two-sided Pearson chi-square test of association was used to ascertain statistically significant differences in carpal bone retention and students' responses between the two cohorts. Seventy percent of the fifth-year (clinical) chiropractic students correctly identified all eight carpal bones compared to only six percent of second-year chiropractic students. The majority of participants in both cohorts believed that gross anatomy knowledge is of clinical importance. The use of mnemonics and the clinical application of anatomy knowledge were identified as factors that significantly influenced participants' gross anatomy knowledge retention within this study.