Medical education for millennials: How anatomists are doing it right: Medical Education for Millennials: How Anatomists Are Doing it Right

Is medical training solely to blame? Generational influences on the mental health of our medical trainees

INTRODUCTION

The negative impact of medical training on trainee mental health continues to be a concern. Situated within a sociocultural milieu, Generation Z and Generation Y, defined by their highly involved parents and the widespread use of technology, currently dominate undergraduate and graduate medical education respectively. It is necessary to explore medical trainees' generational characteristics and job-related factors related to stress, burnout, depression, and resilience. This might provide different perspectives and potential solutions to medical trainees' mental health.

METHODS

A cross-sectional study was conducted among medical trainees (students and residents) from two institutions in Qatar. A self-administered online survey included measures for trainees' social media overuse, their parent's parenting style, the educational support by the clinical teacher, job (demands, control, and support), and work-life balance and their relation with their stress, burnout, depression, and resilience. Relationships were tested with multiple linear regression analyses.

RESULTS

Of the 326 medical trainees who responded, 142 (44%) trainees - 93 students and 49 residents - completed all items and were included in the analysis. Social media overuse and inability to maintain a work-life balance were associated with higher levels of stress, depression, and student burnout. Higher levels of job support were associated with lower levels of stress, depression, and resident burnout, and a higher level of resilience. Job control was associated with lower burnout levels. Parenting style was unrelated to trainees' mental health.

DISCUSSION

The two generations 'Y' and 'Z' dominating current medical training showed more stress-related complaints when there is evidence of social media overuse and failure to maintain a work-life balance, while job support counterbalances this, whereas parenting style showed no effect. Measures to enhance medical trainees' mental health may include education about the wise use of social media, encouraging spending more quality social time, and enhancing job support and job control.

Using design thinking to create and implement a 3D digital library of anatomical specimens

Design thinking (DT) is a five-stage process (empathize, define, ideate, prototype, and test) that guides the creation of user-centered solutions to complex problems. DT is in common use outside of science but has rarely been applied to anatomical education. The use of DT in this study identified the need for flexible access to anatomical specimens outside of the anatomy laboratory and guided the creation of a digital library of three-dimensional (3D) anatomical specimens (3D Anatomy Viewer). To test whether the resource was fit for purpose, a mixed-methods student evaluation was undertaken. Student surveys (n = 46) were employed using the system usability scale (SUS) and an unvalidated acceptability questionnaire. These verified that 3D Anatomy Viewer was usable (SUS of 72%) and acceptable (agreement range of 77%-93% on all Likert-type survey statements, Cronbach's alpha = 0.929). Supplementary interviews (n = 5) were analyzed through content analysis and revealed three main themes: (1) a credible online supplementary learning resource; (2) learning anatomy with 3D realism and interactivity; (3) user recommendations for expanding the number of anatomical models, test questions, and gamification elements. These data demonstrate that a DT framework can be successfully applied to anatomical education for creation of a practical learning resource. Anatomy educators should consider employing a DT framework where student-centered solutions to learner needs are required.

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

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

Histology as a paradigm for a science-based learning experience: Visits by histology education spirits of past, present, and future

The term "histology" was coined a little over 200 years ago and the subject has always relied on microscopy as its defining technology. Microscopy was and still is an essential approach for the description of cellular components and their arrangements in living organisms. For more than a century and a half, histology or microanatomy has also been part of the basic science education for biomedical students. Traditionally, it has been taught in two major components, a didactic transfer of information, either in a lecture or self-learning format, and in active-learning laboratory sessions. These two modes of histology instruction conform with the dual-processing theory of learning, one being more automatic and depending mainly on rote memorization, whereas the other is analytical, requiring more advanced reasoning skills. However, these two components of histology education are not separate and independent, but rather complementary and part of a multi-step learning process that encourages a scientific analysis of visual information and involves higher-level learning skills. Conventional, as well as modern electronic instruction methods (e-learning) have been used in complementary ways to support the integrated succession of individual learning steps as outlined in this manuscript. However, as recent curricular reforms have curtailed instructional time, this traditional format of teaching histology is no longer sustainable and a reflective reassessment of the role of histology in modern biomedical education is a timely necessity.

An intergenerational reading of climate change-health concern nexus: a qualitative study of the Millennials' and Gen Z participants' perceptions

BACKGROUND

The study of climate change through a generational lens is meaningful when one considers the distinct attitudes, behaviors, values, and motivations of each generation. Individuals born between 1980 and 1999, referred to as the Millennial Generation (Millennials) and individuals born up to five years before or after 2000, referred to as Generation Z (Gen Z), may differ widely in their views, values, attitudes, and behaviors. This may lead to conflicts between these two cohorts. As Gen Z enters the labor market, their first-level supervisors will be, in many cases, the Millennials, who may view the topic of climate change-health concern nexus very differently than their Gen Z subordinates. Considering the perspectives of each generation may offer insights on how to engage them to act in an environmentally responsible way to counteract climate change effects.

OBJECTIVE

The study reveals similarities and differences in how Millennials and Gen Z perceive the climate change-health concern nexus, which illuminates the understanding of the potential generational conflicts and the critical points where intervention is needed.

METHOD

Interview data from 41 participants were analyzed via thematic analysis using the Quirkos software program. Reporting is in accordance with the COREQ guidelines.

RESULTS

The interview questions elicited responses related to five dimensions: (i) Views of individual and community health; (ii) Knowledge around climate change; (iii) Perceived health impact; (iv) Attitudes towards climate change; (v) Behaviors related to climate change. The findings revealed a set of commonalities and differences in understanding the climate change-health concern nexus between the participants representative of each of the generations examined. One main result is that while most interviewees perceived changes in summer and winter temperatures, they failed to articulate how climate change affected their health.

CONCLUSION

Thematic analysis revealed that the commonalities of views outweigh the differences between the two generations. A relevant remark is that participants can be described rather as "observers" than "players" since they do not tend to see themselves (through their behavior and their contribution) as active participants in the goal to fight climate change. Consequently, both generations undergo what Stephen Gardiner [1] called "intergenerational buck-passing."

Building successful culture, mission, and vision in dermatology

Building a successful culture in academic dermatology is necessary now more than ever, but this problem is compounded by the shortage of dermatologists, especially academicians. This dearth of academic dermatologists raises questions about who will train future generations of physicians and who will drive innovative research to advance the field and improve patient care. Recruitment and retention of dermatologists in academia faces steep challenges posed by increasing demands within academic medicine and the draw of the private sector. It is important to address barriers to a career in academia. Efforts should be focused on modifiable aspects of dermatology residency experiences to promote a career in academic dermatology. Of equal importance is the retention of faculty already in academia because midcareer shifts from academic settings to private practice can result in a significant leadership gap.

Universal design for learning in anatomy education of healthcare students: A scoping review

There are concerns among healthcare practitioners about poor anatomical knowledge among recent healthcare graduates. Universal Design for Learning (UDL) is a framework developed to enhance students' experience of learning and help students to become motivated learners. This scoping review identified whether UDL has been utilized in third level healthcare education and if so, whether it had been used to enhance student motivation to study anatomy. Seven online databases were searched for studies reporting the use of UDL in the curricula of medical, dental, occupational therapy (OT) or speech and language therapy (SLT) programs. Studies were screened for eligibility with set inclusion criteria. Data were extracted and analyzed. Analysis revealed that UDL was not specifically mentioned in any of the studies thus there are no published studies on UDL being formally applied in healthcare education. However, the authors identified 33 publications that described teaching methods which aligned with UDL in anatomy curricula and a thematic analysis yielded four main themes relating to teaching strategies being employed. Universal design for learning was not mentioned specifically, indicating that educators may not be aware of the educational framework, although they appeared to be utilizing aspects of it in their teaching. The review revealed that there is a lack of research concerning the anatomy education of OT and SLT students. The role of UDL in enhancing motivation to learn anatomy in medical, dental, OT and SLT programs has yet to be explored.

Building successful culture, mission, and vision in dermatology

Building a successful culture in academic dermatology is necessary now more than ever, which is compounded by the shortage of dermatologists, especially academicians. This dearth of academic dermatologists raises questions concerning who will train future generations of physicians and who will drive innovative research to advance the field and improve patient care. Recruitment and retention of dermatologists in academia faces steep challenges posed by increasing demands within academic medicine and the draw of the private sector. It is important to address barriers to a career in academia. Efforts should be focused on modifiable aspects of dermatology residency experiences to promote a career in academic dermatology. Of equal importance is the retention of faculty already in academia because midcareer shifts from academic settings to private practice can result in a significant leadership gap.

What factors motivate male and female Generation Z students to become engaged as peer teachers? A mixed-method study among medical and dental students in the gross anatomy course

Peer-teaching is widely established in anatomy teaching and offers well-described advantages. Nevertheless, at Ulm University, Germany, a reduction in the number of peer teacher applicants for the dissection course was observed. This study examined factors related to the attractiveness of a position as a peer teacher for Generation Z students. Participants of the gross anatomy course were asked to evaluate factors influencing the attractiveness of a peer teacher position using a six-point Likert scale. Additionally, open-ended questions were analyzed qualitatively. Sex-specific subgroup analysis was performed comparing students of low and high motivation to apply for a tutorship. Of the 374 students who participated in this study (response rate 53%), 38% stated that they were intending to apply as peer teachers. Data indicated that students displayed intrinsic motivation to apply for a tutorship because of the opportunity to improve their anatomy knowledge and/or their pleasure in teaching. In contrast, extrinsic factors like remuneration of the tutorship and its relevance for their curriculum vitae were least important. Anatomy educators underestimated the demotivating factor of the workload associated with the tutorship and encouraged students less frequently to apply than peer teachers. Only minor sex-specific differences could be identified. Nevertheless, female students were encouraged less frequently to apply than their male peers. In summary, Generation Z students apply as peer teachers because they are enthusiastic about the task. To motivate students to commit to extracurricular activities like a tutorship, anatomy educators should actively encourage students-particularly females-more frequently to apply.

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

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

Working in Creative Partnership with Students to Co-Produce Neuroanatomy e-Learning Resources in a New Era of Blended Learning

Anatomists are well placed to tackle the transition from face-to-face to blended learning approaches as a result of the rapidly forced changes brought about by Covid-19. The subject is extremely visual and has, therefore, previously been a target for the development of technology-enhanced learning initiatives over the last ten years. Today's students have come to expect the integration of technology in the classroom and remotely. They adjust quickly to the innovative use of new applications and software and have begun to integrate it within their own workflow for note taking and study aids. Given the intense drive toward blended deliveries of anatomy as a result of the Covid-19 pandemic, it is easy to picture how the benefits of working in partnership with students (in order to achieve many of these aims) would be possible, particularly in difficult subjects like neuroanatomy. In doing so, it provides anatomists with new opportunities to engage students in a way that aligns well with best practice frameworks for engaging students through partnership. The current United Kingdom guidelines set out by Advance HE (a professional membership organization for promoting excellence in higher education) strongly encourages the higher education community to seek out appropriate academic contexts where a balance of power can be struck between staff and student to create a community of practice. If such an approach can be fully embraced by anatomists, a strong argument can be made for seizing the opportunity to optimize the benefits of student partnership work in this discipline.

Physicians' viewpoints on faculty anatomists and dissection of human bodies in the undergraduate medical studies

BACKGROUND

Studies abound regarding the views of faculty anatomists and medical students on the importance of anatomy and the dissection of human bodies, but very little is known about the views of practicing physicians.

METHODS

A survey was distributed among physicians and surgeons practicing in Spain in order to find out their views on the practice and consequences of human dissection by undergraduate students of medicine. The most relevant definition to qualify faculty anatomists of medical schools was also requested. Responses were repeatedly clustered into characteristic subgroups for analysis.

RESULTS

In total, 536 physicians and surgeons belonging to 36 different specialties in seven Spanish hospitals responded to the survey. The results highlighted two main facts. Firstly, faculty anatomists were perceived as teachers, above any other professional identity (namely: physician, biologist or scientist); nonetheless, the ascription of identities varied between specialties (p=0.009); and it also depended on whether the respondents had dissected in their undergraduate degree (p=0.03) and on the respondent's gender (p=0.03). Secondly, physicians and surgeons confirmed that dissecting human cadavers serves the undergraduate student not only for acquiring anatomical knowledge, but also essential skills and attitudes, including professionalism.

CONCLUSIONS

The results strongly suggest that dissection practice should be reinforced and enriched in undergraduate medical school. As this is important in itself, the results of the study could also help with the development of strategies to alleviate the current shortage of adequately trained anatomists for medical degrees.

Real three-dimensional cardiac imaging using leading-edge holographic display

Understanding three-dimensional cardiac anatomy is fundamental for the practice of clinical cardiology. However, if three-dimensional images are displayed on two-dimensional monitors, they fail to provide depth perception. Currently, novel technologies, including the three-dimensional printing, three-dimensional monitors/projectors, and virtual reality applications can provide real three-dimensionality with depth perception. However, their relatively high cost and limited user-friendliness prevent their wide application. We introduce novel and commercially available holographic display, which allows multiple observers to see the full-color holographic images simultaneously without any specific glasses and headgear. This leading-edge technology is immediately applicable in both educational and clinical settings.

Harnessing Augmented Reality and CT to Teach First-Year Medical Students Head and Neck Anatomy

RATIONALE AND OBJECTIVES

Three-dimensional (3D) visualization has been shown to benefit new generations of medical students and physicians-in-training in a variety of contexts. However, there is limited research directly comparing student performance after using 3D tools to those using two-dimensional (2D) screens.

MATERIALS AND METHODS

A CT was performed on a donated cadaver and a 3D CT hologram was created. A total of 30 first-year medical students were randomly assigned into two groups to review head and neck anatomy in a teaching session that incorporated CT. The first group used an augmented reality headset, while the second group used a laptop screen. The students were administered a five-question anatomy test before and after the session. Two-tailed t-tests were used for statistical comparison of pretest and posttest performance within and between groups. A feedback survey was distributed for qualitative data.

RESULTS

Pretest vs. posttest comparison of average percentage of questions answered correctly demonstrated both groups showing significant in-group improvement (p < 0.05), from 59% to 95% in the augmented reality group, and from 57% to 80% in the screen group. Between-group analysis indicated that posttest performance was significantly better in the augmented reality group (p = 0.022, effect size = 0.73).

CONCLUSION

Immersive 3D visualization has the potential to improve short-term anatomic recall in the head and neck compared to traditional 2D screen-based review, as well as engage millennial learners to learn better in anatomy laboratory. Our findings may reflect additional benefit gained from the stereoscopic depth cues present in augmented reality-based visualization.

Implementation of Ultrasound in Anatomy Education

The use of different ways to view the body has always been associated with anatomy. With advancing technology, the use of ultrasound has become more portable and accessible as a way for students to learn anatomy. Moreover, ultrasound's direct clinical context makes it an important skill that students need to acquire and be competent in, not only after graduation but on clinical placements as a student. There does appear to be a learned skill in being able to interpret ultrasound images and to be able to relate the anatomy seen to existing anatomical knowledge. In addition, there is a learned skill in being able to correctly hold the ultrasound probe and gain clear images. Because ultrasound use and interpretation is a skill it therefore needs to be taught as part of undergraduate medical and allied health care professional education. A key to successful training is regular teaching sessions distributed longitudinally throughout the curriculum with active, hands-on learning time being the focus of any teaching session.

Virtual Dissection: Emerging as the Gold Standard of Analyzing Living Heart Anatomy

Traditionally, gross cardiac anatomy has been described mainly based on the findings in the dissection suite. Analyses of heart specimens have contributed immensely towards building a fundamental knowledge of cardiac anatomy. However, there are limitations in analyzing the autopsied heart removed from the thorax. Three-dimensional imaging allows visualization of the blood-filled heart in vivo in attitudinally appropriate fashion. This is of paramount importance for not only demonstration of cardiac anatomy for educational purposes, but also for the detailed anatomical evaluation in patients with acquired and congenital heart disease. In this review, we discuss the advantages of three-dimensional imaging, specifically focusing on virtual dissection, a volume rendering-based reconstruction technique using computed tomographic data. We highlight examples of three-dimensional imaging in both education and guiding patient management.

Choosing Educational Resources to Build Interprofessional, Palliative Care Competency: A Replicable Review Methodology

AIM/OBJECTIVE

The purpose of the project was to provide information to inform the choice of educational resources available in British Columbia to support palliative care competency development for 4 disciplines: nurses, physicians, health care assistants, and social workers/counsellors. This article will describe the process of resource review. Results of the review are available at https://www.bc-cpc.ca/cpc/education-resource-review/. The objectives were to (1) identify gaps common to all educational resources, (2) provide information on content addressing competencies as well as logistics such as time required, cost, delivery method, and training requirements for instructors, and (3) develop a reproducible process for assessment of educational resources which is unbiased, transparent, and competency based.

METHOD

Sixteen educational resources were assessed for the percentage of competencies that were addressed. Gaps common to all resources were identified.

RESULTS

The review process is described and can be replicated when assessing future versions of these and other palliative continuing education courses. This is a reproducible methodology for review of competency-based educational resources which could be applied for any practice-related subject.

CONCLUSION

This review process provided information which can inform a provincial interprofessional palliative education plan. The methodology may be used by others to assess and choose between competency-based education resources with a palliative population focus and other patient population foci.

Teaching dermatology to the millennial learner

Millennial learners have educational needs and preferences that differ from those of prior generations. They prefer learning from online resources, appreciate interactive didactic sessions, and desire frequent feedback and guidance. Understanding and adapting to these learner attributes may allow for optimization of the educational environment for members of this generation. The following recommendations were developed to advance a dermatology residency program's curriculum to accommodate the modern learner. Although the efficacy of these teaching tips has yet to be fully established, they are grounded by theory and are evidence-informed. Medical educators who are able to employ these strategies are likely to be successful in teaching and engaging the millennial learner.