The development of a core syllabus for teaching musculoskeletal anatomy of the vertebral column and limbs to medical students

Local experience of laboratory activities in a BS physical therapy course: integrating sEMG and kinematics technology with active learning across six cohorts

Introduction

Integrating technology and active learning methods into Laboratory activities would be a transformative educational experience to familiarize physical therapy (PT) students with STEM backgrounds and STEM-based new technologies. However, PT students struggle with technology and feel comfortable memorizing under expositive lectures. Thus, we described the difficulties, uncertainties, and advances observed by faculties on students and the perceptions about learning, satisfaction, and grades of students after implementing laboratory activities in a PT undergraduate course, which integrated surface-electromyography (sEMG) and kinematic technology combined with active learning methods.

Methods

Six cohorts of PT students (n = 482) of a second-year PT course were included. The course had expositive lectures and seven laboratory activities. Students interpreted the evidence and addressed different motor control problems related to daily life movements. The difficulties, uncertainties, and advances observed by faculties on students, as well as the students' perceptions about learning, satisfaction with the course activities, and grades of students, were described.

Results

The number of students indicating that the methodology was "always" or "almost always," promoting creative, analytical, or critical thinking was 70.5% [61.0-88.0%]. Satisfaction with the whole course was 97.0% [93.0-98.0%]. Laboratory grades were linearly associated to course grades with a regression coefficient of 0.53 and 0.43 R-squared (p < 0.001).

Conclusion

Integrating sEMG and kinematics technology with active learning into laboratory activities enhances students' engagement and understanding of human movement. This approach holds promises to improve teaching-learning processes, which were observed consistently across the cohorts of students.

Further assessment of the clinical relevance of anatomical structures through PubMed and other measures

A previous paper has demonstrated a statistically significant moderate correlation between the number of citations obtained from PubMed and a Delphi study for 251 anatomical structures of the Head and Neck region, suggesting that clinical significance is a major driver of research involving anatomical structures. This raises the possibility that these ranks could be an objective measure of clinical relevance of individual anatomical structures. In the present study, we revisited the rankings of the PubMed results from the previous paper and compared it with a Delphi study for 450 musculoskeletal structures. PubMed ranks were derived using different search parameters; a PubMed search with quotations yielded a moderate, statistically significant correlation coefficient of 0.639 with the musculoskeletal dataset. Additionally, we developed a Python tool, PDF Term Search, to calculate the frequency of anatomical terms in four authoritative textbooks, and these frequencies exhibited moderate significant correlations ranging (0.549-0.646) with our PubMed-derived ranks. We further explored strategies to improve the accuracy of our PubMed results by addressing limitations identified in the previous paper. We refined the syntax of search queries for 500 anatomical structures, resulting in marked improvement in the correlation coefficients with the musculoskeletal dataset, demonstrating clear avenues for future iterations of PubMed-derived ranks. We also created a spreadsheet of 2181 anatomical structures ranked using PubMed, published Delphi studies, and authoritative texts, providing a resource for anatomical educators who are adjusting their curricula to better train future healthcare practitioners.

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.

A core syllabus for histology within the medical curriculum - The cardiovascular and lymphoid systems, the respiratory and digestive systems, and the integument

Medical courses worldwide are undergoing significant curricular changes, including the teaching and learning of histology. In order to set international standards for the anatomical sciences, the International Federation of Associations of Anatomists (IFAA) is developing core anatomical syllabuses by means of Delphi panels. Already published is a core syllabus for the teaching of the cell and the basic tissues within medicine. Here, we record the deliberations of an IFAA Delphi panel commissioned to develop core subject matter for the teaching within a medical histology course of the cardiovascular and lymphatic circulatory system, the lymphoid, respiratory, and digestive systems, and the integument. The Delphi panel was comprised of academics from multiple countries who were required to review relevant histological topics/items by evaluating each topic as being either "Essential," "Important," "Acceptable," or "Not required." Topics that were rated by over 60% of the panelists as being "Essential" are reported in this paper as being core topics for the teaching of medical histology. Also reported are topics that, while not reaching the threshold for being designated as core material, may be recommended or not required within the curriculum.

A History of Musculoskeletal Medicine and Its Place and Progress in Undergraduate Medical Education

Musculoskeletal diseases are responsible for some of the most prevalent conditions affecting population health in the world. Despite the prevalence of these conditions, musculoskeletal medicine has a fraught history within the world of undergraduate medical education. We review the origins of musculoskeletal medicine, its evolution in undergraduate medical education, and progress that has been made over the last decade as a result of global initiatives such as the Bone and Joint Decade. Understanding the history of musculoskeletal medicine is essential to contextualizing the problems that exist today and creating comprehensive solutions to fill the gaps that persist in musculoskeletal curricula.

Needs assessment of essential anatomy: The perspective of adult primary care resident physicians

Curricular development and modification involve first identifying a problem and then performing a needs assessment, which can guide the design of curricular components. Pedagogical changes, coupled with reductions in curricular time for gross anatomy, pose challenges and impose restrictions within medical school curricula. In order to make anatomy education effective and efficient, it is important to determine the anatomy considered essential for medical education through a targeted needs assessment. In this study, 50 adult primary care resident physicians in family medicine (FM) and internal medicine (IM) were surveyed to assess the importance of 907 anatomical structures, or groups of structures, across all anatomical regions from a curated list based on the boldface terms in four primary anatomy texts. There were no statistically significant differences in the ratings of structures between the two groups for any anatomical region. In total, 17.0% of structures, or groups of structures, were classified as essential, 58.0% as more important, 24.4% as less important, and 0.7% as not important. FM residents rated tissues classified as skeleton, nerves, fasciae, anatomical spaces, blood vessels, lymphatics, and surface anatomy (p < 0.0001) significantly higher than IM residents, but there were no differences in the rating of muscles or organs (p > 0.0056). It was notable that 100.0% of cranial nerves were classified as essential, and 94.5% of surface anatomy structures were classified as essential or more important. It is proposed that results of this study can serve to inform curricular development and revision.

A proposed anatomy syllabus for entry-level physiotherapists in the United Kingdom: A modified Delphi methodology by physiotherapists who teach anatomy

The ever-increasing scope of physiotherapy practice is raising questions on what anatomical knowledge and skills ought to be taught within qualifying physiotherapy degree programmes in the United Kingdom (UK). The aim of the study was to create core anatomical knowledge and skills learning objectives to inform knowledge and skills for entry-level physiotherapists in the UK. A two phased modified Delphi methodology created a consensual anatomy curriculum. A Research-Team-Expert-Panel of four physiotherapists who teach anatomy proposed Anatomy Learning Objectives (Anat-LOs) and accompanying clinical rationales relevant for newly qualified entry-level physiotherapists. A Teacher-Expert-Panel of nine physiotherapists who taught anatomy to physiotherapy students in the UK reviewed Anat-LOs in two consecutive Delphi Rounds, and rated and commented on each Anat-LO. After each Delphi Round, the Research-Team-Expert-Panel reviewed the ratings and comments from the Teacher-Expert-Panel and banked Anat-LOs that passed the 85% acceptance threshold. There were 182 banked Anat-LOs that spanned all eight areas: Introductory Concepts, Principles and Basic Histology; Head and Neck; Thorax; Abdomen, Pelvis and Perineum; Upper Limb; Lower Limb; Spine; and Neuroanatomy regions/systems. The Anat-LOs develop both anatomical knowledge and key anatomical skills, such as palpation and conducting manual tests on model patients. A first ever core anatomy curriculum for entry-level physiotherapists has been created for entry-level physiotherapists, typically Band-5 NHS physiotherapists, and takes an integrated learning approach. The anatomy curriculum brings clarity to students, teachers, clinical supervisors and future employers on the expected anatomical standards for entry-level physiotherapists.

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.

Transforming musculoskeletal anatomy learning with haptic surface painting

Anatomical body painting has traditionally been utilized to support learner engagement and understanding of surface anatomy. Learners apply two-dimensional representations of surface markings directly on to the skin, based on the identification of key landmarks. Esthetically satisfying representations of musculature and viscera can also be created. However, established body painting approaches do not typically address three-dimensional spatial anatomical concepts. Haptic Surface Painting (HSP) is a novel activity, distinct from traditional body painting, and aims to develop learner spatial awareness. The HSP process is underpinned by previous work describing how a Haptico-visual observation and drawing method can support spatial, holistic, and collaborative anatomy learning. In HSP, superficial and underlying musculoskeletal and vascular structures are located haptically by palpation. Transparent colors are then immediately applied to the skin using purposive and cross-contour drawing techniques to produce corresponding visual representations of learner observation and cognition. Undergraduate students at a United Kingdom medical school (n = 7) participated in remote HSP workshops and focus groups. A phenomenological study of learner perspectives identified four themes from semantic qualitative analysis of transcripts: Three-dimensional haptico-visual exploration relating to learner spatial awareness of their own anatomy; cognitive freedom and accessibility provided by a flexible and empowering learning process; altered perspectives of anatomical detail, relationships, and clinical relevance; and delivery and context, relating to curricular integration, session format, and educator guidance. This work expands the pedagogic repertoire of anatomical body painting and has implications for anatomy educators seeking to integrate innovative, engaging, and effective learning approaches for transforming student learning.

Quantifying research on anatomical structures, a potential new metric for assessing clinical relevance

Human anatomy remains an integral part of medical education, and recent studies have documented an emerging consensus on the key anatomical learning objectives for physicians and other health professionals in training, both at the graduate and postgraduate levels. Despite this progress, less attention has been given to assessing the clinical relevance of individual anatomical structures, and which structures students should master to achieve these learning objectives. In this study we hypothesized that published research involving individual anatomical structures is largely driven by the clinical relevance of these structures, and that tabulating the number of such publications can provide an up-to-date, evolving metric of clinical relevance. To test this hypothesis, we developed a semi-automated search routine that uses the PubMed database to quantify the publication frequency of anatomical structures and compared that to a previous study that assessed the importance of structures of the head and neck using the Delphi method, a formal procedure of generating expert consensus. Using our new approach, we were able to rank the research intensity of 2182 anatomical structures included in Grant's Dissector, a widely used textbook for anatomical dissection. Furthermore, a sample of these PubMed-derived ranks had a highly significant, positive correlation with ranks derived from a consensus of experts. Similar results were obtained when PubMed searches were restricted to journals that focus on applying knowledge in a clinical setting. Our study provides a potential new tool for anatomical educators who are aligning their basic science curricula with the clinical knowledge expected of medical graduates.

Musculoskeletal anatomy core syllabus for Australian chiropractic programs: A pilot study

OBJECTIVE

The aim of this study is to conduct a pilot survey to determine core anatomy content for chiropractic curriculum based on the perception of chiropractors and anatomy educators involved in teaching in an Australian chiropractic program.

METHODS

A survey of anatomical structures previously used in a medical survey, with similar criteria for synthesizing responses, was used and classified according to whether the respondents rated an item as essential, important, acceptable, or not required in a chiropractic program. The item was scored as core if ≥60% of respondents rated it essential, recommended if 30%-59% rated it essential, not recommended if 20%-29% rated it essential, or not core if <20% rated it essential.

RESULTS

The respondents rated 81.6% of all musculoskeletal concepts as core and 18.4% as recommended, 88.8% of the vertebral column items as core, and 11.2% of the items as recommended, 69.4% upper limb and pectoral girdle items as core, 23.7% of items as recommended, 5.5% as not recommended and 1.3% as not core items for inclusion, 85.3% of all lower limb and pelvic girdle items as core, 14.4% as recommended and 0.3% not recommended.

CONCLUSION

Chiropractors and anatomists involved in teaching in an Australian chiropractic program rated most musculoskeletal items as essential for inclusion in a chiropractic teaching program to ensure adequate preparation for safe practice and to promote alignment with the standards of anatomy education delivered into the clinical professions.

Anatomy teaching in Saudi medical colleges- is there necessity of the national core syllabus of anatomy

Curricular updates in medicine resulted in changes in gross anatomy teaching. We aim to find the trends and methods of gross anatomy teaching in medicine programs in Saudi Arabia. Further, examine whether the data would help to discuss whether a core Anatomy syllabus is required. A survey questionnaire based on the earlier studies, was sent to the anatomy faculty of 25 medical colleges to collect the data on the pedagogic and dissection/laboratory approaches, inclusion of radiological, clinical, surface anatomy sessions, and the total number of hours allocated for anatomy education. A total of 15 responses were received from different medical colleges of which nine provided complete details. A wide variation in the component and mode of delivery of anatomy was observed. The number of hours for the anatomy course ranged from 89 to 388 hours. These data will provide an update on gross anatomy teaching approaches, which will help in making informed decisions in course revisions and adopting the best practices. The variations in anatomy course with short duration raises concern about whether the essential learning outcomes are achieved to prepare a skillful and safe clinician? do we require a core syllabus of Anatomy to be adopted at the national level to achieve the essential learning outcomes? The Anatomical Society, UK has developed core syllabi of Anatomy for undergraduate medical, dental, nursing, and pharmacy students, which can serve as a guide in developing the core syllabus of Anatomy for medicine in Saudi.

An Approach to Determining, Delivering and Assessing Essential Course Content in a Medical Human Anatomy Course

INTRODUCTION

Learning objectives typically indicate subject matter judged to be important or that represents essential material to be learned during a course. We report here on our efforts to identify essential course content and determine our effectiveness teaching and assessing this content in our preclinical human anatomy course.

METHODS AND MATERIALS

Using a consensus driven approach, we identified anatomical structures, relationships and functional concepts judged to represent essential material in our unit on the thorax that students were expected to be familiar with. We then determined performance on specific examination questions that focused directly on the essential material.

RESULTS

Thirty-seven of forty-eight students (77%) correctly answered all 34 of 51 questions that directly focused on content we defined as essential. The remaining eleven students answered the majority of these questions correctly. The overall mean score was 86% (range 61%-98%).

CONCLUSION

Our review of student performance on the End of Block thorax examination confirmed our belief that we were successful in helping students learn material we defined as essential. We found the process described here to be helpful in defining essential content and for helping focus and improve medical education and learning assessment based on that material. We believe the idea of defining essential content that can be efficiently taught and effectively learned within a proscribed period of time is an important and necessary objective. We believe the approach used here might be successfully utilized in other programs in efforts aimed at quality improvement. This article is protected by copyright. All rights reserved.

Movement System Theory and Anatomical Competence: Threshold Concepts for Physical Therapist Anatomy Education

This viewpoint proposes eight anatomy threshold concepts related to physical therapist education, considering both movement system theory and anatomical competence. Movement system theory provides classifications and terminology that succinctly identifies and describes physical therapy practice from a theoretical and philosophical framework. The cardiovascular, pulmonary, endocrine, integumentary, nervous, and musculoskeletal systems are all included within this schema as the movement system theory encompasses all body systems interacting to create movement across the lifespan. Implementing movement system theory requires an ability to use human anatomy in physical therapist education and practice. Understanding the human body is a mandatory prerequisite for effective diagnosis, assessment, treatment, and patient evaluation. Anatomical competence refers to the ability to apply anatomic knowledge within the appropriate professional and clinical contexts. Exploring the required anatomical concepts for competent entry-level physical therapist education and clinical practice is warranted. The recommended threshold concepts (fluency, dimensionality, adaptability, connectivity, complexity, stability or homeostasis, progression or development, and humanity) could serve as an integral and long-awaited tool for guiding anatomy educators in physical therapy education.

Efficacy of an intensive 2-week musculoskeletal anatomy course in a medical education setting

There is little consistency in student contact hours and teaching activities used in medical curriculums across North America, and controversy exists regarding the most efficient or effective way to teach musculoskeletal (MSK) anatomy in medical school. The purpose of this investigation was to retrospectively examine academic performance and levels of course satisfaction among first year medical students who had completed an intensive 2-week MSK anatomy course during the pre-clerkship portion of their Association of Faculties of Medicine in Canada accredited undergraduate medical program. Course data from formative and summative student evaluations, as well as end-of-course satisfaction surveys were analyzed for a homogenous group of 549 first-year medical students over a 5-year period. Data indicated that student's academic performance on both formative and summative evaluations for the 2-week MSK anatomy course were consistently high, and not significantly different from the results for other system-based 1^st year anatomy courses delivered over longer durations. Likert data from end-of-course surveys also suggested that student feedback regarding the course was overwhelmingly positive, and that the 2-week MSK anatomy course had the highest level of overall satisfaction when compared to all other first-year anatomy courses. These results can be used to help in the design and implementation of MSK anatomy courses within medical curriculums, and contribute to a growing body of literature which is focused on examining the effect of curricular design on MSK anatomy learning in a medical education setting.

Clay-Based Modeling in the Anatomist's Toolkit: A Systematic Review

Anatomical education has suffered from reduced teaching time and poor availability of staff and resources over the past thirty years. Clay-based modeling (CBM) is an alternative technique for teaching anatomy that can improve student knowledge and experience. This systematic review aimed to summarize and appraise the quality of the literature describing the uses, advantages, and limitations of CBM compared to alternative methods of teaching human gross anatomy to students or qualified healthcare professionals. A systematic search of Embase, MEDLINE, Scopus, and Web of Science databases was conducted, and the Medical Education Research Quality Instrument (MERSQI) was used to assess study quality. Out of the 829 studies identified, 12 papers met the inclusion criteria and were eligible for this review. The studies were of high quality, with a mean MERSQI score of 11.50/18. Clay-based modeling can be used to teach all gross anatomical regions, and 11 studies demonstrated a significant improvement in short-term knowledge gain in students who used CBM in comparison to other methods of learning anatomy. Eight studies that included subjective assessment showed that CBM is rated highly. However, some studies showed that students viewed CBM as juvenile and experienced difficulty making the models. Additionally, there is no evidence to suggest that CBM improves long-term knowledge. Clay-based modeling is an effective learning method for human gross anatomy and should be incorporated into the anatomists' toolkit. In the future, more randomized controlled studies with transparent study designs investigating the long-term impact of CBM are needed.

A core syllabus for histology within the medical curriculum-The cell and basic tissues

The International Federation of Associations of Anatomists (IFAA) are developing core syllabuses for the anatomical sciences by means of Delphi panels. In this article, we provide the core subject matter for the teaching of the cell and of basic tissues within a medical histology course. The goal is to set an international standard providing guidelines for such a core syllabus. The Delphi panel, composed of members across multiple countries, required two rounds to evaluate 257 relevant items/topics approved by the IFAA. Based on the perception of the core knowledge of histology, the items were to be rated by each member of the Delphi panel as being "Essential," "Important," "Acceptable," or "Not required." Topics that were rated by over 60% of the panelists as being "Essential" and "Important" are provided in this article and are recommended for the teaching of medical histology.

The Anatomical Society's Core Anatomy Syllabus for Dental Undergraduates

The Anatomical Society has developed a series of learning outcomes in consultation with dentists, dental educators and anatomists delivering anatomical content to undergraduate dental students. A modified Delphi methodology was adopted to select experts within the field that would recommend core anatomical content in undergraduate dental programmes throughout the UK. Utilising the extensive learning outcomes from two UK Dental Schools, and neuroanatomy learning outcomes that remained outside the Anatomical Society's Core Gross Anatomy Syllabus for Medical Students, a modified Delphi technique was utilised to develop dental anatomical learning outcomes relevant to dental graduates. The Delphi panel consisted of 62 individuals (n = 62) from a wide pool of educators associated with the majority of undergraduate dental schools in the UK, representing a broad spectrum of UK Higher Education Institutions. The output from this study was 147 anatomical learning outcomes deemed to be applicable to all dental undergraduate programmes in the UK. The new recommended core anatomy syllabus for dental undergraduates, grouped into body regions, offers a comprehensive anatomical framework with which to scaffold clinical practice. The syllabus, presented as a set of learning outcomes, may be used in a variety of pedagogic situations, including where anatomy teaching exists within an integrated dental curriculum (both horizontally in the basic sciences part of the curriculum and vertically within the clinical years).

Anatomical Sciences in Chiropractic Education: A Survey of Chiropractic Programs in Australia

Human anatomy knowledge is a core requirement for all health care clinicians. There is a paucity of information relating to anatomy content and delivery in Australian chiropractic programs. The aim of this study was to describe anatomy teaching in Australian chiropractic programs, utilizing a survey which was distributed to all four programs, requesting information on: anatomy program structure, delivery methods, assessment, teaching resources, and academic staff profile at their institution. The survey was undertaken in 2016 and documented practices in that academic year. All four institutions responded. There was a reported difference in the teaching hours, content, delivery and assessment of anatomy utilized in Australian chiropractic programs. Anatomy was compulsory at all four institutions with the mean total of 214 (SD ± 100.2) teaching hours. Teaching was undertaken by permanent ongoing (30%) and sessional academic staff, and student to teacher ratio varied from 15:1 to 12:1. A variety of teaching resources were utilized, including human tissue access, either as prosected cadavers or plastinated body parts. The results of this survey confirm that anatomy has an established place in chiropractic education programs in Australia and while curricular variations exist, all programs had similar course design, delivery, and assessment methods. This study confirmed the provision of a strong foundation in topographical anatomy and neuroanatomy, while other anatomical sciences, such as histology and embryology were not consistently delivered. Formalization of a core anatomy curriculum together with competency standards is needed to assist program evaluation and development, and for accreditation purposes.