Computer-based sessions in radiological anatomy: one year's experience in clinical anatomy

Effectiveness of blended learning in radiological anatomy for first year undergraduate medical students

PURPOSE

The aim of the study was to assess the effectiveness of blended learning modules for radiological anatomy among first-year medical students by estimating knowledge gain and evaluating student perceptions.

METHODS

A single-group, pre- and post-test study design was utilized. Five radiological anatomy modules consisting of online presentations and self-assessment quizzes were developed for the upper limb, lower limb, head and neck, thorax, and abdomen and pelvis. The content of the modules was uploaded on to a learning management system called TYRO. Each module focused on the normal anatomical features observed on plain and contrast radiographs. Other relevant imaging modalities and clinical contexts were also introduced. During the classroom session, the students were instructed to peruse the modules and answer the self-assessment quiz. The teacher in the classroom acted as a facilitator and was available to the students for any clarifications. A pre- and post-test was administered to the students before and after exposure to the modules, respectively. A paired t test was used to estimate differences in the pre- and post-test scores. Students' perceptions were assessed using a questionnaire.

RESULTS

One-hundred students attended both the tests. The mean and standard deviation of pre- and post-test scores were 17 ± 5.5 and 26 ± 7.6, respectively, and this difference was significant. Students' perceptions about the intervention were on the whole positive.

CONCLUSION

A significant improvement in the knowledge of radiological anatomy was noted after exposure to five blended learning modules of radiological anatomy. The modules were well received by the students.

Teaching medical anatomy: what is the role of imaging today?

PURPOSE

Medical anatomy instruction has been an important issue of debate for many years and imaging anatomy has become an increasingly important component in the field, the role of which has not yet been clearly defined. The aim of the paper was to assess the current deployment of medical imaging in the teaching of anatomy by means of a review of the literature.

MATERIALS

A systematic search was performed using the electronic database PubMed, ScienceDirect and various publisher databases, with combinations of the relevant MeSH terms. A manual research was added.

RESULTS

In most academic curricula, imaging anatomy has been integrated as a part of anatomical education, taught using a very wide variety of strategies. Considerable variation in the time allocation, content and delivery of medical imaging in teaching human anatomy was identified. Given this considerable variation, an objective assessment remains quite difficult.

DISCUSSION

In most publications, students' perceptions regarding anatomical courses including imaging anatomy were investigated by means of questionnaires and, regardless of the method of teaching, it was globally concluded that imaging anatomy enhanced the quality and efficiency of instruction in human anatomy. More objective evaluation based on an increase in students' performance on course examinations or on specific tests performed before and after teaching sessions showed positive results in numerous cases, while mixed results were also indicated by other studies.

CONCLUSION

A relative standardization could be useful in improving the teaching of imaging anatomy, to facilitate its assessment and reinforce its effectiveness.

Evolution of the anatomical theatre in Padova

The anatomical theatre played a pivotal role in the evolution of medical education, allowing students to directly observe and participate in the process of dissection. Due to the increase of training programs in clinical anatomy, the Institute of Human Anatomy at the University of Padova has renovated its dissecting room. The main guidelines in planning a new anatomical theatre included: (1), the placement of the teacher and students on the same level in a horizontal anatomical theatre where it is possible to see (theatre) and to perform (dissecting room); (2), in the past, dissection activities were concentrated at the center of the theatre, while in the new anatomical theatre, such activities have been moved to the periphery through projection on surrounding screens-thus, students occupy the center of the theatre between the demonstration table, where the dissection can be seen in real time, and the wall screens, where particular aspects are magnified; (3), three groups of tables are placed with one in front with two lateral flanking tables in regards to the demonstration table, in a semicircular arrangement, and not attached to the floor, which makes the room multifunctional for surgical education, medical students and physician's continued professional development courses; (4), a learning station to introduce the students to the subject of the laboratory; (5), cooperation between anatomists and architects in order to combine the practical needs of a dissection laboratory with new technologies; (6), involvement of the students, representing the clients' needs; and (7), creation of a dissecting room of wide measurements with large windows, since a well-illuminated space could reduce the potentially negative psychological impact of the dissection laboratory on student morale.

Student perspectives of imaging anatomy in undergraduate medical education

Radiological imaging is gaining relevance in the acquisition of competencies in clinical anatomy. The aim of this study was to evaluate the perceptions of medical students on teaching/learning of imaging anatomy as an integrated part of anatomical education. A questionnaire was designed to evaluate the perceptions of second-year students participating in a clinical anatomy course over three consecutive academic years. A principal component analysis was used to evaluate the dimensionality of the questionnaire. The variables were summarized using frequencies, mean, median, 25th percentile, 75th percentile, minimum, and maximum. The results demonstrated that students felt the teaching of imaging anatomy influenced learning in the clinical anatomy course (mean = 4.5, median = 5.0) and subsequent clinical courses (mean = 4.4, median = 4.0). Regarding the imaging techniques used in the demonstration of anatomical structures, computed tomography (median = 5.0) and magnetic resonance imaging (median = 5.0) were highly rated. Students suggested the use of additional support material (37.6%) and favored a more practical approach. In conclusion, the results of this work highlight the value of imaging anatomy in learning human anatomy. Students' comments pointed out a need to focus teaching/learning programs toward a more practical rather than theoretical approach as well as a need to provide a better fit between sectional anatomy and clinical cases using imaging anatomy. In order to provide an optimal learning environment to students, it also seems important to create improved media material as an additional resource tool.

Self-guided clinical cases for medical students based on postmortem CT scans of cadavers

In the summer of 2009, we began full body computed tomography (CT) scanning of the pre-embalmed cadavers in the University of Michigan Medical School (UMMS) dissection lab. We theorized that implementing web-based, self-guided clinical cases based on postmortem CT (PMCT) scans would result in increased student appreciation for the clinical relevance of anatomy, increased knowledge of cross-sectional anatomy, and increased ability to identify common pathologies on CT scans. The PMCT scan of each cadaver was produced as a DICOM dataset, and then converted into a Quicktime movie file using Osirix software. Clinical cases were researched and written by the authors, and consist of at least one Quicktime movie of a PMCT scan surrounded by a novel navigation interface. To assess the value of these clinical cases we surveyed medical students at UMMS who are currently using the clinical cases in their coursework. Students felt the clinical cases increased the clinical relevance of anatomy (mean response 7.77/10), increased their confidence finding anatomical structures on CT (7.00/10), and increased their confidence recognizing common pathologies on CT (6.17/10). Students also felt these clinical cases helped them synthesize material from numerous courses into an overall picture of a given disease process (7.01/10). These results support the conclusion that our clinical cases help to show students why the anatomy they are learning is foundational to their other coursework. We would recommend the use of similar clinical cases to any medical school utilizing cadaver dissection as a primary teaching method in anatomy education.

A case study on multiple-choice testing in anatomical sciences

Objective testing techniques, such as multiple-choice examinations, are a widely accepted method of assessment in gross anatomy. In order to deter cheating on these types of examinations, instructors often design several versions of an examination to distribute. These versions usually involve the rearrangement of questions and their corresponding answer choices. This study will determine whether the distribution of different versions of an examination affects student performance in a lower division anatomical science course. Students who receive the original version of an examination may be at an advantage over those that receive a shuffled version of an examination because of the systematic tendencies that go into examination construction. This study concludes that the shuffling of questions and answer choices to produce multiple versions of an examination does not affect student performance.

Meta-evaluation in clinical anatomy: a practical application of item response theory in multiple choice examinations

The nature of anatomy education has changed substantially in recent decades, though the traditional multiple-choice written examination remains the cornerstone of assessing students' knowledge. This study sought to measure the quality of a clinical anatomy multiple-choice final examination using item response theory (IRT) models. One hundred seventy-six students took a multiple-choice clinical anatomy examination. One- and two-parameter IRT models (difficulty and discrimination parameters) were used to assess item quality. The two-parameter IRT model demonstrated a wide range in item difficulty, with a median of -1.0 and range from -2.0 to 0.0 (25th to 75th percentile). Similar results were seen for discrimination (median 0.6; range 0.4-0.8). The test information curve achieved maximum discrimination for an ability level one standard deviation below the average. There were 15 items with standardized loading less than 0.3, which was due to several factors: two items had two correct responses, one was not well constructed, two were too easy, and the others revealed a lack of detailed knowledge by students. The test used in this study was more effective in discriminating students of lower ability than those of higher ability. Overall, the quality of the examination in clinical anatomy was confirmed by the IRT models.

Clinical neuroanatomy module 5 years’ experience at the School of Medicine of Padova

Macroscopic anatomy of the brain is scheduled during the last meeting of the Short Course of Dissection, an optional course for second-year medical students at the School of Medicine of Padova, following the official 44 h of lectures of Neuroanatomy. The aim of the present study was to ascertain the value of brain dissection in retention of neuroanatomical knowledge by medical students. An anatomical questionnaire was given to second-year students in the years 2002-2006, aiming at evaluating their initial neuroanatomical background. Administered twice, at the beginning and end of the last meeting of the optional course, the questionnaire consisted of three diagrams, showing the base, the convexity of the brain, and an axial section of the cerebrum. For each diagram, ten anatomical structures were selected, according to their clinical importance. Students then followed a worksheet for external examination of the brain and cutting. The teacher presented three examples of pathologies causing elevated intracranial pressure, and indicated their locations on the relative cerebral structures. At the end of the meeting, the same questionnaire was given again. To evaluate long-term retention of information, it was also given to third-year students. The questionnaire revealed improved knowledge of neuroanatomy in a mean of 57% of students, especially as regards the axial section (72%), with respect to that of the brain base (43%) and convexity (40%). After 1 year, long-term assessment of information retention showed that 65% of the group which had followed the dissection course correctly answered with respect to the control group (40%), and even better (87.5%) as regards anatomical details presented in their clinical aspects. The main guidelines in planning the clinical neuroanatomy module were: (1) selection of anatomical landmarks of importance from the clinical viewpoint; (2) identification of pathologies which involve the above anatomical landmarks; (3) relationships between morphology and pathology enhancing anatomo-clinical importance.

Multimodal visualization interface for data management, self-learning and data presentation

A multimodal visualization software, called the Data Manager (DM), has been developed to increase interdisciplinary communication around the topic of visualization and modeling of various aspects of the human anatomy. Numerous tools used in Radiology are integrated in the interface that runs on standard personal computers. The available tools, combined to hierarchical data management and custom layouts, allow analyzing of medical imaging data using advanced features outside radiological premises (for example, for patient review, conference presentation or tutorial preparation). The system is free, and based on an open-source software development architecture, and therefore updates of the system for custom applications are possible.

[The human body and the computer as pedagogic tools for anatomy: review of the literature]

Since the first dissections, the human body has been the main tool for the teaching of anatomy in medical courses. For the last 30 years, university anatomy laboratory dissection has been brought into question and the total hours of anatomy teaching have decreased. In parallel, new technologies have progressed and become more competitive and more attractive than dissection. The aim of this review of the literature was to evaluate the use of the human body as a pedagogic tool compared to today's computer tools. Twenty comparative studies were reviewed. Their analysis showed that the human body remains the main tool in anatomy teaching even if anatomic demonstration (prosection) can replace dissection, and that the computer tools were complementary but not a substitute to dissection.

Dissection as a teaching tool: Past, present, and future

Cultural changes, scientific progress, and new trends in medical education have modified the role of dissection in teaching anatomy in today's medical schools. We discuss in this article the role of dissection itself, the value of which has been under debate for the last 30 years. The importance of dissection is considered from different points of view: educational, bioethical, and human values. Included are different opinions from professors and students. Finally, the current practice of dissection is described for some universities in the United States and Europe, showing its use as a learning tool.

Teaching and learning gross anatomy using modern electronic media based on the visible human project

This article reviews online (Internet) anatomy projects and multimedia productions (books and CD-ROMs) based on the Visible Human Project (VHP) of the United States National Library of Medicine. The focus of these projects and productions is on the teaching of 3D anatomy using the digitized sections of the visible human male and female. The article also provides information about the VHP, its goals and what it has achieved thus far.

Correlation of Web usage and exam performance in a human anatomy and development course

Course materials for a Human Anatomy and Development Course were placed on the World Wide Web (WWW). The materials included a lab manual, lecture notes and slides, faculty-generated atlases, Web links, and examinations. The lab manual, lecture notes, and atlases were also provided as black-and-white hardcopy. The Office of Education assigned students a code name that allowed them to use the Web site and take exams anonymously. Student Web use was tracked and correlated with their performance on the final examination. Overall use patterns revealed that most students used the Web site to prepare for examinations, but not for daily studying. Old examinations were the most accessed documents; lecture notes were the least accessed. The access patterns of the students with top 20, middle 20 (closest to the mean), and bottom 20 scores on the final examination were compared. In general, there was little difference between the middle and top groups. Students in the bottom group used computer resources significantly less than the other groups. In a second analysis, the 10 students who used the Web site most frequently scored below the mean. The study suggests that interactive exercises will be heavily used, but that the preparation of all course materials for the WWW may not be an efficient use of institutional resources.

Evaluation of the Clinical Anatomy Program in the Medical School of Porto by two cohorts of students

The discipline of Clinical Anatomy, as introduced in the Medical School of Porto in academic year 1995/96, involved major changes in the way we teach anatomy to medical students, by adopting a clinically oriented approach. A questionnaire was designed to evaluate the opinion of second-year medical students enrolled in the program concerning main aspects of the discipline in two consecutive years; 84% of the students returned the questionnaire in 1996/97, and 70% in 1997/98. Students were asked about the level of their approval of the organization of the discipline, the role of the teaching staff, lectures, practical sessions, educational media, and continuous and summative assessments. For items replicated in both academic years, the means of the sum of scores in each year were compared (Student's t-distribution). Whenever a significant difference was found, changes in individual items were tested (chi-square distribution). The evaluation of the discipline in each of the two years was highly favorable for most of the parameters analyzed.

Evaluation of practical sessions in clinical anatomy: a strategy for educational improvement

We have evaluated the students' response to the practical teaching sessions in Clinical Anatomy in our Medical School using an action-research method. The aim was to identify problems and to introduce changes that might improve both the program and the performance of the teaching staff. At the end of each section of the program, each student completed a "target type" questionnaire with eight different components. As each one quarter of the whole class had its own teacher, we used an analysis of variance to evaluate the target questions in the various sections of the program, and the performance of the four teachers. This research method gave us feedback on the students' responses while the program was in progress. The results emphasize the importance of action-research in assessing and improving a developing program in a basic discipline of the medical curriculum.