Changing Study Strategies with Revised Anatomy Curricula: a Move for Better or Worse?

Prior anatomy experience among medical students: What difference does it make?

Prior research has reported that experience in undergraduate anatomy did not significantly affect students' grades in professional schools, yet students would still recommend anatomy experience prior to medical school. It has been further posited that this prior experience may have benefits that do not appear in grade outcomes, such as decreased stress levels or different study strategies. The present study investigated whether different study strategies in anatomy were reported between students with and without prior experience. The data were collected using surveys administered near the beginning and the end of the medical anatomy course. The surveys included questions about study strategies used for the course, basic demographics, and prior experience in anatomy and/or physiology. Results confirmed very few differences in course outcomes between students with and without prior experience in anatomy and/or physiology; however, differences were noted in the study strategies reported. Students with prior experience in anatomy were more likely to report use of a wider variety of strategies and less changes in strategies between the surveys. However, these differences were only noted with prior courses of a certain number and level. It is posited that students with prior experience may have already created a basic scaffold of information in their mind that they could then plug additional information into rather than creating an entirely new knowledge structure. While this did not largely change course outcomes, it is likely to have positive effects on students' perceptions of stress and feelings of being overwhelmed during the course.

The Effect of Histology Examination Format on Medical Student Preparation and Performance: Stand-Alone Versus Integrated Examinations

Most medical schools have transitioned from discipline-based to integrated curricula. Although the adoption of integrated examinations usually accompanies this change, stand-alone practical examinations are often retained for disciplines such as gross anatomy and histology. Due to a variety of internal and external factors, faculty at the University of Cincinnati College of Medicine recently began to phase out stand-alone histology practical examinations in favor of an integrated approach to testing. The purpose of this study was to evaluate this change by (1) comparing examination performance on histology questions administered as part of stand-alone versus integrated examinations and (2) ascertaining whether students alter their approach to learning histology content based on the examination format. Data from two courses over a period ranging from 2018 to 2022 were used to evaluate these questions. Results indicated histology question performance initially dropped after being included on integrated examinations. Stratification of students by class rank revealed this change had a greater impact on lower-performing students. Longitudinal data showed that performance 2 years after the change yielded scores similar to previous standards. Despite the initial performance drop, survey results indicate students overwhelmingly prefer when histology is included on integrated examinations. Additionally, students described alterations in study approaches that align with what is known to promote better long-term retention. The results presented in this study have important implications for those at other institutions who are considering making similar changes in assessment strategies.

The effect of curricular reform on gross anatomy laboratory examination performance: An institutional analysis

Many medical schools have undergone curricular reform recently. With these reforms, time spent teaching anatomy has been reduced, and there has been a general shift to a pass/fail grading system. At Indiana University School of Medicine (IUSM), a new curriculum was implemented in fall 2016. The year-long human gross anatomy course taught in 2015 was condensed into an integrated, semester-long course starting in 2016. Additionally, the grading scale shifted to pass/fail. This study examined first-year medical student performance on anatomy practical laboratory examinations-specifically, among lower-order (pure identification) questions and higher-order (function, innervation) questions. Participants included medical students from a pre-curricular reform cohort (year 2015, 34 students) and two post-curricular reform cohorts (years 2016, 30 students and 2017, 33 students). A Kruskal-Wallis ANOVA test was used to determine differences of these questions among the three cohorts. Additionally, 40 of the same lower-order questions that were asked on gross anatomy laboratory examinations from medical student cohort year 2015 and year 2016 were further analyzed using an independent samples t-test. Results demonstrated that the pre-curricular reform cohort scored significantly higher on both lower-order (median = 81, p < 0.001) and higher-order questions (median = 82.5, p < 0.05) than both post-curricular reform cohorts. Additionally, when reviewing the selected 40 similar questions, it was found that the pre-curricular reform cohort averaged significantly higher (82.1 ± 16.1) than the post-curricular reform cohort from 2016 (69.3 ± 21.8, p = 0.004). This study provides evidence about the impact of curricular reform on medical student anatomical knowledge.

Histology education in an integrated, time-restricted medical curriculum: Academic outcomes and students' study adaptations

In an ever-changing medical curricular environment, time dedicated for anatomical education has been progressively reduced. This happened at the University of Michigan Medical School starting in 2016-2017 when preclinical medical education was condensed to one year. Histology instruction remained integrated in organ system courses but reduced to a lecture-only format without scheduling time for laboratory exercises, requiring students to study virtual histology slides on their own time. In accordance with the shortened instructional time, the number of histology examination questions was reduced more than twofold. This study analyzed students' histology examination results and assessed their motivation to learn histology and use of educational opportunities before and after these curricular changes were implemented. Students' motivation to learn histology and their evaluation of histology lectures increased in the new curriculum. However, students devoted less study time to studying histology. Students' cumulative histology examination scores were significantly lower in the new curriculum and the number of students with overall scores <75%, defined as a substandard performance, increased more than 15-fold. Academically weaker students' histology scores were disproportionately more affected. As medical educational strategies, priorities, and curricular frameworks continue to evolve, traditional didactic topics like histology will need to adapt to continue providing educational value to future health care providers.

Perceptions of Medical Undergraduate Students on Curricular Changes in Anatomy: An Embedded Design Mixed Method Study

INTRODUCTION

Implementation of competency-based medical education (CBME) offers challenges to the faculty and students. As a part of the new curriculum by the National Medical Council of India, we introduced certain teaching and assessment modifications in anatomy. There are few studies on the actual implementation of CBME. The current study aimed to assess the perceived usefulness of the teaching, learning, and assessment methodology (TLAM) based on written feedback from students.

METHODS

All the 147 first MBBS students of the batch who had undergone the new teaching learning methodology answered the questionnaire on usefulness of the various TLAMs on a 3-point Likert scale which was taken as quantitative data. They were also asked to pen down their opinions and suggestions about the TLAM which was thematically analysed and considered as qualitative data. Face and content validity was assessed prior to administration of the questionnaire. Descriptive statistics were used for quantitative variables. Qualitative data were analysed by thematic analysis.

RESULTS

100% of the students found vertical integration and small group teaching as useful. Seminars and quizzes were reported as useful to extremely useful by 75.5% of the students. Self-directed learning and near-peer teaching was also appreciated well by 78% of students. In Embryology and Neuroanatomy, these active learning methods were not found to be useful as these topics were difficult to understand. Overall, the new TLAM introduced as per the new medical curriculum was found useful for the majority of students.

CONCLUSION

This study provides valuable insights on the teaching, learning, and assessment methods as formulated by the competency-based medical curriculum. Though active learning methods are the integral principles of andragogy, the concepts which are difficult to understand need to be taught using the traditional teaching methodology.

Association Between Learning Approaches and Medical Student Academic Progression During Preclinical Training

PURPOSE

Students have diverse learning preferences that can impact the achievement of learning outcomes. However, there is a lack of unequivocal evidence for an association between the learning preferences and academic success. The purpose of the study was to examine the association between learning approaches and academic success of medical students during the basic science curriculum.

METHODS

In this cross-sectional comparative study, low-achieving (n=80) and high-achieving students (n=50) from semesters 1 through 3 of the Ross University School of Medicine's basic science curriculum completed the Approaches and Study Skills Inventory for Students (ASSIST) short-form to provide data on their learning approaches. Student's-t test was applied to find statistical differences in learning approaches of low and high achievers, and point-biserial was used to analyze the correlation between academic performance and learning approaches. Mean sum scores with standard deviation on ASSIST short-form scales (deep, surface, and strategic approaches) as well as subscales are reported.

RESULTS

High-achieving students reported a preference for using deep and strategic learning approaches compared to low-achieving students (p < 0.05). Low achievers indicated that they predominantly used the surface approach to learning (p<0.05). Yet, "fear of failure," a subscale of the surface approach, was greater among high achievers. Additionally, significant gender differences were found on subscales of "lack of purpose," "syllabus bound," "unrelated memorization" (surface approach), and "time management" and "organized studying" (strategic approach).

CONCLUSION

Our results suggest that low-achieving medical students' predominant reliance on the surface approach to learning may affect their academic success and that it may be worthwhile to help medical students become aware of the effectiveness of their individual preferred learning approaches early on in their training. Identification and adoption of optimal learning approaches should increase the achievement of successful learning outcomes.