Learning and retaining normal radiographic chest anatomy: does preclinical exposure improve student performance?

What works in radiology education for medical students: a systematic review and meta-analysis

BACKGROUND

Medical imaging related knowledge and skills are widely used in clinical practice. However, radiology teaching methods and resultant knowledge among medical students and junior doctors is variable. A systematic review and meta-analysis was performed to compare the impact of different components of radiology teaching methods (active versus passive teaching, eLearning versus traditional face-to-face teaching) on radiology knowledge / skills of medical students.

METHODS

PubMed and Scopus databases were searched for articles published in English over a 15-year period ending in June 2021 quantitatively comparing the effectiveness of undergraduate medical radiology education programs regarding acquisition of knowledge and/or skills. Study quality was appraised by the Medical Education Research Study Quality Instrument (MERSQI) scoring and analyses performed to assess for risk of bias. A random effects meta-analysis was performed to pool weighted effect sizes across studies and I2 statistics quantified heterogeneity. A meta-regression analysis was performed to assess for sources of heterogeneity.

RESULTS

From 3,052 articles, 40 articles involving 6,242 medical students met inclusion criteria. Median MERSQI score of the included articles was 13 out of 18 possible with moderate degree of heterogeneity (I2 = 93.42%). Thematic analysis suggests trends toward synergisms between radiology and anatomy teaching, active learning producing superior knowledge gains compared with passive learning and eLearning producing equivalent learning gains to face-to-face teaching. No significant differences were detected in the effectiveness of methods of radiology education. However, when considered with the thematic analysis, eLearning is at least equivalent to traditional face-to-face teaching and could be synergistic.

CONCLUSIONS

Studies of educational interventions are inherently heterogeneous and contextual, typically tailored to specific groups of students. Thus, we could not draw definitive conclusion about effectiveness of the various radiology education interventions based on the currently available data. Better standardisation in the design and implementation of radiology educational interventions and design of radiology education research are needed to understand aspects of educational design and delivery that are optimal for learning.

TRIAL REGISTRATION

Prospero registration number CRD42022298607.

Clinicians' and Students' Perceptions and Attitudes Regarding the Anatomical Knowledge of Medical Students

BACKGROUND

In both the preclinical and clinical sciences, anatomy is considered as the foundation of medical education. Anatomy education serves as a foundation for clinical application and future practice of medicine. Health practitioners and students are interested in the adequacy of anatomical knowledge in clinical years since it has a direct impact on medical education and professional clinical practice.

OBJECTIVE

To examine the opinions and attitudes of medical students and clinicians regarding the preclinical and clinical years' teaching of anatomy and anatomical knowledge to medical students.

METHODS

Participants in the study, including clinicians and medical students, were required to answer an 8-question, 5-point Likert scale questionnaire to assess their attitudes regarding anatomical knowledge. The maximum score was 40, and the higher the score, the more the positive attitude towards anatomical knowledge. The difference in the mean attitude score between males and females was investigated using the Independent sample t-test.

RESULTS

A total of 327 clinicians and 423 students participated in the study. Clinicians and students showed moderately high positive attitude towards anatomical knowledge. The mean statements score for clinicians' attitudes was 31.4(±3.4). There was no significant difference between total attitude score means for clinicians and students, p=0.83. Attitude statements attained a significantly higher percentages and were in favor to clinicians in comparison to students, particularly for clinical significance of anatomical knowledge to students in the clinical years, the importance of anatomical knowledge to surgical and non-surgical specialties, and re-teaching special anatomy for students in the clinical years would improve their clinical background. Both clinicians and students expressed low agreement regarding anatomical educational style and quality of study materials.

CONCLUSION

Teaching anatomy to medical students is a continuous process. Therefore, we recommend reforming the anatomy curriculum by vertical integration of anatomy into the clinical rotations, clerkship, and specialist training.

Comparing learning retention in medical students using mixed-reality to supplement dissection: a preliminary study

OBJECTIVES

To evaluate student impressions of learning anatomy with mixed-reality and compare long-term information retention of female breast anatomy between students who learned with a mixed-reality supplement and their classmates who dissected cadavers.

METHODS

In Part 1, 38 first-year medical student volunteers, randomly divided into two groups, completed a mixed-reality module and cadaveric dissection on the female breast in a counterbalanced design. Participants also completed post-quizzes and surveys. Part 2 was a non-randomized controlled trial, 8-months after completing Part 1 and 6-months after a final exam on this content. The performance of twenty-two Part 1 participants and 129 of their classmates, who only dissected, was compared on a delayed post-quiz. Wilcoxon signed-rank test, Mann-Whitney U test, and 95% confidence intervals were used to analyze the data.

RESULTS

In Part 1, the Wilcoxon signed-rank test determined that participants expressed significantly more positive responses to mixed-reality and found mixed-reality easier for learning and teamwork. In Part 2, the Mann-Whitney U test found mixed-reality participants scored significantly higher on a delayed-post quiz than their classmates who only dissected (U = 928, p < .009).

CONCLUSIONS

  This study suggests that medical students may prefer mixed-reality and that it may be an effective modality for learning breast anatomy while facilitating teamwork. Results also suggest that supplementing cadaveric dissection with mixed-reality may improve long-term retention for at least one anatomical topic. It is recommended that similar studies evaluate a larger sample and additional anatomical regions to determine the generalizability of these findings.

The Effect of Passive and Active Education Methods Applied in Repetition Activities on the Retention of Anatomical Knowledge

This study examines the long-term retention of anatomical knowledge from 180 students after various repetition activities. The retention of anatomical knowledge was assessed by multiple-choice tests at five different points in time: before and after a course in Functional Anatomy, before and after repetition activities that occurred 14 weeks after this course, and 28 weeks after this course to establish long-term retention. Students were divided into five groups: one without any repetition activity, one with a restricted repetition activity (the multiple-choice test), and three groups that were offered repetition activities (traditional lecture, e-learning module, and small group work in the dissection room). During all three repetition activities the same information was conveyed, and this content was not revisited in other courses for the duration of the study. The results showed that students who did not engage in a repetition activity scored significantly lower on the long-term retention test compared to all other groups (ANCOVA: P = 0.0001). Pair-wise comparison with estimated means showed that the other four groups, regardless of the type of repeating activity, did not differ in the amount of knowledge they retained during any of the five assessments (P = 0.008, P = 0.0001, P = 0.001, and P = 0.0001, respectively). This study suggests that the type of repetition activity has no effect on knowledge retention both immediately following the activity and in the long term. It is concluded that the repetition of anatomical knowledge in any form is beneficial for students and will likely improve student outcomes in a curriculum that builds on prior knowledge.

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.

The Spectrum of Learning and Teaching: The Impact of a Fourth-Year Anatomy Course on Medical Student Knowledge and Confidence

There is growing demand from accrediting agencies for improved basic science integration into fourth-year medical curricula and inculcation of medical students with teaching skills. The objective of this study was to determine the effectiveness of a fourth-year medical school elective course focused on teaching gross anatomy on anatomical knowledge and teaching confidence. Fourth-year medical student "teacher" participants' gross anatomy knowledge was assessed before and after the course. Students rated their overall perceived anatomy knowledge and teaching skills on a scale from 0 (worst) to 10 (best), and responded to specific knowledge and teaching confidence items using a similar scale. First-year students were surveyed to evaluate the effectiveness of the fourth-year student teaching on their learning. Thirty-two students completed the course. The mean anatomy knowledge pretest score and posttest scores were 43.2 (±22.1) and 74.1 (±18.4), respectively (P < 0.001). The mean perceived anatomy knowledge ratings before and after the course were 6.19 (±1.84) and 7.84 (±1.30), respectively (P < 0.0001) and mean perceived teaching skills ratings before and after the course were 7.94 (±1.24) and 8.53 (±0.95), respectively (P = 0.002). Student feedback highlighted five themes which impacted fourth-year teaching assistant effectiveness, including social/cognitive congruence and improved access to learning opportunities. Together these results suggest that integrating fourth-year medical students in anatomy teaching increases their anatomical knowledge and improves measures of perceived confidence in both teaching and anatomy knowledge. The thematic analysis revealed that this initiative has positive benefits for first-year students.

The Twelve Cranial Nerves of Christmas: Mnemonics, Rhyme, and Anatomy - Seeing the Lighter Side

Anatomy, has in history, been linked to helpful ways to remember structures, branches of nerves, structures passing through foramina, etc. Scalp is even a mnemonic in itself (Skin, Connective tissue, Aponeurosis, Loose areolar tissue, Pericranium). There has been concern by some educators that using mnemonics or rhymes promotes a surface approach to learning and is unhelpful in establishing long-term and meaningful deep learning. This article argues that mnemonics and rhyme can be used, in the appropriate way, at the right time, by students as an important learning strategy. That strategy can help lay a foundation of knowledge to be developed and later built upon, or simply recall information more easily. Mnemonics, like all information that is to be recalled, is consolidated by rehearsal. In examining the neuroanatomy of learning theories, it is therefore possible to suggest that when students begin to learn an area of anatomy, such as the cranial nerves, using a mnemonic or rhyme, it can help students remember the names and facilitate the engagement of the working memory processes assisting the student to build a construct for subsequent deeper layers of knowledge. Modern approaches to anatomy education involve a myriad of learning opportunities, but educators must assess the value of each one before recommending them to students. It appears that using mnemonics and rhyme is as valid today as it has been for centuries.

Evaluation of an innovative hands-on anatomy-centered ultrasound curriculum to supplement graduate gross anatomy education

Ultrasound (US) can enhance anatomy education, yet is incorporated into few non-medical anatomy programs. This study is the first to evaluate the impact of US training in gross anatomy for non-medical students in the United States. All 32 master's students enrolled in gross anatomy with the anatomy-centered ultrasound (ACUS) curriculum were recruited. Mean Likert ratings on pre- and post-course surveys (100% response rates) were compared to evaluate the effectiveness of the ACUS curriculum in developing US confidence, and gauge its impact on views of US. Post-course, students reported significantly higher (P < 0.001) mean confidence ratings in five US skills (pre-course versus post-course mean): obtaining scans (3.13 ±1.04 versus 4.03 ±0.78), optimizing images (2.78 ±1.07 versus 3.75 ±0.92), recognizing artifacts (2.94 ±0.95 versus 3.97 ±0.69), distinguishing tissue types (2.88 ±0.98 versus 4.09 ±0.69), and identifying structures (2.97 ±0.86 versus 4.03 ±0.59), demonstrating the success of the ACUS curriculum in students with limited prior experience. Views on the value of US to anatomy education and to students' future careers remained positive after the course. End-of-semester quiz performance (91% response rate) provided data on educational outcomes. The average score was 79%, with a 90% average on questions about distinguishing tissues/artifacts, demonstrating positive learning outcomes and retention. The anatomy-centered ultrasound curriculum significantly increased confidence with and knowledge of US among non-medical anatomy students with limited prior training. Non-medical students greatly value the contributions that US makes to anatomy education and to their future careers. It is feasible to enhance anatomy education outside of medical training by incorporating US. Anat Sci Educ 10: 348-362. © 2016 American Association of Anatomists.

An Integrated Interactive-Spaced Education Radiology Curriculum for Preclinical Students

Introduction:

The objective of this study is to determine whether a radiology module, together with online spaced education, helps students of an integrated problem-based learning (PBL) curriculum increase their radiology knowledge and long-term retention.

Materials and Methods:

Second-year students at the American University of Antigua College of Medicine participated in small groups of ten students each into two 2 h of radiology laboratories. The study comprised two cohorts: winter and fall 2013 students (control group) and 2014 students (experimental group). Both groups used face-to-face PBL. The students of the experimental group received additional online-spaced education. The skills were assessed for both groups before the beginning of laboratories and 4 weeks and 7 months after laboratories.

Results:

There was no significant difference on pretest between the control and experimental groups. On completion of the radiology laboratories, comparison of test results before and after training showed net improvement for both groups. The corresponding difference for the experimental group was higher compared to the one for the control group (7.83 vs. 6.21, P < 0.001). The difference between the scores on delayed test and pretest showed that the students of both groups demonstrated average knowledge improvement even though their level of performance was slightly below the posttest. The corresponding difference for the experimental group did not differ much from the posttest (P > 0.05), and no significant difference of scores was observed 7 months later for either group. Further, a higher percentage of the students in the experimental group strongly agreed that their learning objectives were met (92% vs. 71%, P > 0.001), and this trend persisted throughout the study.

Conclusion:

Online spaced education combined to a face-to-face PBL enhances not only the student's knowledge of basic radiology along with his/her self-assessment skills but also the long-term retention of radiology material and satisfaction with the integrated interactive system-based module. Future research is needed to see if medical students in need of additional education support may benefit from spaced education in the field of remediation.

Longitudinal cohort study on medical student retention of anatomical knowledge in an integrated problem-based learning curriculum

BACKGROUND

When modifying a curriculum to accommodate changes in the methods of subject matter presentation or fit within a shortened time frame, student retention of knowledge remains an important issue.

AIM

This study evaluates medical student retention of anatomical knowledge as they matriculate through an anatomy curriculum where the instruction hours are less than half of the current national average.

METHOD

Medical students completed an assessment tool developed to evaluate their baseline level of anatomical knowledge at the beginning of the first year. They then completed the instrument at the end of their 1st, 2nd, 3rd, and 4th years to assess their retention of anatomical knowledge during medical school. Data collection began in September 2010 and concluded in June 2015.

RESULTS

Results demonstrate that students began medical school with a low level of anatomical knowledge (baseline), that knowledge increased during their first year (p < 0.001), continued to increase during their second year (p < 0.001), but was over 90% maintained through years 3 and 4.

CONCLUSION

In conclusion, an anatomy course with reduced hours (∼60), using active learning methods, contextual learning, cadaver demonstrations, increased exposure to imaging, and longitudinal reinforcement can help students build a strong foundation of anatomical knowledge.

The role of ultrasound in graduate anatomy education: Current state of integration in the United States and faculty perceptions

Ultrasound (US) is increasingly taught in medical schools, where it has been shown to be a valuable adjunct to anatomy training. To determine the extent of US training in nonmedical anatomy programs, and evaluate anatomists' perceptions on the role of US in anatomy education, an online survey was distributed to faculty in anatomy Master's and Doctoral programs. Survey results sampled 71% of anatomy graduate degree programs nationally. Of the faculty surveyed, 65% report little to no experience with US. Thirty-six percent of programs surveyed incorporate exposure to US, while only 15% provide hands-on US training. Opportunities for anatomy trainees to teach with US were found in 12% of programs. Likert responses indicated that anatomists hold overwhelmingly positive views on the contributions of US to anatomy education: 91% agreed US reinforces anatomical concepts (average 4.33 ± 0.68), 95% agreed it reinforces clinical correlates (average 4.43 ± 0.65). Anatomists hold moderately positive views on the value of US to the future careers of anatomy graduates: 69% agreed US increases competitiveness on the job market (average 3.91 ± 0.90), 85% agreed US is a useful skill for a medical school teaching career (average 4.24 ± 0.75), and 41% agreed that US should be required for a medical education career (average 3.34 ± 1.09). With continued improvements in technology and the widespread adoption of US into diverse areas of clinical practice, medical education is on the cusp of a paradigm shift with regards to US. Anatomists must decide whether US is an essential skills for the modern anatomist. Anat Sci Educ 9: 453-467. © 2016 American Association of Anatomists.

A practical description and student perspective of the integration of radiology into lower limb musculoskeletal anatomy

BACKGROUND

Anatomy educators are increasing their utilisation of radiology in anatomy education in line with growing requirements for undergraduate radiology competency and clinical need.

AIMS

We aimed to evaluate student perceptions of radiology and to outline the technical and academic considerations underlying the integration of radiology into musculoskeletal practical anatomy sessions.

MATERIALS AND METHODS

The formal integration of radiology into anatomy practical sessions took place over a 5-week period during the lower limb musculoskeletal component of the anatomy course taught to first-year medical students. During practical sessions, students were required to rotate between aligned audio-visual radiology presentations, osteology/anatomical models, and prosection/dissection learning stations. After completing the course, students were invited to complete a survey to establish their opinions on radiology as a mode of learning and their satisfaction with radiological integration in anatomical practical sessions.

RESULTS

Most students were not familiar with radiology prior to attending our university. All our students agreed or strongly agreed that learning to read radiographs in anatomy is important and most agreed that radiology is a valid assessment tool. Sixty percent stated that radiology facilitated their understanding of anatomy. The majority believed that radiology was best suited to clinically relevant anatomy and X-rays were their preferred learning tool.

CONCLUSIONS

The practical approach to integrating radiology into undergraduate musculoskeletal anatomy described here did not place strain on existing academic resources. Most students agreed that radiology should be increased in anatomy education and that learning to understand radiographs in anatomy was important for clinical practice.

Curricular response to increase recall and transfer of anatomical knowledge into the obstetrics/gynecology clerkship

Deficits in retention of anatomy knowledge from the preclinical years to clinical application on the wards have been well documented in the medical education literature. We developed and evaluated a web and laboratory-based curriculum to address deficits in anatomy knowledge retention and to increase anatomy knowledge recall through repetition and application of clinical concepts during the obstetrics and gynecology (Ob/Gyn) core clinical clerkship. Using principles of adult learning and instructional design, a curriculum was designed consisting of (1) interactive, case-based e-modules reviewing clinically relevant anatomical topics and (2) a hands-on laboratory session reinforcing the content of the e-modules, with the practice of clinical techniques using anatomical cadaveric dissections. The curriculum's effectiveness was evaluated by using multiple choice testing and comparing baseline and final test scores. For questions testing content directly covered in this curriculum, mean final scores increased by 14.3% (P < 0.001). In contrast, for questions not directly addressed in this curriculum, mean final scores did not increase significantly, only by 6.0% (P = 0.31). Questions related to the uterus showed the greatest gains in final scores (30.3% improvement, P = 0.002). A curriculum with web-based preparatory material and a hands-on gross anatomy laboratory session effectively addresses deficits in anatomy retention and improves anatomical knowledge recall for medical students on a clinical clerkship. In the future, the authors plan to conduct a multicenter study to further evaluate the ability of this curriculum to improve clinically relevant anatomical knowledge. Anat Sci Educ 9: 337-343. © 2015 American Association of Anatomists.

Assessing Medical Student Knowledge of Imaging Modality Selection Before and After a General Radiology Elective: A Comparison of MS-IIs, MS-IIIs, and MS-IVs

RATIONALE AND OBJECTIVES

Correct selection of imaging tests is essential f or clinicians but until recently has been largely neglected in medical education. How and when students acquire such non-interpretive skills are unknown. This study will assess student knowledge of imaging test selection before and after a general radiology elective.

MATERIALS AND METHODS

Between 2008 and 2015, an unannounced 13-item test was administered to second, third, and fourth-year students on the first and last days of the Johns Hopkins School of Medicine radiology elective. Scores (0–13) were based on the American College of Radiology Appropriateness Criteria. Pre- and posttest means were compared using paired samples t tests. Whether performance on the pretest and posttest differed by class year was assessed using analysis of variance and Kruskal-Wallis, respectively, and whether year was associated with posttest score after controlling for pretest score was assessed using analysis of covariance.

RESULTS

Posttest means were significantly higher than pretest means for students in all years (P values <.0001). Pretest scores differed by year (F(2, 360) = 66.85, P <.0001): fourth-year students scored highest (mean = 9.96 of 13) and second-year students scored lowest (mean = 7.01 of 13). Posttest scores did not differ (χ2(2, 270) = 0.348, P = .841). Year in school had no independent effect on posttest score (F(2, 239) = 0.45, P = .637).

CONCLUSION

Knowledge of modality selection increases with clinical training, but room for improvement remains. A general radiology elective increases this knowledge. Second-year students improve most, suggesting that taking radiology early is efficient, but further research to evaluate retention of this knowledge is needed. Medical student education in radiology must increasingly recognize and address non-interpretive skills and intelligent imaging utilization.

Integrating Radiology and Anatomy Teaching in Medical Education in the UK--The Evidence, Current Trends, and Future Scope

This review article presents the current evidence of the importance of integrating radiology and anatomy in medical education in the UK, a recommendation by a number of key anatomy, education, and radiology organizations. Current evidence highlights that on average only 5% of total teaching time in medical education is dedicated to radiology. Often, radiology teaching does not adequately fulfill students' learning needs and potentially leaves them underprepared for medical practice. Benefits of integrating radiology and anatomy include improved clinical application of anatomy, an increase in student's interest in anatomy, and ultimately improved radiological interpretation. Various modalities exist for the integration of radiology and anatomy, facilitated by the vast portability of radiological images. It appears that combining radiological resources with traditional anatomy teaching methodology in a blended approach is most beneficial.

Pedagogical Approaches to Diagnostic Imaging Education: A Narrative Review of the Literature

OBJECTIVE

The purpose of this study was to examine literature on how radiology is taught and learned by both radiology residents and undergraduates in the health professions.

METHODS

A review of the literature was performed using relevant key words. Articles were retrieved through December 2012 using PubMed, ScienceDirect, ERIC, Proquest, and ICL databases along with a manual review of references.

RESULTS

Of the 4716 unique abstracts reviewed by the author, 91 were found to be relevant to the purpose of this study. The literature retrieved reported pedagogical approaches to teaching radiology including the following: problem solving, technology as teacher, independent learning tools, visiting lectureships, case based teaching, and conferences. There was some exploration of the relative effectiveness of educational formats. Suggestions for future research identify 7 areas of relative consistency.

CONCLUSION

Radiology is a clinical skill that requires integration science, clinical information, clinical experiences, and information recorded on diagnostic imaging studies. The research in this area focuses on problem solving, the use of algorithm/scripts, introducing uncertainty in clinical scenarios, incorporating technology in learning environments, active learning techniques, and methods of independent learning. Although the literature in this area is still in its infancy, the research examining the relative effectiveness of these various educational formats is often contradictory, suggesting that this is a complex area of study with numerous factors influencing student learning.

Integration of medical imaging including ultrasound into a new clinical anatomy curriculum

In 2008 a new clinical anatomy curriculum with integrated medical imaging component was introduced into the University of Sydney Medical Program. Medical imaging used for teaching the new curriculum included normal radiography, MRI, CT scans, and ultrasound imaging. These techniques were incorporated into teaching over the first two years of the program as a part of anatomy practical sessions, in addition to dedicated lectures and tutorials given by imaging specialists. Surveys were conducted between 2009 and 2012 to evaluate the student acceptance of the integration. Students were asked to rate individual activities as well as provide open-ended comments. The number of students who responded to the surveys varied from 40% to 98%. Over 90% of the respondents were satisfied with the overall quality of teaching in the anatomy units. In summary, 48% to 63% of the responding students thought that the specialist imaging lectures helped them learn effectively; 72% to 77% of students thought that the cross-sectional practical sessions helped them to better understand the imaging modalities of CT, MRI, and ultrasound; 76% to 80% of students considered hands-on ultrasound session to be useful in understanding the application of ultrasound in abdominal imaging. The results also revealed key similarities and differences in student perceptions of the new integrated curriculum for students with both a high and low prior exposure to anatomy. Further evaluation will aid in refining the integrated medical imaging program and providing its future direction.

Innovative Approach to Teaching Osteopathic Manipulative Medicine: The Integration of Ultrasonography

Context: Noninvasive diagnostic methods and palpatory physical examination skills are especially important for osteopathic medical students intending to work in rural, underresourced, or underserved areas. The A.T. Still University–Kirksville College of Osteopathic Medicine integrates ultrasonography into the osteopathic manipulative medicine (OMM) courses required during the first 2 years of medical school, allowing students to learn the technology and to visualize anatomical structures and regions. Objective: To assess the feasibility of integrating ultrasonography into the first-year and second-year OMM curriculum through the evaluation of students' success in demonstrating the technology and visualizing the anatomy. Methods: As part of their OMM requirements at the A.T. Still University–Kirksville College of Osteopathic Medicine, all first- and second-year students in OMM courses were given ultrasonography assignments that required them to obtain images of musculoskeletal structures in different regions of the body. First-year students studied craniocervical structures and the thoracic, lumbar, and sacral regions. Second-year students studied the glenohumeral joint and the suprapatellar recess. The assignments focused on identifying structures of interest, making annotations, and measuring the structures of interest. Handouts with detailed instructions and a demonstration were provided before each assignment. Results: A total of 183 first-year students and 165 second-year students participated. Of the first-year students, on average, 177 of 181 were able to successfully complete the assignments, with an average completion rate of 98%. The costotransverse joint assignment yielded the lowest completion rate (97%), and the craniocervical landmarks assignment had the highest completion rate (99%). Of the second-year students, 162 of 165 participants were able to successfully complete the assignments, with an average completion rate of 98%. Mean scores were the same for both second-year assignments. Conclusion: First-year and second-year osteopathic medical students successfully demonstrated their use and understanding of ultrasonography and found their assigned structures using live ultrasound imaging. The skills gained through these assignments added another dimension to students' understanding of normal and pathologic musculoskeletal anatomy and vasculature. The integration of ultrasonography into OMM courses may have created a foundation for learning ultrasound-guided injection techniques. J Am Osteopath Assoc. 2015;115(4):212-220 doi:10.7556/jaoa.2015.043

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.

Development and utilization of a web-based application as a robust radiology teaching tool (radstax) for medical student anatomy teaching

Rationale and Objectives: The primary role of radiology in the preclinical setting is the use of imaging to improve students' understanding of anatomy. Many currently available Web-based anatomy programs include either suboptimal or overwhelming levels of detail for medical students.Our objective was to develop a user-friendly software program that anatomy instructors can completely tailor to match the desired level of detail for their curriculum, meets the unique needs of the first- and the second-year medical students, and is compatible with most Internet browsers and tablets.Materials and Methods: RadStax is a Web-based application developed using free, open-source, ubiquitous software. RadStax was first introduced as an interactive resource for independent study and later incorporated into lectures. First- and second-year medical students were surveyed for quantitative feedback regarding their experience.Results: RadStax was successfully introduced into our medical school curriculum. It allows the creation of learning modules with labeled multiplanar (MPR) image sets, basic anatomic information, and a self-assessment feature. The program received overwhelmingly positive feedback from students. Of 115 students surveyed, 87.0% found it highly effective as a study tool and 85.2% reported high user satisfaction with the program.Conclusions: RadStax is a novel application for instructors wishing to create an atlas of labeled MPR radiologic studies tailored to meet the specific needs their curriculum. Simple and focused, it provides an interactive experience for students similar to the practice of radiologists.This program is a robust anatomy teaching tool that effectively aids in educating the preclinical medical student.

Making education effective and fun: stations-based approach to teaching radiology and anatomy to third-year medical students

RATIONALE AND OBJECTIVES

A hands-on stations-based approach to teaching anatomy to third-year medical students is used at Boston University. The goal of our study was to demonstrate that such an interactive, team-based approach to teaching anatomy would be well received and be helpful in recall, comprehension, and reinforcement of anatomy learned in the first year of medical school.

MATERIALS AND METHODS

Each radiology-anatomy correlation lab was focused on one particular anatomic part, such as skull base, pelvis, coronary anatomy, etc. Four stations, including a three-dimensional model, computer, ultrasound, and posters, were created for each lab. Informed consent was obtained before online survey dissemination to assess the effectiveness and quality of radiology-anatomy correlation lab. This study was approved by our institutional institutional review board, and data were analyzed using a χ(2) test.

RESULTS

Survey data were collected from February 2010 through March 2012. The response rate was 33.5%. Overall, the highest percentage of students (46%) found the three-dimensional model station to be the most valuable. The computer station was most helpful in recall of the anatomic principles from the first year of medical school. Regarding the quality of the anatomy lab, less than 2% of the students thought that the images were of poor quality or the material presented was not clinically relevant.

DISCUSSION

Our results indicate that an interactive, team-based approach to teaching anatomy was well received by the medical students. It was engaging and students were able to benefit from it in multiple ways.

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.

Radiology medical student education: an outcome-based survey of PGY-1 residents

RATIONALE AND OBJECTIVES

Postgraduate year (PGY)-1 residents are frequently required to order imaging studies and make preliminary interpretations on them. This study determines whether PGY-1 residents feel their radiology education in medical school sufficiently trained them for the clinical responsibilities of internship.

MATERIALS AND METHODS

This multicenter, institutional review board-approved survey asked PGY-1 trainees three categories of questions: 1) extent of medical school training for ordering and interpreting imaging studies, 2) confidence levels in ordering appropriate imaging studies and making common/emergent diagnoses, and 3) rating the importance of radiologic interpretation by interns. Respondents also submitted ideas for medical school teaching topics deemed most useful for interns.

RESULTS

A total of 175 questionnaires were returned with good representation across specialties. Although 63.7% of interns were frequently asked to independently preview radiology studies, 12.6% received no formal radiology training in medical school. Participants rated chest radiographs as the most important study for interns to competently interpret (93.4% reporting very or extremely important). However, only 60.2% of interns reported high confidence in recognizing common/emergent pulmonary findings, and 56.3% for evaluating line and tube position. With regard to ordering imaging studies, 81.0% had never used or never heard of the American College of Radiology Appropriateness Criteria®. Only 33.1% had high confidence in knowing when to order oral/intravenous contrast. Similar low percentages had high confidence identifying and premedicating contrast allergies (36.4%) and knowing risk factors of nephrogenic systemic fibrosis (13.2%).

CONCLUSIONS

PGY-1 residents feel that medical school curriculum emphasizing interpretation of chest radiographs and ordering appropriate imaging studies would better prepare students for the responsibilities of internship.

Strategic improvements for gross anatomy web-based teaching

Current generations of graduate students have been immersed in technology from their early school years and have high expectations regarding digital resources. To better meet the expectations of Gross Anatomy students at our institution, electronic radiology teaching files for first-year coursework were organized into a web site. The web site was custom designed to provide material that directly correlated to the Gross Anatomy dissection and lectures. Quick links provided sets of images grouped by anatomic location. Additionally, Lab and Study Companions provided specific material for the students to review prior to and after lectures and gross dissections. Student opinions of this education resource were compared to student opinions of the prior year's digital teaching files. The new content was ranked as more user friendly (3.1 points versus 2.3 points) and more useful for learning anatomy (3.3 points versus 2.6 points). Many students reported that using the web portal was critical in helping them to better understand relationships of anatomical structures. These findings suggest that a well-organized web portal can provide a user-friendly, valuable educational resource for medical students who are studying Gross Anatomy.

Integrated teaching of anatomy and radiology using three-dimensional image post-processing

This article presents a new way of teaching by integrating both anatomy and radiology using three-dimensional image post-processing tools. One preclinical and one clinical module were developed for integrated teaching of anatomy and radiology. Potential benefits were assessed by anonymous evaluation among the 176 participating students. The students highly appreciated the new approach, especially the high degree of interactivity with the post-processing software and the possibility to correlate the real dissection with the virtual dissection. Students agreed that three-dimensional imaging and postprocessing improved their understanding of difficult anatomical topics and topographical relations. We consider the new approach to provide great additional benefits for participating students regarding preparation for everyday clinical practice. In particular, it imparts familiarity with imaging and image post-processing techniques and may improve anatomical understanding, radiological diagnostic skills and three-dimensional appreciation.

Building the body: active learning laboratories that emphasize practical aspects of anatomy and integration with radiology

Active learning exercises were developed to allow advanced medical students to revisit and review anatomy in a clinically meaningful context. In our curriculum, students learn anatomy two to three years before they participate in the radiology clerkship. These educational exercises are designed to review anatomy content while highlighting its relevance to the study of radiology. Laboratory exercises were developed using inexpensive materials in the form of hands-on stations designed for use by students working together in small groups. Station exercises include model building, exploring relevant radiological imaging, and practicing clinical techniques. Students are encouraged to move from abstract conceptualization of the anatomy using models to applying knowledge to living tissues by using a portable ultrasound to explore superficial anatomy on each other. Stations are designed to integrate knowledge and reemphasize concepts in different contexts, so that upon completion students have a reinforced understanding of the three-dimensional anatomy of the region in question, the appearance of the anatomy on radiological images, and an appreciation of the relevance of the anatomy to radiological procedures.

Chest radiographic anatomy retention: the impact of preclinical groundwork on clinical recall in two schools

RATIONALE AND OBJECTIVES

The aim of this study was to verify earlier work on learning and retaining chest radiographic anatomy introduced during preclinical education and revisited in the clinical years by comparing the initial clinical group to clinical students in a second setting who had no preclinical exposure.

MATERIALS AND METHODS

One hundred thirty-seven clinical medical students were pretested and posttested on the same 10 items as were used in the first study. Scores on these 10-item standardized pretests and posttests were compared and assessed for statistical significance.

RESULTS

Although the clinical students with preclinical exposure scored significantly higher on the pretest than the students without preclinical exposure (mean, 4.42 vs 4.09), there was a much larger significant difference in posttest improvement (mean, 8.65 vs 6.09). Isolating only the senior students to control for clinical experience (pretest, 4.42 vs 4.38; posttest, 8.65 vs 6.09) did not significantly affect outcomes.

CONCLUSIONS

Many medical schools are revising curricula and incorporating new models of learning. It may be important to recognize that older approaches such as memorization and testing are still necessary to start building the enormous "filing cabinet" of facts that must be cross-linked, revisited, and retrievable to contribute to a usable fund of medical knowledge.

The long-term impact of preclinical education on medical students' opinions about radiology

RATIONALE AND OBJECTIVES

It has been previously shown that integrating radiology teaching into the first year of medical education has an immediate positive effect on medical students' attitudes toward the practice of radiology. The purpose of this study is to determine whether these changes in attitude persist through the clinical years of training and whether preclinical exposure to radiology has a long-term effect on medical students' opinions about radiology and radiologists.

MATERIALS AND METHODS

The first-year medical curriculum at the University of Pittsburgh School of Medicine was revised between the 2003 and 2004 academic years, with 2.5 hours of additional radiology lectures integrated into the existing preclinical coursework. Additionally, radiology consult sessions were integrated into problem-based learning sessions. An initial survey was administered in the preclinical years of training to assess first-year medical students' attitudes toward radiology before and after the changes to the curriculum. A follow-up survey was administered before graduation to determine whether the changes in attitude revealed in the first survey persisted throughout the remaining years of training, and to assess students' opinions about negative radiologist stereotypes. Students who had undergone the revised curriculum were compared to students who had undergone the traditional curriculum.

RESULTS

There were statistically significant differences between the two graduating classes in terms of interest in, and perceptions of, the field of radiology. At graduation, students exposed to the revised preclinical curriculum with a greater exposure to radiology had a greater interest in radiology as a discipline and were more likely to have taken senior electives in radiology. These graduating students were also less likely to agree with negative stereotypes about radiologists.

CONCLUSIONS

Dedicated medical student teaching from an academic radiologist during the first year of medical school has a positive, long-lasting effect on medical students' attitudes toward radiology. The prevalence of negative stereotypes about radiologists among graduating medical students can be reduced by appropriate teaching of radiology in the preclinical years of medical school.