Design principles for developing an efficient clinical anatomy course

Use of Clinically Oriented Laboratory Manuals in a Prosection Gross Anatomy Laboratory during COVID-19

Gross anatomy is a critical course for the development of a variety of skills such as anatomical knowledge and spatial, critical, and clinical reasoning. There have been few attempts to integrate clinical applications in gross anatomy, with the majority of these being in the lecture hall and not in the laboratory. Clinical cases and guided questions were added to a laboratory manual (Clinically Oriented Laboratory Manuals (COLMs)) in a first-year medical gross anatomy prosection course during COVID-19. The effectiveness of the COLMs was analyzed using in-laboratory assessments between treatment and control groups, as well as student perceptions. There was no significant difference between in-lab assessment scores between students with or without the COLMs in 2020 (t1304.735= 0.647, p ;= 0.518). Student perceptions demonstrated that 61.6% strongly agreed or agreed that the COLMs were a good way to learn anatomy and 32.0% desired more COLMs in the lab. Overall, COLMs did not increase student knowledge by the end of a session. Students thought the COLMs were a good tool to learn anatomy because they helped become more clinically aware; however, students desired better implementation of the COLMs. The addition of COLMs in the laboratory is a potential method to address the need for clinical applications within the gross anatomy laboratory.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40670-023-01970-1.

Apprendre l’anatomie radiographique en présentiel ou en ligne ? Une étude randomisée contrôlée

Résumé

L’enseignement de l’anatomie repose sur diverses techniques: les cours, les dissections, les modèles 3D ou encore les supports en ligne. Ces derniers sont généralement considérés comme des moyens d’apprentissage complémentaires. Cette étude vise à comparer les performances des étudiants vétérinaires (N=83) en anatomie radiographique (radioanatomie) après un apprentissage en ligne ou conventionnel, et de voir dans quelle mesure ces méthodes sont interchangeables. Trois stratégies sont comparées : apprentissage en ligne exclusif, apprentissage en ligne avec des os de chevaux, apprentissage sur radiographies conventionnelles avec des os de chevaux. Les performances au test de rotation mentale et au test de connaissance en radioanatomie sont similaires entre les 3 groupes à la base, lors du test préliminaire. Après l’apprentissage (test final), les scores de rotation mentale et de radioanatomie augment significativement de 6.7/40 points (CI : 5.2–8.2; p < .001) et de 5.1/20 points (CI: 4.3–5.9; p< .001). Il n’y a pas de différence entre les groupes pour les scores de rotation mentale et de radioanatomie après l’apprentissage. Le score de rotation mentale est influencé par le genre, et significativement plus élevé chez les hommes que chez les femmes au test préliminaire (M= 23.0, SD = 8.8 vs. M= 16.5, SD= 6.9; p= .001) et au test final (M= 32.1, SD= 5.5 vs. M= 22.7, SD= 8.6; p< .001). Les performances en radioanatomie ne sont pas influencées par le genre. Ces résultats suggèrent que l’enseignement de la radioanatomie peut être réalisé en présentiel avec des radiographies conventionnelles ou en ligne. Cette interchangeabilité entre apprentissage en présentiel et en distanciel est intéressante au regard des impératifs liés aux crises sanitaires, et des besoins d’adaptation rapide en distanciel.

This translation was provided by the authors. To view the original article visit: https://doi.org/10.3138/jvme-2021-0153

Can Online Teaching of Radiographic Anatomy Replace Conventional On-Site Teaching? A Randomized Controlled Study

Different modalities such as lectures, dissections, 3D models, and online learning are used for teaching anatomy. To date, online learning has been considered a useful additional didactic tool. This study aimed to compare veterinary students' performance in radiographic anatomy (radio-anatomy) after online or classroom-based teaching to assess the extent to which the two methods were interchangeable. Three strategies were compared in a cohort of 83 learners. Students were committed to online learning only, online learning with the use of specimen equine bones, or learning on conventional radiographs with specimen equine bones. At baseline (pre-test), scores from a mental rotation test and radio-anatomy knowledge test were similar between groups. After training (post-test), scores in mental rotation and radio-anatomy significantly increased by 6.7/40 units (95% CI: 5.2-8.2; p < .001) and 5.1/20 units (95% CI: 4.3-5.9; p < .001), respectively. There was no difference in scores for mental rotation and radio-anatomy knowledge between groups at post-test. Gender influenced the mental rotation, with men scoring significantly higher than women at pre-test (M = 23.0, SD = 8.8 vs. M = 16.5, SD = 6.9; p = .001) and post-test (M = 32.1, SD = 5.5 vs. M = 22.7, SD = 8.6; p < .001). However, radio-anatomy knowledge was not influenced by gender. These results suggest radio-anatomy teaching can be safely achieved with either conventional radiographs or online resources. This is of interest since, due to the COVID-19 outbreak, rapidly changing from on-site to online methods for teaching veterinary medical education proved necessary.

Implications of introducing case based radiological images in anatomy on teaching, learning and assessment of medical students: a mixed-methods study

BACKGROUND

Introducing radiological anatomy in the preclinical curriculum can increase the understanding of Anatomy. Regardless of the integration when teaching anatomy, it is essential to maintain oversight as to what and how much is being taught. In addition, the knowledge requirements for preclinical students should be considered. The purpose of this kind of integration is that the student should be able to apply the knowledge which can help them better understand anatomy and not to make the course more challenging. This study aimed to understand whether adding radiological images would increase the difficulty level of the questions.

METHODS

We introduced radiological images, including X Rays, CT scans and MRIs, when teaching anatomy in the preclinical curriculum. A class of 99 students were tested using A-type MCQs (n = 84). All 84 questions were categorized on whether they were case-based with or without a radiological image. The item analysis of both groups of test questions was then compared based on their difficulty and discrimination index. A qualitative student perception regarding the inclusion of radiological images in anatomy was also measured using a questionnaire with a 5-point Likert scale.

RESULTS

The results showed that the performance level of the students was similar when comparing the test questions in both groups. The item analysis of the MCQs in the two groups revealed that by integrating radiological images when teaching anatomy, the various parameters in both groups of test questions were in the same range. More than 80% of the students felt that radiological images facilitate the achievement of learning outcomes and help to apply their knowledge in clinical contexts. The study's findings reported that the rate of satisfaction by including radiological images when teaching anatomy is high.

CONCLUSION

Recognition and interpretation of images are essential in an undergraduate medical program. Students found it helpful when radiological images were introduced to them when teaching anatomy. Since the students' performance in summative exams in both groups of questions was in the same range, the findings also point out that adding radiological images when teaching anatomy does not increase the difficulty of the subject.

Extent of Utilization of Radiologic Images in Gross Anatomy Teaching, the Experience of Ethiopian Medical Schools

BACKGROUND

One of the greatest developments in modern medicine is the strides taken in radiology. Today, thanks to high-tech devices like computer tomography (CT), magnetic resonance imaging (MRI), and ultrasound, a noninvasive glimpse into the human interior has been made possible. These recent developments have revolutionized how doctors see anatomy. To keep pace with this progress, many medical school anatomy curriculums have undergone a facelift. In these new curriculums, radiology has been presented as a practical and sufficient alternative tool for learning anatomy. This study, therefore, aimed to determine the extent of the use of radiologic images in the teaching of anatomy in Ethiopian medical schools.

METHODS

An online questionnaire was used to collect, compile and analyze data from anatomy instructors in Ethiopian medical schools.

RESULTS

The survey showed that 55.9% of the instructors used radiologic images of one form or another in their teaching. However, it also revealed radiological images comprise <5% of the total images used in teaching. The majority (73.5%) of the instructors lacked any prior training or coursework in radiologic anatomy. Despite full-time radiology faculties existing in the schools, a relationship between the anatomy and radiology department is virtually unheard of.

CONCLUSION

The curriculum currently in use in Ethiopian medical schools is designed in a way both vertical and horizontal integration of the traditional subjects are achieved. This way, the introduction of clinical medicine early will provide context and relevance to the learning of basic science. Despite the curriculum's emphasis, we have observed limitations in the degree of integration of anatomy and radiology.

Strengths and Weaknesses of Non-enhanced and Contrast-enhanced Cadaver Computed Tomography Scans in the Teaching of Gross Anatomy in an Integrated Curriculum

Cadaver-specific postmortem computed tomography (PMCT) has become an integral part in anatomy teaching at several universities. Recently, the feasibility of contrast-enhanced (CE)-PMCT has been demonstrated. The purpose of this study was to identify particular strengths and weaknesses of both non-enhanced and contrast-enhanced PMCT compared to conventional cadaver dissection. First, the students' perception of the learning effectiveness of the three different modalities have been assessed using a 34-item survey (five-point Likert scale) covering all anatomy course modules. Results were compared using the nonparametric Friedman Test. Second, the most frequent artifacts in cadaver CT scans, were systematically analyzed in 122 PMCT and 31 CE-PMCT data sets to quantify method-related limitations and characteristics. Perfusion quality was assessed in 57 vascular segments (38 arterial and 19 venous). The survey was answered by n = 257/320 (80.3%) students. Increased learning benefits of PMCT/ CE-PMCT compared to cadaver dissection were found in osteology (2/3 categories, P < 0.001), head and neck (2/5 categories, P < 0.01), and brain anatomy (3/3 categories, P < 0.01). Contrast-enhanced-PMCT was perceived particularly useful in learning vascular anatomy (10/10 categories, P < 0.01). Cadaver dissection received significantly higher scores compared to PMCT and CE-PMCT in all categories of the abdomen and thorax (7/7 categories, P < 0.001), as well as the majority of muscular anatomy (5/6 categories, P < 0.001). Frequent postmortem artifacts (total n = 28, native-phase n = 21, contrast injection-related n = 7) were identified and assessed. The results of this work contribute to the understanding of the value of integrating cadaver-specific PMCT in anatomy teaching.

Anatomy as a Model Environment for Acquiring Professional Competencies in Medicine: Experiences at Harvard Medical School

Anatomy education provides students with opportunities to learn structure and function of the human body, to acquire professional competencies such as teamwork, interpersonal skills, self-awareness, and to reflect on and practice medical ethics. The fulfillment of this wide potential can present challenges in courses that are part of an integrated curriculum and shorter than traditional courses. This new reality, together with students' increasing concern about the stresses within medical education, led to efforts at Harvard Medical School to implement practical steps toward an optimal learning environment in anatomy. These were based on core elements of ethical anatomy education and principles of trauma-informed care. Anatomy is conceptualized here as the "first clinical discipline," with relational interactions between anatomical educators, medical students, and body donors/patients. Essential prerequisites for the implementation of this work were support by the medical school leadership, open partnership between engaged students and faculty, faculty coordination, and peer-teaching. Specific interventions included pre-course faculty development on course philosophy and invitations to students to share their thoughts on anatomy. Student responses were integrated in course introductions, combined with a pre-dissection laboratory visit, an introductory guide, and a module on the history and ethics of anatomy. During the course, team-building activities were scheduled, and self-reflection encouraged, for example, through written exercises, and elective life-body drawing. Students' responses to the interventions were overall positive, but need further evaluation. This first attempt of a systematic implementation of an optimal learning environment in anatomy led to the identification of areas in need of adjustment.

Exploring students' understanding of structured practical anatomy

Objectives

The shift from the traditional curriculum to an integrated organ and system-based one has fragmented anatomy courses. Thus, it has become necessary to implement a structured active learning process for the practical teaching of anatomy. We achieved this goal by using an innovative teaching strategy for practical sessions called structured practical anatomy (SPA). We aimed to document the use of SPA for teaching practical anatomy and to evaluate students’ perceptions of it.

Methods

We subdivided the students into 10 small groups, which we then assigned to structured stations with different teaching modalities. Finally, we administered the Dundee Ready Education Environment Measure (DREEM) questionnaire to assess the students’ perceptions of their learning.

Results

Out of 48 items, our study showed a mean total score of 32 ± 7 (out of 48). We classified the students into four categories according to each student's total score; 56.76% of the students had a score of 25–36 in the ‘positive’ category range, 27% in the ‘excellent’ category (37–48), 15% in the ‘negative’ category (13–24) and 0.5% in the ‘very poor’ category (below 12). Two items on the questionnaire (13–47) were strongly positive items (greater than 3 out of 4), whereas other items were in the positive medium range (2–3 out of 4).

Conclusions

SPA is an effective tool that plays a vital role in enhancing the teaching of practical anatomy. This teaching pedagogy offers an innovation in teaching and learning anatomy. Additionally, the results of the students’ perceptions of their learning reflect areas that require further exploration to boost the effectiveness of teaching methods.

Cadaveric dissection as an educational tool for anatomical sciences in the 21st century

Anatomical education has been undergoing reforms in line with the demands of medical profession. The aim of the present study is to assess the impact of a traditional method like cadaveric dissection in teaching/learning anatomy at present times when medical schools are inclining towards student-centered, integrated, clinical application models. The article undertakes a review of literature and analyzes the observations made therein reflecting on the relevance of cadaveric dissection in anatomical education of 21st century. Despite the advent of modern technology and evolved teaching methods, dissection continues to remain a cornerstone of anatomy curriculum. Medical professionals of all levels believe that dissection enables learning anatomy with relevant clinical correlates. Moreover dissection helps to build discipline independent skills which are essential requirements of modern health care setup. It has been supplemented by other teaching/learning methods due to limited availability of cadavers in some countries. However, in the developing world due to good access to cadavers, dissection based teaching is central to anatomy education till date. Its utility is also reflected in the perception of students who are of the opinion that dissection provides them with a foundation critical to development of clinical skills. Researchers have even suggested that time has come to reinstate dissection as the core method of teaching gross anatomy to ensure safe medical practice. Nevertheless, as dissection alone cannot provide uniform learning experience hence needs to be complemented with other innovative learning methods in the future education model of anatomy. Anat Sci Educ 10: 286-299. © 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.

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.

Role of cadaveric dissections in modern medical curricula: a study on student perceptions

The shift from traditional medical curricula to newer teaching and learning approaches such as problem-based learning has often resulted in omission or significant reduction of cadaveric dissections as a method of learning anatomy. The objective of this study was to evaluate students' perception of dissection in a graduate-entry, problem-based learning-based medical curriculum. At the end of the musculoskeletal dissection program in second year, a Likert-type questionnaire was used to explore medical student perceptions of the perceived advantages and challenges of cadaveric dissections in comparison with other anatomy teaching methods. Overall, a majority of students had a positive perception of dissections. Students who attended dissections regularly had significantly more positive perceptions about their experience and were in agreement with statements such as "dissections make learning more interesting" and "I would be disadvantaged if I did not attend dissection classes." Non-regular attendance was associated with statements about dissections such as "I do not like the smell," "time consuming," and "bored with the way it is carried-out." A follow-up study after completion of the medical program revealed a significant improvement of positive perception about dissection. Student perceptions appear to favour a role for cadaveric dissection in learning anatomy in modern medical curricula. However, optimal and effective integration of dissections is important, with consideration given to its structure and extent of content weighed against logistics and availability of resources; while addressing negative perceptions of dissection-based teaching.

Interactive radiological anatomy eLearning solution for first year medical students: Development, integration, and impact on learning

A technology enhanced learning and teaching (TELT) solution, radiological anatomy (RA) eLearning, composed of a range of identification-based and guided learning activities related to normal and pathological X-ray images, was devised for the Year 1 nervous and locomotor course at the Faculty of Medicine, University of Southampton. Its effectiveness was evaluated using a questionnaire, pre- and post-tests, focus groups, summative assessment, and tracking data. Since introduced in 2009, a total of 781 students have used RA eLearning, and among them 167 Year 1 students in 2011, of whom 116 participated in the evaluation study. Students enjoyed learning (77%) with RA eLearning, found it was easy to use (81%) and actively engaged them in their learning (75%), all of which were associated to the usability, learning design of the TELT solution and its integration in the curriculum; 80% of students reported RA eLearning helped their revision of anatomy and 69% stated that it facilitated their application of anatomy in a clinical context, both of which were associated with the benefits offered by the learning and activities design. At the end of course summative assessment, student knowledge of RA eLearning relevant topics (mean 80%; SD ±16) was significantly better as compared to topics not relevant to RA eLearning (mean 63%; SD ±15) (mean difference 18%; 95% CI 15% to 20%; P < 0.001). A well designed and integrated TELT solution can be an efficient method for facilitating the application, integration, and contextualization of anatomy and radiology to create a blended learning environment.

A chemical application method with underwater dissection to improve anatomic identification of cadaveric foot and ankle structures in podiatric education

BACKGROUND

Many cadaver-based anatomy courses and surgical workshops use prosections to help podiatry students and residents learn clinically relevant anatomy. The quality of these prosections is variable and dependent upon the methods used to prepare them. These methods have not been adequately described in the literature, and few studies describe the use of chemicals to prepare prosections of the cadaveric foot and ankle. Recognizing the need for better teaching prosections in podiatric education, we developed a chemical application method with underwater dissection to better preserve anatomic structures of the cadaveric foot and ankle.

METHODS

We used inexpensive chemicals before, during, and after each step, which ultimately resulted in high-quality prosections that improved identification of anatomic structures relevant to the practice of podiatric medicine.

RESULTS

Careful preservation of clinically important nerves, vessels, muscles, ligaments, and joints was achieved with these prosections.

CONCLUSIONS

Although this method required additional preparation time, the resultant prosections have been repeatedly used for several years to facilitate learning among podiatry students and residents, and they have held up well. This method can be used by educators to teach podiatry students throughout their medical training and even into residency.

Anatomy in occupational therapy program curriculum: practitioners' perspectives

Anatomy education is undergoing significant transformation. It is unknown whether changes are in accordance with occupational therapy (OT) practice needs. The purpose of this pilot study was to survey OT clinicians to determine their perspectives on the value of anatomy in OT curricula, and anatomical knowledge required for practice. In addition to demographics, the survey asked questions on the value of a standalone anatomy course, integration of anatomical content in other coursework, practice areas requiring anatomy knowledge, course content, teaching media recommendations, and their opinions regarding whether graduates have adequate anatomy knowledge for competent practice. Surveys were distributed to OT practitioners in the state of Arizona (n = 107). Response rate was 51% on electronic surveys, 29% on mailed surveys. All respondents recommended an anatomy course in OT curricula; 97% as a standalone course with integration of course content throughout the curriculum. The most recommended teaching method was cadaver dissection. Content areas identified as important to cover included skeletal, muscular, and nervous systems. Regions recommended were the upper limb, thorax/trunk, head and neck, and lower limb. Practice areas requiring anatomy knowledge included joint range of motion and strengthening treatment interventions, goniometry, muscle strength testing, assessing muscle tone, wheelchair assessment/prescription, orthotics, physical agent modalities, and activity adaptation. Eighty-one percent felt that entry-level practitioners had adequate knowledge for competent practice. This study supports inclusion of a separate anatomy course in OT curricula, continued use of cadavers, and the importance of including input from practicing clinicians when determining anatomy course content.

Perceptions of a mobile technology on learning strategies in the anatomy laboratory

Mobile technologies offer new opportunities to improve dissection learning. This study examined the effect of using an iPad-based multimedia dissection manual during anatomy laboratory instruction on learner's perception of anatomy dissection activities and use of time. Three experimental dissection tables used iPads and three tables served as a control for two identical sessions. Trained, non-medical school anatomy faculty observers recorded use of resources at two-minute intervals for 20 observations per table. Students completed pre- and post-perception questionnaires. We used descriptive and inferential analyses. Twenty-one control and 22 experimental students participated. Compared with controls, experimental students reported significantly (P < 0.05) less reliance on paper and instructor resources, greater ability to achieve anatomy laboratory objectives, and clarity of the role of dissection in learning anatomy. Experimental students indicated that the iPad helped them in dissection. We observed experimental students more on task (93% vs. 83% of the time) and less likely to be seeking an instructor (2% vs. 32%). The groups received similar attention from instructors (33% vs. 37%). Fifty-nine percent of the time at least one student was looking at the iPad. Groups clustered around the iPad a third of their time. We conclude that the iPad-manual aided learner engagement, achieved instructional objectives, and enhanced the effectiveness and efficiency of dissection education.

Modernization of an anatomy class: From conceptualization to implementation. A case for integrated multimodal-multidisciplinary teaching

It has become increasingly apparent that no single method for teaching anatomy is able to provide supremacy over another. In an effort to consolidate and enhance learning, a modernized anatomy curriculum was devised by attempting to take advantage of and maximize the benefits from different teaching methods. Both the more traditional approaches to anatomy teaching, as well as modern, innovative educational programs were embraced in a multimodal system implemented over a decade. In this effort, traditional teaching with lectures and dissection was supplemented with models, imaging, computer-assisted learning, problem-based learning through clinical cases, surface anatomy, clinical correlation lectures, peer teaching and team-based learning. Here, we review current thinking in medical education and present our transition from a passive, didactic, highly detailed anatomy course of the past, to a more interactive, as well as functionally and clinically relevant anatomy curriculum over the course of a decade.

The translucent cadaver: an evaluation of the use of full body digital X-ray images and drawings in surface anatomy education

It has been noted by staff at the Faculty of Health Sciences, Stellenbosch University that medical students neglect the study of surface anatomy during dissection. This study reports on the novel use of Lodox(®) Statscan(®) images in anatomical education, particularly the teaching of surface anatomy. Full body digital X-ray images (Lodox Statscan) of each cadaver (n = 40) were provided to second year medical students. During dissection students were asked to visualize landmarks, organs, and structures on the digital X-ray and their cadaver, as well as palpate these landmarks and structures on themselves, their colleagues, and the cadaver. To stimulate student engagement with surface anatomy, dissection groups were required to draw both the normal and actual position of organs on a laminated image provided. The accuracy of the drawings was subsequently assessed and students were further assessed by means of practical identification tests. In addition, students were asked to complete an anonymous questionnaire. A response rate of 79% was obtained for the student questionnaire. From the questionnaire it was gathered that students found the digital X-ray images beneficial for viewing most systems' organs, except for the pelvic organs. Although it appears that students still struggle with the study of surface anatomy, most students believed that the digital X-rays were beneficial to their studies and supported their continued use in the future.

Computer visualizations: factors that influence spatial anatomy comprehension

Computer visualizations are increasingly common in education across a range of subject disciplines, including anatomy. Despite optimism about their educational potential, students sometime have difficulty learning from these visualizations. The purpose of this study was to explore a range of factors that influence spatial anatomy comprehension before and after instruction with different computer visualizations. Three major factors were considered: (1) visualization ability (VZ) of learners, (2) dynamism of the visual display, and (3) interactivity of the system. Participants (N = 60) of differing VZs (high, low) studied a group of anatomical structures in one of three visual conditions (control, static, dynamic) and one of two interactive conditions (interactive, non-interactive). Before and after the study phase, participants' comprehension of spatial anatomical information was assessed using a multiple-choice spatial anatomy task (SAT) involving the mental rotation of the anatomical structures, identification of the structures in 2D cross-sections, and localization of planes corresponding to given cross-sections. Results indicate that VZ had a positive influence on SAT performance but instruction with different computer visualizations could modulate the effect of VZ on task performance.

An international survey of gross anatomy courses in chiropractic colleges

PURPOSE

The purpose of this study is to provide the first comprehensive description of gross anatomy course design in chiropractic colleges internationally and to provide baseline data for future investigation, future comparison with other health care professions, and identification of trends.

METHODS

A 72-question cross-sectional electronic survey was sent to the anatomy department chair at 36 chiropractic colleges internationally using Zoomerang, a web-based survey instrument. To augment the survey response data, public sources of data also were collected.

RESULTS

Forty-four percent of the electronic surveys were returned and information was gathered for 31 institutions from public sources. These results indicate (1) the most common degrees held by anatomy faculty were MS and PhD in anatomy, and DC degrees; (2) 75% of institutions utilized human cadavers and 75% presented laboratory anatomical demonstrations; (3) 62% used PowerPoint and 100% provided students with copies of lecture presentations; (4) 88% required attendance in laboratory and 50% in lecture; (5) 69% issued one grade for lecture and laboratory; (6) 100% of laboratory examinations were anatomical identification; and (7) 80% of written examinations were multiple-choice format.

CONCLUSIONS

While individual variations existed, chiropractic institutions internationally have similar gross anatomy faculty, course design, delivery methods, and assessment methods.

Effectiveness of a shortened, clinically engaged anatomy course for physician assistant students

There is little consensus among programs that train physician assistants (PAs) regarding how much time should be devoted to the study of anatomy, what should be included, or how it should be taught. Similar concerns led us to redesign anatomy for medical students and introduce clinically engaged anatomy, an approach designed in collaboration with clinical faculty. This approach presents anatomy entirely within the context of common clinical cases. This report examines whether clinically engaged anatomy could be adapted to the PA program, where students cover the basic sciences in half the time as medical students. We offered a modified version of clinically engaged anatomy to PA students in which time spent in self-directed learning activities was reduced relative to medical students. We compared their scores on an examination of long-term recall to students who took the previous course. Two classes who took clinically engaged anatomy, scored the same or significantly higher on every portion of the examination (P < 0.05). Students expressed high satisfaction with the course (Likert scale, 4.3-4.8/5 points). Compared to medical students who took clinically engaged anatomy, the data suggest that the tradeoff for reducing the time spent in self-directed learning was reduced skills in applying structure-function relationships and spatial reasoning to clinical problems. The data suggest clinically engaged anatomy can be effective in various educational settings, and can be readily adapted to clinical programs that vary in the depth that anatomy is covered. Nonetheless, careful assessments are needed to determine if the necessary tradeoffs are consistent with the goals of the profession.

Building virtual models by postprocessing radiology images: A guide for anatomy faculty

Radiology and radiologists are recognized as increasingly valuable resources for the teaching and learning of anatomy. State-of-the-art radiology department workstations with industry-standard software applications can provide exquisite demonstrations of anatomy, pathology, and more recently, physiology. Similar advances in personal computers and increasingly available software can allow anatomy departments and their students to build their own three-dimensional virtual models. Appropriate selection of a data-set, followed by processing and presentation are the key steps in creating virtual models. The construction, presentation, clinical application, and educational potential of postprocessed imaging techniques including multiplanar reformats, minimum intensity projections, segmentation, volume-rendering, surface-rendering, fly-throughs, virtual endoscopy, angiography, and cine-loops are reviewed using examples created with only a personal computer and freeware software. Although only static images are presented in this article, further material is available online within the electronic version of this article. Through the use of basic and advanced image reconstruction and also paying attention to optimized presentation and integration, anatomy courses can be strengthened with appropriate radiological material. There are several key advantages for the anatomy department, which is equipped with the ability to produce virtual models using radiology images: (1) Opportunities to present anatomy using state-of-the-art technology as an adjunct to current practices, (2) a means to forge an improved relationship with the local radiology department, and (3) the ability to create material locally, which is integrated with the local curriculum avoiding the problem of information overload when using the internet or other commercially available resources.

Design, implementation, and evaluation of an innovative anatomy course

Starting in 2004, a medical school gross anatomy course faced with a 30% cut in hours went through an extensive redesign, which transformed a traditional dissection course into a course with a clinical focus, learning societies, and extensive on-line learning support. Built into the redesign process was an extensive and ongoing assessment process, which included student focus groups, faculty development, surveys, and examinations. These assessments were used formatively, to enhance the course from year to year, and summatively, to determine how well the course was meeting the new learning objectives. The assessments from focus groups and faculty development prompted changes in support structures provided to students and the training and preparation of faculty. Survey results showed that, after student satisfaction declined the first year, satisfaction increased steadily through the fourth iteration as the course gained acceptance by students and faculty alike. There was a corresponding increase in the performance of students on course examinations. An additional examination given to students one and a half and three years after their anatomy course ended demonstrated the redesigned course's long-term effectiveness for retaining anatomical knowledge and applying it to clinical cases. Compared to students who took the original course, students who took the shorter, more clinical course performed as well, or better, on each section of the examination. We attribute these positive results to the innovative course design and to the changes made based on our formative assessment program.

The anatomy of learning anatomy

The experience of clinical teachers as well as research results about senior medical students' understanding of basic science concepts has much been debated. To gain a better understanding about how this knowledge-transformation is managed by medical students, this work aims at investigating their ways of setting about learning anatomy. Second-year medical students were interviewed with a focus on their approach to learning and their way of organizing their studies in anatomy. Phenomenographic analysis of the interviews was performed in 2007 to explore the complex field of learning anatomy. Subjects were found to hold conceptions of a dual notion of the field of anatomy and the interplay between details and wholes permeated their ways of studying with an obvious endeavor of understanding anatomy in terms of connectedness and meaning. The students' ways of approaching the learning task was characterized by three categories of description; the subjects experienced their anatomy studies as memorizing, contextualizing or experiencing. The study reveals aspects of learning anatomy indicating a deficit in meaningfulness. Variation in approach to learning and contextualization of anatomy are suggested as key-elements in how the students arrive at understanding. This should be acknowledged through careful variation of the integration of anatomy in future design of medical curricula.

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 competencies and the basic sciences: an online case tutorial paradigm for delivery of integrated clinical and basic science content

Understanding the relevance of basic science knowledge in the determination of patient assessment, diagnosis, and treatment is critical to good medical practice. One method often used to direct students in the fundamental process of integrating basic science and clinical information is problem-based learning (PBL). The faculty facilitated small group discussion format traditionally used for PBL is a significant challenge for faculty and facilities with a large class. To provide inductive learning to a large class early in the preclerkship curriculum, a series of online, case-based tutorials was created using the method of inquiry-based learning. The tutorial paradigm is designed to challenge students through a guided inquiry process in which clinical skills and basic science information are seamlessly joined. The psychosocial dimension of patient care is added to the documented case presentation of the tutorials in the form of patient/physician history taking and physical examination videos. These videos augment the written case with additional information providing the student with visual exposure in methods of patient communication and appropriate professional patient/physician interactions that address competencies of patient care, communication, and professionalism. The tutorials were made available via learning management system course sites. The study tracked usage of the tutorials by 270 first-year medical students.

Training tomorrow's anatomists today: a partnership approach

Anatomy is recognized to play a central role in the education and training of clinicians, healthcare professionals, and scientists. However, in recent years, the perceived decline in popularity of anatomy has led to a deficiency in the numbers of new anatomy educators. The tide is now turning with anatomy once again taking its rightful place in a wide of variety of disciplines, and therefore it is imperative that a new generation of anatomists is in place to meet this need. In response, the Anatomical Society of Great Britain and Ireland has made the training of the next set of anatomists, one of its strategic priorities, and in collaboration with the American Association of Anatomists has developed a dedicated Training Program. The overall aim of the Program is to provide trainees with the necessary knowledge, understanding, aptitudes, and attitudes in appropriate detail, sufficient to enable them to teach and examine Anatomy with full competence at the undergraduate and postgraduate level. The Program offers opportunities to consolidate knowledge and deepen understanding of anatomy, improve skills in teaching and communication with students, and be competent in preparing teaching materials and assessment modalities. The Program uses a distance-learning approach with an incorporated Residential School and is particularly aimed at those undertaking a career in the biosciences. Early indications suggest that initiatives such as the development of this Training Program will help deliver the next generation of anatomists and ensure that anatomy continues to play a fundamental role in the education of clinicians, healthcare professionals, and scientists.

Should we continue teaching anatomy by dissection when …?

The central role that human dissection has long held in clinical education is being reevaluated in many institutions. Despite the impression that many institutions are abandoning dissection, very few have and most of those have reinstated dissection within a few years. What are the inherent qualities that lead institutions back to dissection? In our efforts to redesign a shortened dissection course, our consultations with a broad range of clinicians lead us to understand how the rhythms of clinical practice are modeled and developed in the small-group setting of the dissection laboratory. Following further consultation with colleagues who have experimented with different models of anatomy instruction, we discuss three themes in support of dissection. First, problem-solving in the dissection laboratory develops the habits-of-mind of clinical practice. Second, relating dissection to imaging modalities develops the spatial reasoning skills needed to understand computer simulations, interpret imaging data, and interact with surgeons, radiologists, and patients. Third, the human face of dissection fosters self-reflection and integration of the cognitive and affective skills required for medical practice. Through group process, the collaborative effort of dissection teams develops essential of attributes of clinical professionalism.

Anatomical instruction and training for professionalism from the 19th to the 21st centuries

For most of the 19th century, anatomists in the United States saw the affective, emotional aspects of human dissection as salient ingredients in professional formation. Professionalism (or "character") signified medical integrity and guaranteed correct professional conduct. As gross anatomy came under siege in the late-19th and early-20th centuries, crowded out of medical curricula by the new experimental sciences, medical educators rethought what it was that dissecting a human body stood to give medical students. As they embraced a new understanding of professionalism premised on an allegiance to science, anatomists celebrated the habits of mind and sensibility to scientific investigation that could be acquired at the dissecting table. One consequence was a deliberate distancing of gross anatomy from the "art of medicine," and with it a de facto suppression of attention to the affective components of human dissection. During this period in the opening decades of the 20th century, the norm of silence about the emotional dimensions of dissection was set in place. The confluence of various movements by the 1960s and 1970s both revived attention to the emotional experience of dissection and sparked a renewed discussion about the relationship between the affective components of learning anatomy and the professional formation of future healers. There is a need to balance the tension between the "affective" and "scientific" aspects of anatomy, and by extension the tension between the "art" and "science" of medical practice. One method is to use small-group "learning societies" as a means to cultivate and meld both dimensions of the professional ethic.