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Helms JT, Johnson KM, Ball JL. A Comparative Analysis of Physical Therapy Anatomical Knowledge and Retention: Human Donor Dissection Versus Virtual Laboratory. JOURNAL, PHYSICAL THERAPY EDUCATION 2024; 38:107-115. [PMID: 38758175 DOI: 10.1097/jte.0000000000000330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 11/17/2023] [Indexed: 05/18/2024]
Abstract
INTRODUCTION Despite a long history of using human donor dissection (HDD) for physical therapy (PT) anatomy education, there are no PT guidelines that require HDD. The purpose of this quantitative causal-comparative study was to determine if Doctor of Physical Therapy students who used HDD had different grades both within anatomy and within courses that require retention and application of anatomical knowledge (kinesiology and a foundational musculoskeletal course) compared with those who used virtual 3-dimensional anatomical software (VAS). REVIEW OF LITERATURE Numerous factors affect the decision to use HDD within PT anatomy, and few PT studies have compared the effectiveness of VAS to HDD. SUBJECTS All students who took anatomy in an entry-level PT program from 2018 to 2021 (232 total students, 115 who used HDD in 2018-2019 and 117 who used VAS in 2020-2021). METHODS Mann-Whitney tests were used to compare anatomy grades (course, written examination, and practical examination) and future grades in kinesiology and a foundational musculoskeletal course for students who used HDD or VAS. RESULTS Physical therapy students who used VAS had statistically significant higher anatomy course grades (VAS 93.81% ± 4.99% to HDD 92.20% ± 4.53%) and higher practical examination grades (VAS 97.43% ± 2.91% to HDD 93.55% ± 4.39%) compared with those who used HDD. However, there were no significant differences between groups on written anatomy examinations (VAS 89.42% ± 7.21% to HDD 90.40% ± 4.94%), kinesiology grades (VAS 91.86% ± 4.52% to HDD 92.80% ± 4.27%), or foundational musculoskeletal grades (VAS 89.50% ± 3.89% to HDD 89.77% ± 3.83%). DISCUSSION AND CONCLUSION The causal-comparative study design prevents concluding that PT student grade differences were due exclusively to either anatomy laboratory method. It does provide preliminary evidence that the PT anatomy laboratory method did not practically affect anatomy performance or long-term application of anatomy knowledge in future coursework.
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Affiliation(s)
- Jeb T Helms
- Jeb T. Helms is a clinical associate professor in the Doctor of Physical Therapy program at Northern Arizona University, Room 102, Building 066, Health Professions Building, 208 E Pine Knoll Drive, Flagstaff, AZ 86011 . Please address all correspondence to Jeb Helms
- Kristen M. Johnson is an associate professor and the director of curriculum and assessment in the College of Health and Society in the Doctor of Physical Therapy program at Hawaii Pacific University
- Jamie L. Ball is a research and dissertation faculty member at Grand Canyon University, College of Doctoral Studies Online
| | - Kristen M Johnson
- Jeb T. Helms is a clinical associate professor in the Doctor of Physical Therapy program at Northern Arizona University, Room 102, Building 066, Health Professions Building, 208 E Pine Knoll Drive, Flagstaff, AZ 86011 . Please address all correspondence to Jeb Helms
- Kristen M. Johnson is an associate professor and the director of curriculum and assessment in the College of Health and Society in the Doctor of Physical Therapy program at Hawaii Pacific University
- Jamie L. Ball is a research and dissertation faculty member at Grand Canyon University, College of Doctoral Studies Online
| | - Jamie L Ball
- Jeb T. Helms is a clinical associate professor in the Doctor of Physical Therapy program at Northern Arizona University, Room 102, Building 066, Health Professions Building, 208 E Pine Knoll Drive, Flagstaff, AZ 86011 . Please address all correspondence to Jeb Helms
- Kristen M. Johnson is an associate professor and the director of curriculum and assessment in the College of Health and Society in the Doctor of Physical Therapy program at Hawaii Pacific University
- Jamie L. Ball is a research and dissertation faculty member at Grand Canyon University, College of Doctoral Studies Online
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Kimmorley AL, Reynolds MS, Gregory LS. Anatomical variation is the norm: A novel curriculum framework. ANATOMICAL SCIENCES EDUCATION 2024. [PMID: 38654399 DOI: 10.1002/ase.2428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 04/01/2024] [Accepted: 04/03/2024] [Indexed: 04/25/2024]
Abstract
Anatomical variation is an inherent part of every health curriculum, due in large to the negative clinical consequences that can ensue if anatomical variation is not thoroughly understood. However, current literature fails to describe any structured whole-of-course pedagogy for the teaching of anatomical variation in higher education. This study therefore aimed to (i) propose a whole-of-course curriculum framework to guide academic development and implementation of anatomical variation resources and assessment; and (ii) assess the depth of anatomical variation knowledge in a multiyear undergraduate health-science cohort (n = 152) at the Queensland University of Technology. Current anatomical variation pedagogy, and subsequently the need for the curriculum framework, were explored using a scoping review protocol. As part of this study, anatomical variation was novelly defined as macroscopic differences in morphology (shape and size), topography (location), developmental timing, or frequency (number) of an anatomical structure between individuals that form during embryological or subadult development and result in no substantive, observable interruption to physiological function. The framework incorporated three themes of anatomical variation learning outcomes: description of anatomical variation, theories of the professional implications of variation, and investigation of variant formation. These themes were strongly aligned with the concepts recommended for teaching identified through the scoping review. Significant deficits in anatomical variation student knowledge were identified, with the third-year cohort recording a mean total score of only 54.6%. A strong recommendation to implement the anatomical variation curriculum framework in all medical and health-science curricula is made to intentionally develop student understanding of anatomical variation and improve future clinical practice.
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Affiliation(s)
- Annabelle L Kimmorley
- Faculty of Health, School of Biomedical Sciences, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Mikaela S Reynolds
- Faculty of Health, School of Biomedical Sciences, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Laura S Gregory
- Faculty of Health, School of Biomedical Sciences, Queensland University of Technology, Brisbane, Queensland, Australia
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Xiao J. Improving student learning and performance through a continuous flipped anatomy teaching model. ANATOMICAL SCIENCES EDUCATION 2024; 17:219-226. [PMID: 37916536 DOI: 10.1002/ase.2351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 10/15/2023] [Accepted: 10/17/2023] [Indexed: 11/03/2023]
Abstract
The flipped classroom teaching model has been widely used in anatomy education to embrace a blended learning strategy. However, the impact that a continuous flipped classroom teaching model exerts on student learning of human topographic anatomy remains unclear. To address this question, student learning experience and performance were compared between third-year undergraduate students who participated in a continuous flipped anatomy classroom teaching since their first year (n = 65, experimental group) and those under the flipped anatomy teaching model only in their third year (n = 45, control group). A five-point Likert scale learning and teaching survey was conducted to evaluate students' perceptions of the flipped classroom model. Students under a continuous flipped classroom teaching model rated significantly higher on the impact of the flipped model on learning difficult anatomy concepts than the control group (*p = 0.0346). The rating on independent learning remained not statistically different between the two groups, although a trend difference was detected (p = 0.0604). Analysis of learning performance revealed that the experimental group significantly outperformed the control group when answering questions focusing on regional anatomy (*p = 0.0207). No significant difference was identified in students' marks of case-based studies between the two groups. In summary, the results of this study indicate that the flipped classroom model implemented over a long term continues to advance students' learning experience and performance in anatomy, indicating a "dose" effect on active learning. The findings of this study will assist the best practices of the flipped anatomy classroom and develop evidence-informed approaches to advance anatomy education in the future.
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Affiliation(s)
- Junhua Xiao
- Department of Health Sciences and Biostatistics, School of Health Sciences, Swinburne University of Technology, Hawthorn, Victoria, Australia
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Yasser NBM, Tan AJQ, Harder N, Ashokka B, Chua WL, Liaw SY. Telesimulation in healthcare education: A scoping review. NURSE EDUCATION TODAY 2023; 126:105805. [PMID: 37062239 DOI: 10.1016/j.nedt.2023.105805] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 03/15/2023] [Accepted: 03/26/2023] [Indexed: 05/25/2023]
Abstract
OBJECTIVES To provide a comprehensive overview on the utilization and effectiveness of telesimulation in healthcare education. DESIGN A scoping review. DATA SOURCES A search of five databases including PubMed, Web of Science, Cochrane, EMBASE and ProQuest was conducted between 2000 and 2022. REVIEW METHODS Arksey and O' Malley's scoping review framework was utilised. Data were narratively synthesised. RESULTS 29 articles were included. More than half of the publications on telesimulation were borne out of need during the COVID-19 pandemic. Innovation reports were the most prevalent publications followed by descriptive studies. Telesimulation was applied for the delivery of diverse learning content including patient care management, procedural skills and team training. A variety of videoconferencing software and simulation modalities have been used for telesimulation. Telesimulation was generally well-received, despite its technical challenges. Learning effectiveness of telesimulation was evident in quasi-experimental studies. CONCLUSION Telesimulation has been gaining acceptance as a distance-based simulation education modality. It will continue to evolve and potentially blend with in-person simulation. More rigorous research is warranted to evaluate learning outcomes and establish best practices in telesimulation.
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Affiliation(s)
| | - Apphia J Q Tan
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
| | - Nicole Harder
- College of Nursing, Rady Faculty of Health Sciences, University of Manitoba, Canada
| | - Balakrishnan Ashokka
- Department of Anaesthesia, National University Hospital, Singapore; Centre for Medical Education, CenMED, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Wei Ling Chua
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
| | - Sok Ying Liaw
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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Durongphan A, Rungruang J, Nitimanee E, Panichareon B. The effects of enhanced formaldehyde clearance in a gross anatomy laboratory by floor plan redesign and dissection table adjustment. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2023; 30:64246-64253. [PMID: 37062795 PMCID: PMC10106273 DOI: 10.1007/s11356-023-26906-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 04/05/2023] [Indexed: 05/11/2023]
Abstract
Formaldehyde has carcinogenic properties. It is associated with nasopharyngeal cancer and causes irritation of the eyes, nose, throat, and respiratory system. Formaldehyde exposure is a significant health concern for those participating in the gross anatomy laboratory, but no learning method can substitute cadaver dissection. We performed a formaldehyde level study in 2018, which found that most of the breathing zone (S-level) and environment (R-level) formaldehyde levels during laboratory sessions at the Faculty of Medicine Siriraj Hospital exceeded international ceiling standards. In the academic year 2019, we adapted the engineering rationale of the NIOSH hierarchy of controls to facilitate formaldehyde clearance by opening the dissection table covers and increasing the area per dissection table, then measured formaldehyde ceiling levels by formaldehyde detector tube with a gas-piston hand pump during (1) body wall, (2) upper limb, (3) head-neck, (4) thorax, (5) spinal cord removal, (6) lower limb, (7) abdomen, and (8) organs of special senses dissection sessions and comparing the results with the 2018 study. The perineum region data were excluded from analyses due to the laboratory closure in 2019 from the COVID-19 outbreak. There were statistically significant differences between the 2018 and 2019 S-levels (p < 0.001) and R-levels (p < 0.001). The mean S-level decreased by 64.18% from 1.34 ± 0.71 to 0.48 ± 0.26 ppm, and the mean R-level decreased by 70.18% from 0.57 ± 0.27 to 0.17 ± 0.09 ppm. The highest formaldehyde level in 2019 was the S-level in the body wall region (1.04 ± 0.3 ppm), followed by the S-level in the abdomen region (0.56 ± 0.08 ppm) and the spinal cord removal region (0.51 ± 0.29 ppm). All 2019 formaldehyde levels passed the OSHA 15-min STEL standard (2 ppm). The R-level in the special sense region (0.06 ± 0.02 ppm) passed the NIOSH 15-min ceiling limit (0.1 ppm). Three levels for 2019 were very close: the R-level in the head-neck region (0.11 ± 0.08 ppm), the abdomen region (0.11 ± 0.08), the body wall region (0.14 ± 0.12 ppm), and the S-level in the special sense region (0.12 ± 0.04 ppm). In summary, extensive analysis and removal of factors impeding formaldehyde clearance can improve the general ventilation system and achieve the OSHA 15-min STEL standard.
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Affiliation(s)
- Anuch Durongphan
- Department of Anatomy, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, 10700, Thailand
| | - Jarun Rungruang
- Department of Anatomy, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, 10700, Thailand
| | - Eakkapong Nitimanee
- Department of Anatomy, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, 10700, Thailand
| | - Benjaporn Panichareon
- Department of Anatomy, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, 10700, Thailand.
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Shopova D, Yaneva A, Bakova D, Mihaylova A, Kasnakova P, Hristozova M, Sbirkov Y, Sarafian V, Semerdzhieva M. (Bio)printing in Personalized Medicine—Opportunities and Potential Benefits. Bioengineering (Basel) 2023; 10:bioengineering10030287. [PMID: 36978678 PMCID: PMC10045778 DOI: 10.3390/bioengineering10030287] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 02/19/2023] [Accepted: 02/21/2023] [Indexed: 02/25/2023] Open
Abstract
The global development of technologies now enters areas related to human health, with a transition from conventional to personalized medicine that is based to a significant extent on (bio)printing. The goal of this article is to review some of the published scientific literature and to highlight the importance and potential benefits of using 3D (bio)printing techniques in contemporary personalized medicine and also to offer future perspectives in this research field. The article is prepared according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Web of Science, PubMed, Scopus, Google Scholar, and ScienceDirect databases were used in the literature search. Six authors independently performed the search, study selection, and data extraction. This review focuses on 3D bio(printing) in personalized medicine and provides a classification of 3D bio(printing) benefits in several categories: overcoming the shortage of organs for transplantation, elimination of problems due to the difference between sexes in organ transplantation, reducing the cases of rejection of transplanted organs, enhancing the survival of patients with transplantation, drug research and development, elimination of genetic/congenital defects in tissues and organs, and surgery planning and medical training for young doctors. In particular, we highlight the benefits of each 3D bio(printing) applications included along with the associated scientific reports from recent literature. In addition, we present an overview of some of the challenges that need to be overcome in the applications of 3D bioprinting in personalized medicine. The reviewed articles lead to the conclusion that bioprinting may be adopted as a revolution in the development of personalized, medicine and it has a huge potential in the near future to become a gold standard in future healthcare in the world.
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Affiliation(s)
- Dobromira Shopova
- Department of Prosthetic Dentistry, Faculty of Dental Medicine, Medical University, 4000 Plovdiv, Bulgaria
- Correspondence: ; Tel.: +359-887417078
| | - Antoniya Yaneva
- Department of Medical Informatics, Biostatistics and eLearning, Faculty of Public Health, Medical University, 4000 Plovdiv, Bulgaria
| | - Desislava Bakova
- Department of Healthcare Management, Faculty of Public Health, Medical University, 4000 Plovdiv, Bulgaria
| | - Anna Mihaylova
- Department of Healthcare Management, Faculty of Public Health, Medical University, 4000 Plovdiv, Bulgaria
| | - Petya Kasnakova
- Department of Healthcare Management, Faculty of Public Health, Medical University, 4000 Plovdiv, Bulgaria
| | - Maria Hristozova
- Department of Healthcare Management, Faculty of Public Health, Medical University, 4000 Plovdiv, Bulgaria
| | - Yordan Sbirkov
- Department of Medical Biology, Medical University, 4000 Plovdiv, Bulgaria
- Research Institute, Medical University, 4000 Plovdiv, Bulgaria
| | - Victoria Sarafian
- Department of Medical Biology, Medical University, 4000 Plovdiv, Bulgaria
- Research Institute, Medical University, 4000 Plovdiv, Bulgaria
| | - Mariya Semerdzhieva
- Department of Healthcare Management, Faculty of Public Health, Medical University, 4000 Plovdiv, Bulgaria
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Bellier A, Kaladzé N, Rabattu PY, Chaffanjon PC, Cavalié G. Analysis of a multifaceted interactive pedagogy program in an upper limb anatomy course: A time series study. ANATOMICAL SCIENCES EDUCATION 2023; 16:116-127. [PMID: 35020269 DOI: 10.1002/ase.2170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 01/07/2022] [Accepted: 01/08/2022] [Indexed: 06/14/2023]
Abstract
Many new methods have contributed to the learning of anatomy, including several interactive methods, increasing the effectiveness of educational programs. The effectiveness of an educational program involving several interactive learning methods such as problem-based learning and reciprocal peer teaching was researched in this study. A quasi-experimental before-after study on three consecutive groups of second-year students at the Grenoble School of Medicine was conducted. The lectures were replaced by an educational program based on the problem-based learning method and reciprocal peer teaching. The first session was dedicated to reading clinical cases illustrating the medical concept, so that the learning objectives for the second session could be set. Then, after viewing digital courses, the second session was dedicated to a synthetic presentation by the students themselves, followed by an interactive summary with the teacher. The analysis of 630 students showed a significant increase in the theory test results for those who took part in the intervention: 9.71 versus 9.19 (β = 0.57, P = 0.036). Moreover, satisfaction was high after the intervention (mean = 4.5/5), and when comparing the two pedagogical approaches the students showed a clear preference for the program implemented with the concepts highlighted such as interactivity, in-depth work, group work, and autonomy. A multifaceted interactive pedagogy program could have a significant impact on the results of the theoretical concepts presented and on satisfaction as well as increased investment by students in learning anatomy.
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Affiliation(s)
- Alexandre Bellier
- Department of Anatomy, Faculty of Medicine, Grenoble Alpes University, Grenoble, France
- Department of Medical Evaluation, Grenoble Alpes University Hospital, Grenoble, France
- Computational Biology and Mathematics Team, Translational Innovation in Medicine and Complexity Laboratory, Grenoble, France
| | - Noémie Kaladzé
- Department of Anatomy, Faculty of Medicine, Grenoble Alpes University, Grenoble, France
| | - Pierre-Yves Rabattu
- Department of Anatomy, Faculty of Medicine, Grenoble Alpes University, Grenoble, France
| | - Philippe C Chaffanjon
- Department of Anatomy, Faculty of Medicine, Grenoble Alpes University, Grenoble, France
| | - Guillaume Cavalié
- Department of Anatomy, Faculty of Medicine, Grenoble Alpes University, Grenoble, France
- Orthopedic Surgery Service, Grenoble Alpes University Hospital, Grenoble, France
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Keenan ID, Green E, Haagensen E, Hancock R, Scotcher KS, Swainson H, Swamy M, Walker S, Woodhouse L. Pandemic-Era Digital Education: Insights from an Undergraduate Medical Programme. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2023; 1397:1-19. [DOI: 10.1007/978-3-031-17135-2_1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Ashokka B, Ching Lee DW, Dong C. Twelve tips for developing a systematic acute care curriculum for medical students. MEDICAL TEACHER 2023; 45:17-24. [PMID: 34663178 DOI: 10.1080/0142159x.2021.1987405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
There are inadequacies in the practice-readiness of junior doctors for providing acute care in areas of clinical deterioration. In addition, the existing undergraduate curricula are fragmented in how acute care is taught in medical schools. We propose twelve tips for developing a systematic acute care curriculum, including what to teach, how to teach it and, how to assess. Furthermore, we propose and incorporate an acute care learning dashboard as an assessment tool which collates and demonstrates the occurrence of learning, faculty feedback, and students' reflection. We also summarise the existing online resources available for acute care training. We hope to address the existing issues and improve acute care training to prepare the graduates to become practice-ready professionals.
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Affiliation(s)
- Balakrishnan Ashokka
- Department of Anaesthesia, National University Health System, Singapore, Singapore
- Centre for Medical Education, CenMED, National University of Singapore, Singapore, Singapore
| | | | - Chaoyan Dong
- Education Office, Sengkang General Hospital, Singapore, Singapore
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10
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Koh ZJ, Yeow M, Srinivasan DK, Ng YK, Ponnamperuma GG, Chong CS. A randomized trial comparing cadaveric dissection and examination of prosections as applied surgical anatomy teaching pedagogies. ANATOMICAL SCIENCES EDUCATION 2023; 16:57-70. [PMID: 34968002 DOI: 10.1002/ase.2166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 12/21/2021] [Accepted: 12/28/2021] [Indexed: 06/14/2023]
Abstract
Anatomy is an important component in the vertical integration of basic science and clinical practice. Two common pedagogies are cadaveric dissection and examination of prosected specimens. Comparative studies mostly evaluate their immediate effectiveness. A randomized controlled trial design was employed to compare both the immediate and long-term effectiveness of dissection and prosection. Eighty third-year medical students undergoing their surgical rotation from the Yong Loo Lin School of Medicine were randomized into two groups: dissection and prosection. Each participated in a one-day hands-on course following a similar outline that demonstrated surgical anatomy in the context of its clinical relevance. A pre-course test was conducted to establish baseline knowledge. A post-course test was conducted immediately after and at a one-year interval to evaluate learner outcome and knowledge retention. A post-course survey was conducted to assess participant perception. Thirty-nine and thirty-eight participants for the dissection and prosection groups, respectively, were included for analysis. There was no significant difference between mean pre-course test scores between the dissection and prosection groups [12.6 (3.47) vs. 12.7 (3.16), P > 0.05]. Both the mean immediate [27.9 (4.30) vs. 24.9 (4.25), P < 0.05] and 1 year [23.9 (4.15) vs. 19.9 (4.05), P < 0.05] post-course test scores were significantly higher in the dissection group. However, when adjusted for course duration [dissection group took longer than prosection group (mean 411 vs. 265 min)], these findings were negated. There is no conclusive evidence of either pedagogy being superior in teaching surgical anatomy. Based on learner surveys, dissection provides a greater learner experience.
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Affiliation(s)
- Zong Jie Koh
- Department of General Surgery, University Surgical Cluster, National University Health System, Singapore, Singapore
| | - Marcus Yeow
- Department of Internal Medicine, Singapore General Hospital, Singapore, Singapore
| | - Dinesh Kumar Srinivasan
- Department of Anatomy, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Yee Kong Ng
- Department of Anatomy, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Gominda G Ponnamperuma
- Department of Medical Education, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
| | - Choon Seng Chong
- Division of Colorectal Surgery, Department of General Surgery, University Surgical Cluster, National University Health System, Singapore, Singapore
- Dean's office, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
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11
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Xiao J, Adnan S. Flipped anatomy classroom integrating multimodal digital resources shows positive influence upon students' experience and learning performance. ANATOMICAL SCIENCES EDUCATION 2022; 15:1086-1102. [PMID: 35751579 PMCID: PMC9796349 DOI: 10.1002/ase.2207] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 06/18/2022] [Accepted: 06/19/2022] [Indexed: 05/21/2023]
Abstract
Anatomy is shifting toward a greater focus on adopting digital delivery. To advance digital and authentic learning in anatomy, a flipped classroom model integrating multimodal digital resources and a multimedia group assignment was designed and implemented for first-year neuroanatomy and third-year regional anatomy curricula. A five-point Likert scale learning and teaching survey was conducted for a total of 145 undergraduate health science students to evaluate students' perception of the flipped classroom model and digital resources. This study revealed that over two-thirds of participants strongly agreed or agreed that the flipped classroom model helped their independent learning and understanding of difficult anatomy concepts. The response showed students consistently enjoyed their experience of using multimodal digital anatomy resources. Both first-year (75%) and third-year (88%) students strongly agreed or agreed that digital tools are very valuable and interactive for studying anatomy. Most students strongly agreed or agreed that digital anatomy tools increased their learning experience (~80%) and confidence (> 70%). The third-year students rated the value of digital anatomy tools significantly higher than the first-year students (p = 0.0038). A taxonomy-based assessment strategy revealed that the third-year students, but not the first-year, demonstrated improved performance in assessments relating to clinical application (p = 0.045). In summary, a flipped anatomy classroom integrating multimodal digital approaches exerted positive impact upon learning experience of both junior and senior students, the latter of whom demonstrated improved learning performance. This study extends the pedagogy innovation of flipped classroom teaching, which will advance future anatomy curriculum development, pertinent to post-pandemic education.
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Affiliation(s)
- Junhua Xiao
- Department of Health Sciences and Biostatistics, School of Health SciencesSwinburne University of TechnologyHawthornVictoriaAustralia
- School of Allied HealthLa Trobe UniversityBundooraVictoriaAustralia
| | - Sharmeen Adnan
- Department of Health Sciences and Biostatistics, School of Health SciencesSwinburne University of TechnologyHawthornVictoriaAustralia
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Augmented-Reality Enhanced Anatomy Learning (A-REAL): Assessing the Utility of 3D Holographic Models for Anatomy Education. ANNALS OF 3D PRINTED MEDICINE 2022. [DOI: 10.1016/j.stlm.2022.100090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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13
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Shojaei A, Feili A, Kojuri J, Norafshan A, Bazrafkan L. The blacksmith approach: a strategy for teaching and learning in the medical anatomy course (a qualitative study). BMC MEDICAL EDUCATION 2022; 22:728. [PMID: 36266705 PMCID: PMC9584281 DOI: 10.1186/s12909-022-03800-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 09/06/2022] [Accepted: 10/11/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Anatomy is a symbolic, essential core topic and one of the fundamental pillars of medical and paramedical knowledge. Nevertheless, few exploratory data analyses have focused on how students approach learning anatomy. This study examined how students perceive their learning experience during anatomy lessons and how to make a model which promotes their meaningful learning and professional identity. METHODS Using purposive sampling with maximum variation, we conducted a qualitative content analysis at the Shiraz University of Medical Sciences in Iran (2020 to 2021). Twenty-four medical students and twelve faculty members of Iran's medical science universities were enrolled in the study. The data were collected through semi-structured interviews and analyzed according to the theme. RESULTS A conceptual model emerged from the data analysis with the main theme called the blacksmith approach, which included Three sub-themes: (1) making a new forge (adequate preparation and mindful beginning), (2) heating the students' hearts (considering supporting systems that learners need) and (3) using Sledgehammer's approach (teaching anatomy by using more active methods and engaging all neuroanatomical regions) and (Using fun for enjoyable learning). All the concepts were related to each other. CONCLUSION Medical students experience a challenging fundamental evolution into professional doctors. Educational systems focus primarily on teaching and learning, while students' transition can be facilitated by a three-step model called the Blacksmith Approach. It best serves as an educational framework for any pivotal, preclinical course capable of helping students acquire new roles and tackle challenges. Further research should be conducted to confirm how hard work leads to satisfying results with the opportunity to create enjoyable learning.
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Affiliation(s)
- Arash Shojaei
- School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Amin Feili
- Clinical Education Research Center, Shiraz University of Medical Sciences, Shiraz, Iran, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Javad Kojuri
- Clinical Education Research Center, Shiraz University of Medical Sciences, Shiraz, Iran, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ali Norafshan
- Histomorphometry and Stereology Research Center, Department of Anatomy, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Leila Bazrafkan
- Clinical Education Research Center, Shiraz University of Medical Sciences, Shiraz, Iran, Shiraz University of Medical Sciences, Shiraz, Iran.
- Clinical Education Research Center, Shiraz University of Medical Sciences, Shiraz, Iran, Shiraz University of Medical Sciences, Shiraz, Iran.
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14
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Łopińska M, Gielecki JS, Żurada A. Flipped spotters learning model: An innovative student activity-based strategy. A preparation tool for anatomy practical examinations in medical education. ANATOMICAL SCIENCES EDUCATION 2022; 15:886-897. [PMID: 34398534 DOI: 10.1002/ase.2132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 08/06/2021] [Accepted: 08/13/2021] [Indexed: 06/13/2023]
Abstract
The flipped spotters learning model is a modern student activity-based and learner-centered method in medical education. The aim of the study was to determine if the flipped spotters learning model improves students' learning. Participants were 1214 medical students of Polish (PD) and English (ED) divisions between 2013 and 2019 academic years at the University of Warmia and Mazury in Olsztyn, Poland. They were divided into a traditional group (control group) and a flipped spotters learning group (treatment group). Each flipped spotters learning group was asked to label anatomical structures on various specimens according to the structures name list prepared by the teacher on the multiple stations. The flipped spotters learning group leaders were instructed to take pictures with the appropriately marked structures on each of the human body prosections. After completion of the class, each flipped spotters team received photos for evaluation. In the flipped spotters learning model, the students strengthened their skills and knowledge by matching specimens independently as a form of practical laboratory activities. Students' performance in gross anatomy practical examinations between the group utilizing the flipped spotters learning model, and the group with the traditional teaching model was compared. Students participating in the treatment group achieved, on average 9.9 percentage points higher among PD students, and 13.0 percentage points higher among ED students than the control group in all nine practical examinations (the effect size ranging from 0.47 to 0.95). The results suggest the positive impact of flipped spotters model on improving student's performance in the practical examinations.
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Affiliation(s)
- Marcelina Łopińska
- Department of Anatomy, Collegium Medicum, Faculty of Medicine, University of Warmia and Mazury, Olsztyn, Poland
| | - Jerzy Stanisław Gielecki
- Department of Anatomy, Collegium Medicum, Faculty of Medicine, University of Warmia and Mazury, Olsztyn, Poland
| | - Anna Żurada
- Department of Radiology, Collegium Medicum, Faculty of Medicine, University of Warmia. and Mazury, Olsztyn, Poland
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15
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Linton A, Garrett AC, Ivie KR, Jones JD, Martin JF, Delcambre JJ, Magee C. Enhancing Anatomical Instruction: Impact of a Virtual Canine Anatomy Program on Student Outcomes. ANATOMICAL SCIENCES EDUCATION 2022; 15:330-340. [PMID: 33838080 DOI: 10.1002/ase.2087] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 04/07/2021] [Accepted: 04/07/2021] [Indexed: 06/12/2023]
Abstract
Innovative reforms in medical education will require instructional tools to support these changes and to give students more flexibility in where and how they learn. At Colorado State University, the software program Virtual Canine Anatomy (VCA) was developed to assist student learning both inside and outside the anatomical laboratory. The program includes interactive anatomical photographs of dissected canine cadavers, dissection instructions with accompanying videos and diagrams, radiographs, and three-dimensional models. There is a need to evaluate the effectiveness of instructional tools like VCA so that decisions on pedagogical delivery can be evidence-based. To measure the impact of VCA on student outcomes in a dissection laboratory, this study compared student attitudes, quiz scores, dissection quality and accuracy, and instructor reliance between students with and without access to VCA. Students with VCA needed less time with teaching assistants (P < 0.01), asked teaching assistants fewer questions (P = 0.04), felt that the dissection was easier (P = 0.02), and were in stronger agreement that they had access to adequate resources (P = 0.02). No differences were found in the dissection quality or accuracy, quiz scores, or attitudes regarding overall enjoyment of the activity between the two groups. This study shows that VCA increases student independence and can be used to enhance anatomical instruction.
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Affiliation(s)
- Andrea Linton
- Virtual Veterinary Educational Tools, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, Colorado
- Department of Biomedical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, Colorado
| | - Andrew C Garrett
- Virtual Veterinary Educational Tools, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, Colorado
- Department of Biomedical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, Colorado
| | - Kenneth R Ivie
- Department of Biomedical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, Colorado
| | - Jay D Jones
- Virtual Veterinary Educational Tools, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, Colorado
| | - Jason F Martin
- Department of Biomedical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, Colorado
| | - Jeremy J Delcambre
- Virtual Veterinary Educational Tools, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, Colorado
- Department of Biomedical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, Colorado
| | - Christianne Magee
- Virtual Veterinary Educational Tools, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, Colorado
- Department of Biomedical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, Colorado
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16
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Cercenelli L, De Stefano A, Billi AM, Ruggeri A, Marcelli E, Marchetti C, Manzoli L, Ratti S, Badiali G. AEducaAR, Anatomical Education in Augmented Reality: A Pilot Experience of an Innovative Educational Tool Combining AR Technology and 3D Printing. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031024. [PMID: 35162049 PMCID: PMC8834017 DOI: 10.3390/ijerph19031024] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 01/14/2022] [Accepted: 01/15/2022] [Indexed: 01/27/2023]
Abstract
Gross anatomy knowledge is an essential element for medical students in their education, and nowadays, cadaver-based instruction represents the main instructional tool able to provide three-dimensional (3D) and topographical comprehensions. The aim of the study was to develop and test a prototype of an innovative tool for medical education in human anatomy based on the combination of augmented reality (AR) technology and a tangible 3D printed model that can be explored and manipulated by trainees, thus favoring a three-dimensional and topographical learning approach. After development of the tool, called AEducaAR (Anatomical Education with Augmented Reality), it was tested and evaluated by 62 second-year degree medical students attending the human anatomy course at the International School of Medicine and Surgery of the University of Bologna. Students were divided into two groups: AEducaAR-based learning ("AEducaAR group") was compared to standard learning using human anatomy atlas ("Control group"). Both groups performed an objective test and an anonymous questionnaire. In the objective test, the results showed no significant difference between the two learning methods; instead, in the questionnaire, students showed enthusiasm and interest for the new tool and highlighted its training potentiality in open-ended comments. Therefore, the presented AEducaAR tool, once implemented, may contribute to enhancing students' motivation for learning, increasing long-term memory retention and 3D comprehension of anatomical structures. Moreover, this new tool might help medical students to approach to innovative medical devices and technologies useful in their future careers.
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Affiliation(s)
- Laura Cercenelli
- eDIMES Lab-Laboratory of Bioengineering, Department of Experimental Diagnostic and Specialty Medicine, University of Bologna, 40138 Bologna, Italy; (L.C.); (E.M.)
| | - Alessia De Stefano
- Cellular Signalling Laboratory, Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, 40126 Bologna, Italy; (A.D.S.); (A.M.B.); (A.R.); (L.M.)
| | - Anna Maria Billi
- Cellular Signalling Laboratory, Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, 40126 Bologna, Italy; (A.D.S.); (A.M.B.); (A.R.); (L.M.)
| | - Alessandra Ruggeri
- Cellular Signalling Laboratory, Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, 40126 Bologna, Italy; (A.D.S.); (A.M.B.); (A.R.); (L.M.)
| | - Emanuela Marcelli
- eDIMES Lab-Laboratory of Bioengineering, Department of Experimental Diagnostic and Specialty Medicine, University of Bologna, 40138 Bologna, Italy; (L.C.); (E.M.)
| | - Claudio Marchetti
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, 40126 Bologna, Italy; (C.M.); (G.B.)
- Department of Maxillo-Facial Surgery, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Lucia Manzoli
- Cellular Signalling Laboratory, Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, 40126 Bologna, Italy; (A.D.S.); (A.M.B.); (A.R.); (L.M.)
| | - Stefano Ratti
- Cellular Signalling Laboratory, Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, 40126 Bologna, Italy; (A.D.S.); (A.M.B.); (A.R.); (L.M.)
- Correspondence:
| | - Giovanni Badiali
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, 40126 Bologna, Italy; (C.M.); (G.B.)
- Department of Maxillo-Facial Surgery, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
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17
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Fu X, Wu X, Liu D, Zhang C, Xie H, Wang Y, Xiao L. Practice and exploration of the "student-centered" multielement fusion teaching mode in human anatomy. Surg Radiol Anat 2022; 44:15-23. [PMID: 34994830 PMCID: PMC8739373 DOI: 10.1007/s00276-021-02866-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 11/29/2021] [Indexed: 11/29/2022]
Abstract
Purpose Human anatomy is a core course of basic medicine and the first professional course for medical students. Traditional teaching includes "teacher-centered" instruction, passive learning, and a lack of interaction between teachers and students as well as between students. The aim of this study was to develop a "student-centered" multielement fusion teaching mode to address the mentioned drawbacks. Methods A total of 141 clinical medical students from grades 2016 and 2017 of Chengde Medical University participated in this study. The students were randomly divided into four classes: two experimental classes and two control classes. The experimental classes experienced a "student-centered" multielement fusion teaching mode, while the control classes experienced a traditional teaching method. Formative assessments and questionnaires were used to assess the students' preferences and obtain feedback. Theoretical and experimental tests were carried out to detect the students' scores at the end of the semester. Results The results of the questionnaires demonstrated that 100% of the students agreed that the multielement teaching mode was better. In the experimental test, the students in the experimental group achieved a mean score of 16.50 ± 0.3203, which was significantly higher than that of the control group 12.65 ± 0.4731 (P < 0.01). In the theoretical test, the average score of the experimental group was 45.86 ± 0.6273 and that of the control group was 46.59 ± 0.6636; thus, there was no significant difference between the two groups (P > 0.05). Conclusion The application of a "student-centered" multielement fusion teaching mode obtained strong approval from the students. This teaching mode not only improved students' interest in learning and increased the interaction between teachers and students as well as between students but also enhanced students' competence and will lay a solid foundation for their future careers.
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Affiliation(s)
- Xiumei Fu
- Department of Anatomy, College of Basic Medical Sciences, Chengde Medical University, Chengde, 067000, Hebei, China. .,Hebei Key Laboratory of Nerve Injury and Repair, Chengde, 067000, Hebei, China.
| | - Xueyan Wu
- Department of Anatomy, College of Basic Medical Sciences, Chengde Medical University, Chengde, 067000, Hebei, China
| | - Donghui Liu
- Department of Anatomy, College of Basic Medical Sciences, Chengde Medical University, Chengde, 067000, Hebei, China
| | - Chengyun Zhang
- Department of Anatomy, College of Basic Medical Sciences, Chengde Medical University, Chengde, 067000, Hebei, China
| | - Honglin Xie
- Department of Anatomy, College of Basic Medical Sciences, Chengde Medical University, Chengde, 067000, Hebei, China
| | - Ying Wang
- Department of Anatomy, College of Basic Medical Sciences, Mudanjiang College of Medicine, Mudanjiang, 157011, China
| | - Lijun Xiao
- College of Basic Medical Sciences, Chengde Medical University, Chengde, 067000, Hebei, China.
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18
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Stone D, Hennessy CM, Smith CF. Teaching with Cadavers Outside of the Dissection Room Using Cadaveric Videos. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2022; 1356:281-297. [DOI: 10.1007/978-3-030-87779-8_12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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19
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Simons AC, McHugh KM, Appling S, Harris SL, Burgoon JM. Instructional Approaches: Anatomy Education of Physical Therapists. ANATOMICAL SCIENCES EDUCATION 2022; 15:102-114. [PMID: 33253489 DOI: 10.1002/ase.2037] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 11/12/2020] [Accepted: 11/23/2020] [Indexed: 06/12/2023]
Abstract
The profession of physical therapy has undergone an evolution since its inception. Since the early 1900s it has grown from a technical training program to a doctorate level degree. Human anatomy courses remain a requirement for physical therapist educational curricula. However, changes in anatomy pedagogy have been trending within health profession educational models, leading to questions regarding which method is best for student learning. The objective of this study was to determine if anatomy instructional method used within physical therapist educational curricula impacted current anatomy knowledge. Licensed physical therapists were recruited to complete a demographic survey and a questionnaire to demonstrate their knowledge of anatomy topics. Anatomy topics included six regional components: (1) upper limb; (2) lower limb; (3) thorax and abdomen; (4) pelvis; (5) spine; and (6) head. Each regional component contained five questions regarding systemic subsets related to joints and osteology, muscles, nervous system, vasculature, and special areas (e.g., spatial orientations, structures within spaces, pathways of nerves). Within the thorax and abdominal region, data analysis indicated that the dissection instruction method, when compared to no laboratory instruction, led to statistically significant greater anatomical knowledge (P = 0.02). Dissection also showed greater means when compared to the no laboratory method (P = 0.02) and the prosection method in the head region (P = 0.01). However, the variance explained by instructional method was small. This study adds empirical evidence regarding current anatomy knowledge exhibited by physical therapists as the level of anatomical knowledge exhibited small differences based on instructional methods.
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Affiliation(s)
- Ashley C Simons
- Division of Anatomy, Department of Biomedical Education and Anatomy, College of Medicine, The Ohio State University, Columbus, Ohio
- Department of Health and Sport Sciences, Otterbein University, Westerville, Ohio
| | - Kirk M McHugh
- Division of Anatomy, Department of Biomedical Education and Anatomy, College of Medicine, The Ohio State University, Columbus, Ohio
| | - Susan Appling
- School of Health and Rehabilitation Sciences, College of Medicine, The Ohio State University, Columbus, Ohio
| | - Shannon L Harris
- School of Business, Virginia Commonwealth University, Richmond, Virginia
| | - Jennifer M Burgoon
- Division of Anatomy, Department of Biomedical Education and Anatomy, College of Medicine, The Ohio State University, Columbus, Ohio
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20
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Allen LM, Hay M, Palermo C. Evaluation in health professions education-Is measuring outcomes enough? MEDICAL EDUCATION 2022; 56:127-136. [PMID: 34463357 DOI: 10.1111/medu.14654] [Citation(s) in RCA: 34] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 08/18/2021] [Accepted: 08/23/2021] [Indexed: 05/28/2023]
Abstract
INTRODUCTION In an effort to increase the rigour of evaluation in health professions education (HPE), a range of evaluation approaches are used. These largely focus on outcome evaluation as opposed to programme evaluation. We aim to review and critique the use of outcome evaluation models, using the Kirkpatrick Model as an example given its wide acceptance and use, and advocate for the use of programme evaluation models that help us understand how and why outcomes are occurring. METHODS We systematically searched OVID medline, Scopus, CINAHL and Pubmed, and hand searched six leading HPE journals to provide an overview of the use of the Kirkpatrick Model as well as a range of programme evaluation models in HPE. In addition to this, we synthesised the existing critiques of the Kirkpatrick Model as an example of outcome evaluation, to highlight the limitations of such models. RESULTS The use of the Kirkpatrick Model in HPE is widespread and increasing; however, studies focus on categorising outcomes, rather than explaining how and why they occur. The main criticisms of the model are as follows: it is outcomes focused and fails to consider factors that can impact training outcomes; it assumes positive casual linkages between the levels; there is an assumption that the higher-level outcomes are more important; and unintended impacts are not considered. The use of the Kirkpatrick Model by the MERSQI, BEME and WHO contribute to the myth that the Kirkpatrick Model is the gold standard for programme evaluation. DISCUSSION Moving forward, evaluations of HPE interventions must shift from focusing largely on measuring outcomes of interventions with little consideration for how and why these outcomes are occurring to programme evaluation that investigates what contributes to these outcomes. Other models that facilitate the evaluation of the complex processes that occur in HPE should be used instead of Kirkpatrick's.
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Affiliation(s)
- Louise M Allen
- Monash Centre for Professional Development and Monash Online Education, Monash University, Clayton, Victoria, Australia
| | - Margaret Hay
- Monash Centre for Professional Development and Monash Online Education, Monash University, Clayton, Victoria, Australia
| | - Claire Palermo
- Monash Centre for Scholarship in Health Education, Monash University, Clayton, Victoria, Australia
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21
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Abu Bakar YI, Hassan A, Yusoff MSB, Kasim F, Abdul Manan Sulong H, Hadie SNH. A Scoping Review of Effective Teaching Strategies in Surface Anatomy. ANATOMICAL SCIENCES EDUCATION 2022; 15:166-177. [PMID: 33650315 DOI: 10.1002/ase.2067] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 01/21/2021] [Accepted: 02/25/2021] [Indexed: 06/12/2023]
Abstract
To become skilled physicians, medical students must master surface anatomy. However, the study of surface anatomy is less emphasized in medical and allied health science curricula, and the time devoted to direct engagement with the human body is limited. This scoping review was designed to answer one research question: "What are the elements and strategies that are effective in teaching surface anatomy?" The review was performed using a five-stage scoping review framework, including research question identification, relevant study identification, study selection, data charting, and result collating and reporting. Three databases were searched using two search terms combined with a Boolean operator: "teaching" and "surface anatomy." The initial pool of 3,294 sources was assessed for duplication, and study eligibility was evaluated using inclusion and exclusion criteria. Data were abstracted from 26 original articles by one researcher and verified by two other researchers. A thematic analysis was performed, and several elements of effective teaching strategies for surface anatomy were identified, namely contextualized teaching, embracing experiential learning, and learning facilitation. This review revealed that a multimodal approach was most commonly used in surface anatomy instruction. Hence, future research should explore the effectiveness of multimodal teaching strategies that adopt the three aforementioned primary elements of effective teaching in an authentic learning environment. It is pertinent to clarify the effectiveness of these teaching strategies by evaluating their impact on student learning, organizational changes, and benefits to other stakeholders.
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Affiliation(s)
- Yasrul Izad Abu Bakar
- Faculty of Medicine, Medical Campus, Universiti Sultan Zainal Abidin, Terengganu, Malaysia
- Department of Medical Education, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, Kubang Kerian, Kota Bharu, Malaysia
| | - Asma' Hassan
- Faculty of Medicine, Medical Campus, Universiti Sultan Zainal Abidin, Terengganu, Malaysia
| | - Muhamad Saiful Bahri Yusoff
- Department of Medical Education, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, Kubang Kerian, Kota Bharu, Malaysia
| | - Fazlina Kasim
- Department of Anatomy, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, Kubang Kerian, Kota Bharu, Malaysia
| | - Husnaida Abdul Manan Sulong
- Integrative Medicine Cluster, Advanced Medical and Dental Institute, Universiti Sains Malaysia, Bertam, Kepala Batas, Malaysia
| | - Siti Nurma Hanim Hadie
- Department of Anatomy, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, Kubang Kerian, Kota Bharu, Malaysia
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22
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Ortega MAC, Marchese VG, Zarro MJ, Film RJ, Shipper AG, Felter C. Digital and blended curriculum delivery in health professions education: an umbrella review with implications for Doctor of Physical Therapy education programs. PHYSICAL THERAPY REVIEWS 2021. [DOI: 10.1080/10833196.2021.2000286] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Affiliation(s)
- Megan A. Connelly Ortega
- Department of Physical Therapy and Rehabilitation Science, University of Maryland, Baltimore, MD, USA
| | - Victoria G. Marchese
- Department of Physical Therapy and Rehabilitation Science, University of Maryland, Baltimore, MD, USA
| | - Michael J. Zarro
- Department of Physical Therapy and Rehabilitation Science, University of Maryland, Baltimore, MD, USA
- Department of Orthopaedics, University of Maryland, Baltimore, MD, USA
| | - Roy J. Film
- Department of Physical Therapy and Rehabilitation Science, University of Maryland, Baltimore, MD, USA
- Department of Orthopaedics, University of Maryland, Baltimore, MD, USA
| | - Andrea G. Shipper
- Health Sciences and Human Services Library, University of Maryland, Baltimore, MD, USA
| | - Cara Felter
- Department of Physical Therapy and Rehabilitation Science, University of Maryland, Baltimore, MD, USA
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23
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Taylor L, Dyer T, Al-Azzawi M, Smith C, Nzeako O, Shah Z. Extended reality anatomy undergraduate teaching: a literature review on an alternative method of learning. Ann Anat 2021; 239:151817. [PMID: 34391910 DOI: 10.1016/j.aanat.2021.151817] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 07/11/2021] [Accepted: 08/02/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND The majority of undergraduate anatomy learning has shifted online, or to a mixture of virtual and face-to-face teaching, due to the COVID-19 pandemic. Cadaveric shortages have also influenced the need for alternative methods of anatomical education. This study examines the current literature on the use of extended reality technologies (XR) such as Virtual reality (VR), Augmented reality (AR), and Mixed reality (MR) for anatomy teaching and explores its potential for implementation in medical education. METHODS A literature review was performed of PubMed, ProQuest, Science Direct, and Springer databases. Included studies were assessed for user satisfaction, perceived effectiveness, cost, acceptability and side effects. RESULTS The database search identified 1687 papers, of which 45 papers were included in this review. Both AR and VR had high rates of satisfaction and acceptability as a supplementary teaching aid amongst undergraduate participants. AR was found to have higher effectiveness than VR. VR is more expensive than AR. Results and comparisons were limited due to short length of study. CONCLUSIONS VR is a popular choice with undergraduates as an aid to supplement teaching, in spite of the associated cost and side effects such as nausea. AR has shown the most potential for independent study. Larger and long-term studies are required to determine true effectiveness, and consideration of the clinical relevance of these technologies.
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Affiliation(s)
- Lucy Taylor
- GKT School of Medical Education, Kings College London, Great Maze Pond, London SE1 1UL, United Kingdom.
| | - Tamsin Dyer
- GKT School of Medical Education, Kings College London, Great Maze Pond, London SE1 1UL, United Kingdom
| | - Mohammed Al-Azzawi
- Department of Orthopaedics, Guy's and St Thomas' NHS Trust, Westminster Bridge Road, London SE1 7EH, United Kingdom.
| | - Christian Smith
- Department of Orthopaedics, Guy's and St Thomas' NHS Trust, Westminster Bridge Road, London SE1 7EH, United Kingdom
| | - Obi Nzeako
- Department of Orthopaedics, Guy's and St Thomas' NHS Trust, Westminster Bridge Road, London SE1 7EH, United Kingdom
| | - Zameer Shah
- Department of Orthopaedics, Guy's and St Thomas' NHS Trust, Westminster Bridge Road, London SE1 7EH, United Kingdom
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Salinas-Alvarez Y, Quiroga-Garza A, Martinez-Garza JH, Jacobo-Baca G, Zarate-Garza PP, Rodríguez-Alanís KV, Guzman-Lopez S, Elizondo-Omaña RE. Mexican Educators Survey on Anatomical Sciences Education and a Review of World Tendencies. ANATOMICAL SCIENCES EDUCATION 2021; 14:471-481. [PMID: 32902143 DOI: 10.1002/ase.2017] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 08/12/2020] [Accepted: 09/01/2020] [Indexed: 06/11/2023]
Abstract
Anatomical sciences curricula have been under constant reform over the years, with many countries having to reduce course hours while trying to preserve laboratory time. In Mexico, schools have historically been autonomous and unregulated, and data regarding structure and methods are still lacking. A national survey was sent by the Mexican Society of Anatomy to 110 anatomical sciences educators. The questionnaire consisted of 50 items (open and multiple choice) for gross anatomy, microscopic anatomy, neuroanatomy, and embryology courses in medical schools across Mexico. A clinical approach was the most common course approach in all disciplines. Contact course hours and laboratory hours were higher in Mexican anatomy education compared to other countries, with the highest reported contact hours for embryology (133.4 ± 44.1) and histology (125 ± 33.2). There were similar contact hours to other countries for gross anatomy (228.5 ± 60.5). Neuroanatomy course hours (43.9 ± 13.1) were less than reported by the United States and similar to Saudi Arabia and higher than the United Kingdom. Dissection and microscopy with histological slides predominate as the most common laboratory activities. Traditional methods prevail in most of the courses in Mexico and only a few educators have implemented innovative and technological tools. Implementation of new methods, approaches, and curricular changes are needed to enhance anatomical sciences education in Mexico.
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Affiliation(s)
- Yolanda Salinas-Alvarez
- Department of Human Anatomy, School of Medicine, Universidad Autónoma de Nuevo León, Monterrey, México
| | - Alejandro Quiroga-Garza
- Department of Human Anatomy, School of Medicine, Universidad Autónoma de Nuevo León, Monterrey, México
| | | | - Guillermo Jacobo-Baca
- Department of Human Anatomy, School of Medicine, Universidad Autónoma de Nuevo León, Monterrey, México
| | | | | | - Santos Guzman-Lopez
- Department of Human Anatomy, School of Medicine, Universidad Autónoma de Nuevo León, Monterrey, México
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Arráez-Aybar LA, García-Mata R, Murillo-González JA, de-la-Cuadra-Blanco C, Gómez-Martínez A, Bueno-López JL. Physicians' viewpoints on faculty anatomists and dissection of human bodies in the undergraduate medical studies. Ann Anat 2021; 238:151786. [PMID: 34153435 DOI: 10.1016/j.aanat.2021.151786] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 04/17/2021] [Accepted: 06/02/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND Studies abound regarding the views of faculty anatomists and medical students on the importance of anatomy and the dissection of human bodies, but very little is known about the views of practicing physicians. METHODS A survey was distributed among physicians and surgeons practicing in Spain in order to find out their views on the practice and consequences of human dissection by undergraduate students of medicine. The most relevant definition to qualify faculty anatomists of medical schools was also requested. Responses were repeatedly clustered into characteristic subgroups for analysis. RESULTS In total, 536 physicians and surgeons belonging to 36 different specialties in seven Spanish hospitals responded to the survey. The results highlighted two main facts. Firstly, faculty anatomists were perceived as teachers, above any other professional identity (namely: physician, biologist or scientist); nonetheless, the ascription of identities varied between specialties (p=0.009); and it also depended on whether the respondents had dissected in their undergraduate degree (p=0.03) and on the respondent's gender (p=0.03). Secondly, physicians and surgeons confirmed that dissecting human cadavers serves the undergraduate student not only for acquiring anatomical knowledge, but also essential skills and attitudes, including professionalism. CONCLUSIONS The results strongly suggest that dissection practice should be reinforced and enriched in undergraduate medical school. As this is important in itself, the results of the study could also help with the development of strategies to alleviate the current shortage of adequately trained anatomists for medical degrees.
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Affiliation(s)
- Luis-A Arráez-Aybar
- Department of Anatomy & Embryology, Faculty of Medicine, Complutense University of Madrid (CUM), Madrid, Spain.
| | | | - Jorge-A Murillo-González
- Department of Anatomy & Embryology, Faculty of Medicine, Complutense University of Madrid (CUM), Madrid, Spain
| | - Crótida de-la-Cuadra-Blanco
- Department of Anatomy & Embryology, Faculty of Medicine, Complutense University of Madrid (CUM), Madrid, Spain
| | - Ana Gómez-Martínez
- Department of Surgery, Thoracic Surgery Service, Hospital Clínico "San Carlos", Madrid, Spain
| | - José Luis Bueno-López
- Department of Neurosciences, School of Medicine and Nursing, The University of the Basque Country (UPV/EHU), Leioa (Biscay), Spain
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Fournier DE, Groh AMR. A Pilot Study of a Physical Therapy Cadaveric Anatomy Course: Assessing the Impact of Examination Format on the Learning Environment. ANATOMICAL SCIENCES EDUCATION 2021; 14:352-360. [PMID: 32803858 DOI: 10.1002/ase.2011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 07/20/2020] [Accepted: 07/30/2020] [Indexed: 06/11/2023]
Abstract
Anatomy education continues to evolve in health professional programs as curricula shift to competency-based models and contact hours decrease. These changes in curricula may significantly alter the learning environment for students. Importantly, changes in learning environment have been shown to impact student learning strategies and well-being. It follows, then, that an investigation of students' perceptions of the learning environment is key to understand the impact of modern anatomy curriculum alterations. The current pilot study evaluated the impact of modifying examination format on the learning environment of physical therapy students participating in a human cadaveric anatomy course. Two study cohorts of first year (entry-level) physical therapy students were invited to complete a preliminary learning environment questionnaire with 13 visual analog scale items and four short answer items. One study cohort was tested with a viva (oral) practical examination, and the other, with a bell-ringer practical examination. Analysis of quantitative items revealed two significant findings: physical therapy students in the bell-ringer cohort found it was more difficult to prepare for their examination, and that they had inadequate time to respond to questions compared to the viva cohort. Analysis of qualitative items revealed distinct themes that concerned physical therapy student learning environment specific to cadaveric anatomy. These results demonstrate that examination format can influence the learning environment of physical therapy students studying cadaveric anatomy. As a result, care needs to be taken to ensure that modernized curricula align the examination format to the method of instruction and the future application of students' knowledge in clinical practice.
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Affiliation(s)
- Dale E Fournier
- Health and Rehabilitation Sciences (Physical Therapy), Faculty of Health Sciences, The University of Western Ontario, London, Ontario, Canada
| | - Adam M R Groh
- Department of Anatomy and Cell Biology, Schulich School of Medicine and Dentistry, The University of Western Ontario, London, Ontario, Canada
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Moro C, Birt J, Stromberga Z, Phelps C, Clark J, Glasziou P, Scott AM. Virtual and Augmented Reality Enhancements to Medical and Science Student Physiology and Anatomy Test Performance: A Systematic Review and Meta-Analysis. ANATOMICAL SCIENCES EDUCATION 2021; 14:368-376. [PMID: 33378557 DOI: 10.1002/ase.2049] [Citation(s) in RCA: 53] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 12/18/2020] [Accepted: 12/24/2020] [Indexed: 05/24/2023]
Abstract
Virtual and augmented reality have seen increasing employment for teaching within medical and health sciences programs. For disciplines such as physiology and anatomy, these technologies may disrupt the traditional modes of teaching and content delivery. The objective of this systematic review and meta-analysis is to evaluate the impact of virtual reality or augmented reality on knowledge acquisition for students studying preclinical physiology and anatomy. The protocol was submitted to Prospero and literature search undertaken in PubMed, Embase, ERIC, and other databases. Citations were reviewed and articles published in full assessing learning or knowledge acquisition in preclinical physiology and anatomy from virtual or augmented reality were included. Of the 919 records found, 58 eligible articles were reviewed in full-text, with 8 studies meeting full eligibility requirements. There was no significant difference in knowledge scores from combining the eight studies (626 participants), with the pooled difference being a non-significant increase of 2.9 percentage points (95% CI [-2.9; 8.6]). For the four studies comparing virtual reality to traditional teaching, the pooled treatment effect difference was 5.8 percentage points (95% CI [-4.1; 15.7]). For the five studies comparing augmented reality to traditional teaching, the pooled treatment effect difference was 0.07 (95% CI [-7.0; 7.2]). Upon review of the literature, it is apparent that educators could benefit from adopting assessment processes that evaluate three-dimensional spatial understanding as a priority in physiology and anatomy. The overall evidence suggests that although test performance is not significantly enhanced with either mode, both virtual and augmented reality are viable alternatives to traditional methods of education in health sciences and medical courses.
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Affiliation(s)
- Christian Moro
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia
| | - James Birt
- Faculty of Society and Design, Bond University, Gold Coast, Queensland, Australia
| | - Zane Stromberga
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia
| | - Charlotte Phelps
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia
| | - Justin Clark
- Institute for Evidence-Based Healthcare, Bond University, Gold Coast, Queensland, Australia
| | - Paul Glasziou
- Institute for Evidence-Based Healthcare, Bond University, Gold Coast, Queensland, Australia
| | - Anna Mae Scott
- Institute for Evidence-Based Healthcare, Bond University, Gold Coast, Queensland, Australia
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Chumbley SD, Devaraj VS, Mattick K. An Approach to Economic Evaluation in Undergraduate Anatomy Education. ANATOMICAL SCIENCES EDUCATION 2021; 14:171-183. [PMID: 32745338 DOI: 10.1002/ase.2008] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 07/22/2020] [Accepted: 07/25/2020] [Indexed: 06/11/2023]
Abstract
Medical education research is becoming increasingly concerned with the value (defined as "educational outcomes per dollar spent") of different teaching approaches. However, the financial costs of various approaches to teaching anatomy are under-researched, making evidence-based comparisons of the value of different teaching approaches impossible. Therefore, the aims of this study were to report the cost of six popular anatomy teaching methods through a specific, yet generalizable approach, and to demonstrate a process in which these results can be used in conjunction with existing effectiveness data to undertake an economic evaluation. A cost analysis was conducted to report the direct and indirect costs of six anatomy teaching methods, using an established approach to cost-reporting. The financial information was then combined with previously published information about the effectiveness of these six teaching methods in increasing anatomy knowledge, thereby demonstrating how estimations of value can be made. Dissection was reported as the most expensive teaching approach and computer aided instruction/learning (CAI/L) was the least, based on an estimation of total cost per student per year and assuming a student cohort size of just over 1,000 (the United Kingdom average). The demonstrated approach to economic evaluation suggested computer aided instruction/learning as the approach that provided the most value, in terms of education outcomes per dollar spent. The study concludes by suggesting that future medical education research should incorporate substantially greater consideration of cost, in order to draw important conclusions about value for learners.
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Affiliation(s)
- Samuel D Chumbley
- University of Exeter Medical School, College of Medicine and Health, University of Exeter, Devon, United Kingdom
| | - Vikram S Devaraj
- University of Exeter Medical School, College of Medicine and Health, University of Exeter, Devon, United Kingdom
| | - Karen Mattick
- University of Exeter Medical School, College of Medicine and Health, University of Exeter, Devon, United Kingdom
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Maloney S, Pather N, Foo J, Lazarus MD. Spending Wisely: The Role of Cost and Value Research in the Pursuit of Advancing Anatomical Sciences Education. ANATOMICAL SCIENCES EDUCATION 2021; 14:263-269. [PMID: 33068329 DOI: 10.1002/ase.2027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 10/07/2020] [Accepted: 10/13/2020] [Indexed: 06/11/2023]
Abstract
Studies of "cost and value" in anatomical sciences education examine not only what works, but at what cost, thus evaluating the inputs and outputs of education. This research provides insights into how to use available resources (e.g., academic time, budgets, infrastructure) as a mechanism to obtaining the maximum outcomes available. The purpose of this viewpoint article is to expand on the application of cost and value concepts to anatomical sciences education, contextualizing these concepts through a deeper dive into the more costly educational approaches of human donor dissection. In doing so, both questions and opportunities are raised for the discipline of anatomical sciences going forward. Educational decisions, inclusive of cost and value appraisals, consider the range of outcomes for which the activity is designed to achieve, and the activity's integration with the philosophy of the educational program it is contributing to; these decisions, thus, evaluate more than just cost alone. Healthcare students' engagement with human donor dissection pedagogy offers an array of reported non-economic benefits, including non-traditional discipline-independent skill (NDIS) development (e.g., professionalism, teamwork skills). These skills are often harder to measure, but are no less important to the final pedagogical decision-making process. The goal of cost and value research is to create an evidence-base toward education that delivers maximum value for a given spend. Anatomy educators, researchers, and decision makers who embrace cost and value dialogue, and interpret and apply findings from studies of educational costs, are best positioned to improve the educational value for their learners and provide effective outputs for all stakeholders.
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Affiliation(s)
- Stephen Maloney
- School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Nalini Pather
- Department of Anatomy, School of Medical Sciences, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Jonathan Foo
- School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Michelle D Lazarus
- Centre for Human Anatomy Education, Department of Anatomy and Developmental Biology, Faculty of Medicine Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
- Monash Centre for Scholarship in Health Education, Faculty of Medicine Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
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30
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Santos RS, Carvalho AC, Tsisar S, Bastos AR, Ferreira D, Ferreira MA, Povo A, Guimarães B. How Computer-Assisted Learning Influences Medical Students' Performance in Anatomy Courses. ANATOMICAL SCIENCES EDUCATION 2021; 14:210-220. [PMID: 32564474 DOI: 10.1002/ase.1997] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 06/12/2020] [Accepted: 06/14/2020] [Indexed: 06/11/2023]
Abstract
Anatomy is an essential subject of the medical curriculum. Despite its relevance, the curricular time and logistical resources devoted to teaching anatomy are in decline, favoring the introduction of new pedagogical approaches based on computer-assisted learning (CAL). This new pedagogical approach provides an insight into students' learning profiles and features, which are correlated with knowledge acquisition. The aim of this study was to understand how training with CAL platforms can influence medical students' anatomy performance. A total of 611 medical students attending Musculoskeletal Anatomy (MA) and Cardiovascular Anatomy (CA) courses were allocated to one of three groups (MA Group, CA Group, and MA + CA Group). An association between the performance in these anatomy courses and the number of CAL training sessions was detected. In the MA Group (r = 0.761, P < 0.001) and the MA + CA Group (r = 0.786, P < 0.001), a large positive correlation was observed between musculoskeletal anatomy performance and the number of CAL training sessions. Similarly, in the CA Group (r = 0.670, P < 0.001) and the MA + CA Group (r = 0.772, P < 0.001), a large positive correlation was observed between cardiovascular anatomy performance and the number of CAL training sessions. Multiple linear regression models were performed, considering either musculoskeletal or cardiovascular anatomy performance as the dependent variable. The results suggest that using CAL platforms to study has a positive dose-dependent effect on anatomy performance. Understanding students' individual features and academic background may contribute to the optimization of the learning process.
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Affiliation(s)
- Raquel Sofia Santos
- Department of Public Health, Forensic Sciences and Medical Education, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Ana Cristina Carvalho
- Department of Public Health, Forensic Sciences and Medical Education, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Stanislav Tsisar
- Department of Public Health, Forensic Sciences and Medical Education, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Ana Raquel Bastos
- Department of Public Health, Forensic Sciences and Medical Education, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Diogo Ferreira
- Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal
- Cardiovascular Research Center, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Maria Amélia Ferreira
- Department of Public Health, Forensic Sciences and Medical Education, Faculty of Medicine, University of Porto, Porto, Portugal
- Cardiovascular Research Center, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Ana Povo
- Department of Surgery, Abel Salazar Institute of Biomedical Sciences, University of Porto, Porto, Portugal
- Department of Ambulatory General Surgery, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Bruno Guimarães
- Department of Public Health, Forensic Sciences and Medical Education, Faculty of Medicine, University of Porto, Porto, Portugal
- Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal
- Cardiovascular Research Center, Faculty of Medicine, University of Porto, Porto, Portugal
- Department of Physical and Rehabilitation Medicine, Centro Hospitalar de Entre o Douro e Vouga, Santa Maria da Feira, Portugal
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31
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Huynh N, Burgess A, Wing L, Mellis C. Anatomy by Whole Body Dissection as an Elective: Student Outcomes. JOURNAL OF SURGICAL EDUCATION 2021; 78:492-501. [PMID: 32958420 DOI: 10.1016/j.jsurg.2020.07.041] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 06/24/2020] [Accepted: 07/25/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Anatomy education has long been considered fundamental to the medical profession. Recently, Australasian medical schools have favored prosected human material, models and medical imaging in their anatomy curriculum with only 3 medical schools offering whole-body dissection. The aim of this study was to explore the knowledge acquisition and perceptions of an elective anatomy by whole body dissection (AWBD) course for senior medical students. METHODS In the 2017 AWBD course, 53 self-selected senior medical students carried out dissections over an 8-week period. Students were assessed via true/false questions and practical tests involving the identification of structures on anatomical images at precourse, mid-course and end-course. In addition, at completion of the course, students completed a questionnaire using a 5-point Likert scale and 2 open-ended questions. Quantitative data analysis was conducted on test scores and questionnaire data using a paired-sample t-test and descriptive statistics. Qualitative data were coded and categorised into themes. RESULTS There was a significant improvement (p < 0.0001) in student test scores from pre-course (mean 34.1 ± 12.9%) to mid-course (mean 74.8 ± 9.4%) and end-course (mean 75.4 ± 9.8%). Analysis of the questionnaire data showed strongly favorable perceptions of the course, highlighting dissection, complemented by Structure, Clinical, Objective-Referenced, Problem-Based, Integrated and Organized (SCORPIO) teaching, frequent testing and senior surgeon supervision as beneficial teaching methods. CONCLUSIONS Dissecting in small groups has been shown to be an effective part of anatomy learning. Our study suggests complementary teaching methods as possible augmenters to a well-structed, small group AWBD course. We have presented a framework suitable for an intensive AWBD course within medical curricula, that was valued by participants, and improved students' knowledge of anatomy.
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Affiliation(s)
- Nguyen Huynh
- Faculty of Medicine and Health, the University of Sydney School of Medicine, The University of Sydney, Sydney, New South Wales, Australia.
| | - Annette Burgess
- Faculty of Medicine and Health, The University of Sydney School of Medicine - Education Office, The University of Sydney, Sydney, New South Wales, Australia
| | - Lindsay Wing
- Division of Surgery, Faculty of Medicine and Health, University of Sydney School of Medicine, The University of Sydney, Sydney, New South Wales, Australia
| | - Craig Mellis
- Faculty of Medicine and Health, The University of Sydney School of Medicine - Education Office, The University of Sydney, Sydney, New South Wales, Australia; Faculty of Medicine and Health, The University of Sydney School of Medicine - Central, The University of Sydney, Sydney, New South Wales, Australia
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32
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Balta JY, Supple B, O'Keeffe GW. The Universal Design for Learning Framework in Anatomical Sciences Education. ANATOMICAL SCIENCES EDUCATION 2021; 14:71-78. [PMID: 32539206 DOI: 10.1002/ase.1992] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 05/07/2020] [Accepted: 06/08/2020] [Indexed: 06/11/2023]
Abstract
Over the past decades, teaching and learning within the discipline of anatomy has undergone significant changes. Some of these changes are due to a reduction in the number of teaching hours, while others are related to advancements in technology. Faced with these many choices for change, it can be difficult for faculty to decide on which new developments in anatomical education need or indeed can be integrated into their course to enhance student learning. This article presents the universal design for learning (UDL) framework-an informed, evidence-based, and robust approach to underpin new course design and pedagogical reform in anatomy education. Universal design for learning is not a theory but a framework grounded in cognitive neuroscience that focuses on engaging multiple brain networks. The guidelines for UDL are organized into three core principles: (1) provide multiple means of representation, (2) provide multiple means of action and expression, and (3) provide multiple means of engagement. The learning space within the anatomy laboratory provides an excellent opportunity in which to apply this framework. This article also describes current trends employed in the teaching of anatomy. The principles of UDL are then outlined, followed by a description of how UDL approaches have been applied in the design and delivery of anatomy practical teaching to first year medical students at University College Cork. Future implications for this work are a consideration and investigation of how a course designed with the principles of UDL at its heart ultimately benefits student learning.
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Affiliation(s)
- Joy Y Balta
- Department of Anatomy and Neuroscience and Cork Neuroscience Centre, Western Gateway Building, University College Cork, Cork, Ireland
- Division of Anatomy, Department of Biomedical Education and Anatomy, College of Medicine, The Ohio State University, Columbus, Ohio
| | - Briony Supple
- Centre for the Integration of Research, Teaching and Learning (CIRTL), University College Cork, Cork, Ireland
| | - Gerard W O'Keeffe
- Department of Anatomy and Neuroscience and Cork Neuroscience Centre, Western Gateway Building, University College Cork, Cork, Ireland
- Centre for the Integration of Research, Teaching and Learning (CIRTL), University College Cork, Cork, Ireland
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Chytas D, Piagkou M, Salmas M, Johnson EO. "Traditional" Methods of Cardiothoracic Surgical Simulation and Anatomical Education: Are they Adequate? ANATOMICAL SCIENCES EDUCATION 2021; 14:117-118. [PMID: 32599648 DOI: 10.1002/ase.1999] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 03/28/2020] [Accepted: 06/20/2020] [Indexed: 06/11/2023]
Affiliation(s)
- Dimitrios Chytas
- Department of Anatomy, School of Medicine, European University of Cyprus, Nicosia, Cyprus
| | - Maria Piagkou
- Department of Anatomy, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Marios Salmas
- Department of Anatomy, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Elizabeth O Johnson
- Department of Anatomy, School of Medicine, European University of Cyprus, Nicosia, Cyprus
- Dean's Office, School of Medicine, European University of Cyprus, Nicosia, Cyprus
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Holland JC, Ní Dhónaill R, Clarke M, Joyce P. Physician Associate Students' Experience of Anatomy Dissection. ANATOMICAL SCIENCES EDUCATION 2021; 14:52-61. [PMID: 32452170 DOI: 10.1002/ase.1984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Revised: 05/15/2020] [Accepted: 05/16/2020] [Indexed: 06/11/2023]
Abstract
The role of physician assistant/associate (PA) has expanded from its inception in the United States over 50 years ago, to European countries including Ireland. While there is an increasing body of evidence exploring the role and training of PAs in clinical settings, there is a scarcity of research exploring PA students' perspectives in relation to their experience of anatomy dissection, or how these experiences may contribute to the development of their core professional identity. Students in the first two cohorts of PA Program at the Royal College of Surgeons in Ireland program were invited to interviews which solicited them to reflect and report on their own experiences of anatomical dissection during their course. Participants' responses were analyzed using a thematic inductive approach; common themes and patterns were organized into a hierarchical structure, which generated the final framework of themes. Ten participants took part in the study; only one had previous personal experience of dissection, while two further participants had some familiarity with prosected specimens. The first theme concerned the participants' expectation of anatomical dissection, with sub-themes of preconceptions, smell, and emotions. The second theme involves discussion of coping strategies that the participants used, including talking, viewing the cadaver as their first patient, and naming (or not naming) the cadaver. The third theme includes how the participants' talked about respect and compassion in the dissection room, development of team working skills, and awareness of bereavement and organ donation. A number of recommendations were also made for the experience and orientation of future students in such a program.
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Affiliation(s)
- Jane C Holland
- Department of Anatomy, Royal College of Surgeons in Ireland, Dublin, Ireland
| | | | - Maeve Clarke
- Department of Oncology, Beaumont Hospital, Dublin, Ireland
| | - Pauline Joyce
- Physician Associate Program, Royal College of Surgeons in Ireland, Dublin, Ireland
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Naylor KA. Mind the gap: The integration of anatomy course contents with basic procedural skills. J Taibah Univ Med Sci 2020; 15:447-455. [PMID: 33318736 PMCID: PMC7715459 DOI: 10.1016/j.jtumed.2020.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 08/20/2020] [Accepted: 08/23/2020] [Indexed: 11/25/2022] Open
Abstract
Objectives This study investigated the value of procedural skill acquisition in low-fidelity simulation labs for students entering a clinical setting during the mandatory one-month nursing internship. Methods We conducted a course that combined gross anatomy knowledge with the teaching of simple procedural skills. We analysed 299 students' opinions and then compared them with their assessment outcomes. Results The survey results showed general satisfaction of students with the simulation-based course. Regarding the role of procedural labs as an adequate enhancement for traditional anatomy labs, students considered the basic procedural skills course as a strong alternative for traditional anatomy lectures and labs. Moreover, a comparison of participants' pre- and post-course answers indicated a significant increase in their anatomy knowledge. Conclusions This study thus indicated a positive perception of students about a course that employed innovative educational measures. In this way, the positive impact of teaching anatomical knowledge through basic procedures was noted.
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Affiliation(s)
- Katarzyna A Naylor
- Department of Didactics and Medical Simulation, Medical University of Lublin, Poland
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36
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Gonzales RA, Ferns G, Vorstenbosch MATM, Smith CF. Does spatial awareness training affect anatomy learning in medical students? ANATOMICAL SCIENCES EDUCATION 2020; 13:707-720. [PMID: 32048478 DOI: 10.1002/ase.1949] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 02/07/2020] [Accepted: 02/09/2020] [Indexed: 06/10/2023]
Abstract
Spatial ability (SA) is the cognitive capacity to understand and mentally manipulate concepts of objects, remembering relationships among their parts and those of their surroundings. Spatial ability provides a learning advantage in science and may be useful in anatomy and technical skills in health care. This study aimed to assess the relationship between SA and anatomy scores in first- and second-year medical students. The training sessions focused on the analysis of the spatial component of objects' structure and their interaction as applied to medicine; SA was tested using the Visualization of Rotation (ROT) test. The intervention group (n = 29) received training and their pre- and post-training scores for the SA tests were compared to a control group (n = 75). Both groups improved their mean scores in the follow-up SA test (P < 0.010). There was no significant difference in SA scores between the groups for either SA test (P = 0.31, P = 0.90). The SA scores for female students were significantly lower than for male students, both at baseline and follow-up (P < 0.010). Anatomy training and assessment were administered by the anatomy department of the medical school, and examination scores were not significantly different between the two groups post-intervention (P = 0.33). However, participants with scores in the bottom quartile for SA performed worse in the anatomy questions (P < 0.001). Spatial awareness training did not improve SA or anatomy scores; however, SA may identify students who may benefit from additional academic support.
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Affiliation(s)
- Rene A Gonzales
- Department of Medical Education, Brighton and Sussex Medical School, University of Sussex, Brighton, United Kingdom
| | - Gordon Ferns
- Department of Medical Education, Brighton and Sussex Medical School, University of Sussex, Brighton, United Kingdom
| | - Marc A T M Vorstenbosch
- Department of Anatomy, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Claire F Smith
- Department of Medical Education, Brighton and Sussex Medical School, University of Sussex, Brighton, United Kingdom
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Tripodi N, Kelly K, Husaric M, Wospil R, Fleischmann M, Johnston S, Harkin K. The Impact of Three-Dimensional Printed Anatomical Models on First-Year Student Engagement in a Block Mode Delivery. ANATOMICAL SCIENCES EDUCATION 2020; 13:769-777. [PMID: 32163665 PMCID: PMC7687145 DOI: 10.1002/ase.1958] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 03/04/2020] [Accepted: 03/09/2020] [Indexed: 06/10/2023]
Abstract
Student engagement is known to have several positive effects on learning outcomes and can impact a student's university experience. High levels of engagement in content-heavy subjects can be difficult to attain. Due to a major institutional restructure, the anatomy prosection laboratory time per subject was dramatically reduced. In response, the authors set out to redesign their anatomy units with a focus on engaging the learning activities that would increase time-on-task both within and outside of the classroom. One of these curriculum changes was the implementation of a suite of anatomy learning activities centered on sets of three-dimensional printed upper limb skeleton models. A two-part mixed-method sequential exploratory design was used to evaluate these activities. Part one was a questionnaire that evaluated the students' engagement with and perceptions of the models. Part two involved focus groups interviews, which were an extension of the survey questions in part one. The results of the study indicated that the majority of students found the models to be an engaging resource that helped improve their study habits. As a result, students strongly felt that the use of the models inspired greater academic confidence and overall better performance in their assessments. Overall, the models were an effective way of increasing the engagement and deep learning, and reinforced previous findings from the medical education research. Future research should investigate the effects of these models on student's grades within osteopathy and other allied health courses.
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MESH Headings
- Anatomy/education
- Curriculum
- Education, Medical, Undergraduate/methods
- Education, Medical, Undergraduate/organization & administration
- Educational Measurement/statistics & numerical data
- Focus Groups
- Humans
- Imaging, Three-Dimensional
- Models, Anatomic
- Models, Educational
- Osteopathic Medicine/education
- Printing, Three-Dimensional
- Problem-Based Learning/methods
- Program Evaluation
- Qualitative Research
- Stakeholder Participation
- Students, Medical/psychology
- Students, Medical/statistics & numerical data
- Surveys and Questionnaires/statistics & numerical data
- Universities/organization & administration
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Affiliation(s)
| | - Kate Kelly
- First Year CollegeVictoria UniversityMelbourneVictoriaAustralia
| | - Maja Husaric
- First Year CollegeVictoria UniversityMelbourneVictoriaAustralia
| | - Rebecca Wospil
- First Year CollegeVictoria UniversityMelbourneVictoriaAustralia
| | - Michael Fleischmann
- Osteopathy DivisionCollege of Health and BiomedicineVictoria UniversityMelbourneVictoriaAustralia
| | - Susan Johnston
- First Year CollegeVictoria UniversityMelbourneVictoriaAustralia
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Supporting early career anatomists: An international challenge. Ann Anat 2020; 231:151520. [DOI: 10.1016/j.aanat.2020.151520] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 03/27/2020] [Accepted: 04/02/2020] [Indexed: 11/23/2022]
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Gnanasegaram JJ, Leung R, Beyea JA. Evaluating the effectiveness of learning ear anatomy using holographic models. J Otolaryngol Head Neck Surg 2020; 49:63. [PMID: 32814593 PMCID: PMC7439621 DOI: 10.1186/s40463-020-00458-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 08/11/2020] [Indexed: 11/29/2022] Open
Abstract
Background Computer-assisted learning has been shown to be an effective means of teaching anatomy, with 3-D visualization technology more successfully improving participants’ factual and spatial knowledge in comparison to traditional methods. To date, however, the effectiveness of teaching ear anatomy using 3-D holographic technology has not been studied. The present study aimed to evaluate the feasibility and effectiveness of learning ear anatomy using a holographic (HG) anatomic model in comparison to didactic lecture (DL) and a computer module (CM). Methods A 3-D anatomic model of the middle and inner ear was created and displayed using presentation slides in a lecture, computer module, or via the Microsoft HoloLens. Twenty-nine medical students were randomized to one of the three interventions. All participants underwent assessment of baseline knowledge of ear anatomy. Immediately following each intervention, testing was repeated along with completion of a satisfaction survey. Results Baseline test scores did not differ across intervention groups. All groups showed an improvement in anatomic knowledge post-intervention (p < 0.001); the improvement was equal across all interventions (p = 0.06). Participants rated the interventions equally for delivery of factual content (p = 0.96), but rated the HG higher than the DL and CM for overall effectiveness, ability to convey spatial relationships, and for learner engagement and motivation (p < 0.001). Conclusions These results suggest that 3-D holographic technology is an effective method of teaching ear anatomy as compared to DLs and CMs. Furthermore, it is better at engaging and motivating learners compared to traditional methods, meriting its inclusion as a tool in undergraduate medical education curriculum.
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Affiliation(s)
| | - Regina Leung
- Queen's University School of Medicine, 15 Arch Street, Kingston, K7L 3N6, Canada
| | - Jason A Beyea
- Department of Otolaryngology, Kingston Health Sciences Centre, Queen's University, 144 Brock Street, Kingston, Ontario, K7L 5G2, Canada. .,IC/ES Adjunct Scientist IC/ES Queen's, Queen's University, Abramsky Hall, Room 208, 21 Arch Street, Kingston, K7L 3N6, Canada.
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Ashokka B, Dong C, Law LSC, Liaw SY, Chen FG, Samarasekera DD. A BEME systematic review of teaching interventions to equip medical students and residents in early recognition and prompt escalation of acute clinical deteriorations: BEME Guide No. 62. MEDICAL TEACHER 2020; 42:724-737. [PMID: 32493155 DOI: 10.1080/0142159x.2020.1763286] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Background: Current educational interventions and teaching for acute deteriorations seem to address acute care learning in discreet segments. Technology enhanced and team training methodologies are in vogue though well studied in the nursing profession, teaching avenues for junior 'doctors in training' seem to be a lacuna.Aims: The BEME systematic review was designed to (1) appraise the existing published evidence on educational interventions that are intended for 'doctors in training' to teach early recognition and prompt escalation in acute clinical deteriorations (2) to synthesise evidence & to evaluate educational effectiveness.Methodology: The method applied was a descriptive, justification & clarification review. Databases searched included PubMed, PsycINFO, Science Direct and Scopus for original research and grey literature with no restrictions to year or language. Abstract review, full text decisions and data extraction were completed by two primary coders with final consensus by a third reviewer.Results: 5592 titles and abstracts were chosen after removal of 905 duplications. After exclusion of 5555 studies, 37 full text articles were chosen for coding. 22 studies met final criteria of educational effectiveness, relevance to acute care. Educational platforms varied from didactics to blended learning approaches, small group teaching sessions, simulations, live & cadaveric tissue training, virtual environments and insitu team-based training. Translational outcomes with reduction in long term (up to 3-6 years) morbidity & mortality with financial savings were reported by 18% (4/22) studies. Interprofessional training were reported in 41% (9/22) of studies. Recent evidence demonstrated effectiveness of virtual environment and mobile game-based learning.Conclusions: There were significant improvements in teaching initiatives with focus on observable behaviours and translational real patient outcomes. Serious game-based learning and virtual multi-user collaborative environments might enhance individual learners' cognitive deliberate practice. Acute care learning continuum with programmatic acute care portfolios could be a promise of the future.
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Affiliation(s)
| | | | | | - Sok Ying Liaw
- Alice Lee Centre for Nursing Studies, National University of Singapore, Singapore
| | - Fun Gee Chen
- Anaesthesia, National University of Singapore, Singapore
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41
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Pather N, Blyth P, Chapman JA, Dayal MR, Flack NA, Fogg QA, Green RA, Hulme AK, Johnson IP, Meyer AJ, Morley JW, Shortland PJ, Štrkalj G, Štrkalj M, Valter K, Webb AL, Woodley SJ, Lazarus MD. Forced Disruption of Anatomy Education in Australia and New Zealand: An Acute Response to the Covid-19 Pandemic. ANATOMICAL SCIENCES EDUCATION 2020; 13:284-300. [PMID: 32306555 PMCID: PMC7264523 DOI: 10.1002/ase.1968] [Citation(s) in RCA: 219] [Impact Index Per Article: 54.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 04/15/2020] [Accepted: 04/16/2020] [Indexed: 05/03/2023]
Abstract
Australian and New Zealand universities commenced a new academic year in February/March 2020 largely with "business as usual." The subsequent Covid-19 pandemic imposed unexpected disruptions to anatomical educational practice. Rapid change occurred due to government-imposed physical distancing regulations from March 2020 that increasingly restricted anatomy laboratory teaching practices. Anatomy educators in both these countries were mobilized to adjust their teaching approaches. This study on anatomy education disruption at pandemic onset within Australia and New Zealand adopts a social constructivist lens. The research question was "What are the perceived disruptions and changes made to anatomy education in Australia and New Zealand during the initial period of the Covid-19 pandemic, as reflected on by anatomy educators?." Thematic analysis to elucidate "the what and why" of anatomy education was applied to these reflections. About 18 anatomy academics from ten institutions participated in this exercise. The analysis revealed loss of integrated "hands-on" experiences, and impacts on workload, traditional roles, students, pedagogy, and anatomists' personal educational philosophies. The key opportunities recognized for anatomy education included: enabling synchronous teaching across remote sites, expanding offerings into the remote learning space, and embracing new pedagogies. In managing anatomy education's transition in response to the pandemic, six critical elements were identified: community care, clear communications, clarified expectations, constructive alignment, community of practice, ability to compromise, and adapt and continuity planning. There is no doubt that anatomy education has stepped into a yet unknown future in the island countries of Australia and New Zealand.
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Affiliation(s)
- Nalini Pather
- Department of Anatomy EducationSchool of Medical SciencesFaculty of MedicineUniversity of New South WalesSydneyNew South WalesAustralia
| | - Phil Blyth
- Department of AnatomySchool of Biomedical SciencesUniversity of OtagoDunedinNew Zealand
| | - Jamie A. Chapman
- Tasmanian School of MedicineCollege of Health and MedicineUniversity of TasmaniaHobartTasmaniaAustralia
| | - Manisha R. Dayal
- School of ScienceWestern Sydney UniversitySydneyNew South WalesAustralia
| | - Natasha A.M.S. Flack
- Department of AnatomySchool of Biomedical SciencesUniversity of OtagoDunedinNew Zealand
| | - Quentin A. Fogg
- Department of Anatomy and NeuroscienceSchool of Biomedical SciencesThe University of MelbourneMelbourneVictoriaAustralia
| | - Rodney A. Green
- Department of Pharmacy and Biomedical Sciences, College of Science, Health and EngineeringLa Trobe UniversityBendigoVictoriaAustralia
| | - Anneliese K. Hulme
- Department of Anatomy EducationSchool of Medical SciencesFaculty of MedicineUniversity of New South WalesSydneyNew South WalesAustralia
| | - Ian P. Johnson
- Department of Biomedical SciencesFaculty of Medicine, Health and Human SciencesMacquarie UniversitySydneyNew South WalesAustralia
| | - Amanda J. Meyer
- School of Human SciencesFaculty of ScienceThe University of Western AustraliaPerthWestern AustraliaAustralia
| | - John W. Morley
- School of MedicineWestern Sydney UniversitySydneyNew South WalesAustralia
| | - Peter J. Shortland
- School of ScienceWestern Sydney UniversitySydneyNew South WalesAustralia
| | - Goran Štrkalj
- Department of Anatomy EducationSchool of Medical SciencesFaculty of MedicineUniversity of New South WalesSydneyNew South WalesAustralia
| | - Mirjana Štrkalj
- Department of Biomedical SciencesFaculty of Medicine, Health and Human SciencesMacquarie UniversitySydneyNew South WalesAustralia
| | - Krisztina Valter
- Medical Education UnitMedical SchoolCollege of Health and MedicineAustralian National UniversityCanberraAustralian Capital TerritoryAustralia
| | - Alexandra L. Webb
- Medical Education UnitMedical SchoolCollege of Health and MedicineAustralian National UniversityCanberraAustralian Capital TerritoryAustralia
| | - Stephanie J. Woodley
- Department of AnatomySchool of Biomedical SciencesUniversity of OtagoDunedinNew Zealand
| | - Michelle D. Lazarus
- Centre for Human Anatomy EducationDepartment of Anatomy and Developmental BiologyFaculty of Medicine Nursing and Health SciencesMonash UniversityMelbourneVictoriaAustralia
- Monash Centre for Scholarship in Health Education, Faculty of Medicine Nursing and Health SciencesMonash UniversityMelbourneVictoriaAustralia
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42
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Thampi S, Lee CCM, Agrawal RV, Ashokka B, Ti LK, Paranjothy S, Ponnamperuma GG. Ideal Sequence of Didactic Lectures and Simulation in Teaching Transesophageal Echocardiography Among Anesthesiologists. J Cardiothorac Vasc Anesth 2020; 34:1244-1249. [DOI: 10.1053/j.jvca.2019.12.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Revised: 12/04/2019] [Accepted: 12/07/2019] [Indexed: 11/11/2022]
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Abdellatif H. Time Spent in Practicing Dissection Correlated with Improvement in Anatomical Knowledge of Students: Experimental Study in an Integrated Learning Program. Cureus 2020; 12:e7558. [PMID: 32269892 PMCID: PMC7138458 DOI: 10.7759/cureus.7558] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Introduction and aim Cadaveric dissection has long been used as the main domain for teaching anatomy in medical schools. However, recently with a limited number of cadavers and time for practicing dissection, prosections and anatomical models are widely used and may replace traditional dissection. We aimed to explore the possible association between practicing dissection and test results among medical students and to determine whether there are differences in achievements between students who studied anatomy by cadaveric dissection and those who used prosections and anatomical models. Methods The study was conducted at the University of Bisha, College of Medicine, Saudi Arabia, during the period from March to August 2017. Students were randomly assigned to one of two groups (50 in each). The first group studied anatomy (upper limb course) by practicing dissection while the other studied it by using prosections and anatomical models. Both groups were subjected to the same final assessments. Scores of both groups were compared by using the Student’s t-test. Correlation analysis between time spent in practicing dissection (carefully registered using a predesigned portfolio and an attendance logbook) and assessment grades was implemented using the rank-based Pearson correlation coefficient. Results Students practicing dissection achieved higher grades (169 ± 1.99) than those who studied anatomy by only using prosections and anatomical models (142 ± 1.78, p<0.001). There was an association between the time spent in practicing dissections and overall anatomy summative assessments (r2=0.841, p<0.001). Students expressed positive responses towards the effectiveness and value of practicing dissection. Conclusions We concluded that practicing dissection helps students to achieve higher results than learning using only models and prosections. Time spent in practicing dissection correlated with final assessment results. Further research is required to measure not only the statistical significance of results but also their educational effectiveness and long term learning outcomes.
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Affiliation(s)
- Hussein Abdellatif
- Human and Clinical Anatomy, Sultan Qaboos University, College of Medicine and Health Sciences, Muscat, OMN.,Anatomy and Embryology, Faculty of Medicine, University of Mansoura, Mansoura, EGY
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Hulme AK, Luo K, Štrkalj G. Musculoskeletal Anatomy Knowledge Retention in the Macquarie University Chiropractic Program: A Cross-Sectional Study. ANATOMICAL SCIENCES EDUCATION 2020; 13:182-191. [PMID: 30920180 DOI: 10.1002/ase.1879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Revised: 03/20/2019] [Accepted: 03/21/2019] [Indexed: 06/09/2023]
Abstract
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.
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Affiliation(s)
- Anneliese K Hulme
- Faculty of Science and Engineering, Department of Chiropractic, Macquarie University, Sydney, Australia
| | - Kehui Luo
- Faculty of Science and Engineering, Department of Mathematics and Statistics, Macquarie University, Sydney, Australia
| | - Goran Štrkalj
- Faculty of Science and Engineering, Department of Chiropractic, Macquarie University, Sydney, Australia
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Alharbi Y, Al-Mansour M, Al-Saffar R, Garman A, Alraddadi A. Three-dimensional Virtual Reality as an Innovative Teaching and Learning Tool for Human Anatomy Courses in Medical Education: A Mixed Methods Study. Cureus 2020; 12:e7085. [PMID: 32226686 PMCID: PMC7096077 DOI: 10.7759/cureus.7085] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Introduction Poor knowledge retention is one reason for medical student attrition in learning and has been a huge concern in medical education. Three-dimensional virtual reality (3D-VR)-based teaching and learning in medical education has been promoted to improve student learning outcomes. This study aimed to determine the effectiveness of 3D-VR in knowledge retention in human anatomy courses as compared to traditional teaching methods among medical students. Methods A convergent mixed methods design was utilized to evaluate learning outcomes in terms of short- and long-term knowledge retention scores among students using 3D-VR and those using traditional models and to describe students’ experiences and views of the use of 3D-VR as a teaching and learning tool. Results Male students who used the 3D-VR tool had significantly higher short- and long-term knowledge scores than males who used the traditional methods. Meanwhile, females who used traditional methods showed significantly higher short-term knowledge scores than females who used 3D-VR. Conclusion Medical students described 3D-VR as a learning tool with a great deal to offer for learning human anatomy as compared to traditional methods. Therefore, we recommend adding the use of 3D-VR in the anatomy curriculum. However, several 3D-VR limitations were also identified, which may hinder its utilization for teaching and learning. These concerns must be addressed before 3D-VR tools are considered for implementation in medical education human anatomy courses.
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Affiliation(s)
- Yasser Alharbi
- Basic Medical Science, College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
| | - Mubarak Al-Mansour
- Adult Medical Oncology, Princess Noorah Oncology Center / College of Medicine, King Abdulaziz Medical City, Ministry of National Guard Health Affairs-Western Region / King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
| | - Radi Al-Saffar
- Anatomy, College of Medicine, Imam Abdulrahman Ibn Faisal University, Dammam, SAU
| | - Abdullah Garman
- Basic Medical Science, College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
| | - Abdulrahman Alraddadi
- Basic Medical Science, College of Medicine, King Saud Bin Abdulaziz Univesity for Health Sciences, Riyadh, SAU
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Langlois J, Bellemare C, Toulouse J, Wells GA. Spatial Abilities Training in Anatomy Education: A Systematic Review. ANATOMICAL SCIENCES EDUCATION 2020; 13:71-79. [PMID: 30839169 DOI: 10.1002/ase.1873] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 02/25/2019] [Accepted: 03/01/2019] [Indexed: 06/09/2023]
Abstract
Spatial abilities have been correlated to anatomy knowledge assessment and spatial training has been found to improve spatial abilities in previous systematic reviews. The objective of this systematic review was to evaluate spatial abilities training in anatomy education. A literature search was done from inception to 3 August 2017 in Scopus® and several databases on the EBSCOhost platform. Citations were reviewed and those involving anatomy education, an intervention, and a spatial abilities test were retained and the corresponding full-text articles were reviewed for inclusion. Before and after training studies, as well as comparative training programs, relating a spatial training intervention to spatial abilities were eligible. Of the 2,405 citations obtained, 52 articles were identified and reviewed, yielding eight eligible articles. Instruction in anatomy and mental rotations training were found to improve spatial abilities. For the seven studies retained for the meta-analysis that included the effect of interventions on spatial abilities test scores, the pooled treatment effect difference was 0.49 (95% CI [0.17; 0.82]; n = 11) improvement. For the two studies that included the practice effect on spatial abilities test scores in a control group, the pooled treatment effect difference was 0.47 (95% CI [-0.03; 0.97]; n = 2) improvement. In these two studies, the impact of the intervention on spatial abilities test scores was found despite the practice effect. Evidence was found for improvement of spatial abilities in anatomy education using instruction in anatomy and mental rotations training.
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Affiliation(s)
- Jean Langlois
- Department of Emergency Medicine, CIUSSS de l'Estrie - Centre hospitalier universitaire de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Christian Bellemare
- Department of Multidisciplinary Services, Clinical Quality Division, CIUSSS de l'Estrie - Centre hospitalier universitaire de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Josée Toulouse
- Division of Libraries and Archives, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - George A Wells
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
- Cardiovascular Research Methods Centre, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
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Viljoen CA, Scott Millar R, Engel ME, Shelton M, Burch V. Is computer-assisted instruction more effective than other educational methods in achieving ECG competence amongst medical students and residents? A systematic review and meta-analysis. BMJ Open 2019; 9:e028800. [PMID: 31740464 PMCID: PMC6886915 DOI: 10.1136/bmjopen-2018-028800] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVES It remains unclear whether computer-assisted instruction (CAI) is more effective than other teaching methods in acquiring and retaining ECG competence among medical students and residents. DESIGN This systematic review and meta-analysis followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. DATA SOURCES Electronic literature searches of PubMed, databases via EBSCOhost, Scopus, Web of Science, Google Scholar and grey literature were conducted on 28 November 2017. We subsequently reviewed the citation indexes for articles identified by the search. ELIGIBILITY CRITERIA Studies were included if a comparative research design was used to evaluate the efficacy of CAI versus other methods of ECG instruction, as determined by the acquisition and/or retention of ECG competence of medical students and/or residents. DATA EXTRACTION AND SYNTHESIS Two reviewers independently extracted data from all eligible studies and assessed the risk of bias. After duplicates were removed, 559 papers were screened. Thirteen studies met the eligibility criteria. Eight studies reported sufficient data to be included in the meta-analysis. RESULTS In all studies, CAI was compared with face-to-face ECG instruction. There was a wide range of computer-assisted and face-to-face teaching methods. Overall, the meta-analysis found no significant difference in acquired ECG competence between those who received computer-assisted or face-to-face instruction. However, subanalyses showed that CAI in a blended learning context was better than face-to-face teaching alone, especially if trainees had unlimited access to teaching materials and/or deliberate practice with feedback. There was no conclusive evidence that CAI was better than face-to-face teaching for longer-term retention of ECG competence. CONCLUSION CAI was not better than face-to-face ECG teaching. However, this meta-analysis was constrained by significant heterogeneity amongst studies. Nevertheless, the finding that blended learning is more effective than face-to-face ECG teaching is important in the era of increased implementation of e-learning. PROSPERO REGISTRATION NUMBER CRD42017067054.
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Affiliation(s)
| | | | - Mark E Engel
- Medicine, Unversity of Cape Town, Cape Town, South Africa
| | - Mary Shelton
- Health Sciences Library, University of Cape Town, Cape Town, South Africa
| | - Vanessa Burch
- Medicine, Unversity of Cape Town, Cape Town, South Africa
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Backhouse S, Taylor D, Armitage JA. Is This Mine to Keep? Three-dimensional Printing Enables Active, Personalized Learning in Anatomy. ANATOMICAL SCIENCES EDUCATION 2019; 12:518-528. [PMID: 30406975 DOI: 10.1002/ase.1840] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/14/2018] [Revised: 10/04/2018] [Accepted: 10/07/2018] [Indexed: 06/08/2023]
Abstract
Understanding orbital anatomy is important for optometry students, but the learning resources available are often fragile, expensive, and accessible only during scheduled classes. Drawing on a constructivist, personalized approach to learning, this study investigated students' perceptions of an alternative learning resource: a three-dimensional (3D) printed model used in an active learning task. A human skull was three-dimensionally scanned and used to produce a 3D printed model for each student. Students actively participated in model creation by tracing suture lines and coloring individual orbital bones during a practical class, then keeping the model for future study. Students' perceptions of the 3D orbital model were examined through a questionnaire: the impact the model had on their learning; perceptions of the 3D orbit compared to traditional resources; and utility of having their own personalized model. The 3D orbit was well received by the student cohort. Participants (n = 69) preferred the 3D orbit as a resource for learning orbital bone anatomy compared to traditional learning resources, believing the model helped them to understand and visualize the spatial relationships of the bones, and that it increased their confidence to apply this knowledge. Overall, the participants liked that they co-created the model, could touch and feel it, and that they had access to it whenever they liked. Three-dimensional printing technology has the potential to enable the creation of effective learning resources that are robust, low-cost and readily accessible to students, and should be considered by anyone wishing to incorporate personalized resources to their multimodal teaching repertoire.
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Affiliation(s)
- Simon Backhouse
- School of Medicine (Optometry), Faculty of Health, Deakin University, Geelong, Victoria, Australia
| | - Darci Taylor
- Health Learning Design Pod, Deakin Learning Futures, Deakin University, Geelong, Victoria, Australia
| | - James A Armitage
- School of Medicine (Optometry), Faculty of Health, Deakin University, Geelong, Victoria, Australia
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Schnittler H, Ortmann U, Washausen S, Knabe W, Wesemann F, Triphaus S, Schöne-Seifert B. Holding donated human bodies in conservation: A novel interactive safe-keeping system meeting high ethical and safety standards. Ann Anat 2019; 225:11-16. [PMID: 31125600 DOI: 10.1016/j.aanat.2019.05.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 04/11/2019] [Accepted: 05/06/2019] [Indexed: 11/27/2022]
Abstract
"Mortui vivos docent". Learning from donated bodies is widely considered a corner stone in pre-clinical education, advanced clinical training, and scientific progress in medicine. Making such use of dead human bodies must, of course, accord with high ethical standards and legal constraints. Piety and respect towards donors require using their remains (i) for valuable purposes, (ii) with what we call 'practical decency', (iii) in an efficient way, and (iv) with the utmost safety for all parties involved. With regard to these goals, practical aspects of preservation, safekeeping procedures (for up to several years), and complete documentation become of great importance, but have so far only been realized unsatisfactorily. Here, we describe the new Safe-Keeping System-Münster (SKS-Münster) that has been developed and implemented in the Anatomy Department of the University of Münster. Integrated components of the system include a paternoster transport system, a removal station with ventilation and an air barrier, RFID transponder technology, and an easy to use software package allowing the system together to provide all required functions in an unprecedented way.
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Affiliation(s)
- Hans Schnittler
- Anatomy Münster, Germany; Institute of Anatomy and Vascular Biology, Westfälische Wilhelms-Universität Münster, Münster, Germany.
| | - Uwe Ortmann
- Dr. Heinekamp Labor und Institutsplanung GmbH, Berlin, Germany
| | - Stefan Washausen
- Anatomy Münster, Germany; Prosektur Anatomie, Westfälische Wilhelms-Universität Münster, Münster, Germany
| | - Wolfgang Knabe
- Anatomy Münster, Germany; Prosektur Anatomie, Westfälische Wilhelms-Universität Münster, Münster, Germany
| | | | - Stefan Triphaus
- Infrastructure Management of the Universitätsklinikum Münster, Münster, Germany
| | - Bettina Schöne-Seifert
- Institute for Ethics, History and Theory of Medicine, Westfälische Wilhelms-Universität Münster, Münster, Germany
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Maggio LA, Thomas A, Chen HC, Ioannidis JPA, Kanter SL, Norton C, Tannery NH, Artino AR. Examining the readiness of best evidence in medical education guides for integration into educational practice: A meta-synthesis. PERSPECTIVES ON MEDICAL EDUCATION 2018; 7:292-301. [PMID: 30229529 PMCID: PMC6191397 DOI: 10.1007/s40037-018-0450-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
BACKGROUND To support evidence-informed education, health professions education (HPE) stakeholders encourage the creation and use of knowledge syntheses or reviews. However, it is unclear if these knowledge syntheses are ready for translation into educational practice. Without understanding the readiness, defined by three criteria-quality, accessibility and relevance-we risk translating weak evidence into practice and/or providing information that is not useful to educators. METHODS A librarian searched Web of Science for knowledge syntheses, specifically Best Evidence in Medical Education (BEME) Guides. This meta-synthesis focuses on BEME Guides because of their explicit goal to inform educational practice and policy. Two authors extracted data from all Guides, guided by the 25-item STructured apprOach to the Reporting In healthcare education of Evidence Synthesis (STORIES). RESULTS Forty-two Guides published in Medical Teacher between 1999 and 2017 were analyzed. No Guide met all STORIES criteria, but all included structured summaries and most described their literature search (n = 39) and study inclusion/exclusion (n = 40) procedures. Eleven Guides reported the presence of theory and/or educational principles, and eight consulted with external subject matter experts. Accessibility to each Guide's full-text and supplemental materials was variable. DISCUSSION For a subset of HPE knowledge syntheses, BEME Guides, this meta-synthesis identifies factors that support readiness and indicates potential areas of improvement, such as consistent access to Guides and inclusion of external subject matter experts on the review team. This analysis is useful for understanding the current readiness of HPE knowledge syntheses and informing future reviews to evolve so they can catalyze translation of evidence into educational practice.
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Affiliation(s)
- Lauren A Maggio
- Uniformed Services University of the Health Sciences, Bethesda, MD, USA.
| | | | - H Carrie Chen
- Georgetown University School of Medicine, Washington, DC, USA
| | - John P A Ioannidis
- School of Medicine and Meta-Research Innovation Center at Stanford (METRICS), Stanford University, Stanford, CA, USA
| | - Steven L Kanter
- School of Medicine, University of Missouri-Kansas City, Kansas City, MO, USA
| | | | | | - Anthony R Artino
- Uniformed Services University of the Health Sciences, Bethesda, MD, USA
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