Cadaver radiography in the teaching of gross anatomy

Student-Authored Autopsy Reports of Anatomical Donors: Their First Patients

The preparation of student-authored autopsy reports of anatomical donors was added to the Gross Anatomy course to integrate the basic and clinical sciences and determine whether students considered this early clinical exposure to be a valuable experience. All donors were scanned using computerized tomography (CT) and student groups received the scan of their donor and a report written by a radiologist. As students dissected, they took photographs and biopsies of pathological findings that were processed for microscopic evaluation. Following consultation with pathologists and radiologists, each group prepared an autopsy report that proposed a cause of death supported with macroscopic, microscopic, and CT images. Cardiovascular events and cancer were the most common. Autopsy reports were evaluated by the faculty and each student group received feedback with respect to content, accuracy, and completeness and whether faculty agreed with students' proposed cause of death. A majority of students answering an anonymous survey indicated that this exercise was valuable or somewhat valuable, but did not agree that preparation of the autopsy report resulted in their being more engaged during the course. Students agreed or somewhat agreed that the exercise should be repeated next year, that they gained insight into the clinical manifestations of disease, that they were able to interpret the CT scan themselves, that meeting with a pathologist was interesting, and that the time required to prepare the report was adequate. Since autopsy reports prepared by students are feasible and students found it to be a valuable experience, we suggest that medical schools add this to Gross Anatomy courses to introduce clinical material and increase clinical relevance.

Student Learning of Radiological Anatomy Through Team-Based Learning Modules: Early Successes and Qualitative Analysis

Knowledge of the anatomy of radiological images is an essential foundation from which medical students may begin to build clinical skills. This foundation can be laid within an anatomy course optimizing student opportunity to compare cadaveric structures with medical images, possibly improving a student's visual-spatial abilities. Strong visual-spatial abilities allow students to perform better on examinations in medical anatomy. Team-based learning has enhanced the opportunities for active student learning allowing the acquisition of more skills for medical students in a time-limited curriculum. Other less measurable contributions can also be expected from a pedagogy that encourages students to work in teams.

Understanding the Awareness, Knowledge and Perceptions of Interventional Radiology Amongst Undergraduates in the UK

INTRODUCTION

The role of interventional radiology (IR) in health care is rapidly expanding in the United Kingdom (UK). However, the presence of IR in the current undergraduate curriculum is lacking.

PURPOSE

This study investigates the awareness, knowledge and perceptions of IR in undergraduates through the clinical years of medical school to suggest future interventions.

METHODS

A total of 360 questionnaires, designed to test undergraduates' knowledge of, and exposure to, IR were distributed over a 14-day period in a UK medical institution.

RESULTS

Of the 312 respondents (86.7%), the majority had never formally shadowed a radiologist (65.4%) or encountered teaching from an interventional radiologist (54.5%). Most students (88.5%) felt their knowledge of IR was lower than other specialties. Students' knowledge of IR procedures did not statistically increase through the clinical years. Students were most cognisant of vascular procedures and least aware of IR's role in oncology. Only 10.9% would consider a career in IR, with 39.7% citing the lack of knowledge and 18.6% citing patient contact as the top reasons for this.

CONCLUSION

Current students have poor exposure to IR through the undergraduate curriculum. Consequently, there is no increase in knowledge of IR clinical practice through the clinical years. Multi-level interventions, incorporating universities and radiological societies are required to increase undergraduate awareness and promote IR as a career.

LEVEL OF EVIDENCE

Level 3, Local non-random sample.

Post mortem CT scans as a supplementary teaching method in gross anatomy

Despite increasing the integration of radiologic imaging teaching in anatomy dissection courses, studies on learning outcome of these interventions are rare or have certain shortcomings in study design. In this study, students were randomly allocated to an intervention group (n=53) receiving five weekly CT-courses of 30min duration during a 6-week gross anatomy course. Students in the control group (n=329) received no additional teaching. Total teaching time did not differ among groups. All students were asked to participate in a pre- and post-course self-assessment (comparative self-assessment; CSA) of learning objectives related to anatomical spatial relationships and a post-course formative assessment on radiologic anatomy. Items of both assessments were matched. Moreover, students of the intervention group were asked to evaluate the CT-courses. Most participants of the intervention group classified the CT-courses as "good" or "very good". Nevertheless, results of the CSA and formative assessment did not differ among study and control groups. These findings indicate that the teaching intervention (CT-courses) did not have an impact on recognition of anatomical structures in radiological images beyond the knowledge acquired in the anatomical dissection course. As a consequence, interventions integrating radiology imaging into dissection courses should be based on psychological considerations of how to best foster student learning. Learning outcome has to be monitored, as results of evaluation surveys can be misleading. Further research on curricular concepts is needed considering both short- and long-term effects.

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

PURPOSE

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

MATERIALS

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

RESULTS

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

DISCUSSION

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

CONCLUSION

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

An integrated teaching method of gross anatomy and computed tomography radiology

It is essential for medical students to learn and comprehend human anatomy in three dimensions (3D). With this in mind, a new system was designed in order to integrate anatomical dissections with diagnostic computed tomography (CT) radiology. Cadavers were scanned by CT scanners, and students then consulted the postmortem CT images during cadaver dissection to gain a better understanding of 3D human anatomy and diagnostic radiology. Students used handheld digital imaging and communications in medicine viewers at the bench-side (OsiriX on iPod touch or iPad), which enabled "pixel-to-tissue" direct comparisons of CT images and cadavers. Students had lectures and workshops on diagnostic radiology, and they completed study assignments where they discussed findings in the anatomy laboratory compared with CT radiology findings. This teaching method for gross and radiological anatomy was used beginning in 2009, and it yielded strongly positive student perspectives and significant improvements in radiology skills in later clinical courses.

The translucent cadaver: a follow-up study to gauge the efficacy of implementing changes suggested by students

In a study conducted in 2011, the use of full body digital X-ray images (Lodox(®) Statscan(®)) and drawings were described for surface anatomy education during which suggestions were made by students on how to improve the method. Educational innovations should continuously be adjusted and improved to provide the best possible scenario for student learning. This study, therefore, reports on the efficacy of implementing some of these suggestions. Suggestions incorporated into the follow-up study included: (1) The inclusion of eight strategically placed labeled digital X-ray images to the dissection halls, (2) The placement of both labeled and unlabeled digital X-ray images online, (3) The inclusion of informal oral questions on surface anatomy during dissection, (4) The requirement of students to submit individual drawings in addition to group drawings into their portfolios, and (5) Integrating information on how to recognize anatomical structures on X-rays into gross anatomy lectures given prior to dissection. Students were requested to complete an anonymous questionnaire. The results of the drawings, tests and questionnaires were compared to the results from the 2011 cohort. During 2012, an increased usage of the digital X-rays and an increase in practical test marks in three out of the four modules (statistically significant only in the cardiovascular module) were reported. More students from the 2012 cohort believed the images enhanced their experience of learning surface anatomy and that its use should be continued in future. The suggested changes, therefore, had a positive effect on surface anatomy education.

The role of radiology in preclinical anatomy: a critical review of the past, present, and future

RATIONALE AND OBJECTIVES

Radiology has been an increasingly important component of preclinical anatomy instruction since the 1960s. The global status of medical imaging pedagogies and radiologists' roles in medical anatomy education is not well established but is important in determining the specialty's contribution to undergraduate medical education.

MATERIALS AND METHODS

PubMed was searched with various combinations of MeSH terms including "radiology," "undergraduate medical education," and "anatomy." Articles were reviewed for relevance, and referenced articles of possible relevance were hand-traced to ensure a wide capture of articles.

RESULTS

Although more medical schools around the world are using medical imaging to teach anatomy, some regions, such as the United States, show a decline in the proportion of imaging taught by radiologists. Lectures, small group discussions, and self-instruction remain the mainstay of current pedagogies and have witnessed dramatic changes over the past few decades with respect to the types of imaging used. Newer pedagogies use contextual and hands-on experiences to improve spatial and application principles. Qualitative and quantitative studies report somewhat mixed results of pedagogical efficacies but demonstrate generally high acceptance by students and instructors and often significant exam score improvement. Radiology as a specialty must overcome several challenges for it to become more involved in anatomy education, including teaching incentives and protected academic time.

CONCLUSIONS

As anatomy instruction and clinical medicine grow increasingly digital, it is ever more important that radiologists continue to develop new anatomy pedagogies and contribute to anatomy education in greater roles.

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

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

Direct correlation of radiologic and cadaveric structures in a gross anatomy course

BACKGROUND

Radiologic imaging is increasingly utilized as supplemental material in preclinical gross anatomy courses, but few studies have investigated its utility as a fully integrated instructional tool.

AIMS

Establish the benefit of a teaching method that simultaneously correlates cadaveric and radiologic structures for learning human anatomy.

METHOD

We performed a mixed-methods randomized controlled trial and one-way cross-over study comparing exam grades and subjective student perception in a gross anatomy course. The intervention consisted of daily direct correlation small group sessions in which students simultaneously identified and correlated radiologic and cadaveric structures. The control method utilized identical laboratory and teaching conditions but students did not simultaneously correlate structures. Spatial relationships of structures within each respective media (gross or radiologic) were emphasized in both groups.

RESULTS

No significant differences in radiology, gross, or written exam scores were observed between the intervention and control groups. The cross-over group preferred the intervention and control methods equally. The correlation teaching sessions ranked equally with active dissection as the most important instructional components of the course.

CONCLUSION

Direct, simultaneous correlation of radiologic and cadaveric structures did not affect exam scores or student preference but helped students understand anatomical concepts in comparison with other course components.

Strategic improvements for gross anatomy web-based teaching

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

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

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

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

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

Developing a radiology-based teaching approach for gross anatomy in the digital era

RATIONALE AND OBJECTIVES

The purpose of this study was to assess the implementation of a digital anatomy lecture series based largely on annotated, radiographic images and the utility of the Radiological Society of North America-developed Medical Imaging Resource Center (MIRC) for providing an online educational resource.

MATERIALS AND METHODS

A series of digital teaching images were collected and organized to correspond to lecture and dissection topics. MIRC was used to provide the images in a Web-based educational format for incorporation into anatomy lectures and as a review resource. A survey assessed the impressions of the medical students regarding this educational format.

RESULTS

MIRC teaching files were successfully used in our teaching approach. The lectures were interactive with questions to and from the medical student audience regarding the labeled images used in the presentation. Eighty-five of 120 students completed the survey. The majority of students (87%) indicated that the MIRC teaching files were "somewhat useful" to "very useful" when incorporated into the lecture. The students who used the MIRC files were most likely to access the material from home (82%) on an occasional basis (76%). With regard to areas for improvement, 63% of the students reported that they would have benefited from more teaching files, and only 9% of the students indicated that the online files were not user friendly.

CONCLUSIONS

The combination of electronic radiology resources available in lecture format and on the Internet can provide multiple opportunities for medical students to learn and revisit first-year anatomy. MIRC provides a user-friendly format for presenting radiology education files for medical students.

Incorporating radiology into medical gross anatomy: does the use of cadaver CT scans improve students' academic performance in anatomy?

Radiological images show anatomical structures in multiple planes and may be effective for teaching anatomical spatial relationships, something that students often find difficult to master. This study tests the hypotheses that (1) the use of cadaveric computed tomography (CT) scans in the anatomy laboratory is positively associated with performance in the gross anatomy course and (2) dissection of the CT-scanned cadaver is positively associated with performance on this course. One hundred and seventy-nine first-year medical students enrolled in gross anatomy at Boston University School of Medicine were provided with CT scans of four cadavers, and students were given the opportunity to choose whether or not to use these images. The hypotheses were tested using logistic regression analysis adjusting for student demographic characteristics. Students who used the CT scans were more likely to score greater than 90% as an average practical examination score (odds ratio OR 3.6; 95% CI 1.4, 9.2), final course grade (OR 2.6; 95% CI 1.01, 6.8), and on spatial anatomy examination questions (OR 2.4; 95% CI 1.03, 5.6) than were students who did not use the CT scans. There were no differences in performance between students who dissected the scanned cadavers and those who dissected a different cadaver. These results demonstrate that the use of CT scans in medical gross anatomy is predictive of performance in the course and on questions requiring knowledge of anatomical spatial relationships, but it is not necessary to scan the actual cadaver dissected by each student.

Medical student participation in surface anatomy classes

Surface anatomy is an integral part of medical education and enables medical students to learn skills for future medical practice. In the past decade, there has been a decline in the teaching of anatomy in the medical curriculum, and this study seeks to assess the attitudes of medical students to participation in surface anatomy classes. Consequently, all first year medical students at the Guy's, King's and St Thomas's Medical School, London, were asked to fill in an anonymous questionnaire at the end of their last surface anatomy session of the year. A total of 290 medical students completed the questionnaires, resulting in an 81.6% response rate. The students had a mean age of 19.6 years (range 18-32) and 104 (35.9%) of them were male. Seventy-six students (26.2%) were subjects in surface anatomy tutorials (60.5% male). Students generally volunteered because no one else did. Of the volunteers, 38.2% would rather not have been subjects, because of embarrassment, inability to make notes, or to see clearly the material being taught. Female medical students from ethnic minority groups were especially reluctant to volunteer to be subjects. Single-sex classes improved the volunteer rate to some extent, but not dramatically. Students appreciate the importance of surface anatomy to cadaveric study and to future clinical practice. Computer models, lectures, and videos are complementary but cannot be a substitute for peer group models, artists' models being the only alternative.

Diagnostic imaging in undergraduate medical education: an expanding role

Radiologists have been involved in anatomy instruction for medical students for decades. However, recent technical advances in radiology, such as multiplanar imaging, "virtual endoscopy", functional and molecular imaging, and spectroscopy, offer new ways in which to use imaging for teaching basic sciences to medical students. The broad dissemination of picture archiving and communications systems is making such images readily available to medical schools, providing new opportunities for the incorporation of diagnostic imaging into the undergraduate medical curriculum. Current reforms in the medical curriculum and the establishment of new medical schools in the UK further underline the prospects for an expanding role for imaging in medical education. This article reviews the methods by which diagnostic imaging can be used to support the learning of anatomy and other basic sciences.

Teaching radiology to medical students: an integrated approach

RATIONALE AND OBJECTIVES

This study assessed medical student satisfaction with radiology lectures integrated into the 3rd-year student internal medicine clerkship, compared with faculty lectures in an independent radiology course, and investigated the effects of integrated instruction on departmental compensation from the medical school.

MATERIALS AND METHODS

Students' evaluations were compared, with two-way analysis of variance, for faculty who presented lectures in an integrated radiology course and faculty who presented lectures in an independent radiology course from July 1998 to June 2001. Radiology department compensation from the medical school for each course was computed per contact hour.

RESULTS

For the integrated course (663 evaluations), the mean overall faculty rating was 1.44 (1 = excellent, 5 = poor), lower (more positive) than the mean overall rating of 1.53 for the independent course (518 evaluations) (P = .037). The interaction between type of instruction and topic was significant only for chest and musculoskeletal imaging, which were rated more positive and less positive in the integrated course, respectively (P < .001). For the integrated course the radiology department received $762 per lecture hour, and for the independent course it received $296 per contact hour (all types) and $1,183 per lecture hour.

CONCLUSION

Student ratings of faculty lectures in an integrated course were excellent and comparable to those in an independent radiology course. The medical school differentiated the efforts of radiology faculty in the two courses through its budgeting process, awarding greater compensation per contact hour for participation in the integrated course. If only lecture hours are considered, compensation was greater for the independent course.

Retention of radiographic anatomy of the chest by 4th-year medical students

RATIONALE AND OBJECTIVES

The authors performed this study to assess the ability of medical students to retain their knowledge of radiographic anatomy into the 4th year.

MATERIALS AND METHODS

One hundred ninety-four 4th-year medical students were quizzed on their ability to (a) identify 10 anatomic structures on chest radiographs and (b) search an abnormal radiograph to identify two important findings. Frontal and lateral views were used. The students had learned about radiographic anatomy of the chest and plain radiography search techniques in 1st- and 2nd-year courses and had proved their ability to perform these tasks, during their 2nd year of medical school, by achieving grades of 84% or more (average grade, 90%) on individual oral examinations administered by radiologists.

RESULTS

The mean test score was 4.47 out of 12. Only 10 students (5%) were able to identify the main pulmonary artery on the frontal view, and only nine (4%) identified the main bronchi on the lateral view. Of the 194 students, 192 failed to detect a collapsed vertebral body on the lateral view of a patient who had previously undergone a mastectomy.

CONCLUSION

Specific radiologic anatomy facts and search techniques are poorly retained by 4th-year medical students. Preclinical teaching of imaging probably should stress principles rather than specific details.

Effectiveness of laparoscopic cadaveric dissection in enhancing resident comprehension of pelvic anatomy

BACKGROUND

Anatomic instruction during preclinical years of medical school has been in decline recently. There is evidence that residents already lose a considerable portion of basic anatomic knowledge in the transition from student to clinician, and this deficit is even more dramatic in residents who start their training with a decreased understanding of anatomy. We questioned whether anatomy could be adequately retaught to new residents as surgical anatomy. In an effort to address this deficiency, we developed a program to teach pelvic anatomy in fresh cadavers using a laparoscopic approach. The purpose of this investigation is to determine if such a program is effective in enhancing residents' pelvic anatomy comprehension.

STUDY DESIGN

An obstetrics and gynecology residency was divided into intervention (n = 15) and control (n = 13) groups. The intervention was a 4-hour laparoscopic dissection in a fresh cadaver. Outcomes measures included a multiple-choice test, practical exam, faculty evaluation, and satisfaction assessment. The faculty evaluation and satisfaction assessment used a visual analog scale. Univarate and nonparametric analysis were used when appropriate.

RESULTS

Initial test scores (p = 0.32), faculty evaluations (p = 0.25), and satisfaction scores (p = 0.17) were similar. Both groups improved their anatomic knowledge based on test scores (p = 0.004) and faculty evaluations (p < 0.001), and final test scores were not significantly different (p = 0.19). Data measured on a 10-cm visual analog scale suggested higher faculty evaluations in the intervention group (14mm versus 10.3mm, (p = 0.23). Similarly there were higher scores on the cadaver test in the intervention group (65% versus 50%), (p = 0.13). The intervention group was significantly more satisfied with their anatomic training (16.1 mm versus-10.1 mm, p = 0.001).

CONCLUSIONS

This study did not have sufficient power to demonstrate that a single laparoscopic cadaveric dissection improves cognitive measures of anatomic perception, but suggested that it improves spatial perception of anatomy and is perceived by residents to be a valuable educational approach.

Interinstitutional study to compare the effectiveness of a radiology-anatomy module of instruction

RATIONALE AND OBJECTIVES

The purpose of this study was to validate the effectiveness of a proven radiology-anatomy instructional module during I st-year gross anatomy courses at Emory University College of Medicine and the University of Iowa College of Medicine.

MATERIALS AND METHODS

This prospective study involved 108 Emory students and 177 Iowa students. The instructional content was the same at both institutions. Each student was randomly assigned into one of three groups at each institution, and each group received a unique, randomized, five-item pretest. All students were posttested as part of their gross anatomy laboratory examination, and the posttests consisted of all 15 items used in the three five-item pretests.

RESULTS

No statistically significant pretest effects were demonstrated by t tests. Posttest performances across items ranged from 73% to 96% correct for Emory students and 67% to 98% for Iowa students. Performance levels on the posttests were significantly higher than on pretests, and few significant differences were found in the performance of the two populations.

CONCLUSION

The radiology-anatomy instructional module integrated into the gross anatomy courses for 1st-year Emory University and University of Iowa students was not instructor or institution dependent.