Anatomy education in US Medical Schools: before, during, and beyond COVID-19

Going back to anatomy roots: Exploring the integration of anatomy sessions during clinical clerkships

The topic of vertical integration of the basic and clinical sciences is an area of great concern and active investigation in medical education. To explore the feasibility of integrating basic sciences into the clinical phase of medical education, gross anatomy was selected as an appropriate discipline. Anatomy faculty, clerkship directors, medical students, and graduate students developed case-based anatomy modules with a design consistent with the principles of self-directed learning. This pilot study aimed to explore medical student responses to the integration of anatomy sessions during clinical clerkships. One-hour anatomy sessions were conducted during rotations of the following clerkships: internal medicine, pediatrics, family medicine, neurology, obstetrics and gynecology, and general surgery during the academic year 2022-2023. Each session consisted of four case-based stations. Voluntary, anonymous surveys were distributed at the end of each session. Descriptive statistics of survey responses from the 490 participants revealed the overall ratings of the anatomy sessions to be above an 8.50 on a scale of 1.00 (low) to 9.00 (high). A small q thematic analysis of the open-ended survey questions revealed the following themes: relevance of clinical correlations presented, a timely review of anatomical content, appreciation for the collaborative setting and interactivity among the participants, and constructive feedback regarding areas needing improvement. Students reported a high overall rating of the anatomy sessions and shared positive comments about these vertically integrated anatomy experiences. With a reduction in the amount of anatomy instruction during the pre-clinical years and limited exposure during the clinical years, anatomy sessions like the ones proposed could allow for the fluid incorporation of gross anatomy across all 4 years of medical school.

Using Disruptive Technologies in the Anatomy Discipline After the COVID-19 Pandemic: A Scoping Review

COVID-19 pandemic health restrictions affected the theoretical and practical teaching of anatomy. This review aims to analyze studies about teaching anatomy in this period. A search through the PubMed/Medline, Scopus, Lilacs, Web of Science, and Google Scholar databases found 1607 articles. After removing duplicates and excluding articles by reading the title/abstract, and then after full reading, 43 articles were included. The remote synchronous and asynchronous active methodologies employ virtual reality, 3D models, and web conferencing platforms to enable audio-visual interaction. While synchronous remote teaching emerged as an important opportunity, its efficacy in imparting knowledge and practical skills remains under scrutiny.

Technologies for Studying and Teaching Human Anatomy: Implications in Academic Education

The teaching of human anatomy (HA) constitutes one of the fundamental pillars of the curriculum in biological and healthcare-related programs. Therefore, it is imperative that the methodology and didactics employed in this discipline equip students in the best possible way. The traditional method of teaching HA involves lectures and practical classes with previously dissected cadaveric specimens and dissection activities. Concurrently, the present era is witnessing the emergence and popularization of new digital technologies connected to the internet, among which we can highlight smartphones, quick response codes, and virtual reality devices, along with the dissemination of complementary imaging methods, such as radiography, ultrasonography, magnetic resonance imaging, and computerized tomography. From this perspective, the objective of this review is to analyze how each of these new tools integrates into the academic context, in order to diversify the teaching of HA and contribute to better understanding of the HA content during academic training, as well as the clinical applications.

Medical Extended Reality for Radiology Education and Training

Medical extended reality (MXR), encompassing augmented reality, virtual reality, and mixed reality (MR), presents a novel paradigm in radiology training by offering immersive, interactive, and realistic learning experiences in health care. Although traditional educational tools in the field of radiology are essential, it is necessary to capitalize on the innovative and emerging educational applications of extended reality (XR) technologies. At the most basic level of learning anatomy, XR has been extensively used with an emphasis on its superiority over conventional learning methods, especially in spatial understanding and recall. For imaging interpretation, XR has fostered the concepts of virtual reading rooms by enabling collaborative learning environments and enhancing image analysis and understanding. Moreover, image-guided interventions in interventional radiology have witnessed an uptick in XR utilization, illustrating its effectiveness in procedural training and skill acquisition for medical students and residents in a safe and risk-free environment. However, there remain several challenges and limitations for XR in radiology education, including technological, economic, and ergonomic challenges and and integration into existing curricula. This review explores the transformative potential of MXR in radiology education and training along with insights on the future of XR in radiology education, forecasting advancements in immersive simulations, artificial intelligence integration for personalized learning, and the potential of cloud-based XR platforms for remote and collaborative training. In summation, MXR's burgeoning role in reshaping radiology education offers a safer, scalable, and more efficient training model that aligns with the dynamic healthcare landscape.

Standardizing male pelvic anatomy teaching using a clinical enrichment video

INTRODUCTION

Evolving trends in medical education and modern curricular changes have reduced the amount of time and resources allocated for anatomy education. As the amount of dedicated anatomy education time decreases, more self-directed learning is required. Cadaveric dissection and didactic teaching have been supplemented with multimedia, clinical anatomy, and imaging for over 20 years, with mixed results. Specifically, the use of video-based anatomy teaching increases medical learning, if done methodically.

METHODS

A 20-minute video was produced highlighting surgical anatomy using the following operative cases: perineal anatomy (artificial urinary sphincter case), inguinal and testicular anatomy (scrotal orchidopexy for acute testicular torsion), prostate anatomy (robotic radical prostatectomy), and bladder anatomy (endoscopy). The annotated video was shown to first-year medical students. Pre- and post-video multiple choice question quizzes were given to the students. Once submitted, the students completed a survey.

RESULTS

Overall, 191 first-year medical students participated in our study. Average scores were similar between each quiz (50±16% vs. 49±17%) and there was no statistically significant change. Seventy-seven percent of participants felt the video improved their knowledge of urologic anatomy and 83% agreed the video should be shown to future classes. Sixty percent of participants felt the video solidified their anatomy knowledge, 78% felt the video was stimulating and entertaining, and 43% of the students felt the video increased their interest in pursuing urology as a career choice.

CONCLUSIONS

Anatomy teaching can be supplemented using surgical videos, especially in a time when in-person anatomy teaching is limited. Further study is required to determine whether this teaching modality improves long-term anatomy knowledge retention.

Implementing virtual reality technology to teach medical college systemic anatomy: A pilot study

It can be difficult for some students to learn three-dimensional anatomical structure concepts. While virtual reality (VR) systems have been reported as helpful for learning, there has been scarce research on either VR teaching strategies or the influence of visually induced motion sickness (VIMS) in the context of large anatomy classes (i.e., over 100 students). The study thus aimed to (1) establish a VR anatomy instruction video for a large class; (2) determine how many students experience VIMS when watching a VR anatomy instruction video; (3) evaluate the influence of VIMS on VR anatomy video-based learning; and (4) examine whether a small screen size alleviates VIMS. Laboratory course students viewing a VR anatomy instruction video about the vascular system were invited to participate in the questionnaire survey. Anatomy faculty and staff participated in an experimental trial to determine whether small screen size could alleviate VIMS. The Likert scale survey revealed that students reported the VR strategy as advantageous and appropriate for large classes, but that it cannot replace practical dissection. Of the total participants, 32% reported experiencing VIMS, and 40% of those experiencing VIMS agreed that this could negatively impact their learning through a VR anatomy instruction video. Adjusting the screen size from large to small significantly delayed the onset of VIMS. In conclusion, the VR anatomy instruction video strategy is feasible and helpful for large classes, but educators should consider VIMS when planning their use of this teaching approach.

A Brief Review of Anatomy Education in Korea, Encompassing Its Past, Present, and Future Direction

Anatomy is a foundational subject in medicine and serves as its language. Hippocrates highlighted its importance, while Herophilus pioneered human dissection, earning him the title of the founder of anatomy. Vesalius later established modern anatomy, which has since evolved historically. In Korea, formal anatomy education for medical training began with the introduction of Western medicine during the late Joseon Dynasty. Before and after the Japanese occupation, anatomy education was conducted in the German style, and after liberation, it was maintained and developed by a small number of domestic anatomists. Medicine in Korea has grown alongside the country's rapid economic and social development. Today, 40 medical colleges produce world-class doctors to provide the best medical care service in the country. However, the societal demand for more doctors is growing in order to proactively address to challenges such as public healthcare issues, essential healthcare provision, regional medical service disparities, and an aging population. This study examines the history, current state, and challenges of anatomy education in Korea, emphasizing the availability of medical educators, support staff, and cadavers for gross anatomy instruction. While variations exist between Seoul and provincial medical colleges, each manages to deliver adequate education under challenging conditions. However, the rapid increase in medical student enrollment threatens to strain existing anatomy education resources, potentially compromising educational quality. To address these concerns, we propose strategies for training qualified gross anatomy educators, ensuring a sustainable cadaver supply, and enhancing infrastructure.

Incorporating Augmented Reality Into Anatomy Education in a Contemporary Medical School Curriculum

Anatomy education in the medical school curriculum has encountered considerable challenges during the last decade. The exponential growth of medical science has necessitated a review of the classical ways to teach anatomy to shorten the time students spend dissecting, allowing them to acquire critical, new knowledge in other disciplines. Augmented and mixed reality technologies have developed tremendously during the last few years, offering a wide variety of possibilities to deliver anatomy education to medical students. Here, we provide a methodology to develop, deliver, and assess an anatomy laboratory course using augmented reality applications. We suggest a novel approach, based on Microsoft® HoloLens II, to develop systematic sequences of holograms to reproduce human dissection. The laboratory sessions are prepared before classes and include a series of holograms revealing sequential layers of the human body, isolated structures, or a combination of structures forming a system or a functional unit. The in-class activities are conducted either as one group of students (n = 8-9) with a leading facilitator or small groups of students (n = 4) with facilitators (n = 4) joining the groups for discussion. The same or different sessions may be used for the assessment of students' knowledge. Although currently in its infancy, the use of holograms will soon become a substantial part of medical education. Currently, several companies are offering a range of useful learning platforms, from anatomy education to patient encounters. By describing the holographic program at our institution, we hope to provide a roadmap for other institutions looking to implement a systematic approach to teaching anatomy through holographic dissection. This approach has several benefits, including a sequential 3D presentation of the human body with varying layers of dissection, demonstrations of facilitator-selected three-dimensional (3D) anatomical regions or specific body units, and the option for classroom or remote facilitation, with the ability for students to review each session individually.

Transitioning from Faculty-Written Examinations to National Board of Medical Examiners Custom Examinations in Medical Education

Purpose

A challenge for medical educators is choosing a method that best evaluates preclinical students' performance in preparation for Step 1. In previous years, block directors (BDs) of the 2nd year (MS2) neuroscience course at Texas Tech University Health Sciences Center School of Medicine issued faculty-written (FW) examinations during the course. In 2022, BDs replaced FW examinations with National Board of Medical Examiners (NBME) custom examinations. The rationale being that the customized NBME exams would better reflect the national neuroscience curriculum and enhance student preparedness for taking standardized exams.

Methods

FW examinations (2021) were created by the faculty in the neuroscience course and reviewed by BDs. In contrast, questions that best aligned with the material covered for the 2022 course were selected by BDs using MyNBMESM Services Portal. The custom questions selected are assigned a "difficulty" score by NBME, generating a predicted national average score. At the end of the course, undergraduate medical students in the School of Medicine at Texas Tech University Health Sciences Center completed an online Qualtrics questionnaire to compare the transition of assessment type.

Results

Participants reported greater satisfaction in their neuroscience education and block organization with NBME examinations. For example, there was a nearly twofold (1.83) increase in the number of students that strongly agreed with the statement "Overall, I am satisfied with the quality of my neuroscience education in this block." They were also less likely to report the workload as being "much too heavy." Overall, students expressed a preference for the customized NBME exams as opposed to faculty generated exams (88.1%).

Conclusions

From the student perspective, building customized assessments through MyNBMESM Services Portal was found to be useful and preferable for evaluating student performance. From block directors' perspective, it is noted that time is saved assisting faculty in writing valid questions, time defending/justifying FW questions, and time expended generating exams. The only perceived negative regarding the NBME exams is the cost.

Swiss medical schools' experiences with online teaching during the COVID-19 pandemic in light of international experiences

BACKGROUND

During the pandemic, all universities had to switch to digital learning and teaching (DLT), the experiences were diverse. The advantages and obstacles of DLT are well reported in research. To ensure a sustainable DLT implementation, the requirements of institutions, educators and students should be aligned.

OBJECTIVE

This paper aims at identifying and describing the experiences made at the Swiss medical schools after having to switch from on-site to on-line teaching; in particular, the experienced issues, requirements, and solutions were investigated and compared to international literature.

METHODS

We conducted a literature review to derive themes and subthemes regarding the central aspects of the transition from on-site to on-line teaching. Also, we conducted semi-structured interviews with people responsible for the medical curricula at the Swiss Medical Schools. We used a purposive sampling method and invited eleven curriculum managers at the seven Swiss Medical Schools. The interviews were conducted in English, audio-recorded and transcribed. Subsequently the data was analysed with the software NVivo. We used a qualitative, deductive, content analysis to explore faculty experiences.

RESULTS

Twenty-four articles met the eligibility criteria and were included for full text screening. Of the included articles, 15 reported on DLT in general and nine articles reported on DLT during the Pandemic. The thematic analysis of the interviews resulted in four overall themes, requirements, obstacles, facilitators and advantages. Curriculum managers reported that institutions were relatively unprepared for the quick transition from onsite to online at the onset of the pandemic.

CONCLUSIONS

Our research reports a lack of institutional structures, communication, digital competences and literacy, teaching strategies, as well as a theoretical foundation for DLT implementation. A conceptual framework for DLT adapted to the Swiss universities beyond the current situation is needed.

Anatomical Ignorance Resulting in Iatrogenic Causes of Human Morbidity

This article discusses how inadequate anatomy education contributes to iatrogenic causes of human morbidity and mortality. Through a review of the relevant literature, high-yield clinical cases were identified in which a lack of sufficient anatomical knowledge contributed to patient morbidity, such as abscess formation and neuropathy as a result of improper intramuscular injections, superior gluteal nerve injuries due to surgical procedures, and misdiagnoses due to physicians' inability to examine and correlate clinical and radiological findings. The importance of a multimodal learning approach in anatomy education for medical students, which includes the utilization of the cadaveric dissection approach to emphasize spatial understanding, is crucial for the development of competent physicians with a deep-rooted foundational knowledge of anatomy and related concepts, such as physiology, pathology, and radiology. It cannot be understated that anatomy education and a lack of knowledge of anatomy and related concepts may influence iatrogenic causes of human morbidity and mortality. Therefore, all efforts should be made to ensure that students develop a strong foundational anatomy knowledge during their preclinical years.

A comparison of pre- and post-clinical education learning preferences among medical students who elected to dissect compared to those who did not during the COVID-19 pandemic

Anatomy instructional methods varied widely during the COVID-19 pandemic and programs are assessing innovations for retention. Learning preferences were assessed among medical students dichotomized as elective dissectors (ED) or non-dissectors (ND) during the COVID-19 partial re-opening in 2020 (preclinical) and again in 2022 after clinical exposure (post-clinical) to assess the viability of elective dissection post-pandemic. A mixed-method approach was used for the assessment of test scores, learning preference surveys, learning activities rankings, and thematic analyses. No significant differences occurred in anatomy examination scores. Dissection was considered useful by both preclinical groups but significantly more so by ED, while the presence of an instructor was significantly preferred by ED although a majority of ND agreed. Elective dissection was significantly preferred by ND but also by a large minority of ED students. Pre- and post-clinical ND believed that elective dissection offered more academic flexibility, did not hinder clinical learning, and did not negatively impact medical education. The corresponding ED stated that confidence improved, clinical experiences were enhanced, and dissection was irreplaceable. Preclinical ND preferred self-learning, while ED students preferred online learning, but these differences largely disappeared post-clinically. Learning activity rankings were not significantly different among all groups (ND, ED, preclinical, and post-clinical). A hybrid laboratory with a virtual learning environment ranked highest across groups and preferences increased over time suggesting that students benefited from this instructional method during clinical exposure. The absence of laboratory experience ranked lowest, and preference decreased over time suggesting that anatomy dissection is valued.

Flipped classroom assisted by Rain Classroom for anatomy practical classes: Challenges and opportunities of anatomy education

Anatomy practical classes are an essential part of learning human anatomy. The flipped classroom teaching model has been used in medical education in recent years. However, its precise impacts on anatomical knowledge acquisition and learning outcomes remain controversial. With the development of information technology, new educational tools, such as Rain Classroom, have recently attracted much interest. The Rain Classroom is an application that can easily connect students and teachers through smartphones or computers. However, whether and how to apply it to the flipped classroom in anatomy practical classes needs to be evaluated. In this study, we designed a teaching model of flipped classroom assisted by Rain Classroom and carried it out in anatomy practical classes at our university. Results showed that the final exam scores of the experimental group were significantly improved, compared with the control group (p < 0.01); the final exam score was significantly correlated with both the pre-class quiz score (p < 0.05) and the in-class quiz score (p < 0.001). Student satisfaction was measured by a questionnaire on a Likert scale of 1-5. All the mean scores were greater than 4.5, indicating that most students had positive attitudes toward this teaching model. The present study suggests that the Rain Classroom helps support students throughout the learning processes of the flipped classroom, and the model of flipped classroom assisted by Rain Classroom could improve students' learning efficiency and ultimately increase their exam performance in anatomy practical classes.

Cadaver Dissection Experience for First-Time Dissectors: a Hypothetical Three-Pronged Approach for Student Preparation

This systematic review synthesized evidence for the development of a preparatory process for first-time dissectors, geared toward improving cadaver dissection (CD) experiences. Eleven studies focused on pre-CD intervention were selected from a literature search in PubMed, the Education Resources Information Centre (ERIC), Google Scholar, PsycNET, and the Cochrane Library. A three-pronged preparatory process was formulated for first-time dissectors based on the evidence from the review. The process includes (1) background assessment; (2) pre-CD education; and (3) gradual exposure and desensitization. The preparatory process shows some hypothetical potential for decreasing negative CD-related experiences, but it still needs validation before implementation.

Perceptions of Students and Teachers Regarding the Impact of Cadaver-Less Online Anatomy Education on Quality of Learning, Skills Development, Professional Identity Formation, and Economics in Medical Students

Anatomy is one of the most important basic sciences in medical education and is the foundation for doctors to develop clinical skills. In the last few years, anatomy teaching has been transformed from hands-on practice into online modalities. In this study, we aimed to determine the perceptions of students and teachers about learning anatomy without using cadavers (cadaver-less) from a knowledge, technological, and humanistic perspective. The research was carried out in the Faculty of Medicine at Hasanuddin University, located in South Sulawesi, Indonesia, over a period from June to August 2021. A focus group discussion was extended to all medical students in their first year of study following their completion of online anatomy lessons. Furthermore, educators responsible for instructing anatomy in the initial year were sent an invitation to participate in a one-on-one interview with the principal investigator. In general, the results of the study complied with what has been known from the literature about the quality of online learning and its advantages and disadvantages. However, our discussions with students and interviews with teachers revealed that anatomy education without the use of cadavers is perceived as undesirable as it negatively impacts the identity formation of the future physician. It also takes away the opportunity for students to develop empathy for humanity.

Chinese anatomy educators' perceptions of blended learning in anatomy education: A national survey in the post-COVID-19 era

Blended learning, which combines face-to-face lectures with online learning, has emerged as a suitable teaching approach during the COVID-19 pandemic. This study used a national survey of anatomy educators in Mainland China to evaluate the changes in the implementation of blended learning in anatomical pedagogy. A total of 297 responses were collected from medical schools across all provinces. Respondents included 167 males and 130 females, with an average age of 44.94 (±8.28) and average of 17.72 (±9.62) years of professional experience. The survey showed adoption of online teaching and assessment by Chinese anatomy educators increased by 32.7% and 46.8%, respectively, compared to pre-pandemic levels. Perceptions of blended learning outcomes varied, with 32.3% and 37% educators considering it superior and inferior to traditional teaching, respectively. Faculty training programs related to blended learning increased significantly, fostering a collaborative learning environment; however, challenges remained in achieving satisfactory online assessment outcomes. Anatomy educators' attitudes reflected a strong preference for classroom learning (4.941 ± 0.856) and recognition of the importance of relevant technology (4.483 ± 0.954), whereas online learning received lower acceptance (4.078 ± 0.734). Female anatomy teachers demonstrated effective time management in online teaching. Meanwhile, educators with over 15 years of experience encountered difficulties with relevant technology, consistent with negative attitudes toward blended learning. Overall, this survey highlights the persistent challenges in implementing blended learning in anatomy education and provides insights for enhancing the pedagogical model in the post-COVID-19 era.

The impact of human cadaveric dissection on professional identity formation in medical students

BACKGROUND

As technology advances, some schools are moving away from human cadaveric dissection to teach anatomy, leading to concern regarding the possible loss of a professional identity building experience. This study explored the role of dissection in students' professional identity formation.

METHODS

A mixed-methods study was conducted using survey methodology and semi-structured interviews of medical students at an American-style graduate-entry medical school in Singapore. The questionnaire adopted the conceptual framework of the Ring Theory of Personhood and the MacLeod-Clark Professional Identity Scale was used to measure professional identity, followed by semi-structured interviews of students using Braun and Clarke's six-phase reflexive thematic analysis.

RESULTS

Respondents did not differ substantively from non-respondents by age, nationality, or ethnicity, and year of entering medical school, however, they were slightly more female dominant. The number of hours of hands-on participation in dissection showed no significant relationship (r2 = 0.010; p = 0.424) with professional identity formation measured by the MacLeod-Clark Professional Identity Scale. Despite the survey results, semi-structured interviews revealed rich and nuanced findings suggesting the influence of dissection in participants' professional identity formation through deepening students' appreciation of humanistic values and enhancing their notions of patients' personhood. Notably, students without dissection experience did not express these sentiments and were orientated towards knowledge acquisition.

CONCLUSION

While our findings do not suggest that dissection strongly impacts students' professional identity formation, students shared thought-provoking experiences which suggest some level of its contribution. Careful consideration of this phenomenon should be exercised prior to removing dissection in favour of technological alternatives.

Comparing the emotional experiences of students in similar dissection- and prosection-based medical gross anatomy courses: A mixed-methods study

The anatomy laboratory can incite strong emotional reactions in students, which can in turn facilitate growth in empathy, care for vulnerable others, and professionalism. Despite this, little is known about the relative emotional impacts of different laboratory modalities. The response to the COVID-19 pandemic created an opportunity to compare the emotional experiences of students in similar courses in which one group of students dissected donors and the other group learned from prosected donors. The courses were otherwise the same in content, length, instructional design, and assessment. Students in the dissection-based (Fall 2019) and prosection-based (Fall 2020) courses completed a previously validated survey that used quantitative and qualitative questions to assess their feelings about the donors and the anatomy laboratory experience. Students in both cohorts reported overall appreciation for having had the experience. Negative themes experienced by both groups included feeling anxiety, worries about depersonalizing donors, and physical discomfort in the laboratory. Students in the dissection course reported stronger connections with the donors and the donors' families but also more frequently felt negative feelings such as disgust, anxiety, and feeling alone. Students in the prosection course reported more consistently positive responses but worried about not using the donors to the fullest extent possible. Regardless of pedagogical design, students have complex emotional experiences in the anatomy laboratory and our results indicate that these feelings may be more intense in the context of dissection. Anatomists should foster educational settings that enable students to learn to process complex or challenging emotions.

Perceptions and Attitudes of Jordanian Medical Students on Using 3D Interactive Anatomy Dissection in Teaching and Learning Anatomy

BACKGROUND AND AIMS

This study evaluates the use of virtual anatomy dissection (Anatomage Table) in teaching anatomy for Jordanian medical students. The study also highlights any gender differences in students' perception on this method of teaching anatomy.

METHODS

This is a cross-sectional questionnaire-based study that was carried out on medical students enrolled in Al-Balqa Applied University, a Jordanian public university. A group of expert anatomists designed a questionnaire that investigates the students' perceptions and attitudes toward using virtual anatomy dissection. The questionnaire also investigated student's opinions and expectations on the impact of using this method on the academic achievement of students.

RESULTS

The findings of the study showed that most students agreed that Anatomage Table helped them better understand (64.3%) and memorize (64%) anatomy lectures. In addition, most students were interested in using this learning method in lab groups (72.3%). However, the didactic approach that combined anatomical models and the Anatomage Table was preferred over the unilateral approach that included only the Anatomage Table (80.5% vs 30.2%, p<0.001, r=0.9). Of note, there was a statistically significant difference between males and females in their preference for Anatomage Table (p<0.001), and in their perceptions on the impact of Anatomage Table on understanding of lectures (p<0.001) and memorization of anatomical structures (p=0.004).

CONCLUSION

The Anatomage Table is a powerful teaching and learning method in undergraduate medical education. Its application to Al-Balqa Applied University has proven to be effective so far. It can be used to overcome the problems facing anatomical education in the college of medicine in Al-Balqa Applied University and perhaps other universities in Jordan, but this needs better cooperation between universities and stakeholders to provide adequate funding for this method.

Commentary: Is There a Lack of Insight on the Anatomy Teaching Adaptations Made by "Cadaver-Free" Medical Schools in Response to the COVID-19 Pandemic?

The COVID-19 pandemic negatively impacted anatomy education as it ceased face-to-face anatomy teaching sessions and laboratory practicals. In the past 2 years, a growing body of literature has been dedicated to the adaptations made in the teaching of anatomy predominantly by medical schools who employ cadaveric dissection and prosection-based practicals to teach anatomy. Despite this, there is dearth of evidence in terms of the challenges that medical schools who do not use cadaveric dissection or prosected specimens to teach anatomy faced as well as the adaptations they made in response to the pandemic.

Differences in medical education before, during, and in the post-peak period of the COVID-19 pandemic-exploring senior medical students' attitudes

BACKGROUND

The burden that COVID-19 has brought to the economy, healthcare systems, and education is unmatched. Public health and social measures were implemented to halt transmission. Thus, social gathering and in-person learning, core aspects of medical education, were interrupted. Studies have documented the detrimental impact students graduating during the pandemic have had on their confidence and skills. However, data comparing pre-pandemic, pandemic, and post-peak students still lack. This study aimed to identify senior medical students' attitudes regarding their education and compare them according to the three previously described periods.

METHODS

In this cross-sectional study, the survey employed was designed based on a previous questionnaire and applied to senior medical students before graduating between January 2018 and June 2022. Answers were collected using a three-point Likert scale and Yes/No questions. Associations between variables were examined using Chi-squared, Fisher's Exact tests, and ANOVA, employing logistic regression to calculate odds ratio (OR) when appropriate.

RESULTS

A total of 679 responses were analyzed. Most students (59%) were women. Up to 383, 241, and 55 senior medical students answered the survey before, during, and in the post-peak period of the COVID-19 pandemic, respectively. There was a staggering decrease in the percentage of students in the post-peak compared to the pre-pandemic period that considered certain factors such as being taught about the doctor-patient relationship (62% vs 75%), practicing teamwork (33% vs 54%), preclinical & clinical subjects (44% vs 63%), and being taught to conduct research (22% vs 32%) as "very useful" to their professional traineeship. There was a significant difference between pre-pandemic, pandemic, and post-peak students when asked if the study curriculum accomplished the goal of training a professional with integrity (89% vs 66% vs 64%, p < 0.001), respectively. In a multivariate analysis graduating during the pandemic (OR 3.92; 95% CI, 2.58-5.94) and in the post-peak period (OR 4.24; 95% CI, 2.23-8.07) were independent factors for the appreciation that the study curriculum did not meet its objective.

CONCLUSIONS

The pandemic has hindered medical education. Students' appreciation of their instruction has deteriorated. Urgent interventions that halt the negative impact on training, ensure readiness for future problems and improve schooling worldwide are needed.

Application of Blended Learning to Veterinary Gross Anatomy Practical Sessions: Students' Perceptions of Their Learning Experience and Academic Outcomes

The use of blended learning strategies is increasingly common in health sciences, including veterinary medicine; however, there are very few descriptions of these methods being applied to practicals. We describe here the application of blended learning based on the implementation of flipped classrooms with collaborative learning and gamification to the 2020-2021 veterinary medicine gross anatomy practicals at CEU Cardenal Herrera University (Spain). Students prepared for the sessions by pre-viewing videos and taking a quiz before the start. The sessions were conducted in small groups where students learned through collaborative work and reviewed their learning with a card game. A small but significant increase was observed when comparing the scores of practical exams of the locomotor apparatus with those of 2018-2019 (6.79 ± 2.22 vs. 6.38 ± 2.24, p < 0.05), while the scores were similar (7.76 ± 1.99 vs. 7.64 ± 1.92) for the organ system exams. Students' responses in a satisfaction survey were mostly positive (>80%) regarding the motivating and learning-facilitating effect of this educational method. Our work shows that the application of blended learning in anatomy practicals based on a flipped classroom and with elements of gamification and collaborative work can be an effective way to improve the learning experience of students.

Faculty Perception of Student Engagement in Online Anatomy Laboratory Courses During the COVID-19 Pandemic

When the social distancing guidelines, as a result of the COVID-19 pandemic, caused universities to close campuses, there was a rapid shift in the course delivery methods of human gross anatomy laboratory sessions. Courses were delivered online, and this change created new challenges for anatomy faculty to engage students effectively. This profoundly impacted student-instructor interactions, the quality of the learning environment, and successful student outcomes. Because of the importance of student interaction and engagement for hands-on laboratory courses like anatomy, which rely on cadaver dissections and in-person learning communities, as well as the novel opportunity, this qualitative study sought to explore the faculty perspectives of transitioning their in-person laboratory sessions online and unearth their experience with student engagement in this new teaching format. The Delphi technique was used to explore this experience in two rounds of qualitative inquiry using questionnaires and semi-structured interviews, and thematic analysis was used to analyze the data, identifying codes and building themes. The study utilized indicators of student engagement in online courses to formulate four themes: instructor presence, social presence, cognitive presence, and reliable technology design and access. These were constructed based on the factors faculty used to maintain engagement, new challenges they faced, and strategies deployed to overcome these challenges and engage students in the new learning format. These are supported by strategies such as using video and multimedia, ice-breaker activities, chat and discussion features, immediate and personalized feedback, and virtual meeting via synchronous sessions. These themes highlight important lessons that faculty designing online anatomy laboratory courses can use to guide their course design, and institutions and instructional design faculty can use to inform best practices and faculty development efforts. Additionally, the study calls for further research to design a standardized and global assessment tool that measures student engagement in the online learning environment.

Graphic medicine meets human anatomy: The potential role of comics in raising whole body donation awareness in Italy and beyond. A pilot study

Cadaver dissection has always played a fundamental role in medical education. However, especially in Italy, the topic of body donation has remained partially unknown for years. The current study analyses graphic medicine as a new possible communication tool, evaluating and reflecting, with second-year students enrolled in the International School of Medicine and Surgery at the University of Bologna, about its potentialities for body donation awareness-raising in both the scientific community and the general population. For the first time in an Italian University, two graphic medicine workshops were organized focusing on human anatomy and body donation. Seminars were positively evaluated by students using a four items Likert-scale question: mean 3.54 (± SD 0.73) for the Likert question about the experiences of the workshops; 3.88 (± 0.33) for the Likert question regarding the use of graphic medicine in body donation awareness campaigns among the general population; 3.59 (± 0.65) for the Likert question regarding the use of graphic medicine in body donation awareness campaigns among the scientific community. Furthermore, the open-ended questions included in the anonymous questionnaire were analyzed using the constructivist grounded qualitative analysis, whence various themes emerged. Finally, five graphic medicine projects about body donation were created by students, proving their interest in testing this method to promote body donation, focusing the attention on different communicative aspects. Considering the results of this pilot study, the co-creative collaborative use of graphic medicine could be evaluated as an additional strategy to increase body donation awareness-raising in Italy and beyond, especially in the non-experts' community.

Supplemental musculoskeletal anatomy education in a shortened medical school curriculum

To address anatomy knowledge gaps exacerbated by the education constraints of a new shortened medical school curriculum and the COVID-19 pandemic, the Orthopedic Surgery Interest Group (OSIG) created a novel hybrid anatomy curriculum for students interested in orthopedic surgery. The main objectives were to determine (1) Does this elective supplement to the curriculum improve students' perceived confidence with regard to orthopedic anatomy? (2) What are the students' preferred formats for receiving this elective supplement to the curriculum? To determine this, we used a prospective study design to determine the impact of the OSIG's student-led hybrid anatomy sessions. A survey with a five-point Likert scale (1) Strongly disagree; (2) Disagree; (3) Neither agree nor disagree; (4) Agree; (5) Strongly agree; was used to quantify responses. Chi-squared tests, Fisher's exact tests and T-tests were used when appropriate. Our results show that participants without prior anatomy experience rated the course higher on average when compared with those with prior anatomy experience (4.27 vs. 3.67, respectively; p = 0.168). Most students (88.2%) prefer for anatomy sessions to be held more frequently and 76.4% enjoyed having virtual components. 82.4% of participants reported that this course improved their self-confidence regarding orthopedic anatomy, and 100% would recommend it to other students. Most students enjoyed the course and reported improved self-perceived anatomy knowledge after participating. Medical schools that have a shortened anatomy curriculum can consider using the present study as a model for an optional musculoskeletal anatomy supplement at their institution.

Virtual Reality and Augmented Reality in Anatomy Education During COVID-19 Pandemic

The pandemic of COVID-19 has radically changed the anatomy education approaches. This happens because medical students, due to the necessity of remote education, didn't have access to cadavers, which was the principal method of dissection training. Circumstances like these encouraged the health care providers to innovate new teaching methods with the help of virtual and augmented reality to outdistance the restrictions. This review aims to examine the pioneer technological and educational tools and their usage in the future. Detailed research was performed via the PubMed database using the following keywords "Virtual Reality (VR), Augmented Reality (AR), Anatomy Education, and COVID-19". No further filters were used. All the existing evidence suggests that the vast majority was negatively affected by the COVID-19 era. Using new technological methods in anatomy training could not effectively replace the absence of the traditionally used teaching methods like dissection, prosection, and lectures by physical presence. Although the new digital anatomy teaching approaches seem to be very promising, it is not clear if they can fully replace the traditional anatomy education methods.

In the eye of the beholder - how course delivery affects anatomy education

BACKGROUND

The COVID-19 pandemic caused major shifts in students' learning strategies as well as teaching environments that profoundly affected the delivery of anatomy courses in medical schools. The Department of Anatomy at the University of Zagreb School of Medicine had a unique experience where the anatomy course in 2019/2020 was first taught in-person before transferring to an online course delivery, while the inverse happened in 2020/2021. The core curriculum, course material and examination criteria were the same in both academic years. The aim of the study was to determine whether course delivery affected students' perceptions of the course and whether it impacted students' engagement and success.

METHODS

The students' perceptions of the course were assessed via an anonymous course survey (student evaluation of teaching, SET). The questions in the SET assessed the usefulness of teaching modalities rather than students' satisfaction. Most questions were in the form of statements to which students responded with their level of agreement on a five-point Likert scale. Differences between responses in 2019/2020 and 2020/2021 were analyzed using the Mann-Whitney test. Effect size was estimated using Cliff's delta and association between responses was assessed using Spearman's r coefficient.

RESULTS

Students' perceptions were significantly affected by changes in course delivery. Students' success and engagement were higher in 2019/2020 when in-person teaching preceded online teaching. Furthermore, students' views on course organization and the usefulness of continuous assessment were more positive in 2019/2020. Finally, students' perceptions of the usefulness of online materials and activities were more positive in 2019/2020. All comparisons between the two academic years were statistically significant (P ≤ 0.0001 for all comparisons, Mann-Whitney test).

CONCLUSIONS

Students' perceptions of the anatomy course were dependent on the teaching environment they were exposed to at the beginning of the course. A transfer from in-person to online course delivery was more successful than vice-versa. This has important implications for structuring hybrid courses in medical education in the future.

Student Engagement Using HoloLens Mixed-Reality Technology in Human Anatomy Laboratories for Osteopathic Medical Students: an Instructional Model

Mixed-reality technology is a powerful tool used in healthcare and medical education to engage students in life-like scenarios. This blend of virtual and augmented reality images incorporates virtual projections with the real environment to allow real-time observation and interaction [1]. While this immersive technology offers advantages over cadaver dissections, it creates new challenges to keeping students engaged [2, 3]. Student engagement improves students' commitment to learning, critical thinking, and motivation and results in successful course outcomes [4, 5]. This paper provides an activity model using the HoloLens mixed-reality technology to deliver human gross anatomy laboratory sessions to first-year osteopathic medical students. The activity was designed using Gagne's model for instructional design and team-based learning to create an active learning model, which targets the behavioral, emotional, and cognitive dimensions of student engagement [6, 7]: behavioral engagement through autonomy and time on task, emotional engagement through providing the guiding exploration and narrative flow to accompany students' visual experience, and cognitive engagement by incorporating team-based learning (TBL) and case-based learning (CBL). The instructional model also answers the call for a new type of virtual reality instructor and pedagogical strategy that addresses the unique challenges and increases student engagement with this new technology. The effectiveness of this classroom activity was assessed by observing students for indicators or behaviors of student engagement, which are discussed. Further studies are required to measure the extent to which these indicators were exhibited and compare student engagement with this mixed-reality to didactic cadaver-based laboratory sessions.

Association between the social network of medical students and their academic performance on the anatomy written examination

Although medical students learn human anatomy within a social network of friends/classmates, limited research has examined how social network structure is related to student's performance in human anatomy examinations. This study aimed to examine the association between centrality (i.e., the degree to which a student is connected to other students in class) before the start of the anatomy laboratory and changes in centrality owing to the start of the laboratory and failing the written examination taken on the last day of the course. Data included all 211 medical students at Tokyo Medical and Dental University who took anatomy classes in 2018 and 2019. The in-class social network before the laboratory was defined as "connected" if the student had more than one connection to the same individual in terms of the type of club activity, high school, and affiliation with an extracurricular program. The laboratory group adds the connection to the prelaboratory network, resulting in a postlaboratory network. Logistic regression models were used to estimate the association of degree and eigenvector centrality and changes in centrality after the laboratory with failing the written examination. Of the 211 students, 38 failed the examination. A one standard deviation increase in eigenvector centrality before the laboratory was significantly associated with a 44% decrease in odds of failing the examination (OR: 0.56, 95% CI: 0.34, 0.92). Changes in centrality measures were not associated with the performance of students in the examination. Higher in-class network centrality was associated with lower odds of failing the written examination.

Evaluating the knowledge acquisition of lower limb anatomy among medical students during the post-acute COVID-19 era

Anatomy is the foundation of many medical and surgical specialties yet knowledge acquisition and retention among medical students is questionable. Over the years the anatomy teaching environment and teaching modalities have changed, even more so with the onset of the COVID-19 pandemic and the shift to a virtual environment. The aim of this study was to evaluate the knowledge acquisition of applied musculoskeletal lower limb clinical anatomy among first year medical students in Malta following the transition back to face-to-face lectures. The Kahoot online game-based quiz platform was used through a best out of four multiple-choice setting across four sessions. Scores generated by the platform along with frequencies of correctly answered questions were utilized to measure knowledge acquisition. The average scores for each question across sessions were statistically analyzed using ANOVA and student's t-test accordingly. Across the four sessions, the positive percentage response for clinical based questions remained higher than for pure anatomy questions. Anatomy knowledge acquisition appears to be subjective to clinical based knowledge rather than pure anatomy. There may be a plethora of reasons as to this outcome including the misconception that anatomy is not essential for clinical practice as well as the potential aftermath of the COVID-induced virtual learning environment. Further research is merit to ensure that students are provided with the best tools to enhance their knowledge acquisition, both as students and as future doctors.

Flipped anatomy classroom integrating multimodal digital resources shows positive influence upon students' experience and learning performance

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.

Effects of three-dimension movie visual fatigue on cognitive performance and brain activity

To further develop three-dimensional (3D) applications, it is important to elucidate the negative effects of 3D applications on the human body and mind. Thus, this study investigated differences in the effects of visual fatigue on cognition and brain activity using visual and auditory tasks induced by watching a 1-h movie in two dimensions (2D) and 3D. Eighteen young men participated in this study. Two conditions were randomly performed for each participant on different days, namely, watching the 1-h movie on television in 2D (control condition) and 3D (3D condition). Before and after watching the 1-h movie on television, critical flicker fusion frequency (CFF: an index of visual fatigue), and response accuracy and reaction time for the cognitive tasks were determined. Brain activity during the cognitive tasks was evaluated using a multi-channel near-infrared spectroscopy system. In contrast to the control condition, the decreased CFF, and the lengthened reaction time and the decreased activity around the right primary somatosensory cortex during Go/NoGo blocks in the visual task at post-viewing in the 3D condition were significant, with significant repeated measures correlations among them. Meanwhile, in the auditory task, the changes in cognitive performance and brain activity during the Go/NoGo blocks were not significant in the 3D condition. These results suggest that the failure or delay in the transmission of visual information to the primary somatosensory cortex due to visual fatigue induced by watching a 3D movie reduced the brain activity around the primary somatosensory cortex, resulting in poor cognitive performance for the visual task. This suggests that performing tasks that require visual information, such as running in the dark or driving a car, immediately after using a 3D application, may create unexpected risks in our lives. Thus, the findings of this study will help outlining precautions for the use of 3D applications.