Breaking with Tradition: A Scoping Meta-Analysis Analyzing the Effects of Student-Centered Learning and Computer-Aided Instruction on Student Performance in Anatomy

Human anatomy curriculum reform for undergraduate nursing students: An exploratory study

This study aims to cultivate students' independent learning capacity, promote the interdisciplinary integration of "nursing + anatomy," and establish a curriculum system to enhance applied nursing abilities based on project-based teaching reform of everyday clinical nursing operations. A total of 151 second-year (class of 2021) undergraduate nursing students at a Chinese university were selected for this study. By adjusting the curriculum, reconstructing the teaching contents, employing the "hybrid + flip" teaching method based on BOPPPS (bridge-in, outcomes, preassessment, participatory learning, post-evaluation, summary), and implementing a teaching system based on the "three re-three linkage," a Human Anatomy curriculum with a focus on basic anatomical knowledge was developed and connected with nursing clinical operation practice. The restructuring of the course content received unanimous recognition from both the teaching staff and the students. Notably, students in the class of 2021 achieved significantly higher grades than did students in the class of 2020, who received traditional face-to-face instruction (p < 0.01). These results indicate enhanced clinical application skills among the former group of students. following the implementation of instructional reforms during one semester, students exhibited notable improvements in motivation, program implementation, self-management, and interpersonal communication. A statistically significant increase in overall scores for self-directed learning capacities over the preinstructional period was observed (p < 0.05). Furthermore, the findings of the student satisfaction surveys reflected highly favorable perceptions of the enriched instructional format, high levels of course engagement, frequent faculty-student interactions, and augmented overall competence. The practical implementation of the reform in the context of a Human Anatomy course for undergraduate nursing students led to significant positive outcomes, thereby enhancing the effectiveness of teaching and learning. Students' clinical application abilities and self-directed learning capacities notably improved, while overall satisfaction with the course remained high.

Fostering engagement in virtual anatomy learning for healthcare students

BACKGROUND

The use of virtual learning platforms is on the rise internationally, however, successful integration into existing curricula is a complex undertaking fraught with unintended consequences. Looking beyond medical and pedagogic literature can provide insight into factors affecting the user experience. The technology acceptance model, widely used in software evaluation, can be used to identify barriers and enablers of engagement with virtual learning platforms. Here, the technology acceptance model was used to scaffold the exploration of the factors that influenced students' perceptions of the virtual anatomy platform, Anatomage and how these shaped their intention to use it.

METHODS

Focus groups identified factors influencing students use of the Anatomage tables. Interventions were rolled out to address these findings, then further focus groups and the technology acceptance model identified how factors including self-efficacy, enjoyment, and social norms influenced students' intention to use the Anatomage table in the future.

RESULTS

Students raised significant concerns about understanding how to use the Anatomage table. Moreover, students who considered themselves to be poor at using technology perceived the Anatomage table as more complicated to use. The subjective norm of the group significantly altered the perceived ease of use and usefulness of the Anatomage. However, enjoyment had the greatest impact in influencing both perceived usefulness and perceived ease of use. Indicating that enjoyment is the largest contributing factor in altering technology engagement in healthcare cohorts and has the biggest potential to be manipulated to promote engagement.

CONCLUSIONS

Focus groups used in tandem with the technology acceptance model provide an effective way to understand student perceptions around technology used in the healthcare curricula. This research determined interventions that promote student engagement with virtual learning platforms, which are important in supporting all healthcare programmes that incorporate technology enhanced learning.

Immersive virtual reality and augmented reality in anatomy education: A systematic review and meta-analysis

The purpose of this review was to (1) analyze the effectiveness of immersive virtual reality (iVR) and augmented reality (AR) as teaching/learning resources (collectively called XR-technologies) for gaining anatomy knowledge compared to traditional approaches and (2) gauge students' perceptions of the usefulness of these technologies as learning tools. This meta-analysis, previously registered in PROSPERO (CRD42023423017), followed PRISMA guidelines. A systematic bibliographical search, without time parameters, was conducted through four databases until June 2023. A meta-analytic approach investigated knowledge gains and XR's usefulness for learning. Pooled effect sizes were estimated using Cohen's standardized mean difference (SMD) and 95% confidence intervals (95% CI). A single-group proportional meta-analysis was conducted to quantify the percentage of students who considered XR devices useful for their learning. Twenty-seven experimental studies, reporting data from 2199 health sciences students, were included for analysis. XR-technologies yielded higher knowledge gains than traditional approaches (SMD = 0.40; 95% CI = 0.22 to 0.60), especially when used as supplemental/complementary learning resources (SMD = 0.52; 95% CI = 0.40 to 0.63). Specifically, knowledge performance using XR devices outperformed textbooks and atlases (SMD = 0.32; 95% CI = 0.10 to 0.54) and didactic lectures (SMD = 1.00; 95% CI = 0.57 to 1.42), especially among undergraduate students (SMD = 0.41; 95% CI = 0.20 to 0.62). XR devices were perceived to be more useful for learning than traditional approaches (SMD = 0.54; 95% CI = 0.04 to 1), and 80% of all students who used XR devices reported these devices as useful for learning anatomy. Learners using XR technologies demonstrated increased anatomy knowledge gains and considered these technologies useful for learning anatomy.

Constructive alignment: Teaching introductory gross anatomy to sport science students

The purpose of this descriptive article was to illustrate the process of using constructive alignment in redesigning an introductory gross anatomy unit that is taught specifically to sports science and physical education students at Victoria University. The unit was redesigned as an intensive learning unit in 2017 as part of a broader university-wide process. The teaching team decided that the first stage of the constructive alignment process should be necessarily focused on an understanding of the career destinations of graduates from the courses. With this understanding, it became easier to work through the redesign of intended learning objectives, the shift from systemic to regional anatomy changes in content and learning support mechanisms, and alterations to assessment practices. A comparison of student pass rates for the unit from 2018 to 2023 with pass rates in the previous semester-long version of the unit, suggests optimism about the changes that were made through the constructive alignment process. However, there were a number of other factors that may have contributed to this result, and more research is needed on the specific effectiveness of the changes made during the constructive alignment process before a confident conclusion about the success of the process can be made.

Comparative effectiveness study of flipped classroom versus online-only instruction of clinical reasoning for medical students

CONTEXT

Bedside clinical teaching is the backbone of clerkship education. Data-driven methods for supplementing bedside encounters with standardized content from vetted resources are needed.

OBJECTIVE

To compare a flipped-classroom versus an interactive online-only instruction for improving knowledge, skills, self-directed learning (SDL) behaviors, and satisfaction in a medical school clerkship.

METHODS

An IRB-approved prospective study employing a peer-reviewed clinical reasoning curriculum in neurology was conducted; 2nd-4th year medical students rotating through a required clerkship were enrolled. Students were randomized to flipped-classroom (i.e., flipped) or interactive asynchronous online instruction (i.e., online-only), which supplemented existing bedside teaching. Baseline and end-of-course knowledge, skill development, SDL behaviors, satisfaction, and long-term retention were assessed by peer-reviewed clinical reasoning exam, NBME scores, faculty/resident clinical evaluations, non-compulsory assignment completion, end-of-clerkship surveys, and objective structured clinical exam (OSCE).

RESULTS

104 students (49 flipped, 55 online-only) were enrolled. Age, gender, and training level did not differ by group (all p > 0.43); baseline knowledge was higher in the flipped group (p = 0.003). Knowledge-based exam scores did not differ by group even after adjusting for differences in baseline knowledge (2.3-points higher in flipped group, 95%CI -0.4-4.8, p = 0.07). Clinical skills were significantly higher in the flipped group, including examination skills (4.2 ± 0.5 vs. 3.9 ± 0.7, p = 0.03) and future housestaff potential (4.8 ± 0.3 vs 4.5 ± 0.6, p = 0.03). Students in the online-only group were more likely to engage in SDL (42 vs. 12%, p = 0.001) and reported more hours studying (6.1 vs. 3.8 hours, p = 0.03). Satisfaction (p = 0.51) and OSCE scores (p = 0.28) were not different by group.

CONCLUSIONS

In this comparative study of two evidence-based curricular delivery approaches, we observed no difference in knowledge acquired. Greater clinical skills were observed with flipped instruction, while more SDL was observed with online-only instruction. Supplementing bedside teaching with blended instruction that balances live skill development with vetted online resources is optimal for clerkship education.

The interplay between self-regulation, learning flow, academic stress and learning engagement as predictors for academic performance in a blended learning environment: A cross-sectional survey

Aim

To examine the correlations between self-regulation, learning flow, academic stress and learning engagement as predicting variables for academic achievement in a blended learning environment in Namibia.

Design

Cross-sectional survey.

Methods

Data were collected from 166 randomly selected undergraduate nursing students through an online survey between January and February 2023, and were analysed using IBM SPSS AMOS version 28.0. The data were explored through factor, parallel and confirmatory factor analyses. The relationship between the study factors and the total score of the scale was analysed using the Pearson correlation coefficient.

Results

The results indicate that the two factors identified in the factor analysis are consistent with the theoretical proposition in this research. Factor 1 comprises items C1 to C24, which pertain to self-regulation (SR), while factor 2 consists of items D1 to D9, which relate to learning flow (LR). The findings demonstrate that self-regulation significantly predicts both flow and stress, as well as learning engagement. Additionally, there is a significant relationship between stress and self-regulated learning, as well as between stress and learning flow (r = 0.23-0.26; p= < .05). However, none of the study constructs were found to predict academic achievement.

Conclusion

Although self-regulation significantly predicted flow, stress and learning engagement, a non-significant association exists between all the study constructs and academic achievement. The results of this study have significant implications for improving the development of a positive learning environment that fosters active student engagement. Future studies should investigate correlation by conducting large-scale studies.

Impact

This study makes a valuable contribution to the current body of literature concerning academic achievement within the context of undergraduate nursing education. The insignificant relationship between the study variables and academic achievement indicate that these elements are not of considerable significance in enhancing educational achievements in blended learning surroundings in Namibia.

Patient or public contribution

One hundred and sixty-six undergraduate nursing students participated in the survey. The data collected were analysed and interpreted by a skilled statistician.

Factors associated with utilization of student-centered pedagogy by nurse educators

BACKGROUND

Despite suboptimal level of the utilization of student-centered pedagogy, multidimensional, modifiable factors associated with the utilization have been rarely examined among nurse educators.

PURPOSE

The aim of this study was to examine the utilization status of student-centered pedagogy and factors associated with the utilization by nurse educators.

METHODS

Data on student-centered pedagogy utilization, knowledge, beliefs in effectiveness, stress, coping, support, degree earned, teaching experiences, and other demographic characteristics were analyzed using multiple regression analyses.

RESULTS

The status of the student-centered pedagogy utilization was moderate, and knowledge was consistently associated with the utilization in the total sample (N = 108) and in both subgroups (≤50 vs. >50 years old). Beliefs in effectiveness were associated with the utilization only in the age > 50 years old group.

CONCLUSIONS

Nurse educators need to develop and deliver interventions to facilitate the utilization of student-centered pedagogy through increase in knowledge and beliefs in effectiveness of student-centered pedagogy.

Student and Faculty Perspectives on the Usefulness and Usability of a Digital Health Educational Tool to Teach Standardized Assessment of Persons After Stroke: Mixed Methods Study

BACKGROUND

The VSTEP Examination Suite is a collection of evidence-based standardized assessments for persons after stroke. It was developed by an interdisciplinary team in collaboration with clinician users. It consists of 5 standardized assessments: 2 performance-based tests using the Kinect camera (Microsoft Corp) to collect kinematics (5-Time Sit-to-Stand and 4-Square Test); 2 additional performance-based tests (10-Meter Walk Test and 6-Minute Walk Test); and 1 patient-reported outcome measure, the Activities-Specific Balance Confidence Scale.

OBJECTIVE

This study aimed to describe the development of the VSTEP Examination Suite and its evaluation as an educational tool by physical therapy students and faculty to determine its usefulness and usability.

METHODS

A total of 6 students from a Doctor of Physical Therapy program in the United States and 6 faculty members who teach standardized assessments in different physical therapy programs from the United States and Israel were recruited by convenience sampling to participate in the study. They interacted with the system using a talk-aloud procedure either in pairs or individually. The transcripts of the sessions were coded deductively (by 3 investigators) with a priori categories of usability and usefulness, and comments were labeled as negative or positive. The frequencies of the deductive themes of usefulness and usability were tested for differences between faculty and students using a Wilcoxon rank sum test. A second round of inductive coding was performed by 3 investigators guided by theories of technology adoption, clinical reasoning, and education.

RESULTS

The faculty members' and students' positive useful comments ranged from 83% (10/12) to 100%. There were no significant differences in usefulness comments between students and faculty. Regarding usability, faculty and students had the lowest frequency of positive comments for the 10-Meter Walk Test (5/10, 50%). Students also reported a high frequency of negative comments on the 4-Square Test (9/21, 43%). Students had a statistically significantly higher number of negative usability comments compared with faculty (W=5.7; P=.02), specifically for the 5-Time Sit-to-Stand (W=5.3; P=.02). Themes emerged related to variable knowledge about the standardized tests, value as a teaching and learning tool, technology being consistent with clinical reasoning in addition to ensuring reliability, expert-to-novice clinical reasoning (students), and usability.

CONCLUSIONS

The VSTEP Examination Suite was found to be useful by both faculty and students. Reasons for perceived usefulness had some overlap, but there were also differences based on role and experience. Usability testing revealed opportunities for technology refinement. The development of the technology by interdisciplinary teams and testing with multiple types of users may increase adoption.

Virtual Microscopy Goes Global: The Images Are Virtual and the Problems Are Real

For the last two centuries, the scholarly education of histology and pathology has been based on technology, initially on the availability of low-cost, high-quality light microscopes, and more recently on the introduction of computers and e-learning approaches to biomedical education. Consequently, virtual microscopy (VM) is replacing glass slides and the traditional light microscope as the main instruments of instruction in histology and pathology laboratories. However, as with most educational changes, there are advantages and disadvantages associated with a new technology. The use of VM for the teaching of histology and pathology requires an extensive infrastructure and the availability of computing devices to all learners, both posing a considerable financial strain on schools and students. Furthermore, there may be valid reasons for practicing healthcare professionals to maintain competency in using light microscopes. In addition, some educators may be reluctant to embrace new technologies. These are some of the reasons why the introduction of VM as an integral part of histology and pathology instruction has been globally uneven. This paper compares the teaching of histology and pathology using traditional or VM in five different countries and their adjacent regions, representing developed, as well as developing areas of the globe. We identify general and local roadblocks to the introduction of this still-emerging didactic technology and outline solutions for overcoming these barriers.

The gross anatomy course: SARS-CoV-2 pandemic-related effects on students' learning, interest in peer-teaching, and students' perception of its importance

The COVID-19 pandemic required adjustments and limitations in university teaching, thereby challenging teaching concepts in anatomy requiring in-person contact, including the gross anatomy course. Therefore, the present study investigates the impact of COVID-19-associated adjustments on students' perception of the gross anatomy course's importance and quality, students' preferred learning setting and outcome, and their motivation to involve themselves in academic activities, including becoming a future peer-teacher of the course. Using paper-based questionnaires in Ulm, Germany, 397 (response rate: 82.3%) students of the winter term of 2020/2021 were surveyed using quantitative and qualitative items, which were compared with cohorts prior to the pandemic. Students reported a higher global rating on course quality during COVID-19 (pre-COVID-19: 5.3 ± 0.9, during-COVID-19: 5.6 ± 0.7, p < 0.001; 1 = very bad, 6 = very good). Students' perceived importance of the gross anatomy course showed a small but significant increase (pre-COVID-19: 4.2 ± 0.6, during-COVID-19: 4.3 ± 0.6, p < 0.001; 1 = strongly disagree, 6 = strongly agree). Students' motivation to apply as a peer-teacher remained stable, nevertheless, they reported less interest in transferring their knowledge to junior students. Finally, students reported that they spent significantly more learning time alone and their examination grades remained unchanged during the pandemic. Astonishingly, despite radical changes of the teaching environment due to COVID-19, students appreciate the offered teaching and highly valued the gross anatomy course.

Combined Tai Chi and cognitive interventions for older adults with or without cognitive impairment: A meta-analysis and systematic review

BACKGROUND AND PURPOSE

Evidence from the field of cognitive interventions indicates that nonpharmaceutical interventions seem more promising in enhancing cognition. The number of clinical trials that examine the cognitive benefits of combined physical exercise with cognitive intervention on older adults has recently increased. Tai Chi (TC) has been recommended as an effective and safe exercise for older adults aged 60 and over. However, there is a lack of conclusion about whether combined TC with cognitive interventions can show more benefits than a single intervention for older adults. Thus, this review aimed to evaluate the effects of combined TC and cognitive interventions on older adults.

METHODS

PubMed, Embase, PsycINFO, and Web of Science were searched for English peer-reviewed papers from inception until November 12, 2021. Data were extracted by two independent reviewers.

RESULTS

A total of 1524 records were generated and nine studies were included. The pooled results showed that combined TC and cognitive interventions showed significantly large gains on memory [standardised mean difference (SMD) = 0.87, 95% confidence interval (CI): (0.01, 1.74), P 0.05], moderate gains on cognition [SMD = 0.74, 95% CI:(0.19, 1.29), P 0.05], and small size effects on balance. No statistically significant difference was found in executive function, depression, risk of falls, or well-being.

CONCLUSION

Combined TC and cognitive interventions have positive effects on improving cognition and balance in older adults, but their superiority over the single intervention, as well as their additional effects on the physical and psychological function, are required further investigation.

Development of a Perceptions of Online Learning Scale to Assess Teachers’ Beliefs

During the COVID pandemic, the sudden switch to online learning brought an unintended spotlight to this gradually expanding educational innovation. However, while numerous tools exist to assess student perceptions of or readiness for online learning quantitatively, a research gap exists regarding teachers' perceptions of online learning. To facilitate future research among teachers, the authors describe the development of a new perceptions of online learning scale (POOLS). The POOLS seeks to measure teachers' perceptions of online learning across four theoretical constructs associated with quality education in online and traditional face-to-face formats. The POOLS was constructed using expert review and a sample ( N=654), where an exploratory and confirmatory factor analysis were conducted on split halves of these data. The results of this initial validation study provide the basis for using the POOLS as an approach to measuring four aspects of perceptions of online learning: Effective Learning ([Formula: see text] = 0.77), Student-Centered Learning ([Formula: see text] = 0.67), Interactive Learning ([Formula: see text] = 0.73), and Engaged Learning ([Formula: see text] = 0.66). We recommend that the POOLS be used in research settings to describe the relationship among POOLS factors and other characteristics such as self-efficacy, amount or type of experience with online learning, and personality traits.

Learning Head and Neck Anatomy Through a Radiological Imaging Platform

INTRODUCTION

Head and neck anatomy is complex for students to learn and educators to teach. Instructing students on anatomy using radiological imaging can aid comprehension and prepare them for future clinical practice. Computer-aided anatomy instruction is accessible to diverse learners and avoids barriers identified with face-to-face teaching.

METHODS

We designed a self-guided PowerPoint tutorial with multiple medical imaging modalities, clinical correlations, and self-review questions incorporated throughout. The tutorial was evaluated with a group of 178 Australian preclinical medical students who had prior teaching related to head and neck anatomy. Student participants were divided into experimental and control groups. Participants completed two knowledge assessments: experimental group before and after tutorial engagement and control group before tutorial engagement. All participants were invited to provide feedback on their experiences with the tutorial via questionnaires.

RESULTS

Engagement with the tutorial improved overall head and neck anatomy knowledge (p < .001). Knowledge outcomes were maintained across question group type (e.g., multiple-choice questions, identification, and short-answer questions; p < .05), with participants reporting 96% overall positive feedback related to the tutorial experience.

DISCUSSION

Given the improved outcomes following tutorial exposure, our results suggest that this tutorial is efficacious when used in concert with existing anatomy curricula. Participants' perceived value of the tutorial additionally suggests that it would be taken up well by medical students and is an effective addition to the existing tutorial series. Further research is needed to assess the tutorial's use as a stand-alone addition to the anatomy curriculum.

Enhancing Anatomical Instruction: Impact of a Virtual Canine Anatomy Program on Student Outcomes

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.

The impact of using an "anatomy escape room" on nursing students: A comparative study

BACKGROUND

Anatomy is an important part of health science education. In teaching anatomy, new teaching strategies have been studied in comparison with traditional-based approaches. In this manner, strategies such as the escape room-based approach have been used as an innovative learning approach in nursing education, but little is known about its application in an Anatomy module.

OBJECTIVE

To evaluate the effectiveness of the escape room for anatomy-related knowledge retention in nursing and the perceived value of the game.

DESIGN

In the first semesters of the academic years 2017-2018 and 2018-2019, a comparative cross-sectional study was conducted.

SETTINGS

This study took place at the University of Almeria with students enrolled in the Anatomy module.

PARTICIPANTS

A total of 248 first-year nursing students took part in the study.

METHODS

The study included two groups: an experimental group (EG) that participated in an escape room in the final session of their Anatomy module, and a control group (CG) that received a traditional-based teaching approach in their final lesson.

RESULTS

Students enrolled in the Anatomy module were randomly assigned to either the experimental (EG, n = 128) or control groups (CG, n = 120). The escape room was conducted in groups of four and lasted no more than 15 min. In terms of satisfaction with the escape room, EG scored above the mean. The item "I enjoyed playing" received the highest score (4.88 ± 0.35). Taking the final scores of each group into account, the EG had a final average score of 8.94 ± 0.96, while the CG had a final average score of 7.70 ± 1.25 (p = 0.001).

CONCLUSIONS

According to the findings, the "Anatomy Escape Room" is a game-based approach that motivates students and constitutes a down-to-earth resource for anatomy learning in healthcare students.

Issues in Teaching Vascular Anatomy: Thoughts and Suggestions from the Clinician's Point of View

The role of anatomy in modern curricula is under reform due to competency of other rapidly evolving subjects and the rapid evolution of several practical aspects and applications dictating modernization of teaching methods as well as of teaching demands. Moreover, modern practice of medicine has put the arterial and vascular system in the center of numerous minimally invasive techniques. Therefore, regardless of their specialty, most doctors should have a very clear and precise knowledge of the vascular anatomy and the basic access techniques from the early years. This viewpoint commentary reflects the experience of the two authors in applying the principles and content of surgical vascular anatomy in undergraduate anatomy teaching and discusses the rationale of this. Moreover, it is suggested that cadaveric dissections should be modified with emphasis on standard surgical vascular exposures and the multidisciplinary teaching of vascular anatomy as a means not only to gain optimal long-term knowledge retention, but also to emphasize through realistic examples on the practical clinical value of vascular anatomy.

Novel and Innovative Approaches to Teaching Human Anatomy Classes in an Online Environment During a Pandemic

In view of the current situation with a worldwide pandemic, the use of online teaching has become critical. This is difficult in the context of human anatomy, a subject contingent primarily on the use of human cadaveric tissues for learning through face-to-face practical laboratory sessions. Although anatomy has been taught using online resources including 3D models and anatomy applications, feedback from students and academic staff does not support the replacement of face-to-face teaching. At Charles Sturt University, we were obligated to cancel all classes on-campus in 2020 due to the COVID-19 pandemic. We ran exclusive online anatomy practical classes replacing classes usually run on campus. We designed an alternative program that consisted of twenty pre-recorded videos that were prepared in the anatomy laboratory using cadaveric tissues, and then discussed in live (and interactive) tutorials. Furthermore, innovative approaches to learning were shown and encouraged by the lecturer. Student survey responses indicated a positive response to both the anatomical videos and the innovative learning approaches. The results obtained by students showed a statistically significant increase in high distinctions and marked decrease in the amount of fail grades, compared with the previous three years (not online). The use of these videos and the encouragement of innovative learning approaches was a novel experience that will add valuable experiences for improved practice in online anatomy teaching. We propose that online anatomy videos of cadavers combined with innovative approaches are an efficient and engaging approach to replace face-to-face anatomy teaching under the current contexts.

Effects of Chinese Mind-Body Exercises on Executive Function in Middle-Aged and Older Adults: A Systematic Review and Meta-Analysis

Chinese mind-body exercises (CMBEs) are positively associated with executive function (EF), but their effects on EF, from synthesized evidence using systematic and meta-analytic reviews, have not been conducted. Therefore, the present systematic review with meta-analysis attempted to determine whether CMBEs affect EF and its sub-domains, as well as how exercise, sample, and study characteristics moderate the causal relationship between CMBEs and EF in middle-aged and older adults. Seven electronic databases were searched for relevant studies published from the inception of each database through June 2020 (PubMed, Web of Science, Embase, Cochrane Controlled Trials Register, Wanfang, China National Knowledge Infrastructure, and Weipu). Randomized controlled trials with at least one outcome measure of CMBEs on EF in adults of mean age ≥ 50 years with intact cognition or mild cognitive impairment (MCI) and with or without chronic diseases were included. A total of 29 studies (N = 2,934) ultimately were included in this study. The results indicated that CMBEs improved overall EF (Standardized Mean Differences = 0.28, 95% CI 0.12, 0.44), as well as its sub-domains of working memory and shifting. The beneficial effects of CMBEs on EF occurred regardless of type (Tai Chi, Qigong), frequency of group classes (≤2 time, 3-4 time, ≥5 times), session time (≤45 min, 46-60 min), total training time (≥150 to ≤300 min, >300 min), and length of the CMBEs (4-12 week, 13-26 week, and >26 week), in addition to that more frequent participation in both group classes and home practice sessions (≥5 times per week) resulted in more beneficial effects. The positive effects of CMBEs on EF were also demonstrated, regardless of participants mean age (50-65 years old, >65 years old), sex (only female, both), and cognitive statuses (normal, MCI, not mentioned), health status (with chronic disease, without chronic disease), as well as training mode (group class, group class plus home practice) and study language (English, Chinese). This review thus suggests that CMBEs can be used as an effective method with small to moderate and positive effects in enhancing EF, and that more frequent group classes and home practice sessions may increase these effects. However, certain limitations, including strictly design studies, limited ES (effect size) samples for specific variables, and possible biased publications, required paying particular attention to, for further exploring the effects of CMBEs on EF.

Examining the Short-, Medium-, and Long-Term Success of an Embodied Learning Activity in the Study of Hand Anatomy for Clinical Application

A student's own body provides an often disregarded site of knowledge production and corporeal wisdom. Learning via cognitive processes anchored in physical movement and body awareness, known as embodied learning, may aid students to visualize structures and understand their functions and clinical relevance. Working from an embodied learning perspective, the current article evaluates the use of an offline physical learning tool (Anatomical Glove Learning System; AGLS) for teaching hand anatomy for clinical application in medical students. Two student samples (N₁  = 105; N₂  = 94) used the AGLS in two different ways. In the first sample, the AGLS was compared to a traditional approach using hand bones, models and prosected specimens. Secondly, the AGLS and traditional approach were combined. The evaluation consisted of three outcomes: short-term learning (post-test), medium-term applications (mock-objective structured clinical examination, MOSCE), and longer-term assessment (objective structured clinical examination, OSCE). Findings from the first sample indicated no significant differences between the AGLS and traditional laboratory groups on short- (F_(1,78) = 0.036, P = 0.849), medium- (F_(1,50) = 0.743, P = 0.393), or longer-term (F_(1,82) = 0.997, P = 0.321) outcomes. In the second sample using the AGLS in combination with a traditional approach was associated with significantly better short-term post-test scores (F_(2,174) = 5.98, P = 0.003) than using the AGLS alone, but demonstrated no effect for long-term OSCE scores. These results suggest an embodied learning experience alone does not appear to be advantageous to student learning, but when combined with other methods for studying anatomy there are learning gains.

How Computer-Assisted Learning Influences Medical Students' Performance in Anatomy Courses

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.

The Impact of Three-Dimensional Printed Anatomical Models on First-Year Student Engagement in a Block Mode Delivery

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.

A Three-Dimensional Print Model of the Pterygopalatine Fossa Significantly Enhances the Learning Experience

The pterygopalatine fossa (PPF) is a bilateral space deep within the skull that serves as a major neurovascular junction. However, its small volume and poor accessibility make it a difficult space to comprehend using two-dimensional illustrations and cadaveric dissections. A three-dimensional (3D) printed model of the PPF was developed as a visual and kinesthetic learning tool for completely visualizing the fossa, its boundaries, its communicating channels, and its neurovascular structures. The model was evaluated by analyzing student performance on pre- and post-quizzes and a student satisfaction survey based on the five-point Likert scale. The first cohort comprised of 88 students who had never before studied the PPF. The second cohort consisted of 30 students who were previously taught the PPF. Each cohort was randomly divided into a control group who were provided with a half skull and an intervention group that were provided with the 3D printed model. The intervention group performed significantly better on the post-quiz as compared to the control group in cohort I (P = 0.001); while not significant, it also improved learning in cohort II students (P = 0.124). Satisfaction surveys indicated that the intervention group found the 3D printed model to be significantly more useful (P < 0.05) as compared to the half skull used by the control group. Importantly, the effect sizes for cohorts I and II (0.504 and 0.581, respectively) validated the statistical results. Together, this study highlights the importance of 3D printed models as teaching tools in anatomy education.

Effectiveness of Three-Dimensionally Printed Models in Anatomy Education for Medical Students and Resident Physicians: Systematic Review and Meta-Analysis

INTRODUCTION

Despite a surge in the use of three-dimensional printing (3DP) in medical education, a comprehensive evaluation of randomized trials in its effectiveness is lacking. Radiologic studies play an integral role in affording educators the ability to create customized realistic anatomic models. This systematic review and meta-analysis sought to assess the effect of 3DP versus traditional 2-D methods for anatomy education.

METHODS

PubMed, Scopus, Cochrane Library, ERIC, and IEEE Xplore were queried to identify randomized controlled trials that quantitatively investigated anatomy education via postintervention assessments of medical students or resident physicians who were exposed to 3DP versus traditional methods. Criteria for the meta-analysis required that studies additionally included a pre-intervention assessment.

RESULTS

A total of 804 articles were reviewed, identifying 8 and 7 studies for systematic reviews of medical students and resident physicians, respectively, of which 4 and 7 were included in the meta-analyses. 3DP models were associated with higher anatomy examination scores for medical students (P < .0001), but for resident physicians were statistically not significant (P = .53).

DISCUSSION

The 3DP models are shown to positively impact medical students especially given their limited fund of knowledge in anatomy. It is postulated that the lack of a statistically significant result for the resident physicians was multifactorial, in part because of the small test group sizes introducing noise and nonrepresentative samples, as well as relative simplicity of the 3DP models used with resident physicians, which were below their level of training. More trials are required to evaluate the usefulness of highly customized 3DP models.

Forced Disruption of Anatomy Education in Australia and New Zealand: An Acute Response to the Covid-19 Pandemic

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.

How Can We Show You, If You Can't See It? Trialing the Use of an Interactive Three-Dimensional Micro-CT Model in Medical Education

Teaching internal structures obscured from direct view is a major challenge of anatomy education. High-fidelity interactive three-dimensional (3D) micro-computed tomography (CT) models with virtual dissection present a possible solution. However, their utility for teaching complex internal structures of the human body is unclear. The purpose of this study was to investigate the use of a realistic 3D micro-CT interactive visualization computer model to teach paranasal sinus anatomy in a laboratory setting during pre-clinical medical training. Year 1 (n = 79) and Year 2 (n = 59) medical students undertook self-directed activities focused on paranasal sinus anatomy in one of two laboratories (traditional laboratory and 3D model). All participants completed pre and posttests before and after the laboratory session. Results of regression analyses predicting post-laboratory knowledge indicate that, when students were inexperienced with the 3D computer technology, use of the model was detrimental to learning for students with greater prior knowledge of the relevant anatomy (P < 0.05). For participants experienced with the 3D computer technology, however, the use of the model was detrimental for students with less prior knowledge of the relevant anatomy (P < 0.001). These results emphasize that several factors need to be considered in the design and effective implementation of such models in the classroom. Under the right conditions, the 3D model is equal to traditional laboratory resources when used as a learning tool. This paper discusses the importance of preparatory training for students and the technical consideration necessary to successfully integrate such models into medical anatomical curricula.

Three-dimensional Visualization Software Assists Learning in Students with Diverse Spatial Intelligence in Medical Education

This study evaluated effect of mental rotation (MR) training on learning outcomes and explored effectiveness of teaching via three-dimensional (3D) software among medical students with diverse spatial intelligence. Data from n = 67 student volunteers were included. A preliminary test was conducted to obtain baseline level of MR competency and was utilized to assign participants to two experimental conditions, i.e., trained group (n = 25) and untrained group (n = 42). Data on the effectiveness of training were collected to measure participants' speed and accuracy in performing various MR activities. Six weeks later, a large class format (LCF) session was conducted for all students using 3D software. The usefulness of technology-assisted learning at the LCF was evaluated via a pre- and post-test. Students' feedback regarding MR training and use of 3D software was acquired through questionnaires. MR scores of the trainees improved from 25.9±4.6 points to 28.1±4.4 (P = 0.011) while time taken to complete the tasks reduced from 20.9±3.9 to 12.2±4.4 minutes. Males scored higher than females in all components (P = 0.016). Further, higher pre- and post-test scores were observed in trained (9.0±1.9 and 12.3±1.6) versus untrained group (7.8±1.8; 10.8±1.8). Although mixed-design analysis of variance suggested significant difference in their test scores (P < 0.001), both groups reported similar trend in improvement by means of 3D software (P = 0.54). Ninety-seven percent of students reported technology-assisted learning as an effective means of instruction and found use of 3D software superior to plastic models. Software based on 3D technologies could be adopted as an effective teaching pedagogy to support learning across students with diverse levels of mental rotation abilities.

The Utilization of ExamSoft®-iPad® Technology in Administering and Grading Anatomy Practical Examinations

This article provides a detailed, step-by-step description of the introduction of technology (iPad® use of ExamSoft® web-based assessment software) for administering and grading cadaver-oriented anatomy practical examinations. We explain the advantages of computer-based testing in the delivery and grading of practical examinations, including minimizing human error inherent in hand grading, improving the efficiency of reporting, and mapping the examination to course objectives. Furthermore, item analysis (including item difficulty, discrimination indices, and point biserial correlations) allows evaluation of laboratory teaching and testing and monitoring of the curriculum. We also address how the advantages of this format override any limitation, such as cost. In conclusion, we describe our future directions and how others could adopt this approach.

Exploring the Dimensions of Medical Student Engagement with Technology-Enhanced Learning Resources and Assessing the Impact on Assessment Outcomes

Anatomy curricula are becoming increasingly populated with blended learning resources, which utilize the increasing availability of educational technology. The educational literature postulates that the use of technology can support students in achieving greater learning outcomes by increasing engagement. This study attempts to investigate the dimensions of student engagement with technology-enhanced learning (TEL) resources as part of a medical program's anatomy curriculum using exploratory factor analysis. A 25-item five-point Likert-based survey was administered to 192 first-year medical students, with three emergent factors discerned: satisfaction, goal setting and planning, and physical interaction. The three factors closely aligned with the existing literature and therefore additional nonparametric analysis was conducted that explored the levels of engagement across three custom-made anatomy TEL resources, including: (1) anatomy drawing screencasts; (2) an eBook; and (3) a massive open online course (MOOC). Usage data indicated that the most popular resource to be accessed across the cohort was the anatomy drawing screencasts via YouTube, with the MOOC being used least. Moreover, some evidence suggests that those students who utilized the MOOC were more engaged. Generally, however, no correlations were observed between the levels of engagement and TEL resource usage or assessment outcomes. The results from this study provide a clear insight into how students engage with TEL resources, but do not reveal any relationship between levels of engagement, usage, and assessment outcomes.