An evidence-based approach to learning clinical anatomy: A guide for medical students, educators, and administrators

Reflecting on gamified learning in medical education: a systematic literature review grounded in the Structure of Observed Learning Outcomes (SOLO) taxonomy 2012-2022

BACKGROUND

The acquisition of in-depth medical knowledge, skills, and competencies is of utmost importance when training future medical professionals. This systematic literature review delves into the empirical connection between gamified learning in medical education and the Structure of Observed Learning Outcomes (SOLO) taxonomy.

METHODS

Following PRISMA guidelines, a systematic literature review was conducted in seven databases to identify empirical studies related to gamification and medical education. The literature search was limited to peer-reviewed articles published between January 2012 and December 2022. Articles focusing on games or learning technologies in a broader sense as well as research focusing on nursing or pharmacy education were excluded.

RESULTS

Upon reviewing 23 qualified empirical studies that applied gamified learning strategies in medical education, 18 (78%) studies are associated with the second lowest level (uni-structural) of the SOLO taxonomy. The mid-level (multi-structural) learning outcomes are associated with three (13%) of the reviewed studies. There are five (22%) studies focusing on the second highest (relational) level of the SOLO. Only one study (4%) is associated with the highest SOLO level (extended-abstract). Finally, three (13%) studies were identified with multiple levels of the SOLO. In addition to the SOLO levels, the review found six (26%) studies emphasizing motivational and engagement support of gamified learning strategies in facilitating intended learning outcome attainment. A total of three (13%) studies, across three SOLO levels, suggested that gamified learning strategies can improve students' soft skills in medical education programs.

CONCLUSION

These findings collectively emphasize the need for future research and development to design gamified learning experiences capable of fostering higher SOLO taxonomy attainment in medical education. Moreover, there is potential to extend the SOLO framework to encompass motivational and affective learning outcomes, providing a comprehensive understanding of the impact of gamified learning on medical students.

Focus on evidence-based anatomy in contemporary anatomy education: Arguments in favor of a pragmatic approach

The concept of evidence-based anatomy (EBA) emerged in 2014 and has become a significant element in contemporary anatomy education. The evolving fabric of the medical education curriculum has necessitated critical changes in practice. EBA enables these changes to be incorporated seamlessly and implemented congruently into anatomy education programs. However, in parallel, non-evidence-based (classical) knowledge that has been built up through centuries of anatomical practice continues to be the core element of anatomy education in some countries/regions. Its inherent limitations hinder integration with clinical practice, leading to a rise in misadventures in the clinical setting. This viewpoint commentary highlights the strengths of EBA vis-à-vis the related attributes of classical anatomy. Appropriate arguments show that EBA helps to reduce cognitive load and enables knowledge to be delivered through innovative education tools. EBA also helps to create an inclusive learning environment in a technology-driven era. Moreover, empowered by robust resources, it is driving the pertinent amalgamation of anatomy knowledge with clinical practice. This viewpoint article endorses the adoption of EBA in contemporary anatomy education on the basis of its potential for shaping future anatomical practice.

Clinical anatomy teaching: A promising strategy for anatomic education

Background

Human anatomy is a predominant course that helps medical students enhance their performance in other clinical curricula. However, it is difficult for students to learn the relationship between anatomy and diseases, since the traditional teaching modality of anatomy courses does not contain enough clinical contents. Clinical anatomy education merges clinical diagnosis and treatment into anatomy learning. This study seeks to determine whether systematic clinical anatomy teaching can improve students' performance and interest in anatomy courses.

Methods

This study was a retrospective study conducted at West China Medical School, Sichuan University. Medical students of the 8-year program who participated in the course "HUMAN MORPHOLOGY" in the academic years of 2014-2018 did not receive a systematic clinical anatomy course, while those in the academic years of 2018-2022 did. These two groups were involved to analyze their final examination. Then, a questionnaire for students in the academic year of 2021-2022 was conducted to assess their general satisfaction and opinions on the usefulness and learning modalities of clinical anatomy courses.

Results

Students who received systematic clinical anatomy lessons performed significantly better than those who were not in the final examinations. The average grades were 73.64 and 79.90 in the 3rd semester of medicine (p < 0.0001) and 75.70 and 82.18 in the 4th semester of medicine (p < 0.0001) before and after 2018, respectively. The response rate of the questionnaire was 77.78%, and most of the students agreed that the clinical anatomy lessons were satisfactory, with 40 out of 71 (56.34%) strongly agreeing and 26 out of 71 (36.62%) agreeing.

Conclusion

Clinical anatomy education should be more emphasized and merged into the gross anatomy curriculum owing to the better performance in the final examination and high rate of satisfaction.

Quantifying research on anatomical structures, a potential new metric for assessing clinical relevance

Human anatomy remains an integral part of medical education, and recent studies have documented an emerging consensus on the key anatomical learning objectives for physicians and other health professionals in training, both at the graduate and postgraduate levels. Despite this progress, less attention has been given to assessing the clinical relevance of individual anatomical structures, and which structures students should master to achieve these learning objectives. In this study we hypothesized that published research involving individual anatomical structures is largely driven by the clinical relevance of these structures, and that tabulating the number of such publications can provide an up-to-date, evolving metric of clinical relevance. To test this hypothesis, we developed a semi-automated search routine that uses the PubMed database to quantify the publication frequency of anatomical structures and compared that to a previous study that assessed the importance of structures of the head and neck using the Delphi method, a formal procedure of generating expert consensus. Using our new approach, we were able to rank the research intensity of 2182 anatomical structures included in Grant's Dissector, a widely used textbook for anatomical dissection. Furthermore, a sample of these PubMed-derived ranks had a highly significant, positive correlation with ranks derived from a consensus of experts. Similar results were obtained when PubMed searches were restricted to journals that focus on applying knowledge in a clinical setting. Our study provides a potential new tool for anatomical educators who are aligning their basic science curricula with the clinical knowledge expected of medical graduates.

Effect of an online module designed to promote first-year dental students' evidence-based study strategies

OBJECTIVE

The aim of this study was to investigate the effect of an online module in promoting study strategies based on neuroscience applied to education for first-year dental students at the University of the Andes in Santiago, Chile.

METHODS

Four weeks after the start of the 2018 first academic semester, all 82 first-year dental students (72% females, 28% males, average 19.0 years old) were invited to voluntarily and anonymously complete the self-reported Study Strategies Questionnaire (SSQ) in a session of an Introduction to Dentistry course, which served as a baseline. Subsequently, the session included an interactive workshop on learning how to learn so that students could analyse how the human brain learns and relate this information to mental tools to foster learning. Furthermore, during the semester, students were sent information via email to reinforce the content they were exposed to during the learning how to learn activity so that they could use the toolbox of study techniques to improve their learning in all subjects. At the end of the semester, students were invited to voluntarily and anonymously complete a second SSQ to assess the effects of the study intervention. Exam marks from the previous (2017) and studied year (2018), as well as both SSQ results, were compared and analysed using IBM Statistical Package for the Social Sciences (SPSS).

RESULTS

A total of 75 and 71 students answered the SSQ before and after the intervention, respectively. The mean exam mark from 2017 was 63.7% (SD = 8.8), whilst in 2018, it was 69.6% (SD = 5.0) (p < .044); the effect size of the intervention was 0.75. The most significant changes observed after the intervention were reductions in the number of students who studied whilst checking messages on their smartphones (p = .001), studied by highlighting and/or underlining in their notes or textbooks (p ≤ .0001) and studied the day before an examination (p ≥ .0001). On the contrary, there were significant increases in the number of students who studied without access to social networks (p = .046), wrote notes or words in the margins of texts (p = .001), practised self-testing (p = .001) and studied the day before an examination (p ≤ .0001).

CONCLUSIONS

An online module to promote evidence-based study strategies in first-year dental students can have an impact on increasing students' marks as well as on some practices that can improve their academic achievements and learning.

A Simplified Abdominal Wall Model to Teach Complex Abdominal Wall Reconstruction

A simplified and functional abdominal wall model is necessary for surgical education. The utility of such a model encompasses medical student, resident, and fellow education. This is especially relevant in the fields of general surgery and plastic surgery. An abdominal wall model helps with a more complete understanding of abdomen access, hernia repair, and complex abdominal wall reconstruction. Although several models have been proposed, they are expensive and limitations exist due to access, costly repairs, maintenance, and part replacements. There is currently no consensus or widely adopted model used in surgical training programs. We present a simplified abdominal wall model that is inexpensive and easily reproducible.

How do medical students learn conceptual knowledge? High-, moderate- and low-utility learning techniques and perceived learning difficulties

BACKGROUND

Acquiring medical knowledge is a key competency for medical students and a lifelong requirement for physicians. Learning techniques can improve academic success and help students cope with stressors. To support students' learning process medical faculties should know about learning techniques. The purpose of this study is to analyse the preferred learning techniques of female and male as well as junior and senior medical students and how these learning techniques are related to perceived learning difficulties.

METHODS

In 2019, we conducted an online survey with students of the undergraduate, competency-based curriculum of medicine at Charité - Universitätsmedizin Berlin. We chose ten learning techniques of high, moderate and low utility according to Dunlosky et al. (2013) and we asked medical students to rate their preferred usage of those techniques using a 5-point Likert scale. We applied t-tests to show differences in usage between female and male as well as junior and senior learners. Additionally, we conducted a multiple regression analysis to explore the predictive power of learning techniques regarding perceived difficulties.

RESULTS

A total of 730 medical students (488 women, 242 men, M_age = 24.85, SD = 4.49) use three techniques the most: 'highlighting' (low utility), 'self-explanation' (moderate utility) and 'practice testing' (high utility). Female students showed a significantly higher usage of low-utility learning techniques (t(404.24) = -7.13, p < .001) and a higher usage of high-utility learning techniques (t(728) = -2.50, p < .05) than male students (M = 3.55, SD = .95). Compared to junior students (second to sixth semester; M = 3.65, SD = .71), senior students (seventh semester to final clerkship year; M = 3.52, SD = .73) showed a lower use of low-utility learning techniques (t(603) = 2.15, p < .05). Usage of low-utility techniques is related to more difficulties (β = .08, t(724) = 2.13, p < .05). Usage of moderate-utility techniques is related to less learning difficulties (β = -.13, t(599) = -3.21, p < .01).

CONCLUSIONS

Students use a wide range of low-, moderate- and high-utility learning techniques. The use of learning techniques has an influence on the difficulties perceived by students. Therefore, they could benefit from knowing about and using high-utility learning techniques to facilitate their learning. Faculties should inform their students about effective learning and introduce them to useful learning techniques.

Utilizing Medical Students as Internal Assets to Enhance Gross Anatomy Laboratory Learning

Identification of cadaveric structures during anatomy summative practical examinations is a challenge for first-year medical students. To assist in cultivating this skill, we offered 12 formative laboratory activities (anatomy boot camps [ABCs]) that approximated the summative practical examination format using reciprocal and near-peer teaching. Students assisted in crafting the formative practical examination, then engaged in a self-review by scoring their individual answer sheets. Students performing below designated thresholds (≤60%) were offered laboratory review sessions led by medical student upperclassmen. Mann-Whitney U tests were used to compare the performance of participants who attended the ABC sessions leading up to each summative examination. Correlation analysis was utilized to examine the relationship between student participation in ABCs summative examinations. Voluntary surveys were administered to assess the perceived value of the experience. Mann-Whitney U tests indicated students who attended the ABC review preceding three of the four summative practical and two of the four written examinations scored consistently higher on these examinations than students who chose not to attend. Correlation analysis revealed that as the overall frequency of ABC attendance increased, students' performance on the summative practical and written examinations increased significantly (P < 0.001). These findings suggest that the provision of supplemental learning experiences, such as the ABCs, contributes to improved student learning outcomes. This sentiment was echoed in student surveys. This activity, which combines multiple peer teaching approaches, appears to be an effective strategy for guiding and enhancing student success in the anatomy practical examinations. Clin. Anat. 33:286-292, 2020. © 2019 Wiley Periodicals, Inc.