Assessment of anatomical knowledge for clinical practice: perceptions of clinicians and students

A comparison of 1- versus 3-month regional anatomy exposure on learning outcomes of undergraduate medical students

Regional anatomy teaching forms a cornerstone of undergraduate medical education. Owing to an increase in teaching and learning content throughout the medical curriculum in recent years, contact hours and overall course durations in anatomy are under review worldwide. This study aimed to assess whether shortening the course content duration impacts learning gain and the ability to identify anatomical structures correctly. Undergraduate medical students of the Johannes Kepler University Linz (JKU; n = 310) and at the Medical University of Graz (MUG; n = 156) participating in regional anatomy courses were included. Whole body regional anatomy courses, including hands-on dissection and accompanying lectures, were delivered over one or three months. Course content and examination mode were kept consistent, while the duration of knowledge delivery was one or three months, respectively. Objective structured practical examinations (OSPE) were then carried out on prosections for the neck, thorax, and abdomen. 3-month course exposure resulted in significantly higher OSPE scores for the neck (49 vs. 37%), thorax (65 vs. 54%), and abdomen (65 vs. 45%), respectively. Further evaluation of the utility of different embalming types yielded higher 3-month scores in the neck and thorax regions with Thiel-embalmed tissues and thorax and abdomen regions in ethanol-glycerin-embalmed tissues. Course exposure over a more extended period, like three months, appears to be highly beneficial.

Assessing anatomical knowledge and confidence in central venous catheter insertion: a single-center cross-sectional study among physicians in a resource-limited setting

Background

Central venous catheterization (CVC) is a vital but technically demanding procedure that requires understanding of vascular anatomy to minimize complications and enhance patient safety. This study evaluates physicians' anatomical knowledge and confidence in CVC placement, focusing on the internal jugular vein (IJV), subclavian vein (SCV), and femoral vein (FV). It aims to identify critical knowledge gaps, assess their impact on procedural competency, and explore their association with complications. This research uniquely examines a low-resource setting where the reliance on anatomical landmarks is crucial due to limited ultrasound availability. The findings will inform targeted educational interventions to improve training, enhance procedural expertise, and ultimately optimize patient outcomes.

Materials and methods

A single-center, hospital-based descriptive cross-sectional study was conducted among 164 medical practitioners using a structured questionnaire, validated through expert review and pilot testing. The questionnaire included image-based anatomical questions and a confidence scale to assess knowledge and self-reported proficiency in CVC insertion. Participants were randomized ensuring balanced subgroup representation. Statistical analyses, including chi-square tests, effect size calculations (Cohen's d and Cramer's V), and confidence intervals, were performed to evaluate associations between demographic factors, anatomical knowledge, and confidence levels.

Results

The study population had near-equal gender distribution (51.22% female, 48.78% male), with participants primarily being early-career physicians. The average knowledge accuracy was 86.03% for IJV, 82.9% for FV, and 86.9% for SCV. Significant associations were observed between anatomical knowledge and job title (P = 0.03), specialty (P = 0.02), and clinical experience (P = 0.02). Gender disparities were noted, with male participants scoring significantly higher for IJV (P = 0.04) and FV (P = 0.03), although no significant difference was found for SCV (P = 0.12). Confidence levels correlated with knowledge but did not necessarily reflect procedural competence, particularly in SCV insertion. The most frequently reported challenges included difficulty in vein identification (25.6%), and insufficient training (23.2%), reinforcing the need for structured educational interventions.

Conclusion

This study highlights the critical need for improved anatomical education and standardized training to enhance patient safety in catheterization. It uniquely contributes to the literature by identifying challenges specific to resource-limited settings, where clinicians rely heavily on anatomical knowledge due to the limited availability of imaging technology. The study's limitations include its single-center design, self-reported data, and cross-sectional nature, limiting generalizability and long-term trend analysis. Procedural competence was not directly assessed, emphasizing the need for objective evaluations. Future studies should focus on larger, multi-center designs with direct competency assessments to better identify training gaps. Additionally, exploring advanced educational methods, such as simulation-based training and virtual reality, could offer valuable insights into improving clinical skills in environments with constrained resources. Ultimately, this study highlights substantial knowledge gaps in CVC insertion, particularly among physicians with limited procedural exposure. Addressing these gaps through structured, evidence-based training programs is essential for patient safety.

Implementing Formative Assessment in Human Anatomy Practical Sessions: Medical Students' Perception and Effect on Final Exam Performance

Background

Formative assessment with feedback is part of the assessment program in medical education to improve students' learning. Limited research has focused on its application and impact on practical anatomy education.

Methods

This study aimed to examine medical students' perceptions of formative assessment in practical anatomy sessions of body systems-based educational units and explore its influence on final practical exam performance. A descriptive, cross-sectional study was conducted. Data was collected from 173 Year 2 medical students through a survey that addressed their perception of process and importance of formative assessment and feedback. The survey employed a 5-point Likert scale. Two open-ended questions were appended at the end of the survey. Students' performance in Unit 3 (where formative assessment was conducted) was compared to their performance in Unit 2 (where no formative assessment was conducted) and with the performance of the previous academic year's students in Unit 3 (where no formative assessment was conducted). Descriptive statistics were used. The level of statistical significance was set at p-value < 0.05. Responses to open-ended questions (qualitative data) were counted, categorized as themes, and presented as frequencies and percentages.

Results

The survey showed high internal consistency, and its validity was established through exploratory factor analysis. Results showed that the mean mark for the unit with formative assessment and feedback was significantly higher than for the units without formative assessment and feedback. Students showed positive perception of formative assessment and feedback conducted after practical anatomy sessions. They reported useful insights regarding the benefits they gained from formative assessment and feedback as well as constructive suggestions for future improvements.

Conclusion

The study indicates that students positively perceived formative assessment and feedback sessions after practical anatomy sessions. Findings also refer to a positive effect of formative assessment on students' performance in summative practical assessment in anatomy.

Spot(ters) the difference: Bringing traditional anatomical examinations online

The COVID-19 pandemic caused a shift in anatomy education forcing institutions to find innovative ways to teach and assess online. This study details the development of an online spotter across multiple modules that allowed students to sit the examination at home whilst still maintaining the integrity of the assessment. The online spotter consisted of individual, Zoom calls between students and examiners whereby slides with images and questions were screen shared. To examine the viability of this spotter in non-lockdown scenarios several parameters were considered. Mean marks were compared to traditional versions and Pearson's r correlation coefficients were calculated between online and traditional spotters and between online spotters and overall performance in anatomy modules. A survey was carried out to determine the students' view of the assessment. Pearson's r was between 0.33 and 0.49 when comparing online spotters to the traditional format, and between 0.65 and 0.75 (p < 0.01) when compared to a calculated anatomy score. The survey indicated overall student satisfaction as 82.5% reported that it was a fair way to test their knowledge and 55% reported the same or lower levels of anxiety when compared to traditional spotters. However, there was nothing to indicate that the students preferred this format over laboratory-based spotters. These results indicate that this new exam format would be useful for small cohorts who are undertaking online or hybrid courses, or in circumstances when running a full spotter is too costly, and represents a fair and robust way to assess practical anatomical knowledge online.

Undergraduate medical student perceptions and learning outcomes related to anatomy training using Thiel- and ethanol-glycerin-embalmed tissues

Anatomical dissection is known to serve as an integral tool in teaching gross anatomy, including postgraduate training. A variety of embalming techniques exist, resulting in different haptic and optical tissue properties. This study aimed to objectify learning outcomes and medical student perceptions related to the use of two widely used embalming techniques, namely Thiel and ethanol-glycerin embalming. Between 2020 and 2022, first- and second-year medical students enrolled in the course on topographic anatomy participated in this study. Objective structured practical examinations were carried out for the head, neck, thorax, abdomen, pelvis, and extremity regions following regional dissection just before the oral examinations began. Six to ten numbered tags were marked in prosections of each region in Thiel- and ethanol-glycerin-embalmed specimens. Following the examinations, the students were surveyed regarding the suitability of the two embalming techniques with respect to preservation, colorfastness, tissue pliability, and the suitability in preparing for their anatomy examinations. Consistently higher scores were achieved for the thoracic and abdominal regions in ethanol-glycerin-embalmed specimens when compared to Thiel. No benefit was found for Thiel-embalmed upper or lower extremities. Tissues embalmed with ethanol-glycerin were rated higher for preservation and suitability to achieve the learning objectives, tissue pliability was rated higher for Thiel-embalmed tissues. Ethanol-glycerin embalming appears to offer certain advantages for undergraduate students in recognizing visceral structures, which may align with students' ideas on tissue suitability for their learning. Consequently, the benefits reported for Thiel embalming for postgraduate study unlikely reflect its suitability for novices.

The Efficacy of Utilizing the Anatomage Table as a Supplementary Educational Resource in Osteology Instruction for First-Year Medical Students

Introduction Osteology is the detailed study of the structure of the bones. This study assesses the effectiveness of employing the 3D visualization tool Anatomage table as a learning adjunct to osteology training in first-year medical students by post-test evaluations related to the humerus, radius, and ulna bones. Method This study was conducted in first-year medical graduate students in the Department of Anatomy, All India Institute of Medical Science (AIIMS), Raipur, India. Students included in the study were divided into two groups by simple random sampling after voluntary consent. The study group students, Group A, were taught osteology by traditional teaching and visualizing bone with a tool, an Anatomage table. The control group (Group B) is for traditional teaching. The study involved demonstrating each group's humerus, radius, and ulna bones, with sessions lasting 60 minutes. After each topic, a post-test was administered. A total of 94 students for the test for the humerus bone, 98 students for the radius bones, and 85 students for the ulna bones responded to the post-test conducted after sessions. Descriptive statistics were assessed using mean and standard deviation. Independent sample t-tests compare the mean marks obtained post-test by two groups of students. Results The results indicated that students in Group A scored higher mean marks than their counterparts in Group B across all three bone post-tests, but the significance of the differences varied. For humerus, mean marks obtained by students of Group A (Anatomage table teaching) (mean±SD: 4.00± 1.10) were higher than those of Group B (traditional teaching) (mean±SD: 3.63± 1.36). Still, we do not observe a statistically significant difference in mean marks of students of Group A vs. students of Group B (P=0.166, P>0.05). For radius, we observe statistically higher mean marks among students of Group A (mean±SD: 3.72±0.944) compared to students of Group B (mean±SD: 3.22±1.08) (P=0.021, P<0.05). Similarly, for ulna, we observe higher mean marks for Group A (mean±SD: 3.18.00±1.55) as compared to Group B (mean±SD: 3.13±1.21) but do not observe a statistically significant difference in mean marks of students of Group A vs. students of Group B (P=0.875, P>.05). Conclusion Including the Anatomage table for visualization during osteology sessions yielded benefits for all three sessions. Future studies could employ more extensive and diverse samples to validate the findings further and incorporate qualitative methods to gain insights into students' perceptions of both teaching methods.

On the added benefit of virtual anatomy for dissection-based skills

Technological approaches deploying three-dimensional visualization to integrate virtual anatomy are increasingly used to provide medical students with state-of-the-art teaching. It is unclear to date to which extent virtual anatomy may help replace the dissection course. Medical students of Johannes Kepler University attend both a dissection and a virtual anatomy course. This virtual anatomy course is based on Cinematic Rendering and radiological imaging and teaches anatomy and pathology. This study aims to substantiate student benefits achieved from this merged teaching approach. Following their dissection course, 120 second-year students took part in objective structured practical examinations (OSPE) conducted on human specimens prior to and following a course on Cinematic Rendering virtual anatomy. Likert-based and open-ended surveys were conducted to evaluate student perceptions of both courses and their utility. Virtual anatomy teaching was found to be unrelated to improvements in student's ability to identify anatomical structures in anatomical prosections, yielding only a 1.5% increase in the OSPE score. While the students rated the dissection course as being more important and impactful, the virtual anatomy course helped them display the learning content in a more comprehensible and clinically applicable way. It is likely that Cinematic Rendering-based virtual anatomy affects knowledge gain in domains other than the recognition of anatomical structures in anatomical prosections. These findings underline students' preference for the pedagogic strategy of the dissection course and for blending this classical approach with novel developments like Cinematic Rendering, thus preparing future doctors for their clinical work.

Universal design for learning in anatomy education of healthcare students: A scoping review

There are concerns among healthcare practitioners about poor anatomical knowledge among recent healthcare graduates. Universal Design for Learning (UDL) is a framework developed to enhance students' experience of learning and help students to become motivated learners. This scoping review identified whether UDL has been utilized in third level healthcare education and if so, whether it had been used to enhance student motivation to study anatomy. Seven online databases were searched for studies reporting the use of UDL in the curricula of medical, dental, occupational therapy (OT) or speech and language therapy (SLT) programs. Studies were screened for eligibility with set inclusion criteria. Data were extracted and analyzed. Analysis revealed that UDL was not specifically mentioned in any of the studies thus there are no published studies on UDL being formally applied in healthcare education. However, the authors identified 33 publications that described teaching methods which aligned with UDL in anatomy curricula and a thematic analysis yielded four main themes relating to teaching strategies being employed. Universal design for learning was not mentioned specifically, indicating that educators may not be aware of the educational framework, although they appeared to be utilizing aspects of it in their teaching. The review revealed that there is a lack of research concerning the anatomy education of OT and SLT students. The role of UDL in enhancing motivation to learn anatomy in medical, dental, OT and SLT programs has yet to be explored.

Tablet-assisted objective structured spotter practical examination (TOSSPE): Advantages of an innovative anatomy spotter examination method for medical student assessment

The affordances of technology-based assessments, like the objectively structured practical examination, have become an integral part of gross anatomy courses. The Department of Anatomy Faculty of Medicine at the University of Warmia and Mazury developed and introduced an application for tablet devices which has been implemented in student examinations and assessments, called the tablet-assisted objective structured spotter practical examination. It was created to simplify the educational process and to build a rich learning environment, facilitating deep learning for students through examination and feedback data. The method consists of cadaver stations with traditional corresponding pin spotters in an expanded tablet application. It not only provides instant feedback on various observations of teaching-learning skills but has also positively affected the entire process of education. The method provides an unbiased evaluation of knowledge and understanding of the anatomy course, ensuring objectivity and standardization. The current study was performed on a total of 608 first-year medical students in Polish and English divisions and focused on the observed advantages since the new method was introduced. Outcomes indicate that after the implementation of the method for both the Polish and English divisions' first-year medical students, the mean score of examinations significantly increased compared to other teaching-learning methods. The study highlights that students were excited about the implementation of the new method and identified its many benefits. It is recognized that technological development and the digital environment offer a range of opportunities and added value versus traditional assessment activities, methods, and processes.

Digital body preservation: Technique and applications

High-fidelity anatomical models can be produced with three-dimensional (3D) scanning techniques and as such be digitally preserved, archived, and subsequently rendered through various media. Here, a novel methodology-digital body preservation-is presented for combining and matching scan geometry with radiographic imaging. The technique encompasses joining layers of 3D surface scans in an anatomical correct spatial relationship. To do so, a computed tomography (CT) volume is used as template to join and merge different surface scan geometries by means of nonrigid registration into a single environment. In addition, the use and applicability of the generated 3D models in digital learning modalities is presented. Finally, as computational expense is usually the main bottleneck in extended 3D applications, the influence of mesh simplification in combination with texture mapping on the quality of 3D models was investigated. The physical fidelity of the simplified meshes was evaluated in relation to their resolution and with respect to key anatomical features. Large- and medium-scale features were well preserved despite extensive 3D mesh simplification. Subtle fine-scale features, particular in curved areas demonstrated the major limitation to extensive mesh size reduction. Depending on the local topography, workable mesh sizes ranging from 10% to 3% of the original size could be obtained, making them usable in various learning applications and environments.

Standard-Setting of Multidisciplinary Objective Structured Practical Examination

Purpose

The present work applies the standard-setting in the multidisciplinary Objective Structured Practical Examination (OSPE) of the MusculoSkeletal and Integument systems (MSK) module using Modified Ebel’s method to differentiate the competent students from the non-competent ones.

Materials and methods

One hundred fifty-six students participated in the multidisciplinary OSPE. The MSK-OSPE consists of mid-module and final. According to the blueprint of the OSPE, the mid-module OSPE tested the knowledge and skills of the upper limb, and the final OSPE verified the knowledge and skills of the lower limb. Modified Ebel’s method was used to identify the Minimum Pass Level (MPL) in each station and the whole exam accordingly.

Results

Fifty-seven percent (57%) of the students passed both exams, while 25.6% did not pass the mid-module exam and 31.4% did not pass the final exam, 17.9% did not pass both exams and 25% did not pass one exam. The MPL for most of the stations in both exams using modified Ebel’s method of the standard-setting was more than 50% which is the conventional pass mark. However, the MPL for stations 4, and 6 in the mid-module exam (ulna and arteries of the upper limb) and stations 7, 9, and 14 (muscles of the lower limb, anatomy of ankle joint, physiology of nerve) was < 50%. While the total pass mark of the mid-module OSPE was 66% and the pass mark for the final OSPE was 60%

Conclusion

The minimal pass level (MPL) in mid module and final OSPE were 66% and 60% respectively which are more than the conventional cut off point (50%) that indicating that the standard-setting was effective in identifying poor performers who cannot be identified by the conventional method that led to enhance the quality of OSPE as an assessment tool. Moreover, students developed the skills to deal with standardized patients in clinical stations. However, some defects and areas of improvement were identified in some physiological and anatomical stations. The organizing committee recommended identifying the poor performers and conducting extra-tutorial sessions on the defective topics.

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

BACKGROUND

Anatomy education in US medical schools has seen numerous changes since the call for medical education reform in 2010. The purpose of this study was to survey US medical schools to assess recent trends in anatomy education, the impact of the COVID-19 pandemic on anatomy teaching, and future directions of medical school anatomy curricula.

METHODS

We sent a 29-item survey to anatomy course directors of 145 AAMC-associated allopathic medical schools inquiring about their schools' anatomy curricula. The survey contained objective discrete questions concerning the curricula changes preceding COVID-19 and those directly related to COVID-19. We also asked subjective and open-ended questions about the impact of COVID-19 and future directions of anatomy education.

RESULTS

A total of 117/143 course directors (82%) completed the survey. Most schools (60%) reported a major change to their anatomy course within the past five years, including a decrease in total course time (20%), integration of anatomy into other courses (19%), and implementation of a "flipped classroom" (15%) teaching style. Due to COVID-19, there was a decrease in the fraction of course time dedicated to "hands-on" learning (p < 0.01) and teaching of clinical correlates (p = 0.02) and radiology (p < 0.01). Most course directors (79%) reported that COVID-19 had a negative impact on quality of learning due to decreased interactive or in-person (62%) learning and lack of dissection (44%). Incorporation of virtual-reality applications or 3D anatomy software (23%) and a decrease in cadaver dissection (13%) were the most common future anticipated changes.

CONCLUSION

The constraints conferred by COVID-19 highlight the importance of maximizing interactive learning in the discipline of anatomy. In an era of social distancing and decreased emphasis on conventional anatomy dissection, adaptations of new technologies and teaching modalities may allow for traditional educational rigor to be sustained.

Instructional Approaches: Anatomy Education of Physical Therapists

The profession of physical therapy has undergone an evolution since its inception. Since the early 1900s it has grown from a technical training program to a doctorate level degree. Human anatomy courses remain a requirement for physical therapist educational curricula. However, changes in anatomy pedagogy have been trending within health profession educational models, leading to questions regarding which method is best for student learning. The objective of this study was to determine if anatomy instructional method used within physical therapist educational curricula impacted current anatomy knowledge. Licensed physical therapists were recruited to complete a demographic survey and a questionnaire to demonstrate their knowledge of anatomy topics. Anatomy topics included six regional components: (1) upper limb; (2) lower limb; (3) thorax and abdomen; (4) pelvis; (5) spine; and (6) head. Each regional component contained five questions regarding systemic subsets related to joints and osteology, muscles, nervous system, vasculature, and special areas (e.g., spatial orientations, structures within spaces, pathways of nerves). Within the thorax and abdominal region, data analysis indicated that the dissection instruction method, when compared to no laboratory instruction, led to statistically significant greater anatomical knowledge (P = 0.02). Dissection also showed greater means when compared to the no laboratory method (P = 0.02) and the prosection method in the head region (P = 0.01). However, the variance explained by instructional method was small. This study adds empirical evidence regarding current anatomy knowledge exhibited by physical therapists as the level of anatomical knowledge exhibited small differences based on instructional methods.

[Assessment of trainee urologists' knowledge in urogenital anatomy]

The purpose of this study was to assess trainee urologists' [interns and assistant heads of university hospitals (CHU)] knowledge of the anatomy of the urogenital system. An examination consisting of 10 timed (16minutes) multiple-choice questions (MCQ) based on urogenital anatomy assessments for students in third year of the general medical science diploma program (DFGSM3) was sent to members of the French Association of Trainee Urologists (AFUF) in May 2018 in order to compare the average scores of these two populations. In addition, a questionnaire consisting of epidemiological data, their opinion on the quality of education in anatomy and the willingness to have more courses on this subject was included in the examination. The same scale based on a score out of 20 was applied to both populations. Of the 501 AFUF members solicited, 144 answered all the questions (28.7%). The mean score for urologists was lower than that of DFGSM3 students (10.56±1.82 vs. 11.4±2.37 respectively) (P=0.0013). Moreover, the desire for further education in anatomy was widespread among urologists (87%). According to our study, urologists have less knowledge of urogenital anatomy than third year medical students. Many means are being implemented or are available to rectify this failing, especially since the majority of trainee urologists consider that there are insufficient anatomy lessons in the curriculum and would like to receive further education in anatomy. LEVEL IF EVIDENCE: 3.

Identification-Based Multiple-Choice Assessments in Anatomy can be as Reliable and Challenging as Their Free-Response Equivalents

Multiple-choice (MC) anatomy "spot-tests" (identification-based assessments on tagged cadaveric specimens) offer a practical alternative to traditional free-response (FR) spot-tests. Conversion of the two spot-tests in an upper limb musculoskeletal anatomy unit of study from FR to a novel MC format, where one of five tagged structures on a specimen was the answer to each question, provided a unique opportunity to assess the comparative validity and reliability of FR- and MC-formatted spot-tests and the impact on student performance following the change of test format to MC. Three successive year cohorts of health science students (n = 1,442) were each assessed by spot-tests formatted as FR (first cohort) or MC (following two cohorts). Comparative question difficulty was assessed independently by three examiners. There were more higher-order cognitive skill questions and more of the course objectives tested in the MC-formatted tests. Spot-test reliability was maintained with Cronbach's alpha reliability coefficients ≥ 0.80 and 80% of the MC items of high quality (having point-biserial correlation coefficients > 0.25). These results also demonstrated guessing was not an issue. The mean final score for the MC-formatted cohorts increased by 4.9%, but did not change for the final theory examination that was common to all three cohorts. Subgroup analysis revealed that the greatest change in spot-test marks was for the lower-performing students. In conclusion, our results indicate spot-tests formatted as MC are suitable alternatives to FR tests. The increase in mean scores for the MC-formatted spot-tests was attributed to the lower demand of the MC format.

Multiple-Choice versus Open-Ended Questions in Advanced Clinical Neuroanatomy: Using a National Neuroanatomy Assessment to Investigate Variability in Performance Using Different Question Types

Methods of assessment in anatomy vary across medical schools in the United Kingdom (UK) and beyond; common methods include written, spotter, and oral assessment. However, there is limited research evaluating these methods in regards to student performance and perception. The National Undergraduate Neuroanatomy Competition (NUNC) is held annually for medical students throughout the UK. Prior to 2017, the competition asked open-ended questions (OEQ) in the anatomy spotter examination, and in subsequent years also asked single best answer (SBA) questions. The aim of this study is to assess medical students' performance on, and perception of, SBA and OEQ methods of assessment in a spotter style anatomy examination. Student examination performance was compared between OEQ (2013-2016) and SBA (2017-2020) for overall score and each neuroanatomical subtopic. Additionally, a questionnaire explored students' perceptions of SBAs. A total of 631 students attended the NUNC in the studied period. The average mark was significantly higher in SBAs compared to OEQs (60.6% vs. 43.1%, P < 0.0001)-this was true for all neuroanatomical subtopics except the cerebellum. Students felt that they performed better on SBA than OEQs, and diencephalon was felt to be the most difficult neuroanatomical subtopic (n = 38, 34.8%). Students perceived SBA questions to be easier than OEQs and performed significantly better on them in a neuroanatomical spotter examination. Further work is needed to ascertain whether this result is replicable throughout anatomy education.

Team-Based Ultrasound Objective Structured Practice Examination (OSPE) in the Anatomy Course

The clinical use of ultrasound has dramatically increased, necessitating early ultrasound education and the development of new tools in ultrasound training and assessment. The goal of this study was to devise a novel low-resource examination that tested the anatomical knowledge and technical skill of early undergraduate medical students in a gross anatomy course. The team-based ultrasound objective structured practice examination (OSPE) was created as a method for assessing practical ultrasound competencies, anatomical knowledge, and non-technical skills such as teamwork and professionalism. The examination utilized a rotation of students through four team roles as they scanned different areas of the body. This station-based examination required four models and four instructors, and tested ultrasound skills in the heart, abdominal vessels, abdominal organs, and neck regions. A Likert scale survey assessed student attitudes toward the examination. Survey data from participants (n = 46) were examined along with OSPE examination grades (n = 52). Mean and standard deviations were calculated for examination items and survey responses. Student grades were high in both technical (96.5%). and professional (96.5%) competencies with structure identification scoring the lowest (93.8%). There were no statistical differences between performances in each of the body regions being scanned. The survey showed that students deemed the examination to be fair and effective. In addition, students agreed that the examination motivated them to practice ultrasound. The team-based OSPE was found to be an efficient and student-favored method for evaluating integrated ultrasound competencies, anatomical knowledge, team-work, and professional attributes.

Development of a Virtual Three-Dimensional Assessment Scenario for Anatomical Education

In anatomical education three-dimensional (3D) visualization technology allows for active and stereoscopic exploration of anatomy and can easily be adopted into medical curricula along with traditional 3D teaching methods. However, most often knowledge is still assessed with two-dimensional (2D) paper-and-pencil tests. To address the growing misalignment between learning and assessment, this viewpoint commentary highlights the development of a virtual 3D assessment scenario and perspectives from students and teachers on the use of this assessment tool: a 10-minute session of anatomical knowledge assessment with real-time interaction between assessor and examinee, both wearing a HoloLens and sharing the same stereoscopic 3D augmented reality model. Additionally, recommendations for future directions, including implementation, validation, logistic challenges, and cost-effectiveness, are provided. Continued collaboration between developers, researchers, teachers, and students is critical to advancing these processes.

Online Assessment of Applied Anatomy Knowledge: The Effect of Images on Medical Students' Performance

Anatomical examinations have been designed to assess topographical and/or applied knowledge of anatomy with or without the inclusion of visual resources such as cadaveric specimens or images, radiological images, and/or clinical photographs. Multimedia learning theories have advanced the understanding of how words and images are processed during learning. However, the evidence of the impact of including anatomical and radiological images within written assessments is sparse. This study investigates the impact of including images within clinically oriented single-best-answer questions on students' scores in a tailored online tool. Second-year medical students (n = 174) from six schools in the United Kingdom participated voluntarily in the examination, and 55 students provided free-text comments which were thematically analyzed. All questions were categorized as to whether their stimulus format was purely textual or included an associated image. The type (anatomical and radiological image) and deep structure of images (question referring to a bone or soft tissue on the image) were taken into consideration. Students scored significantly better on questions with images compared to questions without images (P < 0.001), and on questions referring to bones than to soft tissue (P < 0.001), but no difference was found in their performance on anatomical and radiological image questions. The coding highlighted areas of "test applicability" and "challenges faced by the students." In conclusion, images are critical in medical practice for investigating a patient's anatomy, and this study sets out a way to understand the effects of images on students' performance and their views in commonly employed written assessments.

Rethinking Assessment Design: Evidence-Informed Strategies to Boost Educational Impact in the Anatomical Sciences

University assessment is in the midst of transformation. Assessments are no longer designed solely to determine that students can remember and regurgitate lecture content, nor in order to rank students to aid with some future selection process. Instead, assessments are expected to drive, support, and enhance learning and to contribute to student self-assessment and development of skills and attributes for a lifetime of learning. While traditional purposes of certifying achievement and determining readiness to progress remain important, these new expectations for assessment can create tensions in assessment design, selection, and deployment. With the recognition of these tensions, three contemporary approaches to assessment in medical education are described. These approaches include careful consideration of the educational impact of assessment-before, during (test or recall enhanced learning) and after assessments; development of student (and staff) assessment literacy; and planning of cohesive systems of assessment (with a range of assessment tools) designed to assess the various competencies demanded of future graduates. These approaches purposefully straddle the cross purposes of assessment in modern health professions education. The implications of these models are explored within the context of medical education and then linked with contemporary work in the anatomical sciences in order to highlight current synergies and potential future innovations when using evidence-informed strategies to boost the educational impact of assessments.

Evaluation of a 3D-MC examination format in anatomy

INTRODUCTION

The quality of education in medical anatomy is a fundamental pillar of good clinical practice. Current reforms of the medical curriculum have resulted in major methodological changes in the teaching and testing of anatomy. A number of recent studies have however described a decrease in positive metrics of anatomical knowledge among students so taught. It has been suggested that the reduced anatomical knowledge measured in these studies may endanger patient safety. As proxy measures of exam quality, evaluation of the levels of students 'achievement in the examinations, assessment of the subjectively perceived level of question difficulty and analysis of exam satisfaction are each suitable parameters of investigation of medical education.

MATERIAL AND METHODS

To address these issues with regard to medical education at the Charité-Universitätsmedizin Berlin, we have analyzed students' levels of achievement in the anatomical Three Dimensional Multiple Choice (hereafter, 3D-MC)-examination of 2,015 students matriculated in medical studies from Summer Semester of 2014 through Summer Semester of 2017. We either compared students' achievement levels of identical 3D-MC questions using models or prepared anatomical specimen. Furthermore, we have analyzed the type and frequency of cognitive levels used in the anatomical questions in relation to the students' level of achievement. Finally, we conducted an anonymous survey to measure students' (n = 207) and instructors' (n = 16) satisfaction with the 3D-MC-examination in comparison to other employed anatomical testing strategies.

RESULTS

Students' achievement is significantly enhanced with anatomical questions using models relative to those utilizing anatomical specimen. Over 80% of the anatomical questions in the 3D-MC-examinations assessed the lowest cognitive levels and higher cognitive question levels were accompanied by a significant decrease of the levels of students' performance. Our survey further revealed that both, students and instructors preferred the practical examinations in anatomy and that the difficulty levels of the 3D-MC-examination was perceived as being the lowest in comparison to the other anatomical testing strategies.

DISCUSSION

Testing levels of anatomical understanding using anatomical models is not comparable to human specimen, and thus using specimen before models should be preferred to learn and test close to an authentic medical situation. The application of anatomical models and low cognitive question levels in the examination reduces the subjectively perceived level of difficulty, encourages superficial learning, and therefore decreases the retention of anatomical knowledge.

CONCLUSION

Although students and instructors prefer practical examinations in anatomy, the current development does not reflect these results. Therefore, it would be recommendable to rethink the development of anatomical testing strategies based on the existing evidence.

Australian chiropractors' perception of the clinical relevance of anatomical sciences and adequacy of teaching in chiropractic curricula

Background

Human anatomy education is compulsory in the undergraduate curriculum in all Australian chiropractic education programs. There is very little data on clinicians’ perceptions of the adequacy of their anatomy training and its relevance to practice. The aims of this study were to evaluate Australian registered chiropractors’ perceptions on the relevance and adequacy of anatomy training for clinical practice and analyse their opinion on the usefulness of the teaching resources utilized during their preprofessional training.

Methods

A questionnaire-based survey was conducted on a sample of Australian registered chiropractors focussing on the adequacy of their anatomical science (gross anatomy, histology, neuroanatomy and embryology) training and the clinical relevance of each individual sub-discipline, and the perceived value of each of the different anatomy teaching resources utilized.

Results

A total of 128 completed surveys were returned from an estimated 387 attendees at two national chiropractic conferences (estimated 33% response rate). The respondents represent 2.6% of registered chiropractors in Australia in 2016 and were representative in terms of gender (66.4% male) but not age, with older generations being over-represented (peak age group 35–44 vs. 25–34). The majority of the survey respondents obtained their chiropractic qualification in Australia (89.1%) and graduated after 1990 with an average of 21.7 years (SD = 11.3, range = 1–44) in practice. Respondents were equally likely to have undertaken anatomy training in Medicine, Science, Health Science, or other faculties. The disciplines perceived most relevant for clinical practice were neuroanatomy (100% of respondents agreeing) and gross anatomy (99.2%), followed by histology (86.0%) and embryology (81.1%). Respondents also perceived their training to be most adequate in neuroanatomy (99.3%) and gross anatomy (99.2%) followed by histology (91.4%) and embryology (85%). Respondents confirmed exposure to a varied suite of anatomy teaching tools utilized during their pre-professional training and highly valued access to cadavers and prosected specimens.

Conclusions

The majority of respondents perceived anatomy as highly relevant to their clinical practice and noted that it was adequately taught within a wide range of educational approaches. These results will assist educators to refine content and delivery of anatomy course offerings to maximize relevance in chiropractic clinical practice.

Focused Multisensory Anatomy Observation and Drawing for Enhancing Social Learning and Three-Dimensional Spatial Understanding

The concept that multisensory observation and drawing can be effective for enhancing anatomy learning is supported by pedagogic research and theory, and theories of drawing. A haptico-visual observation and drawing (HVOD) process has been previously introduced to support understanding of the three-dimensional (3D) spatial form of anatomical structures. The HVOD process involves exploration of 3D anatomy with the combined use of touch and sight, and the simultaneous act of making graphite marks on paper which correspond to the anatomy under observation. Findings from a previous study suggest that HVOD can increase perceptual understanding of anatomy through memorization and recall of the 3D form of observed structures. Here, additional pedagogic and cognitive underpinnings are presented to further demonstrate how and why HVOD can be effective for anatomy learning. Delivery of a HVOD workshop is described as a detailed guide for instructors, and themes arising from a phenomenological study of educator experiences of the HVOD process are presented. Findings indicate that HVOD can provide an engaging approach for the spatial exploration of anatomy within a supportive social learning environment, but also requires modification for effective curricular integration. Consequently, based on the most effective research-informed, theoretical, and logistical elements of art-based approaches in anatomy learning, including the framework provided by the observe-reflect-draw-edit-repeat (ORDER) method, an optimized "ORDER Touch" observation and drawing process has been developed. This is with the aim of providing a widely accessible resource for supporting social learning and 3D spatial understanding of anatomy, in addition to improving specific anatomical knowledge.

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.

Predictors of confidence in anatomy knowledge for work as a junior doctor: a national survey of Australian medical students

BACKGROUND

Major changes to the teaching of anatomy associated with the integration of basic and clinical sciences in modern medical curricula have coincided with students reporting concern over achievement of learning outcomes in anatomy. Little guidance exists for medical educators designing anatomy courses that account for factors that positively influence medical student confidence in their own anatomy knowledge. We sought to determine what factors are associated with medical students' self-reported confidence in their anatomy knowledge in preparation for clinical practice.

METHODS

Cross-sectional national survey of Australian medical students distributed using social media. We performed univariate and multivariable ordinal regression to determine the factors in anatomy learning and teaching that influence medical student self-reported confidence to have sufficient anatomy knowledge by the time of graduation, for practice as a junior doctor.

RESULTS

Of 1309 surveyed, 1101 (84%) responded, representing 6.5% of the Australian medical student population. Mean age was 23.9 years (SD 4.8 years), a majority were female (644, 58.5%), and students in all years of both undergraduate (52%, 575) and graduate entry courses (48%, 529) were represented. Items associated with increased self-reported confidence in anatomy knowledge included adequate assessment of anatomy (Odds Ratio 2.17 [95% CI 1.69-2.81]), integration of anatomy with other basic sciences (OR 1.97 [1.52-2.56]) and clinical teaching (OR 1.90 [1.46-2.48]), male gender (OR 1.89 [1.48-2.42]), anatomy education prior to medical school (OR 1.46 [1.14-1.87]) and exposure to dissection (OR 1.39 [1.08-1.78]). Medical students in their clinical years reported lower confidence in their anatomy knowledge (OR 0.6 [0.47-0.77], p < 0.0001). Age and career intention were not significant predictors of confidence.

CONCLUSIONS

Medical educators can enhance student confidence in their own anatomy knowledge by developing curricula that vertically integrating anatomy learning and teaching, integrate anatomy teaching with other basic sciences, and providing consistent assessment through both the pre-clinical and clinical stages of medical training. Anatomy education should also incorporate dissection as a teaching method, and students could benefit from completion of anatomy education prior to medical school. Consideration should also be given to further investigate the confidence of female students in their anatomy knowledge.

Learning styles and strategies preferences of Iranian medical students in gross anatomy courses and their correlations with gender

The learning approaches can help anatomy teachers design a suitable curriculum in harmony with their students' learning styles. The research objective is to evaluate gross anatomy learning styles and strategies preferences of Iranian medical students at Kashan University of Medical Sciences (KAUMS). This cross-sectional questionnaire-based study was carried out on 237 Iranian medical students. The students answered questions on approaches to learning anatomy and expressed opinions about learning anatomy in medical curriculum. The data were analyzed to disclose statistically significant differences between male and female students. Iranian male and female students were interested in learning anatomy using notes, plastic models, pictures and diagrams, clinical context, dissection and prosection of cadavers; however, they rarely used cross-sectional images and web-based resources. Both groups of medical students used region and system in learning anatomy. However, there existed some striking differences, particularly in having difficulty in studying anatomy using cadaveric specimens, using books alone, and learning it in small groups. Male students were less interested in learning with cadavers than female counterparts. However, female students were more interested in learning anatomy in small groups. This study suggests that instructors should design gross anatomy curriculum based on limitations of using dissection of cadaver in Iranian universities, emphasis on the applied anatomy, and learning of gross anatomy in small groups.

Learning methods and strategies of anatomy among medical students in two different Institutions in Riyadh, Saudi Arabia

BACKGROUND

Anatomy instructors adopt individual teaching methods and strategies to convey anatomical information to medical students for learning. Students also exhibit their own individual learning preferences. Instructional methods preferences vary between both instructors and students across different institutions.

AIMS

In attempt to bridge the gap between teaching methods and the students' learning preferences, this study aimed to identify students' learning methods and different strategies of studying anatomy in two different Saudi medical schools in Riyadh.

MATERIALS AND METHODS

A cross-sectional study, conducted in Saudi Arabia in April 2015, utilized a three-section questionnaire, which was distributed to a consecutive sample of 883 medical students to explore their methods and strategies in learning and teaching anatomy in two separate institutions in Riyadh, Saudi Arabia.

RESULTS

Medical students' learning styles and preferences were found to be predominantly affected by different cultural backgrounds, gender, and level of study. Many students found it easier to understand and remember anatomy components using study aids. In addition, almost half of the students felt confident to ask their teachers questions after class. The study also showed that more than half of the students found it easier to study by concentrating on a particular part of the body rather than systems. Students' methods of learning were distributed equally between memorizing facts and learning by hands-on dissection. In addition, the study showed that two thirds of the students felt satisfied with their learning method and believed it was well suited for anatomy.

CONCLUSIONS

There is no single teaching method which proves beneficial; instructors should be flexible in their teaching in order to optimize students' academic achievements.

The effect of images on item statistics in multiple choice anatomy examinations

Although multiple choice examinations are often used to test anatomical knowledge, these often forgo the use of images in favor of text-based questions and answers. Because anatomy is reliant on visual resources, examinations using images should be used when appropriate. This study was a retrospective analysis of examination items that were text based compared to the same questions when a reference image was included with the question stem. Item difficulty and discrimination were analyzed for 15 multiple choice items given across two different examinations in two sections of an undergraduate anatomy course. Results showed that there were some differences item difficulty but these were not consistent to either text items or items with reference images. Differences in difficulty were mainly attributable to one group of students performing better overall on the examinations. There were no significant differences for item discrimination for any of the analyzed items. This implies that reference images do not significantly alter the item statistics, however this does not indicate if these images were helpful to the students when answering the questions. Care should be taken by question writers to analyze item statistics when making changes to multiple choice questions, including ones that are included for the perceived benefit of the students. Anat Sci Educ 10: 68-78. © 2016 American Association of Anatomists.

Assessment of anatomical knowledge by practical examinations: The effect of question design on student performance

The objective structural practical examination (OSPE) is a timed examination that assesses topographical and/or applied knowledge of anatomy with the use of cadaveric resources and medical images. This study investigated whether elements of question design (provision of clinical context, type of visual resources used, gender context, and difficulty) of an anatomy question affected students' performance and also whether there was any effect of basic demography or participation in various voluntary activities. Study participants were second-year medical students (n = 150), 83 of whom consented to fill in a questionnaire collecting demographics, revision preferences, and assessment preferences. The examination scores were matched with students' responses collected on the questionnaire and all data analyzed by multiple linear regression. Difficulty of the question was the only design element found to be significantly associated with the number of students that answered correctly (P = 0.001); clinical context, visual resources used and gender of the question were not significant. When individual students' marks were analyzed along with the questionnaire data, only the students' interest in participating in department's demonstrator program was a significant predictor of a high individual score, gender of the students showed a strong trend toward significance, with female students scoring on average higher than male students. The two part OSPE questions were dissociated and analyzed using binary logistic regression to determine whether a correct answer to Part 1 (identification of a tagged or pinned anatomical structures on a specimen or medical image) was predictive of a correct answer to Part 2 (assessment of the relevant functional, applied, or clinical knowledge), but no association was found. Anat Sci Educ 9: 446-452. © 2016 American Association of Anatomists.

The intelligent anatomy spotter: A new approach to incorporate higher levels of Bloom's taxonomy

The spotter test is an assessment that has been used widely to test practical knowledge of anatomy. Traditional spotter formats often focus solely on knowledge recall, in addition to being an onerous marking burden on staff where consistency in marking free text responses can be questioned. First-year optometry students at the University of Manchester study the functional anatomy of the eye in the first semester of their first year. Included in the assessment of this unit is a spotter examination worth 45% of the total unit mark. Due to the factors listed above, a new spotter format was designed. Students had to answer three questions per specimen where the answers to the questions were the labeled structures themselves (A, B, C, or D). They had to work out the answer to the question and then work out which of the labeled structures was the correct structure, negating the "cueing effect" of standard multiple choice questions. Examination results were analyzed over a six-year period (control groups 2008/2009, 2009/2010, 2010/2011; treatment groups 2011/2012, 2012/2013, 2013/2014). There were no significant differences between marks obtained for the new spotter format when compared with the traditional format. The new format spotter tested comprehension rather than just knowledge, and facilitated marking because subjectiveness was erased, and less time was spent determining whether an answer was correct or not. Anat Sci Educ 9: 440-445. © 2015 American Association of Anatomists.

A Comparison of Fourth-Year Health Sciences Students' Knowledge of Gross Lower and Upper Limb Anatomy: A Cross-Sectional Study

OBJECTIVE

The aim of the study was to assess and compare the knowledge of fourth-year medicine, physiotherapy (PT), nursing, and podiatry students in carpal and tarsal bone anatomy.

METHODS

A cross-sectional study was carried out. Based on a nonprobability convenience sampling, 177 fourth-year students (117 women and 60 men, mean age of 23.16 ± 3.82 years) from the podiatry (n = 39), nursing (n = 26), PT (n = 73), and medicine (n = 39) schools at a large Spanish university were included. Measurements were taken of their gross anatomy knowledge by means of the carpal and the tarsal bone tests. Students were asked to identify all carpal and tarsal bones in an illustration of the bony skeleton of both regions and were given a maximum of 5 minutes per test.

RESULTS

Of a total of 15 bones to be labeled, the PT (11.07 ± 3.30) and podiatry (9.36 ± 2.93) students had the highest rate of correct answers compared with the medicine (6.13 ± 3.27) and nursing (4.04 ± 3.72) undergraduates. When assessing academic degrees and test scores, significant differences were observed between PT and podiatry participants vs those from the medicine and nursing schools (P < .001).

CONCLUSION

Fourth-year students from the PT and podiatry programs correctly identified a higher number of carpal and tarsal bones than students from the nursing and medicine schools.

Student performance on practical gross anatomy examinations is not affected by assessment modality

Anatomical education is becoming modernized, not only in its teaching and learning, but also in its assessment formats. Traditional "steeplechase" examinations are being replaced with online gross anatomy examinations. The aims of this study were to: (1) determine if online anatomy practical examinations are equivalent to traditional anatomy practical examinations; and (2) to examine if students' perceptions of the online or laboratory testing environments influenced their performance on the examinations. In phase one, 10 third-year students were interviewed to generate perception items to which five anatomy lecturers assigned content validity. In phase two, students' gross anatomical knowledge was assessed by examinations in two modes and their perceptions were examined using the devised survey instrument. Forty-five second-year chiropractic students voluntarily participated in Phase Two. The two randomly allocated groups completed the examinations in a sequential cross-over manner. Student performance on the gross anatomy examination was not different between traditional "steeplechase" (mean ± standard deviation (SD): 69 ± 11%) and online (68 ± 15%) modes. The majority of students (87%) agreed that they felt comfortable using computers for gross anatomy examinations. However, fewer students found it easy to orientate images of cadaver specimens online. The majority of students (85%) agreed that they felt comfortable working with cadavers but there was less agreement on the effect of moving around the laboratory during practical examinations. This data will allow anatomists to confidently implement online assessments without fear of jeopardizing academic rigor or student performance.

Clinical vignettes improve performance in anatomy practical assessment

Although medical curricula now adopt an integrated teaching approach, this is not adequately reflected in assessment of anatomy knowledge and skills. In this study, we aimed to explore the impact of the addition of clinical vignette to item stems on students' performance in anatomy practical examinations. In this study, 129 undergraduate medical students of Durham University took part in a 30-item anatomy practical test consisting of those with and without clinical stem, in a crossover design. Classical test theory was used to analyze item difficulty, discrimination index, point biserial, and reliability. Student performance on items with clinical stem and the percentage of students who correctly answered each item was significantly improved by the addition of a clinical stem in the Year 2 cohort. Also, items with a clinical stem showed much better discrimination index than non-clinical items in the Year 2 cohort. In contrast, there was no significant difference in item performance, student performance and discrimination index between items with a clinical and non-clinical stem in Year 1 cohort. Over 65% of test items in both year groups were of good quality with point biserial exceeding 0.2. However, Year 1 test reliability for non-clinical items was better than clinical items. The results raise question as to what level to apply this method of assessment in undergraduate education. Although interpreted on the basis of a relatively small item sample, the findings support the need for improving anatomy practical examinations in line with overriding curricula changes.

The integrated anatomy practical paper: A robust assessment method for anatomy education today

Assessing anatomy in a way that tests higher cognitive domains and clinical application is not always straightforward. The old "spotter" examination has been criticized for only testing low level "identify" knowledge, whereas other assessment modalities such as multiple choice questions do not reflect the three dimensional and application nature of clinical anatomy. Medical curricula are frequently integrated and subject specific examinations do not reflect the case based, spiral, integrative nature of the curricula. The integrated anatomy practical paper (IAPP) is a hybrid of the old "spotter" and an objective structured clinical examination but it demonstrates how higher levels of taxonomy can be assessed, together with clinical features and integrates well with other disciplines. Importantly, the IAPP has shown to be reliable and practical to administer. Data gathered from the Bachelor of Medicine five-year program over two academic years for four IAPP examinations, each being 40 minutes with (K = 60 items) based on 440 students revealed consistently strong reliability coefficients (Cronbach alpha) of up to 0.923. Applying Blooms taxonomy to questions has shown a marked shift resulting in an increase in the complexity level being tested; between 2009 and 2013 a reduction of 26% in the number of low level "remember knowledge" domain questions was noted with up to an increase of 15% in "understanding" domain and 12% increase in the "applying" knowledge domain. Our findings highlight that it is possible to test, based in a laboratory, anatomy knowledge and application that is integrated and fit for practice.

Exploring the validity of assessment in anatomy: do images influence cognitive processes used in answering extended matching questions?

Assessment is an important aspect of medical education because it tests students' competence and motivates them to study. Various assessment methods, with and without images, are used in the study of anatomy. In this study, we investigated the use of extended matching questions (EMQs). To gain insight into the influence of images on the validity of test items, we focused on students' cognitive processes while they answered questions with and without images. Seventeen first-year medical students answered EMQs about gross anatomy, combined with either labeled images or answer lists, while thinking aloud. The participants' verbal reports were transcribed verbatim and then coded. Initial codes were based on a task analysis and were adapted into final codes during the coding process. Results showed that students used more cues from EMQs with images and visualized more often in EMQs with answer lists. Ready knowledge and verbal reasoning were used equally often in both conditions. In conclusion, EMQs with and without images elicit different results in this think aloud experiment, indicating different cognitive processes. They seem to measure different skills, making them valid for different testing purposes. The take-home message for anatomy teachers is that questions without images seem to test the quality of students' mental images while questions with images test their ability to interpret visual information. It makes sense to use both response formats in tests. Using images from clinical practice instead of anatomical drawings will help to improve test validity.

What is an objective structured practical examination in anatomy?

Assessing teaching-learning outcomes in anatomical knowledge is a complex task that requires the evaluation of multiple domains: theoretical, practical, and clinical knowledge. In general, theoretical knowledge is tested by a written examination system constituted by multiple choice questions (MCQs) and/or short answer questions (SAQ). The assessment of practical knowledge (three-dimensional anatomical concepts) involves oral, spot, or objective structured practical examinations (OSPE). Finally, the application of anatomical knowledge to patients is tested mainly through objective structured clinical examinations (OSCE). The major focus of this study is the OSPE. Although many schools challenge students using this tool in practical examinations in the early phase of the curriculum, the true meaning of OSPE is frequently forgotten and it becomes, in reality, a spot examination. This article, for the first time, describes how the concept of the OSPE has evolved and is currently being used to assess the practical domain of anatomical knowledge in a problem-based curriculum at Alfaisal University College of Medicine. In addition, it describes the main differences from the spot examination, which is normally used in traditional medical curricula. The authors believe that the OSPE remains the most efficient tool to assess the practical aspects of anatomical knowledge in a system where basic knowledge is integrated with the clinical or functional part of anatomy. However, this contention only holds true if the OSPE process revolves around structured objectives.

Anatomy learning styles and strategies among Jordanian and Malaysian medical students: the impact of culture on learning anatomy

PURPOSE

The study aims to investigate anatomy learning styles and strategies of Jordanian and Malaysian medical students at the Jordan University of Science and Technology.

METHODS

The study is a cross-sectional questionnaire-based study. Students' responses for the questionnaire were numerically coded, and the results were analyzed to reveal statistically significant differences between Jordanian and Malaysian students.

RESULTS

The results showed that Jordanian medical students were less interested in using cadavers in learning anatomy than Malaysian medical students. However, similar to their Malaysian counterparts, they prefer to employ other tools to learn anatomy like plastinated models and Internet-based resources. In addition to the aforementioned tools, Malaysian students were more interested in using cross-sectional images and making their own revision cards. Both Jordanian and Malaysian medical students were more interested in learning anatomy through clinical cases, and by system rather than by region. Moreover, it was revealed that Jordanian medical students learn anatomy more efficiently when they formulate a general view of a particular topic. Both Jordanian and Malaysian medical students also relied on reciting definitions and memorizing facts to learn anatomy. The study also reported significant differences between Jordanian and Malaysian students' perspectives on learning anatomy.

CONCLUSIONS

The findings of the study suggest that Jordanian and Malaysian medical students posses different cultures of learning. Jordanian anatomy instructors need to consider these different learning cultures when they prepare their instructional methods and teaching materials to fulfill the educational needs of their culturally diverse students.

Do images influence assessment in anatomy? Exploring the effect of images on item difficulty and item discrimination

Anatomists often use images in assessments and examinations. This study aims to investigate the influence of different types of images on item difficulty and item discrimination in written assessments. A total of 210 of 460 students volunteered for an extra assessment in a gross anatomy course. This assessment contained 39 test items grouped in seven themes. The answer format alternated per theme and was either a labeled image or an answer list, resulting in two versions containing both images and answer lists. Subjects were randomly assigned to one version. Answer formats were compared through item scores. Both examinations had similar overall difficulty and reliability. Two cross-sectional images resulted in greater item difficulty and item discrimination, compared to an answer list. A schematic image of fetal circulation led to decreased item difficulty and item discrimination. Three images showed variable effects. These results show that effects on assessment scores are dependent on the type of image used. Results from the two cross-sectional images suggest an extra ability is being tested. Data from a scheme of fetal circulation suggest a cueing effect. Variable effects from other images indicate that a context-dependent interaction takes place with the content of questions. The conclusion is that item difficulty and item discrimination can be affected when images are used instead of answer lists; thus, the use of images as a response format has potential implications for the validity of test items.

The anatomy competence score: a new marker for anatomical ability

The assessment of students' ability in gross anatomy is a complex process as it involves the measurement of multiple facets. In this work, the authors developed and introduced the Anatomy Competence Score (ACS), which incorporates the three domains of anatomy teaching and assessment namely: theoretical knowledge, practical 3D application of the knowledge, and clinical or bedside application of knowledge on patients. Equal contributions from these tripartite domains were used to synthesize the ACS. The theory knowledge was assessed using MCQs and short answer questions while the knowledge of practical 3D application was assessed using an Objective Structured Practical Examination (OSPE). The clinical or bedside application of anatomy knowledge was assessed by an Objective Structured Clinical Examination (OSCE). In this correlation study, the authors examined the interdomain correlations of the summative marks for the three contributing domains of the ACS, in order to examine the rationality of this new marker. Three cohorts of medical students (n = 538) at St. George's, University of London (SGUL) Medical School in the United Kingdom were included and analyzed. The results demonstrated that the correlations between the three domains were significantly low or moderate. The three domains probably represent unique knowledge and abilities. Therefore, it would appear that the average of the domains scores (the ACS) provide a comprehensive picture of a student's ability in anatomy.