Clinical anatomy: a review course for emergency medicine residents

Why don't they know enough about anatomy? A narrative review

BACKGROUND

Publications in a variety of journals have described the problem of medical students' decreasing anatomical knowledge. Interestingly, the number of people making this assertion is growing, despite a lack of empirical evidence that today's medical graduates actually know less about anatomy than medical students in the past. Nevertheless, many people are claiming that students' anatomical knowledge is impaired due to negative effects from several factors, including teaching by non-medically qualified teachers, diminished use of cadaver dissection as a teaching tool and neglect of vertical integration of anatomy teaching.

AIM

To find empirical evidence for the factors claimed to have an influence on anatomical knowledge of students.

METHOD

A literature search.

RESULTS

There is a lack of sufficient quantity and quality of information within the existing literature to support any of the claims, but the gathered literature did reveal some fascinating insights which are discussed.

CONCLUSION

Anatomy education should be made as effective as possible, as nobody will deny that medical students cannot do without anatomical knowledge. Because of promising findings in the areas of teaching in context, vertical integration and assessment strategies, it is recommended that future research into anatomy education should focus on these factors.

A human dissection training program at Indiana University School of Medicine-Northwest

As human cadavers are widely used in basic sciences, medical education, and other training and research venues, there is a real need for experts trained in anatomy and dissection. This article describes a program that gives individuals interested in clinical and basic sciences practical experience working with cadavers. Participants are selected through an open application process and attend sessions focused on anatomical terminology, gross anatomy and radiography, and some of the educational applications of human cadavers. Dissection skills are honed during an intensive, two-day cadaver dissection and orthopedic workshop. Participants communicate the knowledge they gain through table-side discussions, reflect upon the experience during a memorial service, and submit written program evaluations. Additionally, the dissection and preparation of cadaveric materials accomplished in this course are used in the medical school gross anatomy course during the next academic year. From 2004 through 2008, the annual number of applicants increased from 40 to 167, and the number of participants increased from 25 to 43 per year. Program participants have represented diverse ethnic, educational, and professional backgrounds. Feedback from participants has been remarkably positive, including comments on the large amount of learning that takes place during the sessions, the positive impact the program has had on career choice, and the desire for program expansion. This program, which could be replicated at other institutions, teaches anatomy, prepares cadaveric prosections for teaching and training others, and encourages participants to pursue careers in anatomical and biomedical sciences.

A review of clinically relevant human anatomy in emergency medicine

The objectives of this project were to establish a practical model for the review of clinical anatomy relevant to the assessment and care of the ill and injured patient, and to design practice models for invasive procedures using human cadaver, porcine cadaver, and plastic model material. A practical course based on the human gross anatomy of the face, neck, thorax, airway, arm, and leg was designed. Regional anesthesia techniques, arthrocentesis, saphenous vein cutdown, central venous and arterial cannulation, surgical airway, thoracostomy tube placement and thoracotomy were integrated into the appropriate practice stations. A syllabus was developed. A clinically relevant, online anatomy atlas demonstrating all of the above was developed. In conclusion, an anatomy review course combining clinically relevant, human, gross anatomy and procedure practice stations was established.

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

BACKGROUND

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

STUDY DESIGN

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

RESULTS

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

CONCLUSIONS

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