How we teach anatomy efficiently and effectively

A proposed anatomy syllabus for entry-level physiotherapists in the United Kingdom: A modified Delphi methodology by physiotherapists who teach anatomy

The ever-increasing scope of physiotherapy practice is raising questions on what anatomical knowledge and skills ought to be taught within qualifying physiotherapy degree programmes in the United Kingdom (UK). The aim of the study was to create core anatomical knowledge and skills learning objectives to inform knowledge and skills for entry-level physiotherapists in the UK. A two phased modified Delphi methodology created a consensual anatomy curriculum. A Research-Team-Expert-Panel of four physiotherapists who teach anatomy proposed Anatomy Learning Objectives (Anat-LOs) and accompanying clinical rationales relevant for newly qualified entry-level physiotherapists. A Teacher-Expert-Panel of nine physiotherapists who taught anatomy to physiotherapy students in the UK reviewed Anat-LOs in two consecutive Delphi Rounds, and rated and commented on each Anat-LO. After each Delphi Round, the Research-Team-Expert-Panel reviewed the ratings and comments from the Teacher-Expert-Panel and banked Anat-LOs that passed the 85% acceptance threshold. There were 182 banked Anat-LOs that spanned all eight areas: Introductory Concepts, Principles and Basic Histology; Head and Neck; Thorax; Abdomen, Pelvis and Perineum; Upper Limb; Lower Limb; Spine; and Neuroanatomy regions/systems. The Anat-LOs develop both anatomical knowledge and key anatomical skills, such as palpation and conducting manual tests on model patients. A first ever core anatomy curriculum for entry-level physiotherapists has been created for entry-level physiotherapists, typically Band-5 NHS physiotherapists, and takes an integrated learning approach. The anatomy curriculum brings clarity to students, teachers, clinical supervisors and future employers on the expected anatomical standards for entry-level physiotherapists.

El ultrasonido, de la cabecera del paciente al aula

In recent years, ultrasound at the patient’s bedside has exponentially grown. Its application has been observed in the operating room, intensive care units, emergency rooms, first-level care and even in field work. It is so versatile that it facilitates diagnosis, improves patient monitoring and supports invasive procedures, all in a safe and effective manner. It has been used as a didactic tool in medical education that helps create a link between basic sciences and clinical application. Ultrasound is one of the most versatile instruments in contemporary medicine, hence, more training and research in the subject is a must and a priority. Key words: Point-of-care ultrasonography; insonation; medical education; anatomy; physiology

Student Perceptions of Veterinary Anatomy Practical Classes: A Longitudinal Study

Using cadaveric material to teach veterinary students poses many challenges. However, little research exists on the contribution of this traditional approach to student learning. This longitudinal study aimed to investigate student perceptions of cadaver-based anatomy classes in a vertically integrated veterinary curriculum at the University of Nottingham's School of Veterinary Medicine and Science. Likert-scale statements and free-text boxes were used in a questionnaire distributed to second-year veterinary students (response rate 59%, 61/103). The same questionnaire was subsequently distributed to the same cohort 2 years later, in the students' fourth year of study (response rate 68%, 67/98). Students agreed that cadaver-based activities aid their learning, and they particularly value opportunities to develop practical skills while learning anatomy. There are few changes in perception as undergraduates progress to clinical years of teaching. Students perceive anatomy to be important, and feel that their learning has prepared them for clinical placements. This study emphasizes the importance of using cadaveric materials effectively in anatomy teaching and, in particular, using clinical skills training to enhance the anatomy curriculum.

Ultrasound imaging in medical student education: Impact on learning anatomy and physical diagnosis

Ultrasound use has expanded dramatically among the medical specialties for diagnostic and interventional purposes, due to its affordability, portability, and practicality. This imaging modality, which permits real-time visualization of anatomic structures and relationships in vivo, holds potential for pre-clinical instruction of students in anatomy and physical diagnosis, as well as providing a bridge to the eventual use of bedside ultrasound by clinicians to assess patients and guide invasive procedures. In many studies, but not all, improved understanding of anatomy has been demonstrated, and in others, improved accuracy in selected aspects of physical diagnosis is evident. Most students have expressed a highly favorable impression of this technology for anatomy education when surveyed. Logistic issues or obstacles to the integration of ultrasound imaging into anatomy teaching appear to be readily overcome. The enthusiasm of students and anatomists for teaching with ultrasound has led to widespread implementation of ultrasound-based teaching initiatives in medical schools the world over, including some with integration throughout the entire curriculum; a trend that likely will continue to grow. Anat Sci Educ 10: 176-189. © 2016 American Association of Anatomists.

Teaching bedside sonography using peer mentoring: a prospective randomized trial

OBJECTIVES

Bedside sonography is a growing field of medicine, but there is little evidence about how to teach it to medical students. A peer-mentoring system may help preclinical medical students learn bedside sonography.

METHODS

In 2008 and 2009, participating first-year medical students completed an image recognition test at 0, 2, and 4 months and were randomized to an early or a late intervention group. In hands-on sessions, senior medical students taught the early intervention group how to perform a Trinity hypotensive ultrasound protocol between months 0 and 2 and then taught the late intervention group the Trinity protocol between months 2 and 4. Participants completed a practical examination at month 4. We measured the improvement in knowledge after the intervention and retention of knowledge and skills in the early intervention group at month 4. First-year medical students completed precourse and postcourse surveys about comfort and skills with sonography.

RESULTS

Eighty-six first-year medical students enrolled; 79 completed the precourse survey; 54 completed all knowledge tests; 52 completed the practical examination; and 49 completed the postcourse survey. Of the 125 nonparticipants, 109 completed the precourse survey, and 25 completed the postcourse survey. Participants' knowledge scores increased by 30% after the intervention. The early intervention group retained 92% of the knowledge gained. Thirty-six percent of participants were able to complete the Trinity protocol in 15 minutes during the practical examination, with no significant difference between the early and late intervention groups. Participants responded positively about the experience and indicated that hands-on sessions were helpful.

CONCLUSIONS

Peer mentoring is a useful method for teaching sonography to preclinical medical students.

Properties of publications on anatomy in medical education literature

Publications on anatomy in medical education appear to be largely anecdotal. To explore this, we investigated the literature on anatomy in medical education, aiming first to evaluate the contribution of the literature on anatomy in medical education to "best evidence medical education" (BEME) and second to evaluate the development of this literature toward more "best evidence" between 1985 and 2009. Four databases were searched for publications on anatomy in medical education published between 1985 and 2009, resulting in 525 references. Hundred publications were characterized by five variables (journal category, paper subject, paper category, author perspective, and paper perspective). Statements from these publications were characterized by two variables (category and foundation). The publications contained 797 statements that involved the words "anatomy," "anatomical," or "anatomist." Forty-five percent of the publications contained no explicit research question. Forty percent of the statements made were about "teaching methods" and 17% about "teaching content," 8% referred to "practical value," and 10% to "side effects" of anatomy education. Ten percent of the statements were "positional," five percent "traditional," four percent "self-evident," and two percent referred to "quality of care." Fifty-six percent of the statements had no foundation, 17% were founded on empirical data, and 27% by references. These results substantiated the critical comments about the anecdotal nature of the literature. However, it is encouraging to see that between 1985 and 2009 the number of publications is rising that these publications increasingly focus on teaching methods and that an academic writing style is developing. This suggests a growing body of empirical literature about anatomy education.

A bedside ultrasound curriculum for medical students: prospective evaluation of skill acquisition

OBJECTIVE

We conducted a study to evaluate the efficacy of an introductory ultrasound (US) curriculum for medical students rotating through our emergency department.

MATERIALS AND METHODS

Third- and 4th-year medical students indicated their previous US experience and were given a pretest consisting of static US images to assess baseline interpretation skills. They participated in a 45-min interactive didactic session followed by a 45-min session of hands-on experience practicing real-time US image acquisition on a normal model. After this session, we tested the timing and quality of their image acquisition skills on a separate normal model. Quality of images was based on a point value from 0 to 2 per image. This was followed by a posttest of static US images, which was graded in the same manner as the pretest.

RESULTS

Thirty-one students participated in the study. Median time to acquire 2 images was 112.5 sec (range = 15420 sec). Acquisition time was unaffected by previous experience (p = .97). The mean score on the quality of 2 images (maximum score = 4) was 3.84; median was 4 (range = 14). Image quality was significantly better in participants with previous US experience (p = .014). Scores on interpretation of static images improved significantly from pretest to posttest by a median of 8.25 points (p = .0001).

CONCLUSION

Our introductory US course is effective at significantly improving medical students' interpretation of static US images. The majority of students were able to acquire high quality images in a short period of time after this session.

Anatomy instruction in medical schools: connecting the past and the future

Anatomy curriculum has changed dramatically around the world since the 1960s. These changes include the reduction of course hours, the abandonment of cadaver dissection, the use of problem-based learning, application of other teaching modalities such as prosected specimens, models, radiographic images, computer simulations, and the introduction of humanity and death education. This article discusses the controversies in anatomy curriculum in Western countries, including the rationale for those changes, and the opinions of the objections.

Students' evaluation on a two-stage anatomy curriculum

This study evaluated students' perspectives of the two-stage anatomy course, which is designed to retain the time-honored tradition of cadaver dissection and to include innovative components into anatomy education. A total of 94 sixth-year medical students completed a questionnaire survey at the end of the second stage anatomy course. The results showed that more than half of the students were satisfied with the two-stage anatomy course. Students found that cadaver dissection was most helpful in learning anatomy. The two-stage anatomy course can enhance understanding and memory of anatomical knowledge. However, students disagreed on whether or not the two-stage course can reduce the burden of learning or that the parallel study of anatomy and the 'Life and Death' course could change their attitude toward death more effectively. National Licensing Examination revealed no obvious change after the implementation of the new anatomy course. Traditional and innovative components in anatomy curriculum could coexist in harmony. We provided an alternative for those who wanted to retain cadaver dissection in a reformed curriculum. Further study is needed to evaluate the adequacy of anatomy knowledge and student performance in the long run.

Using fresh tissue dissection to teach human anatomy in the clinical years

PURPOSE

Gross anatomy is taught in medical school with textbooks, cadaver dissection, plastic models, and multimedia illustration, but all lack the reality of color and texture that is possible with fresh tissue dissection. The authors studied the use of fresh tissue dissection of the thorax and abdomen of the rat to teach human anatomy.

METHOD

In a half-day exercise, 52 fourth-year medical students paired off and completed an exercise to dissect in less than three hours the thorax and abdomen of a euthanized rat. Observation of organs was augmented by active manipulation such as passing a tube down the esophagus, cannulating the trachea and inflating the lungs, injecting dye in the kidney to trace the ureter and bladder, and pulling the testis through the inguinal canal. Comparison of the rat and human was emphasized to enhance the education. The exercise ended with practice suturing fresh tissue.

RESULTS

Students rated the exercise to teach anatomy as 4.9 positive on a 5.0 (high) scale. The significant positive structures (p <.05) for texture were heart, liver, lungs and trachea; for color they were lungs and spleen; for location and size they were adrenal gland and urinary bladder; and for function they were adrenal gland and esophagus.

CONCLUSION

Fresh tissue dissection of the thorax and abdomen of the rat is a valuable tool for human anatomy education. The dissonances in human and rat anatomy enhance abstraction and transfer of knowledge. Active manipulation of organs promotes retention of knowledge, and suturing provides a "clinical" context. Fresh tissue dissection is an efficient innovative method to provide a global review of anatomy of the thorax and abdomen during the busy clinical years of medical education.

Teaching anatomy without cadavers

BACKGROUND

Anatomy learning is generally seen as essential to medicine, and exposure to cadavers is generally seen as essential to anatomy learning around the world. Few voices dissenting from these propositions can be identified.

AIMS

This paper aims to consider arguments relating to the use of cadavers in anatomy teaching, and to describe the rationale behind the decision of a new UK medical school not to use cadaveric material.

DISCUSSION

First, the background to use of cadavers in anatomy learning is explored, and some general educational principles are explored. Next, arguments for the use of human cadaveric material are summarised. Then, possible arguments against use of cadavers, including educational principles as well as costs, hazards and practicality, are considered. These are much less well explored in the existing literature. Next, the rationale behind the decision of a new UK medical school not to use cadaveric material is indicated, and the programme of anatomy teaching to be employed in the absence of the use of human remains is described. Curriculum design and development, and evaluation procedures, are briefly described. Issues surrounding pathology training by autopsy, and postgraduate training in surgical anatomy, are not addressed in this paper.

FUTURE DIRECTIONS

Evidence relating to the effect on medical learning by students not exposed to cadavers is scant, and plainly opportunities will now arise through our programme to gather such evidence. We anticipate that this discussion paper will contribute to an ongoing debate, in which virtually all previous papers on this topic have concluded that use of cadavers is essential to medical learning.

The use of brainstorming for teaching human anatomy

Interactive teaching techniques have been used mainly in clinical teaching, with little attention given to their use in basic science teaching. With the aim of partially filling this gap, this study outlines an interactive approach to teaching anatomy based on the use of "brainstorming." The results of the students' critique of the teaching techniques are also included. Seventy-five students from the first-year nursing curriculum were tested by a structured questionnaire after three brainstorming sessions. The overall response to these sessions was very positive, indicating that students perceived this interactive technique as both interesting and useful. Furthermore, this approach may provide a useful strategy when learning the clinical courses of the upcoming academic years.

Handouts as an educational support for the teaching/learning program in clinical anatomy

Handouts were developed to support the program of Clinical Anatomy in the Medical School of Porto, and since 1996/97 alterations have been made to improve their format and content with our educational objectives in mind. A questionnaire was designed to evaluate the opinion of second-year medical students enrolled in the program. Students were asked about their approval of the way handouts were organized and their usefulness, especially for lectures and practical sessions on physical examination, sectional and imaging anatomy, anatomical variations and malformations and case studies. Of 152 students, 138 (90.8%) returned the questionnaire. To describe the relationship between the value of handouts and several aspects of their organization and adequacy, the Spearman rank correlation coefficient was used for lectures, and canonical correlation for the various practical sessions. Students fully approved the way the handouts of lectures and practical sessions were organized (81.8% and 87%, respectively), their presentation (74.6% and 86.2%), relevance (88.3% and 85.5%), usefulness in understanding the lectures (77.6%) and their value in preparing for practical sessions (83.3%). Handouts were considered highly useful for case studies (90%), physical examination (81.9%) and sectional anatomy (65.7%). Students stating a higher degree of utility of the handouts emphasized that they were useful-indeed essential-in preparing for sessions, and noted their objectivity. The evaluation of the handouts was highly favorable and showed that they can be used as a guide through the complexities of an innovative program of Clinical Anatomy.

A case-based anatomy course

A course is described in which the students give consideration to clinical cases as they review their current knowledge, and follow a set protocol which guided them in preparing their learning. The students are required to examine a case history, put down as key words either their first answer or the knowledge they consider they would need to answer specific questions. They then select stations at which additional information, wet specimens, models and radiological images assist them in upgrading their knowledge. They complete the exercise by writing a final answer to the questions on the case. The tutor is able through examination of the key words to determine the knowledge of the students as they enter, and confirm appropriate learning by inspection of the final answer. The students are able to identify their own deficiencies, develop strategies for thinking and learning, resulting in the acquisition of expertise in problem solving, and extend their communication skills by working with colleagues. While the course was designed for second-year anatomy teaching it could be applied to other disciplines.