Improving Medical Student Anatomy Knowledge and Confidence for the Breast Surgical Oncology Rotation

How about an anatomy elective? Making a case for utilizing spaced repetition and longitudinal integration of anatomy in medical curricula

BACKGROUND

Anatomy can be rapidly forgotten without repetition and retrieval. With an overall decrease in time allotment for teaching discrete subjects, longitudinal integration of anatomy throughout medical curricula is a more effective approach. This study sought to assess the efficacy of spaced repetition in an integrated anatomy elective.

METHODS

An advanced anatomy elective course was designed for second-year medical students at one medical school. Spaced repetition was utilized to review gross and radiological anatomy. A total of 21 students participated in 2022 and 2023. Student reflections were collected via an online survey and focus group interviews. Qualitative data was thematically analyzed using an abductive coding scheme. Major themes and subthemes were identified via cross-case analyses.

RESULTS

Survey results showed that 95% of students felt better prepared for USMLE Step 1 after taking this elective. Strongest aspects of the course were identified as: 1) reviewing anatomy in the context of medical imaging, 2) revisiting anatomy lab as teaching assistants, 3) reinforcing foundational and multidisciplinary basic science concepts using clinical case questions. Overall findings based on both phases of data analysis indicated that participation in the elective increased student confidence in preparation for Step 1 and helped solidify their understanding of foundational anatomical knowledge while also enhancing metacognition.

CONCLUSIONS

An anatomy elective course can serve as an efficient and effective step toward longitudinal integration of anatomy in undergraduate medical curricula. Future research is needed to assess the quantitative impact of this educational intervention on long-term learning and student performance on Step 1.

Medical Student Musculoskeletal Knowledge: Examining the Impact and Value of an Orthopaedic Surgery Clerkship Using the Freedman and Bernstein Examination

PURPOSE

Given the importance of musculoskeletal knowledge but the limited orthopaedic instruction offered in medical school, our Orthopaedic Surgery Department developed a three-week clerkship for interested students. This study assesses the clerkship's impact on medical student musculoskeletal knowledge through administration of the Freedman and Bernstein Basic Cognitive Musculoskeletal Examination.

METHODS

Medical students enrolled in the orthopaedic surgery clerkship between February 2019 and May 2024 were asked to participate in pre- and post-clerkship surveys using the Freedman and Bernstein Basic Cognitive Musculoskeletal Examination. Raw and weighted scores were computed according to the guidelines provided by Freedman and Bernstein. Averaged scores were used to compute mean pre- and post-test scores.

RESULTS

There were 64 responses to the pre-test and 33 responses to the post-test. The mean pre-test weighted score was 54% with 12 students (18.8%) passing. The mean post-test score was 70% with 17 students (51.5%) passing. Raw scores showed that musculoskeletal knowledge improved from pre-test (M = 55.13, SD = 19.90) to post-test (M = 70.22, SD = 14.70; p < .001). The results comparing weighted scores showed that the participants' musculoskeletal knowledge also improved from pre-test (M = 52.86, SD = 21.12) to post-test (M = 67.11, SD = 19.02; p < .001).

CONCLUSION

While students demonstrated improved musculoskeletal knowledge after completing our institution's orthopaedic surgery clerkship, almost half of the students did not pass the post-test. Most of the students who did not pass the post-test expressed definite or possible interest in pursuing an orthopaedic surgery residency.

Going back to anatomy roots: Exploring the integration of anatomy sessions during clinical clerkships

The topic of vertical integration of the basic and clinical sciences is an area of great concern and active investigation in medical education. To explore the feasibility of integrating basic sciences into the clinical phase of medical education, gross anatomy was selected as an appropriate discipline. Anatomy faculty, clerkship directors, medical students, and graduate students developed case-based anatomy modules with a design consistent with the principles of self-directed learning. This pilot study aimed to explore medical student responses to the integration of anatomy sessions during clinical clerkships. One-hour anatomy sessions were conducted during rotations of the following clerkships: internal medicine, pediatrics, family medicine, neurology, obstetrics and gynecology, and general surgery during the academic year 2022-2023. Each session consisted of four case-based stations. Voluntary, anonymous surveys were distributed at the end of each session. Descriptive statistics of survey responses from the 490 participants revealed the overall ratings of the anatomy sessions to be above an 8.50 on a scale of 1.00 (low) to 9.00 (high). A small q thematic analysis of the open-ended survey questions revealed the following themes: relevance of clinical correlations presented, a timely review of anatomical content, appreciation for the collaborative setting and interactivity among the participants, and constructive feedback regarding areas needing improvement. Students reported a high overall rating of the anatomy sessions and shared positive comments about these vertically integrated anatomy experiences. With a reduction in the amount of anatomy instruction during the pre-clinical years and limited exposure during the clinical years, anatomy sessions like the ones proposed could allow for the fluid incorporation of gross anatomy across all 4 years of medical school.

Interactive multidisciplinary pilot workshop to improve medical student perception of and interest in breast surgical oncology

BACKGROUND

Exposure to breast surgical oncology (BSO) and the multidisciplinary management of patients with breast cancer is limited in medical school. The purpose of this study was to assess changes in student perceptions of BSO as a career following an interactive multidisciplinary workshop.

METHODS

Pre-clinical medical students participated in a multidisciplinary, hands-on workshop, composed of breast radiology (BR), breast surgical oncology (BSO) and breast plastic reconstructive surgery (B-PRS). BR presented students screening and diagnostic breast imaging followed by hands-on ultrasound-guided biopsy on phantom simulators. BSO demonstrated lumpectomy, mastectomy, sentinel lymph node biopsy, and axillary lymph node dissections while B-PRS demonstrated oncoplastic techniques and autologous flap reconstruction with cadavers. Pre-and post-workshop surveys assessed student opinions on surgery and BSO. Results were compared using Wilcoxon Signed Rank, Wilcoxon Rank Sum, and Fisher's Exact.

RESULTS

The workshop was attended by twenty-four students. There was a statistically significant increase in interest in BSO from 52% to 86% after the workshop (p = 0.003). The event improved understanding of the work and lifestyle in BSO for 79% (19/24). All students (100%) expressed interest to further explore BSO. The most common attractors to a career in BSO were impacts on patients' lives (N = 23), intellectual stimulation (N = 22), and earnings (N = 20). The most reported deterrents were lack of personal time (N = 18) and stress (N = 15).

CONCLUSION

An interactive, anatomically based exposure to multidisciplinary breast cancer surgery improves medical student perception and interest in BSO. Medical schools should consider incorporating similar events to foster interest in BSO and other surgical subspecialties.