Student Perceived Value of Anatomy Pedagogy, Part I: Prosection or Dissection?

A comparison of pre- and post-clinical education learning preferences among medical students who elected to dissect compared to those who did not during the COVID-19 pandemic

Anatomy instructional methods varied widely during the COVID-19 pandemic and programs are assessing innovations for retention. Learning preferences were assessed among medical students dichotomized as elective dissectors (ED) or non-dissectors (ND) during the COVID-19 partial re-opening in 2020 (preclinical) and again in 2022 after clinical exposure (post-clinical) to assess the viability of elective dissection post-pandemic. A mixed-method approach was used for the assessment of test scores, learning preference surveys, learning activities rankings, and thematic analyses. No significant differences occurred in anatomy examination scores. Dissection was considered useful by both preclinical groups but significantly more so by ED, while the presence of an instructor was significantly preferred by ED although a majority of ND agreed. Elective dissection was significantly preferred by ND but also by a large minority of ED students. Pre- and post-clinical ND believed that elective dissection offered more academic flexibility, did not hinder clinical learning, and did not negatively impact medical education. The corresponding ED stated that confidence improved, clinical experiences were enhanced, and dissection was irreplaceable. Preclinical ND preferred self-learning, while ED students preferred online learning, but these differences largely disappeared post-clinically. Learning activity rankings were not significantly different among all groups (ND, ED, preclinical, and post-clinical). A hybrid laboratory with a virtual learning environment ranked highest across groups and preferences increased over time suggesting that students benefited from this instructional method during clinical exposure. The absence of laboratory experience ranked lowest, and preference decreased over time suggesting that anatomy dissection is valued.

Comparing the emotional experiences of students in similar dissection- and prosection-based medical gross anatomy courses: A mixed-methods study

The anatomy laboratory can incite strong emotional reactions in students, which can in turn facilitate growth in empathy, care for vulnerable others, and professionalism. Despite this, little is known about the relative emotional impacts of different laboratory modalities. The response to the COVID-19 pandemic created an opportunity to compare the emotional experiences of students in similar courses in which one group of students dissected donors and the other group learned from prosected donors. The courses were otherwise the same in content, length, instructional design, and assessment. Students in the dissection-based (Fall 2019) and prosection-based (Fall 2020) courses completed a previously validated survey that used quantitative and qualitative questions to assess their feelings about the donors and the anatomy laboratory experience. Students in both cohorts reported overall appreciation for having had the experience. Negative themes experienced by both groups included feeling anxiety, worries about depersonalizing donors, and physical discomfort in the laboratory. Students in the dissection course reported stronger connections with the donors and the donors' families but also more frequently felt negative feelings such as disgust, anxiety, and feeling alone. Students in the prosection course reported more consistently positive responses but worried about not using the donors to the fullest extent possible. Regardless of pedagogical design, students have complex emotional experiences in the anatomy laboratory and our results indicate that these feelings may be more intense in the context of dissection. Anatomists should foster educational settings that enable students to learn to process complex or challenging emotions.

Dyad pedagogy in practical anatomy: A description of the implementation and student perceptions of an adaptive approach to cadaveric teaching

Prior to the challenges imposed by the Covid-19 pandemic, anatomy practical sessions at Trinity College Dublin involved eight to 10 students per donor station, rotating between digital learning, anatomical models/osteology, and dissection activities for three hours weekly. To maintain cadaveric participation in the anatomy laboratory while adhering to distancing guidelines, a transition to dyad pedagogy was implemented. This mode of delivery allowed two students per donor station to spend one hour per week in the anatomy laboratory with all digital learning elements transferred to the virtual learning platform Blackboard as pre- and post-practical session learning activities. Dyad pedagogy has been explored in clinical settings and simulation procedural-based training but is yet to be fully verified in anatomy education. To determine the effectiveness of hybrid practical sessions and reduced donor to student ratios, the opinions of first year medical students were examined using an online questionnaire with a 51% response rate. Although students recognized the merits of more time in the anatomy laboratory, including opportunities for self-directed study and exposure to anatomical variation, they felt that having two students per station enabled sufficient hands-on time with the donor body and fostered learning opportunities that would not be possible with larger groups. Strong preferences for quality time with the donor body supported by online resources suggests this modality should be a key consideration in course design for anatomy curricula and emphasizes the importance of gauging students' preferences to optimize satisfaction and learning output when pivoting to blended learning strategies in anatomy education.

Effectiveness of Pedagogical Tools for Teaching Medical Gross Anatomy During the COVID-19 Pandemic

Medical institutions have been forced to modify gross anatomy pedagogy to comply with the health restrictions imposed by the novel coronavirus (COVID-19). Boston University School of Medicine (BUSM) is one such institution that temporarily restructured its course. We replaced cadaveric dissection activities with prosections and placed a greater emphasis on a flipped classroom model. This study investigates the effectiveness of new course materials developed to aid these curriculum changes. Course materials were developed for three purposes: (1) preparation before laboratory sessions (orientation videos and Complete Anatomy (3D4Medical, Elsevier) screens); (2) guidance during laboratory sessions (laboratory guides); and (3) review after laboratory sessions (Zoom recitation sessions). We performed a grounded theory thematic analysis of students' responses (80/160, 50% response) to qualitative survey questions and to focus group questions (16 students who self-selected between 4 different sessions). Data from both the survey and focus groups demonstrated that the vast majority of students agreed that the materials helped them navigate through learning gross anatomy. However, laboratory guides were used mostly for post-lab review as opposed to the intended direction during laboratory sessions. Students within all focus groups overwhelmingly touted the value of Zoom recitation sessions, with many stating that they were imperative to course success. When comparing performance data between 2019 (pre-COVID) and 2020 students, we found that the students who took the anatomy course during the onset of COVID had a slightly higher overall average score in all three modules of the course than compared to the 2019 students. We propose that the utilization of course materials that students perceived as time saving and pertinent to their exam performance, when combined with cadaveric prosection, emphasized the benefits of flipped-classroom learning to help students learn gross anatomy effectively and efficiently during the pandemic and beyond.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s40670-022-01524-x.

Differences Between Attached and Detached Cadaveric Prosections on Students' Identification Ability During Practical Examinations

Cadaveric prosections are effective learning tools in anatomy education. They range from a fully dissected, sometimes plastinated, complete cadaver (in situ prosections), to a single, carefully dissected structure detached from a cadaver (ex situ prosections). While most research has focused on the advantages and disadvantages of dissection versus prosection, limited information is available on the instructional efficacy of different prosection types. This contribution explored potential differences between in situ and ex situ prosections regarding the ability of undergraduate students to identify anatomical structures. To determine if students were able to recognize the same anatomical structure on both in situ and ex situ prosections, or on either one individually, six structures were tagged on both prosection types as part of three course summative examinations. The majority of students (61%-68%) fell into one of the two categories: those that recognized or failed to recognize the same structure on both in situ and ex situ prosections. The percentage of students who recognized a selected structure on only one type of prosection was small (1.6%-31.6%), but skewed in favor of ex situ prosections (P ≤ 0.01). These results suggest that overall students' identification ability was due to knowledge differences, not the spatial or contextual challenges posed by each type of prosection. They also suggest that the relative difficulty of either prosection type depends on the nature of the anatomical structure. Thus, one type of prosection might be more appropriate for teaching some structures, and therefore the use of both types is recommended.

Dissection in the Modern Medical Curriculum: An Exploration into Student Perception and Adaptions for the Future

For centuries cadaveric dissection has been a cornerstone of medical anatomy education. However, time and financial limitations in modern, compressed medical curricula, coupled with the abundance of alternate modalities, have raised questions about the role of dissection. This study was designed to explore student perceptions of the efficacy of a dissection program for learning musculoskeletal anatomy, and possible adaptations for appropriate inclusion of dissection in the modern medical curricula. A paper-based questionnaire was used to collect data from 174 medical students after completion of cadaveric dissections. Data were analyzed using both quantitative and qualitative methods. Students strongly believed that cadaver-based learning is essential to anatomy education and modern teaching modalities only complement this. Moreover, most students reported that dissection provided an additional, immersive learning experience that facilitated active learning and helped in developing manual competencies. Students with previous dissection experience or an interest in anatomy-related specialties were significantly more likely to attend dissection sessions. Students found that the procedural dissection components enhanced the knowledge of applied anatomy and is beneficial for the development of clinical skills. They welcomed the idea of implementing more procedure-based dissections alongside lectures and prosections-based practical (PBP) sessions. Cadaveric dissection plays an integral role in medical anatomy education. Time restraints and an increased focus on clinical significance, however, demand carefully considered adaptations of existing dissection protocols. The introduction of procedure-based dissection offers an innovative, highly engaging and clinically relevant package that would amalgamate skills essential to medical practice while retaining the benefits that have allowed dissection to stand the test of time.