Team-based learning in a medical gross anatomy and embryology course

The application of team-based learning (TBL) as a major component of a medical gross anatomy course was evaluated. TBL is a method of small group instruction that addresses some of the shortcomings of other small-group teaching approaches. The core components of TBL were instituted in 12 small group sessions in the course. Each session included objective-oriented assignments, an individual readiness assurance test, a group readiness assurance test and a group application problem. Peer evaluation was carried out on a regular basis. Scores from TBL session activities and course examinations were analyzed and compared to previous years' course performance. Student course evaluation data and faculty feedback were also collected. Student evaluation data and faculty response indicated strong support for the TBL method as it was implemented in the course. Faculty noted improvements in students' day-to-day preparedness and group problem solving skills. Students' mean scores on exams were not significantly different from those of previous years. There was, however, a significantly smaller variance in examination scores that was reflected in a lower course failure rate compared to previous years. Correlation analyses of TBL and examination performance suggested that individual readiness assurance test performance is a good predictor of examination performance. TBL proved to be a superior method for small group learning in our anatomy course. Student performance suggested that TBL may most benefit academically at-risk students who are forced to study more consistently, are provided regular feedback on their preparedness and given the opportunity to develop higher reasoning skills.     

Seminar in breast self-examination for female medical students integrated into a human gross anatomy course

A breast self-examination (BSE) seminar for first-year female medical students is presented and a single-gender approach for other subjects in the medical curriculum is discussed. In 1999 a small group seminar on BSE was offered at the Hannover Medical School to female medical students as part of their curriculum in human gross anatomy. An evaluation questionnaire was answered by 94 students (87% of participants). Frequencies of answers to two open questions were used as indicators of: 1) the acceptance of a single-gender course and 2) an increased awareness of breast cancer prevention. A linear regression analysis was carried out to identify the most important predictors for the global course evaluation and a heightened interest in breast cancer prevention. The mean global rating of the seminar was 13.8 (minimum: 1 point; maximum: 15 points). Factors that significantly influenced the global rating were the course atmosphere, the teacher's enthusiasm, and the professional interest of the students. An increased concern for breast cancer prevention was significantly dependent on the professional interest and the self-awareness of the women. The results suggest that there is a need for single-gender seminars in academic medicine and that instruction of female students in BSE is an ideal subject for this approach. Because of the prevalence of breast cancer, it is recommended that such a seminar become an integral part of the preclinical curriculum for all female medical students.     

Saturated salt solution: a further step to a formaldehyde‐free embalming method for veterinary gross anatomy

In the field of veterinary anatomy, most of the specimens used in practical sessions are perfused with fixatives. Thus, they can be used for a longer time_, reducing the number of animals for educational purposes. Formalin is the most commonly used fixative, consisting of a 37% formaldehyde solution. However, formaldehyde is a powerful irritant of the eyes and airways and is considered carcinogenic, causing nasopharyngeal cancer in exposed workers and professionals. In the present study, we explored an alternative method to avoid the use of formaldehyde in specimens used for gross anatomy practical sessions. We propose an inexpensive, non‐toxic fixative that is available worldwide, such as sea salt. This method consists of a continuous perfusion of saturated salt solution for a period of 6–8 h, enabling drainage of the solution to avoid a weight increase of the specimen, and allowing salt to be retained in the tissue. The method is based on recirculation of the saturated salt solution instead of maceration. Perfused specimens retained their natural consistency and joint mobility, with no blood, resembling a piece of meat from the slaughterhouse. They could be used immediately without a maceration period, or stored in the fridge until use and then kept in a bath of saturated salt solution for future conservation. In the case of the former, no refrigeration was needed. The specimens did not have an irritating or offensive smell, and could be used for long sessions (several hours per day) and stored for long periods. However, the blood vessels used for perfusion determine the results: a less invasive approach (through common carotid arteries) gave good preservation of the musculoskeletal system, whereas more invasive access to cannulate the abdominal aorta and vena cava caudalis was required to achieve better preservation of the viscera. In conclusion, we propose that perfusion followed by immersion in a saturated salt solution is a good alternative method for the preservation of specimens used in the practical teaching of gross veterinary anatomy. It is a very simple and inexpensive technique, and is much healthier for users than traditional formalin. Moreover, specimens can be preserved for prolonged periods, and maintain a similar appearance and consistency to fresh material.     

A paradigm shift from teaching to learning gross anatomy: meta-analysis of implications for instructional methods

Anatomy teaching in terms of content and methodology has undergone major changes in the recent times due to time constraints, scarcity of cadavers, rapid advances in information technology, and changes in the demands of the medical profession. Moreover, there has been a major paradigm shift in medical education from passive, didactic, and teacher-centered approach to active, clinical-based, and student-centered approach. The debate on how to teach anatomy in the most effective way continues, and there is not yet a workable solution to integrate the two lines of thought (teacher-centered/student-centered) that can resolve the dispute between the two approaches. The present article therefore meta-analyses the role and effectiveness of various instructional modalities in teaching and learning anatomy in the context of the shifting paradigm from teaching to learning. The available literature on the use of various instructional strategies employed for teaching-learning anatomy suggests that the challenge should not be to determine superiority of one methodology over another but to capitalize on the learning benefits offered by the different methods. Learners should be provided opportunity to use multiple resources, thus favoring flexibility in the acquisition of knowledge. Proper amalgamation of traditional teaching methodologies such as lectures and dissection and the newer instructional methods, namely problem-based learning and computer-aided learning, would help to catalyze the shift from pedagogy to andragogy, where educators no longer serve chiefly as the dispensers of the subject content, but act as facilitators of learning and evaluators of competency. The net result should be to produce lifelong learners committed to continuous improvement of skills and knowledge.     

A follow-up comparative study of two modes of learning human anatomy: By dissection and from prosections

Two groups of medical students (traditional and experimental), who had studied the gross anatomy of the lower limb by different methods (by dissection and from prosections, respectively) 5 years earlier, were re-assessed without warning. The objective was to determine whether or not the learning mode had any implications for the subsequent recall of the material studied. Three tests were administered: a 100-item two-choice theory paper, a practical test consisting of 18 time stations with specimen-based questions, and a standardized oral examination. Both qualitative and quantitative assessments were made in the practical and oral examinations. Although the numerical scores gained by both groups in the practical test were statistically similar, the incidence of random guesswork was significantly less among students on the experimental program. The same group was also adjudged to have performed better in the oral examination by two of the investigators who were blind to the group affiliations of the students. The results suggest that on testing 5 years after a practical learning experience in gross anatomy, the numerical scores gained by students who had studied from prosections were similar to those of their peers who had carried out dissections but that, by some qualitative considerations, the recall ability of the non-dissecting students was superior. Furthermore, the program of study from prosections lasted only 74% of the duration of the dissection course and is thus more efficient. The results recommend the program to institutions faced with unfavorable student-to-cadaver ratios. The time it liberates may be dedicated to such other imaginative pedagogical purposes as autonomous student learning, clinical demonstrations, and problem-solving team exercises. © 1996 Wiley-Liss, Inc.     

Analysis of medical students' use of web-based resources for a gross anatomy and embryology course

An extensive Web site supporting our gross anatomy and embryology course, which includes various course management pages as well as online lectures, has been in use for the past 2 years. To determine how this Web site is being used by students, we examined server log files to track access to each of the Web pages on the site. Using this data, along with student responses on a course evaluation, we have been able to quantitatively characterize Web site use and gain some insight into students' perception of the site. This analysis showed that all of the resources available online, including course management information, exam reviews, online lectures, and dissection guides were heavily used and deemed useful by students. Despite universal computer ownership and Internet access from home, most use of the Web site was from on-campus computer labs, especially for lectures with audio streams. This was probably due to the limited bandwidth of off-campus connections. Data on the day of the week and time of the day of access showed peak activity at expected times, but also significant activity at all hours, as students took full advantage of 'access on demand.' This on-demand nature of the Web was also evident in students' viewing of lectures in short sessions rather than in one sitting. Online lectures were used regularly by a majority of students both before and after corresponding class sessions, however, this was not the preferred venue for all students. Although the flexibility of Web-based resources accommodates students' varying study habits, the alternative of traditional print material and live lectures should not be abandoned lightly.     

Achievement of learning outcomes in non-traditional (online) versus traditional (face-to-face) anatomy teaching in medical schools: A mixed method systematic review

In recent years, the logistical challenges posed by the Covid-19 pandemic have prompted medical educators teaching gross anatomy to explore an expanded use of online instructional modalities. There is concern that this shift to online anatomy education in medical schools could affect long-term learning outcomes for future healthcare providers. In this systematic review, the educational effectiveness of online anatomy teaching is compared with traditional (“face-to-face”) teaching methods, specifically in terms of students' academic performance and satisfaction. A search of four databases identified and screened 162 studies. Subsequently, 31 studies were analyzed, including both (a) teaching outcome measures (test scores) and (b) student satisfaction ratings. Authors chose studies, extracted data, assessed quality and examined risk of bias. Nineteen studies compared students' academic performances between online and face-to-face teaching methods. Twenty-six studies measured students' levels of satisfaction in both teaching methods. Both qualitative and quantitative analyses of the data revealed comparable academic performances with no statistical difference between the two teaching methods, but a higher level of satisfaction with face-to-face teaching. The findings confirm that students can learn from online teaching but are more satisfied with face-to-face teaching. The authors conclude that online teaching cannot replace traditional teaching and there is no preference for one type of modality over the other. Therefore, a multi-modal learning approach combining online with face-to-face educational modalities for medical students could be efficient and successful.     

Testing knowledge of human gross anatomy in medical school: An applied contextual-learning theory method

The traditional gross anatomy laboratory experience, with modifications in evaluations that we outline later, meets the criteria of contextual-learning theory, expands the repertoire of core objectives we identify for our students, and may increase the likelihood of cognitive permanence of anatomical data. Our subjects included approximately 54 first-year medical students from each of three sequential class years (1996, 1997, 1998). As an alternative to more typical written and practical exams, examinations in a major portion of our gross anatomy program consist of two approximately 30 minute oral expositions by each student to his or her peers and a faculty member. Students demonstrate specific detail on cadaver, x-ray, cross sections, or a model. Clinical applications, spatial relationships, nomenclature, and functions are strongly emphasized. The results of this teaching approach to the utilization of anatomical knowledge in clinical situations requires further assessment; however, new attributes have been afforded our students with implementation of the present program: First, students learn anatomical detail equally well as the students of the more traditional system (based on board exam results). Second, students who completed the program indicate that this approach provides a useful simulation of what is expected later in their training. Third, students gradually gain confidence in verbal presentation, they demonstrate cognitive synthesis of separate conceptual issues, they retain information, and they are quite visibly more enthusiastic about anatomy and its importance in medicine. Our program demonstrates that the learning of applicable human anatomy is facilitated in a contextual-learning environment. Moreover, by learning anatomy in this way, other equally beneficial attributes are afforded the medical student, including, but not limited to, increases in communication skills, confidence in verbal presentation, synthesis of anatomical concepts, appreciation of the clinical importance of anatomy, and the general development of professionalism. © 1996 Wiley-Liss, Inc.     

Undergraduate coursework in anatomy as a predictor of performance: comparison between students taking a medical gross anatomy course of average length and a course shortened by curriculum reform

The performance of students taking medical gross anatomy at the University of California at Davis during a 4-year period (1999-2002) was correlated with prior undergraduate anatomy coursework. Significant correlations were observed between class rank in medical anatomy and taking any undergraduate anatomy as well as the total number of undergraduate anatomy units (P<0.01). Taking human gross anatomy and an anatomy laboratory course were significantly correlated with medical anatomy class rank (P<0.01) as were grades in human anatomy, comparative vertebrate anatomy and anatomy laboratory courses (P<0.05). The medical anatomy course offered in 1999-2000 was 172 hr long, and the course offered in 2001-2002 was 135 hr long, with most of the difference made by decreasing lecture time while sparing the dissection laboratory. The reduction in course length was the consequence of a curriculum-wide cap in weekly contact hours. In the 172-hr medical anatomy course there were significant correlations between the students who took undergraduate anatomy and both class rank and the score on the final examination (P<0.01). These correlations did not exist for the 135-hr course. This may be explained by previous anatomy experiences helping students learn from lecture more than from dissection laboratory, as well as the extra study time available to students in the reformed medical curriculum. Pre-medical students and health science advisors need to consider that the benefits of taking anatomy as an undergraduate may be dependent on the configuration of a medical school's curriculum.     

Clinical anatomy in the oncology patient: A preclinical elective that reinforces cross-sectional anatomy using examples of cancer spread patterns

A preclinical elective entitled Oncologic Anatomy is described which emphasizes the study of anatomy from a three-dimensional approach using examples of cancer spread patterns. Features of this elective course include patient presentations, a review of the anatomy, a diagnostic presentation and overview of radiologic imaging techniques, and “hands on” experience where students are introduced to aspects of the physical examination. This course format encourages active learning, facilitates basic and clinical science integration, offers early exposure to patients, and validates the importance of the psychosocial aspects of the medical profession. Clin. Anat. 11:95–99, 1998. © 1998 Wiley-Liss, Inc.     

A novel method with which to visualize the human sinuatrial node: Application for a better understanding of the gross anatomy of this part of the conduction system

For various clinical/surgical procedures, it is important to accurately understand the location of the sinuatrial node (SAN). Therefore, this study's goal was to develop a new and simple method to visualize the SAN in human hearts. A total of 16 formalin-fixed human hearts were used in the study. After the epicardium was removed, the fat tissue on the myocardium's surface was brushed and removed in a solution of 40°C water with a surfactant to show the SAN's location. Once the structure considered to be the SAN was observed, histological observation was conducted with Masson's trichrome staining to confirm its identity. The working myocardium, SAN branch of the coronary artery, and the structure believed to be the SAN were observed in all specimens. Histological analysis confirmed this structure to be the SAN. We believe that the method described herein might contribute to a better understanding of the SAN's morphologic features and serve as an improved teaching aide. Clin. Anat. 33:232–236, 2020. © 2019 Wiley Periodicals, Inc.     

The importance of teaching clinical anatomy in surgical skills education: Spare the patient,use a sim!

Anatomical knowledge is a key tenet in graduate medical and surgical education. Classically, these principles are taught in the operating room during live surgical experience. This puts both the learner and the patient at a disadvantage due to environment, time, and safety constraints. Educational adjuncts such as cadaveric courses and surgical skills didactics have been shown to improve resident confidence and proficiency in both anatomical knowledge and surgical techniques. However, the cost-effectiveness of these courses is a limiting factor and in many cases prevents implementation within institutional training programs. Anatomical simulation in the form of “desktop” three-dimensional (3D) printing provides a cost-effective adjunct while maintaining educational value. This article describes the anatomical and patient-centered approach that led to the establishment of our institution's 3D printing laboratory for anatomical and procedural education. Clin. Anat. 32:124–127, 2019. © 2019 Wiley Periodicals, Inc.     

The human meniscus: A review of anatomy,function, injury,and advances in treatment

Meniscal injuries are recognized as a cause of significant musculoskeletal morbidity. The menisci are vital for the normal function and long‐term health of the knee joint. The purpose of this review is to provide current knowledge regarding the anatomy and biomechanical functions of the menisci, incidence, injury patterns and the advancements in treatment options of meniscal injury. A literature search was performed by a review of PubMed, Google Scholar, MEDLINE, and OVID for all relevant articles published between 1897 and 2014. This study highlights the anatomical and biomechanical characteristics of the menisci, which may be relevant to injury patterns and treatment options. An understanding of the normal anatomy and biomechanical functions of the knee menisci is a necessary prerequisite to understanding pathologies associated with the knee. Clin. Anat. 28:269–287, 2015. © 2014 Wiley Periodicals, Inc.     

The evolving ethics of anatomy: Dissecting an unethical past in order to prepare for a future of ethical anatomical practice

Anatomical practice has arguably one of the most ethically challenging histories in the medical sciences. Among the oldest scientific disciplines in medicine, dissection of the human body for scientific purposes occurred as early as the third century Before the Common Era. Throughout the history of anatomical practice, human dissection has occurred in ways that cross the line from progressing medical science to violating the sanctity of the human body. The dissection of the human body creates ethical dilemmas which stem from the need for anatomical science to gain medical knowledge in juxtaposition with prevailing religious and moral views surrounding anatomy as a threat to the sanctity of the human body. This article examines the unethical history of human dissection throughout the ages and explores the rationale behind the unethical practices. In addition, this article explores imperative modern day ethical standards in anatomy including, the ethical handling of human bodies, respecting human life, and ensuring informed consent for dissection of bodies that are donated. Finally, this article explores the question of which ethical prism we should use when dealing with anatomy collections or works of the past. Learning both the history of unethical practices in anatomy and the rationale behind them is imperative so that the discipline can prepare for an ethical, diverse, and inclusive future. This article provides a foundation for understanding the evolution of ethics in anatomical practice and is a valuable resource for students and anatomists alike.