Flipped classroom – A student perspective of an innovative teaching method during the times of pandemic

BackgroundFlipped Classroom is a blended form of learning in which the traditional didactic lectures are replaced by active classroom learning experience. Flipping the lectures outside the classroom and using the classroom for active interaction and projects has been the need of the hour. It is an innovative way of learning anatomy.MethodsThe study was done at Department of Anatomy, ESIC Medical College, KK Nagar, Chennai. After obtaining ethical committee approval and Consent for participating in the study, Pre-test questionnaire was shared through Google forms. The lecture PowerPoint about anatomy of larynx was shared with the students. Next day, during the scheduled class, the students were asked to present anatomy of larynx using different types of models. Post-test questionnaires were also shared, and the students were asked to submit feedback forms at the end of the session. The students were assessed by a group of subject experts who assessed the student’s anatomical knowledge, innovation with which they prepared the model, presentation, correctness of presentation and clinical application.ResultsOut of the 126 first year MBBS undergraduates, 100 students actively participated in the study. 41% of students agreed and 47% of students strongly agreed that flipped classroom was an enjoyable way of learning. 51% of students strongly agreed that they were able to go through the lecture prior to the presentation.ConclusionsFlipped classroom enhanced student learning through knowledge applications. Flipped classroom helped teachers to review and understand how much their students have read, retained, and applied the knowledge which was catered to them. There was largely a positive response for flipped classroom though flipped classroom cannot replace a regular classroom. Flipped classroom can be cumbersome as it involves extensive planning and coordination. It can be used to promote interest in the subject. Flipped classroom enhanced peer assisted learning.     

Student evaluation of faculty teaching in molecular anatomy course at Nippon Medical School: results of a questionnaire survey

For the purpose of improving education, the lecture and practices employed in the Molecular Anatomy Course were evaluated by students. The survey was performed with personal computer connected to a local area network and the results were readily exhibited on our website the following day. The total number of answers was 528 and the reply percentage was 31.2%. The average score (from 1: very bad to 5: very good) was 3.9, with a range of 3.2 to 4.8. Faculty teaching got better grades in the latter half of the period compared to those in the first half, particularly on "preparation" and "understanding". The correlation analysis showed a strong relationship between the understanding of the lecture and the orientation of practice. These findings suggest that constant evaluation by students during the whole period of the instruction is useful for improving the quality of education of our Anatomy Course.     

Correlation of Web usage and exam performance in a human anatomy and development course

Course materials for a Human Anatomy and Development Course were placed on the World Wide Web (WWW). The materials included a lab manual, lecture notes and slides, faculty-generated atlases, Web links, and examinations. The lab manual, lecture notes, and atlases were also provided as black-and-white hardcopy. The Office of Education assigned students a code name that allowed them to use the Web site and take exams anonymously. Student Web use was tracked and correlated with their performance on the final examination. Overall use patterns revealed that most students used the Web site to prepare for examinations, but not for daily studying. Old examinations were the most accessed documents; lecture notes were the least accessed. The access patterns of the students with top 20, middle 20 (closest to the mean), and bottom 20 scores on the final examination were compared. In general, there was little difference between the middle and top groups. Students in the bottom group used computer resources significantly less than the other groups. In a second analysis, the 10 students who used the Web site most frequently scored below the mean. The study suggests that interactive exercises will be heavily used, but that the preparation of all course materials for the WWW may not be an efficient use of institutional resources.     

Reciprocal peer teaching: students teaching students in the gross anatomy laboratory

Three common instructional strategies used to teach gross anatomy are lecture, discovery or inquiry-based learning, and cooperative learning. One form of cooperative learning, called reciprocal peer teaching (RPT), illustrates circumstances where students alternate roles as teacher and student. By assuming the responsibility of teaching their peers, students not only improve their understanding of course content, but also develop communication skills, teamwork, leadership, confidence and respect for peers that are vital to developing professionalism early in their medical careers. Traditionally in our Anatomy department, students dissect the entire body using a standard dissection manual. More non-traditionally, however, we have increased cooperative learning in the dissection laboratory by involving students in a series of supplementary RPT activities. During these exercises, 10% of the class practiced their demonstration with course instructors until the students felt prepared to demonstrate the exercise to their classmates. We designed one peer demonstration emphasizing three to six teaching objectives for most of the 40 dissection units. This resulted in a compendium of peer demonstrations for implementation throughout the course. The multitude of diverse exercises permitted each student many opportunities to teach their peers. A debriefing questionnaire was administered at the end of the course demonstrating that 100% of students agreed the RPT experience increased their understanding of the topics they taught and 97% agreed it increased their retention of information they taught to their peers. In addition, 92% agreed that RPT improved their communication skills, which can be applied beyond anatomy to their careers as future physicians.     

Using Keynote to Present Radiology Images

Numerous articles have offered instructions for working with advanced radiology images in Microsoft PowerPoint (Redmond, WA); however, no articles have detailed instructions to do the same on alternative presentation software. Apple Macintosh (Cupertino, CA) computers are gaining popularity with many radiologists, due in part to the availability of a powerful, free, open-source Digital Imaging and Communications in Medicine (DICOM) viewing and manipulating software OsiriX (). Apple’s own presentation software, Keynote, is particularly effective in dealing with medical images and cine clips. This article demonstrates how to use Apple’s Keynote software to present radiology images and scrollable image stacks, without third-party add-on software. The article also illustrates how to compress media files and protect patient information in Keynote presentations. Lastly, it addresses the steps to converting between PowerPoint and Keynote file formats. Apple’s Keynote software enables quick and efficient addition of multiple static images or scrollable image stacks, compression of media files, and removal of patient information. These functions can be accomplished by inexperienced users with no software modifications.     

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.     

Use of virtual microscopy for didactic live-audience presentation in anatomic pathology

Didactic presentations on the topic of anatomic pathology in front of a live audience have been largely dependent on the use of standard 2 x 2 inch projection slides (Kodachromes) of selected still images from the topic at hand. Because of the highly visual nature of the specialty of anatomic pathology, this method has had some serious limitations. With the advent of digital imaging techniques and the availability of new electronic software for the projection of images, new possibilities have become available for didactic presentations in anatomic pathology in front of a large, live audience. We describe a method whereby large digital images or "virtual slides" were produced from digitally scanned whole-mount sections of histologic glass slides and projected using a combination of PowerPoint (Microsoft Corp, Redmond, WA) and virtual microscopy in front of a live audience. To provide a seamless transition between the two presentation formats, the personal computer-based PowerPoint slides were hyperlinked to a browser-based virtual microscope viewer. The presenter, with the use of a mouse, was able to "move" the image of the scanned slide on the screen, to transition seamlessly among various magnifications, and to rapidly select from the whole-mount scanned slide among any areas of interest pertinent to the topic. Thus, the visual experience obtained by the audience simulated that of viewing a glass slide at a multi-headed microscope during a glass slide tutorial. Because this most closely approximates the experience of reviewing glass slides under the microscope for practicing pathologists, the educational experience of the presentation is greatly enhanced by the use of this technique. Also, this method permits making this type of presentation available to a much larger group of individuals in a live audience.     

An introductory course to biomedical microsystems for undergraduates

At the University of Cincinnati the state-of-the-art BioMEMS and Biomedical Microsystems research was successfully integrated within the undergraduate electrical engineering curricula through the development of a course Introduction to Biomedical Microsystems. In the first three course offerings, enrollment has spread beyond the initial target audience of the Department of Electrical and Computer Engineering, and now includes students from mechanical engineering, environmental engineering, computer engineering, and biomedical engineering. The use of research articles to supplement lecture materials worked effectively, providing undergraduate students with a real world perspective. Reading assignments, discussions of research papers, and short quizzes at the beginning of lectures were used to test understanding of concepts. This was also done to ensure that students were not overwhelmed by the multidisciplinary material or the pace of the course. This paper provides an overview of the course, summarizes results of student assessment, and discusses future improvements.     

Application of Image Compression Ratio Analysis as a Method for Quantifying Complexity of Dental Enamel Microstructure

It is well recognized that enamel microanatomy in mammals reflects biomechanical demands placed upon teeth, as determined by mechanical properties of species' diets, use of teeth as weapons, and so forth. However, there are limited options for researchers wishing to perform large-scale comparisons of enamel microstructure with adaptive questions in mind. This is because to date there has been no efficient method for quantification and statistical analysis of enamel complexity. Our study proposes to apply a method previously developed for quantification of 3D tooth cusp morphology to the problem of quantifying microstructural enamel complexity. Here, we use image compression ratio (ICR) as a proxy variable for enamel complexity in 2D enamel photomicrographs taken using circularly polarized transmitted light microscopy. ICR describes the relationship between a digital image captured in an uncompressed file format and the identical image that has had its file size compressed using computer algorithms; more complex images receive less compression. In our analyses, ICR analysis is able to distinguish between images of teeth with simple, radial enamel and teeth with complex decussating enamel. Moreover, our results show a significant correlation between ICR and enamel complexity ranks assigned via visual assessment. Therefore, our results demonstrate that ICR analysis provides a viable methodology for efficient comparison of overall enamel complexity among dental samples. Anat Rec, 302:2279–2286, 2019. © 2019 American Association for Anatomy     

Strategies for teaching pathology to graduate students and allied health professionals

Pathology is an essential course for many students in the biomedical sciences and allied health professions. These students learn the language of pathology and medicine, develop an appreciation for mechanisms of disease, and understand the close relationship between basic research and clinical medicine. We have developed 3 pathology courses to meet the needs of our undergraduates, graduate students, and allied health professionals. Through experience, we have settled on an approach to teaching pathology that takes into account the diverse educational backgrounds of these students. Educational resources such as assigned reading, online homework, lectures, and review sessions are carefully balanced to adjust course difficulty. Common features of our pathology curricula include a web-based computer laboratory and review sessions on the basis of selected pathology images and open-ended study questions. Lectures, computer-guided homework, and review sessions provide the core educational content for undergraduates. Graduate students, using the same computer program and review material, rely more heavily on assigned reading for core educational content. Our experience adapting a pathology curriculum to the needs of divergent groups of students suggests a general strategy for monitoring course difficulty. We hypothesize that course difficulty is proportional to the information density of specific learning resources (eg, lecture or textbook) multiplied by the weight of those learning resources placed on examinations. This formula allows educators to match the difficulty of a course with the educational needs of students, and provides a useful tool for longitudinal studies of curriculum reform.     

The profession of medicine: an integrated approach to basic principles.

OBJECTIVE: The University of South Florida College of Medicine developed and implemented an innovative three-week course entitled, "The Profession of Medicine: An Integrated Approach to Basic Principles" to introduce new medical students to topics and skills that are important to their successful study of medicine. Demonstrating the clinical relevance of the basic sciences, the importance of lifelong learning, and ethics and professionalism in medicine were emphasized. Basic physical examination techniques, searching the medical literature and evidence-based medicine, and study and computer skills were introduced in addition to traditional orientation topics. DESCRIPTION: Four interdisciplinary "state of the art" presentations demonstrated the importance of lifelong learning and the clinical relevance of basic science concepts. Lectures on acute myocardial infarction, breast cancer, duodenal ulcer, and pulmonary prematurity were presented as if the lectures were being given in 1980. Students attended lectures on basic science principles relevant to these topics, and then met in small groups with librarians, content experts, and small-group facilitators to begin investigating an assigned topic. For example, student groups researched the development of EMS and chest pain centers, thrombolysis and percutaneous coronary intervention, and the psychological implications of acute myocardial infarction for patients and families. Students were introduced to effective literature-searching techniques, the tenets of evidence-based medicine, and effective computer skills in the context of studying their assigned topics. Each group then selected a student presenter to deliver an eight-minute PowerPoint presentation of its 2001 "state of the art" findings, making particular note of scientific advances and new therapeutic protocols developed since 1980, such as the use of artificial surfactant in premature babies, the role of H. pylori in duodenal ulcers, and the discovery of the genetics of breast cancer. These projects as well as a series of small-group educational programs enabled students and faculty to develop a strong sense of team-work and cohesiveness. Students had opportunities to practice components of the history and physical examination on standardized patients relevant to the four clinical topic areas, such as cardiac and abdominal examinations with emphasis on anatomic principles. Basic ethical principles and their application to cases that pertained to the four clinical topics were introduced, and students participated in a small-group ethics case conference. Throughout the course, students and faculty were required to wear specially designed nametags. By the time the course concluded with the White Coat ceremony, the 75 participating faculty and 104 students knew one another, making the ceremony particularly meaningful. DISCUSSION: The pace at which scientific findings revolutionize the practice of medicine continues to accelerate. While it is important for undergraduate medical students to master the basic and clinical science foundations of medical practice, it may be even more important to teach students how to find and interpret medical information, form professional relationships with mentors and peers, and make a commitment to lifelong learning and professionalism. It is critical that students understand that the curricular program at any college of medicine is only the beginning of a life of study.     

The teaching of computer programming and digital image processing in radiography

The increased use of digital processing techniques in Medical Radiations imaging modalities, along with the rapid advance in information technology has resulted in a significant change in the delivery of radiographic teaching programs. This paper details a methodology used to concurrently educate radiographers in both computer programming and image processing. The students learn to program in visual basic applications (VBA), and the programming skills are contextualised by requiring the students to write a digital subtraction angiography (DSA) package. Program code generation and image presentation interface is undertaken by the spreadsheet Microsoft Excel. The user-friendly nature of this common interface enables all students to readily begin program creation. The teaching of programming and image processing skills by this method may be readily generalised to other vocational fields where digital image manipulation is a professional requirement.     

Departing from PowerPoint Default Mode: Applying Mayer’s Multimedia Principles for Enhanced Learning of Parasitology

Purpose: PowerPoint (PPT™) presentation has become an integral part of day-to-day teaching in medicine. Most often, PPT™ is used in its default mode which in fact, is known to cause boredom and ineffective learning. Research has shown improved short-term memory by applying multimedia principles for designing and delivering lectures. However, such evidence in medical education is scarce. Therefore, we attempted to evaluate the effect of multimedia principles on enhanced learning of parasitology. Methodology: Second-year medical students received a series of lectures, half of the lectures used traditionally designed PPT™ and the rest used slides designed by Mayer’s multimedia principles. Students answered pre and post-tests at the end of each lecture (test-I) and an essay test after six months (test-II) which assessed their short and long term knowledge retention respectively. Students’ feedback on quality and content of lectures were collected. Results: Statistically significant difference was found between post test scores of traditional and modified lectures (P = 0.019) indicating, improved short-term memory after modified lectures. Similarly, students scored better in test II on the contents learnt through modified lectures indicating, enhanced comprehension and improved long-term memory (P < 0.001). Many students appreciated learning through multimedia designed PPT™ and suggested for their continued use. Conclusions: It is time to depart from default PPT™ and adopt multimedia principles to enhance comprehension and improve short and long term knowledge retention. Further, medical educators may be trained and encouraged to apply multimedia principles for designing and delivering effective lectures.     

The humoral immune response is initiated in lymph nodes by B cells that acquire soluble antigen directly in the follicles

The initial step in a humoral immune response involves the acquisition of antigens by B cells via surface immunoglobulin. Surprisingly, anatomic studies indicate that lymph-borne proteins do not have access to the follicles where naive B cells reside. Thus, it is unclear how B cells acquire antigens that drain to lymph nodes. By tracking a fluorescent antigen and a peptide:MHC II complex derived from it, we show that antigen-specific B cells residing in the follicles acquire antigen within minutes of injection, first in the region closest to the subcapsular sinus where lymph enters the lymph node. Antigen acquisition, presentation, and subsequent T cell-dependent activation did not require B cell migration through the T cell area or exposure to dendritic cells. These results indicate that the humoral response is initiated as soluble antigens diffuse directly from lymph in the subcapsular sinus to be acquired by antigen-specific B cells in the underlying follicles.     

Role of anatomy in our contemporary age and the history of the Anatomy Museum of Naples

This work analyzes the significance of anatomical knowledge in the contemporary age through the history of a prestigious institution, the Anatomy Museum of Naples. The museum's past was ineluctably linked not only to the local sociopolitical events but also to the scientific developments of medicine. The museum is an academic place where the importance of the anatomic science in the contemporary age both in the scientific and in the cultural fora is evident.     

Outcomes of the gross and developmental anatomy teaching assistant experience

During the first-year Gross and Developmental Anatomy Course at Mayo Medical School, third-year medical students volunteer as teaching assistants (TAs). Their responsibilities include preparing for dissection, instructing students during dissection, writing examination questions, and giving a lecture. To evaluate the academic and professional impact of this experience on former TAs, a survey instrument was developed, and was sent to former TAs from the past 17 years. Seventy-two percent of the surveys were returned. Most respondents (84%) indicated that the TA experience was beneficial during their third-year surgical rotation. Over 60% identified benefits during Neurology, Obstetrics and Gynecology, and Internal Medicine rotations. The majority (62%) indicated they regularly use the knowledge gained from the TA experience. Communication was the most highly ranked area of skill development, with 86% of respondents indicating gains in lecture effectiveness and 97% in one-on-one teaching. Among respondents, 32% entered surgical or radiological fields, roughly paralleling the non-TA medical student population. All respondents indicated that they would repeat the experience and recommend it to other medical students. Although benefits for long-term career development have not yet been established, the Gross and Developmental Anatomy TA experience had perceived short-term benefits with respect to clinical rotations and teaching skill development.     

Interactive computer simulations of knee-replacement surgery.

OBJECTIVE: Current surgical training programs in the United States are based on an apprenticeship model. This model is outdated because it does not provide conceptual scaffolding, promote collaborative learning, or offer constructive reinforcement. Our objective was to create a more useful approach by preparing students and residents for operative cases using interactive computer simulations of surgery. Total-knee-replacement surgery (TKR) is an ideal procedure to model on the computer because there is a systematic protocol for the procedure. Also, this protocol is difficult to learn by the apprenticeship model because of the multiple instruments that must be used in a specific order. We designed an interactive computer tutorial to teach medical students and residents how to perform knee-replacement surgery. We also aimed to reinforce the specific protocol of the operative procedure. Our final goal was to provide immediate, constructive feedback. DESCRIPTION: We created a computer tutorial by generating three-dimensional wire-frame models of the surgical instruments. Next, we applied a surface to the wire-frame models using three-dimensional modeling. Finally, the three-dimensional models were animated to simulate the motions of an actual TKR. The tutorial is a step-by-step tutorial that teaches and tests the correct sequence of steps in a TKR. The student or resident must select the correct instruments in the correct order. The learner is encouraged to learn the stepwise surgical protocol through repetitive use of the computer simulation. Constructive feedback is acquired through a grading system, which rates the student's or resident's ability to perform the task in the correct order. The grading system also accounts for the time required to perform the simulated procedure. We evaluated the efficacy of this teaching technique by testing medical students who learned by the computer simulation and those who learned by reading the surgical protocol manual. Both groups then performed TKR on manufactured bone models using real instruments. Their technique was graded with the standard protocol. The students who learned on the computer simulation performed the task in a shorter time and with fewer errors than the control group. They were also more engaged in the learning process. DISCUSSION: Surgical training programs generally lack a consistent approach to preoperative education related to surgical procedures. This interactive computer tutorial has allowed us to make a quantum leap in medical student and resident teaching in our orthopedic department because the students actually participate in the entire process. Our technique provides a linear, sequential method of skill acquisition and direct feedback, which is ideally suited for learning stepwise surgical protocols. Since our initial evaluation has shown the efficacy of this program, we have implemented this teaching tool into our orthopedic curriculum. Our plans for future work with this simulator include modeling procedures involving other anatomic areas of interest, such as the hip and shoulder.     

Exploring presentation methods for tomographic medical image viewing

This paper explores the presentation of tomographic medical images on a computer screen. Limitations of the computer screen are apparent, as even a very large computer monitor cannot display an entire study consisting of dozens of images at once. Our objective is to propose filmless computer presentation methods for these images, in particular for magnetic resonance images. First, we observe the magnetic resonance image analysis task in the traditional light screen environment where presentation of many images has always been possible. We then propose solutions for meeting requirements in the computer environment. After implementation of these solutions we obtain user feedback on alternatives in order to determine feasibility and preference.Observations reveal three requirement categories: user control of film management, navigation of images and image series, and simultaneous availability of detail and context. We developed a framework of detail-in-context-technique parameters for the purpose of viewing tomographic medical images and presented our solution directions to the radiologists for feedback. Results from the user feedback study support the feasibility of the proposed approaches and clearly indicate the importance of presentation issues in the development of medical imaging viewing systems.     

Software for browsing sectioned images of a dog body and generating a 3D model

The goals of this study were (1) to provide accessible and instructive browsing software for sectioned images and a portable document format (PDF) file that includes three‐dimensional (3D) models of an entire dog body and (2) to develop techniques for segmentation and 3D modeling that would enable an investigator to perform these tasks without the aid of a computer engineer. To achieve these goals, relatively important or large structures in the sectioned images were outlined to generate segmented images. The sectioned and segmented images were then packaged into browsing software. In this software, structures in the sectioned images are shown in detail and in real color. After 3D models were made from the segmented images, the 3D models were exported into a PDF file. In this format, the 3D models could be manipulated freely. The browsing software and PDF file are available for study by students, for lecture for teachers, and for training for clinicians. These files will be helpful for anatomical study by and clinical training of veterinary students and clinicians. Furthermore, these techniques will be useful for researchers who study two‐dimensional images and 3D models. Anat Rec, 299:81–87, 2016. © 2015 Wiley Periodicals, Inc.     

Using web-based animations to teach histology

We have been experimenting with the use of animations to teach histology as part of an interactive multimedia program we are developing to replace the traditional lecture/laboratory-based histology course in our medical and dental curricula. This program, called HistoQuest, uses animations to illustrate basic histologic principles, explain dynamic processes, integrate histologic structure with physiological function, and assist students in forming mental models with which to organize and integrate new information into their learning. With this article, we first briefly discuss the theory of mental modeling, principles of visual presentation, and how mental modeling and visual presentation can be integrated to create effective animations. We then discuss the major Web-based animation technologies that are currently available and their suitability for different visual styles and navigational structures. Finally, we describe the process we use to produce animations for our program. The approach described in this study can be used by other developers to create animations for delivery over the Internet for the teaching of histology.