A critique of utilitarian and instrumentalist concepts for the teaching of gross anatomy to medical and dental students: Provoking debate

Medical and dental curricula, together with anatomical sciences courses, are increasingly having to change, mainly because there is a drive to being what is termed, without adequate definition, “clinically relevant.” The concept of “clinical anatomy” has accordingly been invented and it is expected that, at all times, the teaching of anatomy is directly focused on clinical scenarios, meaning almost invariably the disease‐based model of medicine and dentistry. Furthermore, students are not expected to have a detailed knowledge of gross anatomy and the time devoted to teaching and learning the subject has decreased significantly. The notion being fostered is that knowledge is not required “just in case” but “just in time.” However, the absence of agreed core syllabuses that are internationally accepted complicates a discussion about what is relevant practically and what does not need to be taught. In this article, we critique such an utilitarian and instrumentalist approach to the teaching of gross anatomy within medical and dental curricula. We draw attention to the need to embrace the functionality‐based model of medicine and dentistry by returning to an understanding that the role of the medical or dental practitioner is to value health and to restore to functionality the ill person or the pathologically affected region/organ/system. A fuller knowledge of anatomy than is presently taught is regarded as a prerequisite for appreciating normality and health. A further problem with the instrumentalist approach to medical education is that, by concentrating on what is seen to be at the time “useful” or “clinically relevant,” there is the danger of undermining, or discouraging, future developments that rely on what contemporaneously seems “useless” and “irrelevant” knowledge. Finally, the reliance instrumentalism has on just what is pragmatic and regardless of scientific validity is contrary to the ethos and practice of a university education that values deep learning and the development of learnèd professions. Clin. Anat. 30:912–921, 2017. © 2017 Wiley Periodicals, Inc.     

Help of third-year medical students decreases first-year medical students' negative psychological reactions on the first day of gross anatomy dissection

The assistance of third-year medical students (MS3) may be an easy, inexpensive, educational method to decrease physical and emotional stress among first-year medical students (MS1) on the first day of gross anatomy dissection. In the academic years 2000-2001 and 2001-2002, a questionnaire on the emotional and physical reactions on the first day of dissection was distributed to 84 MS1 at Mayo Medical School (Rochester, MN); 74 (88%) responded. Student perceptions were assessed on a 5-point Likert scale. The 42 second-year medical students (MS2) whose first academic year was 1999-2000 were used as a control group, because they had not had assistance from MS3. MS2 completed the same questionnaire (59% response rate). Data were collected from MS1 on the day of their first gross anatomy dissection. The most frequent reactions were headache, disgust, grief or sadness, and feeling light-headed. Significant differences (alpha < 0.05) were found with use of the chi(2) test to compare the emotional and physical reactions of MS1 and MS2. MS1 had significantly fewer physical reactions (64% vs. 88%), reporting lower levels of anxiety (23% vs. 48%), headache (14% vs. 36%), disgust (9% vs. 20%), feeling light-headed (11% vs. 24%), and reaction to the smell of the cadaver and laboratory (8% vs. 52%). MS1 commented that having MS3 at the dissection table was extremely helpful. They relied less on their peers and felt they learned more efficiently about the dissection techniques and anatomical structures. Using MS3 as assistants is one method to reduce fear and anxiety on the first day of gross anatomy dissection.     

Survey of clinicians' attitudes to the anatomical teaching and knowledge of medical students

There is considerable and ongoing debate surrounding the teaching of anatomy to medical students, and the anatomical knowledge of those medical students once they graduate. Few attempts have been made to gather the opinions of clinicians on this subject. A questionnaire was sent to 362 senior clinicians in hospitals affiliated to the University of Aberdeen. A total of 162 replies were received, with this sample being representative of the population of hospital consultants. Our results indicate that the majority of clinicians feel that the current anatomical education of medical students is inadequate, and below the minimum necessary for safe medical practice. There is widespread support among clinicians for more vertical integration of anatomy teaching throughout the undergraduate curriculum.     

Sharing personal information about anatomical body donors: What first‐year medical students want to know and how it affects emotional responses to dissection

Among educators who teach in the human anatomy laboratory, there has been lively debate about sharing information about anatomical donors. One consideration in this debate is concern about the emotional effect of personalizing donors on the students. The purpose of this study was to evaluate student responses to being exposed to donor information (DI). Three cohorts of first‐year medical students (n = 284) were surveyed at four time points throughout the year. Surveys queried students about positive and negative responses to working in the laboratory, wanting to know specific DI, and if knowing this DI would/did affect their responses to working with donors. Analyses examined the relationships between desire to know DI and indices of the following: positive response index (PRI), negative response index (NRI), avoid‐approach index (AAI), and compassion‐respect index. Across all surveys, a majority of respondents wanted to know some form of DI. At all time points, a majority of respondents felt that knowing all types of DI would increase their positive responses to working with donors. A greater PRI and AAI tended to be associated with wanting to know more personal DI (e.g., names and personal histories). A greater NRI tended to be associated with anticipating that learning personal DI would increase their negative responses before entering the laboratory, which did not persist after dissection began. These data suggest that for a majority of students, knowing personal DI increases their positive response and does not elicit negative responses to dissection or working with anatomical donors. Clin. Anat. 32:1019–1032, 2019. © 2019 Wiley Periodicals, Inc.     

A core syllabus for the teaching of neuroanatomy to medical students

There is increasingly a call for clinical relevance in the teaching of biomedical sciences within all health care courses. However, this presupposes that there is a clear understanding of what can be considered core material within the curricula. To date, the anatomical sciences have been relatively poorly served by the development of core syllabuses, particularly for specialized core syllabuses such as neuroanatomy. One of the aims of the International Federation of Associations of Anatomists (IFAA) and of the European Federation for Experimental Morphology (EFEM) is to formulate, on an international scale, core syllabuses for all branches of the anatomical sciences using Delphi Panels consisting of anatomists, scientists, and clinicians to initially evaluate syllabus content. In this article, the findings of a Delphi Panel for neuroanatomy are provided. These findings will subsequently be published on the IFAA website to enable anatomical (and other cognate learned) societies and individual anatomists, clinicians, and students to freely comment upon, and elaborate and amend, the syllabuses. The aim is to set internationally recognized standards and thus to provide guidelines concerning neuroanatomical knowledge when engaged in course development. Clin. Anat. 28:706–716, 2015. © 2015 Wiley Periodicals, Inc.     

Anxiety in first year medical students taking gross anatomy

To study anxiety levels in first‐year medical students taking gross anatomy. Thirty medical students per year, for 2 years, completed the Beck Anxiety Inventory (BAI) 10 times during a 13‐week gross anatomy course. In addition, behavioral observations were made by a psychiatrist during gross anatomy for demonstrations of assertive, destructive, neutral, or passive behavior. Additional qualitative outcome measures were group exit interviews with the faculty and students. The mean BAI for all 60 students per year, for 2 years, was 2.19 ± 3.76, 93% of the scores indicated minimal anxiety, and 89% of BAI values were less than five which confirmed a minimal level of anxiety. The low level of reported BAI contrasted sharply with verbal reports by the same students and face‐to‐face exit interviews with the psychiatrist. Symptoms of stress and anxiety emerged as a result of these conversations. The high levels of subjective stress and anxiety revealed by the interviews were unknown to the gross anatomy faculty. The low scores of students on the BAI's stand in sharp contrast to the BAI's reported for medical students in other published reports. Although it is possible that our students were truthfully devoid of anxiety, it is more likely that our students were denying even minimal anxiety levels. There have been reports that medical students feel that admitting stress, depression, or anxiety put their competitiveness for a residency at risk. We conclude that students may be in frank denial of experiencing anxiety and, if so, this behavior is not conducive to good mental health. Clin. Anat. 27:835–838, 2014. © 2014 Wiley Periodicals, Inc.     

Self-guided clinical cases for medical students based on postmortem CT scans of cadavers

In the summer of 2009, we began full body computed tomography (CT) scanning of the pre-embalmed cadavers in the University of Michigan Medical School (UMMS) dissection lab. We theorized that implementing web-based, self-guided clinical cases based on postmortem CT (PMCT) scans would result in increased student appreciation for the clinical relevance of anatomy, increased knowledge of cross-sectional anatomy, and increased ability to identify common pathologies on CT scans. The PMCT scan of each cadaver was produced as a DICOM dataset, and then converted into a Quicktime movie file using Osirix software. Clinical cases were researched and written by the authors, and consist of at least one Quicktime movie of a PMCT scan surrounded by a novel navigation interface. To assess the value of these clinical cases we surveyed medical students at UMMS who are currently using the clinical cases in their coursework. Students felt the clinical cases increased the clinical relevance of anatomy (mean response 7.77/10), increased their confidence finding anatomical structures on CT (7.00/10), and increased their confidence recognizing common pathologies on CT (6.17/10). Students also felt these clinical cases helped them synthesize material from numerous courses into an overall picture of a given disease process (7.01/10). These results support the conclusion that our clinical cases help to show students why the anatomy they are learning is foundational to their other coursework. We would recommend the use of similar clinical cases to any medical school utilizing cadaver dissection as a primary teaching method in anatomy education.     

Reassessing the importance of dissection: A critique and elaboration

How important is dissection in basic anatomical education? In an attempt to provide an adequate basis for a rigorous answer to this seminal question, a number of subsidiary questions are asked. What is the value of the direct experience of human cadavers? What is the value of dissection? Where does the use of prosections fit in? What are the alternatives? The emphasis throughout is on the need for hard data and serious analysis. To this end, a variety of issues are raised for debate, including the variety of responses demonstrated by students to human cadavers, the importance of dissection for introducing students to aspects of the clinical ethos, the problems raised by students who attempt to bypass dissection, and the relative costs and educational merits of using cadavers and alternative approaches (including prosections and computer-based approaches). The relevance of the debate for histology teaching is also raised. Clin. Anat. 10:123–127, 1997 © 1997 Wiley-Liss, Inc.     

Attitudes to anatomy dissection in an Irish medical school

Many studies around the world have looked at the stresses placed on medical students by cadaveric dissection. Although these studies have linked the use of cadavers in medical teaching to stress, some investigations have suggested an association with severe psychological stress and even post‐traumatic stress disorder. This study assessed the attitudes of medical and biomedical sciences students in an Irish medical school towards cadaveric dissection by recording, through a questionnaire, their perceptions and experience before initial exposure to dissection and subsequently examining their attitudes after the first dissection and after 9 weeks. Student attitudes towards the dissecting room remained consistently positive for the duration of the study with only a minority of respondents reporting negative symptoms. Pre‐existing attitudes to the idea of dissection were unaffected by exposure and subsequent continuous experience of dissection. The majority of students in this study did not find the dissecting room experience stressful, and considered time spent in the dissecting room valuable. However, the proportion of students with negative experiences in the dissecting room was higher than has been reported in previous studies. Many respondents felt they could be better prepared for the dissecting room experience, indicating an increasing requirement for effective preparatory programmes. Clin. Anat. 22:386–391, 2009. © 2009 Wiley‐Liss, Inc.     

A core syllabus for the teaching of gross anatomy of the thorax to medical students

Discussion is ongoing concerning the need to ensure the clinical relevance of the biomedical sciences. However, clinical relevance within health care courses presupposes that there is internationally agreed core material to be taught and learned. For anatomy, by the initial use of Delphi Panels that comprise anatomists, scientists, and clinicians, the International Federation of Associations of Anatomists (IFAAs) is developing internationally accepted core syllabuses for all anatomical sciences disciplines in the health care professions. In this article, the deliberations of a Delphi Panel for the teaching of thoracic anatomy in the medical curriculum are presented, prior to their publication on the IFAA's website. To develop the syllabus further, it is required that anatomical societies, as well as individual anatomists and clinicians, comment upon, elaborate, and amend this draft recommended syllabus. The aim is to set internationally recognized standards and thus to provide guidelines concerning the knowledge of the human thorax expected of graduating medical professionals. Such information should be borne in mind by those involved in the development of medical courses. Clin. Anat. 33:300–315, 2020. © 2019 Wiley Periodicals, Inc.     

A survey of medical students on the impact of a new digital imaging library in the dissection room

Radiology has a recognised role in undergraduate anatomy education. The recent digitalisation of radiology has created new learning opportunities involving techniques such as image labelling, 3D reconstruction, and multiplanar reformatting. An opportunity was identified at the University of Nottingham to create a digital library of normal radiology images as a learner‐driven adjunct in anatomy dissection sessions. We describe the process of creating a de novo digital library by sourcing images for presentation at computer workstations. Students' attitudes towards this new resource were assessed using a questionnaire which used a 5 point Likert scale and also offered free text responses. One hundred and forty‐one out of 260 students (54%) completed the questionnaire. The most notable findings were: a positive response to the relevance of imaging to the session topics (median score 4), strong agreement that images should be available on the university website (median score 5), and disagreement that enough workstations were available (median score 2). About 24% of respondents suggested independently that images needed more labeling to help with orientation and identification. This first phase of supplying a comprehensive imaging library can be regarded as a success. Increasing availability and incorporating dynamic labeling are well recognized as important design concepts for electronic learning resources and these will be improved in the second phase of delivery as a direct result of studentfeedback. Hopefully other centers can benefit from this experience and will consider such a venture to be worthwhile. Clin. Anat. 22:761–769, 2009. © 2009 Wiley‐Liss, Inc.     

Comparisons between the attitudes of medical and dental students toward the clinical importance of gross anatomy and physiology

Marked changes are occurring within both the medical and dental curricula and new ways of teaching the basic sciences have been devised and traditional methods (e.g., dissection for gross anatomy and of bench‐based animal preparations for physiology) are increasingly no longer the norm. Although there is much anecdotal evidence that students are not in favor of such changes, there is little evidence for this based on quantitative analyses of students' attitudes. Using Thurstone and Chave attitude analyses, we assessed the attitudes of first year medical and dental students at Cardiff University toward gross anatomy and physiology in terms of their perceived clinical importance. In addition, we investigated the appropriateness (“fitness for purpose”) of teaching methodologies used for anatomy and physiology. The hypotheses tested recognized the possibility that medical and dental students differed in their opinions, but that they had a preference to being taught gross anatomy through the use of dissection and had no preference for physiology teaching. It was found that both medical and dental students displayed positive attitudes toward the clinical relevance of gross anatomy and that they preferred to be taught by means of dissection. Although both medical and dental students displayed positives attitudes toward the clinical relevance of physiology, this was greater for the medical students. Both medical and dental students showed a preference for being taught physiology through didactic teaching in small groups but the medical students also appreciated being taught by means of practicals. Overall, this study highlights the expectations that students have for the basic science foundation teaching within their professional training and signals a preference for being taught experientially/practically. Differences were discerned between medical and dental students that might reflect the direct association between systems physiology and pathophysiology and the application of this knowledge within the medical field in comparison to the dental field, which is heavily skill‐based. Clin. Anat. 27:976–987, 2014. © 2014 Wiley Periodicals, Inc.     

Information technology,medical education,and anatomy for the twenty-first century

Medicine is experiencing an escalating explosion of information. With more data available about more topics, the key questions are how to access and make sense of the medical information jungle. Skill in choosing and applying information is essential for both medical education and practice and will require new approaches to mastering data. Medical education, like medicine itself, will continue to be driven by technology, and we can expect our students to be increasingly computer literate. Thus the role of medical education will become more one of how to use this information than of obtaining the information itself. What medical education must focus on is the processing of information for appropriate medical care. This, in turn, depends upon practitioners having contexts in which the relevance and significance of information can be evaluated. New imaging technologies and molecular advances demand a broader understanding of both health and disease. With the information explosion “on line,” how can a student use this to understand the structure and function of the human body in four dimensions? Anatomy, the structural basis for life, provides a unique and necessary perspective on the human body from the molecular to the macroscopic. A solid foundation in anatomy is the best preparation for an effective physical examination and for safe, efficient basic clinical procedures. Finally, anatomy laboratories provide a context for learning other important aspects of medicine—group process, clinical problem solving, and a sensitivity to human mortality. Advocating for these unique features of our discipline in medical education is the task facing anatomists as we end this millennium. The challenges and opportunities for us have never been greater, if we don't throw out the baby with the bath water. © 1996 Wiley-Liss, Inc.     

A panorama of medical education in Brazil: Anatomy in focus

The scenario of Medical Education in Brazil is complex and diverse, like the very culture of our country. In this commentary, we reflect on the challenges and opportunities of progress while describing a panorama of the history, and the current scenario of Medical Education in Brazil. Moving our focus toward Anatomy, we review pedagogical strategies and methods, the role of the Brazilian Society of Anatomy, and share our experience on using of creativity and technology to make the teaching of Anatomy more modern, updated and significant for the future doctors.     

First year medical students' approaches to study and their outcomes in a gross anatomy course

Three approaches to study have been described in phenomenographic educational research: deep, strategic, and surface. Deep approaches to learning have been correlated with meaningful learning and academic success, whereas surface approaches produce an externalization of learning and poor outcomes. Students adopting a strategic approach adopt either a deep or surface approach in response to perceived examination demands. Despite being well known in Europe and Australia, this research paradigm has been applied sporadically in the United States. In this study, the approaches to study of a group of first year American medical students were collected using the Approaches and Study Skills Inventory for Students instrument at the beginning and end of their first year to find how consistent these approaches remained over time. At both times, the majority of participants adopted deep approaches, followed by strategic and then surface approaches. The percentage of participants using a surface approach grew during the first year but never exceeded 10%. The mean anatomy grades of students adopting each approach were then compared to find how each approach correlated with success in the course. Mean grades of students using a strategic approach were significantly higher than average at both times. Students who maintained a strategic approach throughout the first year had significantly higher mean grades than average while students who changed to a surface approach had significantly worse mean anatomy grades. Problem-based students had significantly higher scores on several deep submeasures than lecture-based peers and female students demonstrated greater fear of failure than male peers at both times.     

Impact of the clinical ultrasound elective course on retention of anatomical knowledge by second‐year medical students in preparation for board exams

Ultrasound has been integrated into a gross anatomy course taught during the first year at an osteopathic medical school. A clinical ultrasound elective course was developed to continue ultrasound training during the second year of medical school. The purpose of this study was to evaluate the impact of this elective course on the understanding of normal anatomy by second‐year students. An anatomy exam was administered to students enrolled in the clinical ultrasound elective course before the start of the course and after its conclusion. Wilcoxon signed ranks tests were used to determine whether exam scores changed from the pre‐test to the post‐test. Scores from two classes of second‐year students were analyzed. Students who took the elective course showed significant improvement in the overall anatomy exam score between the pre‐test and post‐test (P < 0.001). Scores for exam questions pertaining to the heart, abdomen, upper extremity, and lower extremity also significantly improved from the pretest to post‐test (P < 0.001), but scores for the neck and eye showed no significant improvement. The clinical ultrasound elective course offered during the second year of medical school provided students with an important review of key anatomical concepts while preparing them for board exams. Our results suggested that more emphasis should be placed on head and neck ultrasound to improve student performance in those areas. Musculoskeletal, abdominal, and heart ultrasound labs were more successful for retaining relevant anatomical information. Clin. Anat. 28:156–163, 2015. © 2014 Wiley Periodicals, Inc.     

Daily medical education for confined students during coronavirus disease 2019 pandemic: A simple videoconference solution

The outbreak of coronavirus disease 2019 caused by severe acute respiratory syndrome coronavirus 2 infection has recently spread globally and is now a pandemic. As a result, university hospitals have had to take unprecedented measures of containment, including asking nonessential staff to stay at home. Medical students practicing in the surgical departments find themselves idle, as nonurgent surgical activity has been canceled, until further notice. Likewise, universities are closed and medical training for students is likely to suffer if teachers do not implement urgent measures to provide continuing education. Thus, we sought to set up a daily medical education procedure for surgical students confined to their homes. We report a simple and free teaching method intended to compensate for the disappearance of daily lessons performed in the surgery department using the Google Hangouts application. This video conference method can be applied to clinical as well as anatomy lessons.     

Posterior subscapular dissection: An improved approach to the brachial plexus for human anatomy students

Students of human anatomy are required to understand the brachial plexus, from the proximal roots extending from spinal nerves C5 through T1, to the distal-most branches that innervate the shoulder and upper limb. However, in human cadaver dissection labs, students are often instructed to dissect the brachial plexus using an antero-axillary approach that incompletely exposes the brachial plexus. This approach readily exposes the distal segments of the brachial plexus but exposure of proximal and posterior segments require extensive dissection of neck and shoulder structures. Therefore, the proximal and posterior segments of the brachial plexus, including the roots, trunks, divisions, posterior cord and proximally branching peripheral nerves often remain unobserved during study of the cadaveric shoulder and brachial plexus. Here we introduce a subscapular approach that exposes the entire brachial plexus, with minimal amount of dissection or destruction of surrounding structures. Lateral retraction of the scapula reveals the entire length of the brachial plexus in the subscapular space, exposing the brachial plexus roots and other proximal segments. Combining the subscapular approach with the traditional antero-axillary approach allows students to observe the cadaveric brachial plexus in its entirety. Exposure of the brachial dissection in the subscapular space requires little time and is easily incorporated into a preexisting anatomy lab curriculum without scheduling additional time for dissection.     

E-learning program for medical students in dermatology

INTRODUCTION:

Dermatological disorders are common in medical practice. In medical school, however, the time devoted to teaching dermatology is usually very limited. Therefore, online educational systems have increasingly been used in medical education settings to enhance exposure to dermatology.

OBJECTIVE:

The present study was designed to develop an e-learning program for medical students in dermatology and evaluate the impact of this program on learning.

METHODS:

This prospective study included second year medical students at the University of Technology and Science, Salvador, Brazil. All students attended discussion seminars and practical activities, and half of the students had adjunct online seminars (blended learning). Tests were given to all students before and after the courses, and test scores were evaluated.

RESULTS:

Students who participated in online discussions associated with face-to-face activities (blended learning) had significantly higher posttest scores (9.0±0.8) than those who only participated in classes (7.75±1.8, p <0.01).

CONCLUSIONS:

The results indicate that an associated online course might improve the learning of medical students in dermatology.