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.     

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.     

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.     

Learning gross anatomy: Dissection and prosection

The gross anatomy course at St. Louis University School of Medicine consists of 40 regions or units covering the entire body and utilizes peer teaching in which students do every fourth dissection. One-fourth of the students learn each unit by dissecting; three-fourths learn from predissected material. Four multiple choice tests were studied to determine whether students scored better on questions on units they dissected than those who learned from predissected material. Results were adjusted on the basis of students' scores on whole tests. There were four teams of students and four tests resulting in 16 sets of questions. Dissectors scored better than nondissectors in 13 sets, but the overall differences were small (67.80 vs. 66.70). It is concluded that there is a small advantage gained from dissecting and demonstrating to their peers, but that learning from dissected cadavers is a satisfactory method of study, since our students traditionally score above the national average on the anatomy portion of the National Board Examination. Clin. Anat. 9:57–59, 1996. © 1996 Wiley-Liss, 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.     

Development of instructional, interactive, multimedia anatomy dissection software: a student-led initiative

Although dissection provides an unparalleled means of teaching gross anatomy, it constitutes a significant logistical and financial investment for educational institutions. The increasing availability and waning cost of computer equipment has enabled many institutions to supplement their anatomy curriculum with Computer Aided Learning (CAL) software. At the Royal College of Surgeons in Ireland, two undergraduate medical students designed and produced instructional anatomy dissection software for use by first and second year medical students. The software consists of full-motion, narrated, QuickTime MPG movies presented in a Macromedia environment. Forty-four movies, between 1-11 min in duration, were produced. Each movie corresponds to a dissection class and precisely demonstrates the dissection and educational objectives for that class. The software is distributed to students free of charge and they are encouraged to install it on their Apple iBook computers. Results of a student evaluation indicated that the software was useful, easy to use, and improved the students' experience in the dissection classes. The evaluation also indicated that only a minority of students regularly used the software or had it installed on their laptop computers. Accordingly, effort should also be directed toward making the software more accessible and increasing students' comfort and familiarity with novel instructional media. The successful design and implementation of this software demonstrates that CAL software can be employed to augment, enhance and improve anatomy instruction. In addition, effective, high quality, instructional multimedia software can be tailored to an educational institution's requirements and produced by novice programmers at minimal cost.     

Implementing and integrating computer‐based activities into a problem‐based gross anatomy curriculum

A problem‐based learning curriculum in gross anatomy was begun for a limited number of students to address unsuccessful methodology inherent in a traditional instructional approach. To eliminate some concerns associated with the laboratory component, computer‐based instruction and other computer‐ related activities were actively integrated into the total instructional process. Prosections, directions, quizzes, images, and grades were provided in lab at table‐side computer workstations, in the library, and on the web. Results were assessed through questionnaires in which students rated their learning experience according to a Likert‐type scale. Success was measured by quantitative improvements in student perception. In this three‐year study, observations and measurements have suggested increasingly positive student attitudes toward educational technology, for networks as a faster and more effective method of student/faculty communication, and in the utilization of computer‐based instruction for greater flexibility and efficiency in learning. This allowed a rethinking of the structure and content of the curriculum by the faculty, which permitted reduced laboratory time, more small‐group activity, and less reliance on staff. Clin. Anat. 12:191–198, 1999. © 1999 Wiley‐Liss, Inc.     

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.     

Latin and Greek in gross anatomy

BACKGROUND: Medical students and practitioners learn and use a vocabulary originating almost entirely from classical Latin and Greek languages. Previous generations required Latin or Greek prior to medical school, but the current generation does not have such requirements. Anecdotal evidence suggests that understanding Latin or Greek helps students to learn and practitioners to recall otherwise foreign terminology. This study evaluated students' familiarity with Latin and Greek etymologies before and after a gross anatomy course that incorporated etymologies into its curriculum. METHODS: First-year medical students at Mayo Clinic College of Medicine were taught Latin and Greek etymologies through lectures and handouts during their gross anatomy course. They took a pretest and a posttest before and after the course to assess their understanding of etymologies. In addition, students from all four years of medical school, residents, and staff physicians also took a general etymology quiz to assess their understanding of etymologies. RESULTS: After their gross anatomy course emphasizing etymologies, first-year students scored higher on the posttest than they did on the pretest. First-year students also reported that learning etymologies enhanced anatomy learning, made the experience more enjoyable, and proved to be less difficult than they thought it would be prior to the course. Medical students, residents, and staff physicians scored almost equally on the general etymology quiz and almost equally reported that etymologies enhanced learning and recalling terminology. Medical students, residents, and staff physicians almost equally endorsed incorporating etymologies into medical education. CONCLUSIONS: This study provides novel scientific evidence that a basic understanding of Latin and Greek etymologies enhances performance and comfort when learning and using medical terminology.     

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.     

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.     

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.     

Premedical anatomy experience and student performance in medical gross anatomy

Gross anatomy is considered one of the most important basic science courses in medical education, yet few medical schools require its completion prior to matriculation. The effect of taking anatomy courses before entering medical school on performance in medical gross anatomy has been previously studied with inconsistent results. The effect of premedical anatomy coursework on performance in medical gross anatomy, overall medical school grade point average (GPA), and Comprehensive Osteopathic Medical Licensing Examination Level 1 (COMLEX 1) score was evaluated in 456 first‐year osteopathic medical students along with a survey on its perceived benefits on success in medical gross anatomy course. No significant differences were found in gross anatomy grade, GPA, or COMLEX 1 score between students with premedical anatomy coursework and those without. However, significant differences and higher scores were observed in students who had taken three or more undergraduate anatomy courses including at least one with cadaveric laboratory. There was significantly lower perceived benefit for academic success in the medical gross anatomy course (P<.001) from those students who had taken premedical anatomy courses (5.9 of 10) compared with those who had not (8.2 of 10). Results suggest that requiring any anatomy course as a prerequisite for medical school would not have significant effect on student performance in the medical gross anatomy course. However, requiring more specific anatomy coursework including taking three or more undergraduate anatomy courses, one with cadaveric laboratory component, may result in higher medical gross anatomy grades, medical school GPA, and COMLEX 1 scores. Clin. Anat. 30:303–311, 2017. © 2017 Wiley Periodicals, Inc.     

Bygone theatres of events: A history of human anatomy and dissection

Over the last four millennia, the discipline of anatomy and its relationships with medicine and society have evolved dramatically. Human dissection, the perennial tool for anatomical discovery and education, has both guided this evolution and matured alongside it. Soon after the first cadaveric dissections recorded in ancient Greece, China, India, and Persia, clear endorsements of its practice fell largely silent in the anatomical record for 1,500 years before reappearing in Europe at the dawn of the Renaissance. Between the 13th and 18th centuries CE, the performance of anatomical dissection became a popular form of education and public entertainment, and the demand for human cadavers steadily increased among European anatomical schools while supply remained limited by legal statute. This gave rise to an informal group of amateur and professional body snatchers called the Resurrectionists and, later, inspired the Anatomy Act of 1832 CE. In the 20th and 21st centuries CE, voluntary body bequeathal programs have enabled the practice of human dissection to continue in academic centers as a cornerstone of anatomical education, now with a newfound focus on the development of affective skills. This article provides an abridged account of anatomy's development, highlighting key moments in its growth, the valuable contributions of many different societies to the discipline, and the important roles of several luminary anatomists of antiquity. Within the broader context of this history, it offers an overview of anatomical dissection's evocative past, spanning from its inception to its present-day practice.     

The relationship between premedical coursework in gross anatomy and histology and medical school performance in gross anatomy and histology

Many premedical students enroll in courses whose content will be encountered again during their medical education. Presumably, students believe this practice will lead to improved academic performance in corresponding medical school courses. Therefore, this study was undertaken to determine whether a premedical gross anatomy and/or histology course resulted in increased performance in corresponding medical school courses. A second aim of the study was to examine whether the type of premedical gross anatomy and/or histology course differentially affected medical school performance. A survey that assessed premedical gross anatomy and histology coursework was administered to 440 first-year medical students. The results from this survey showed that students with premedical gross anatomy (n = 236) and/or histology (n = 109) earned significantly more points in the corresponding medical school course than students without the premedical coursework (P < 0.05). Analysis of premedical course types revealed that students who took a gross anatomy course with prosected specimens (n = 35) earned significantly more points that those students without premedical gross anatomy coursework (P < 0.05). The results from this study suggest: 1) premedical gross anatomy and/or histology coursework improves academic performance in corresponding medical school courses, and 2) a premedical gross anatomy course with prosected specimens, a specific type of undergraduate course, significantly improves academic performance in medical gross anatomy.     

On behalf of tradition: An analysis of medical student and physician beliefs on how anatomy should be taught

Human anatomy, one of the basic medical sciences, is a time‐honored discipline. As such, it is taught using traditional methods, cadaveric dissection chief among them. Medical imaging has recently gained popularity as a teaching method in anatomy courses. In light of a general tendency to reduce course hours, this has resulted in a decrease of dissection time and intense debates between traditional and modern approaches to anatomy teaching. In an attempt to explore trends in the attitudes of medical professionals toward the various methods of anatomy teaching, medical imaging in particular, the authors constructed a questionnaire and conducted a nationwide survey among medical students (in all stages at medical school), residents, and specialists in all fields of medicine. The survey results demonstrated indisputable appreciation of traditional methods of anatomy teaching, particularly cadaveric dissection, and showed that specialists believe significantly more strongly than clinical or preclinical students that anatomy and medical imaging should be taught separately. Strong correlations among the components of the traditional approach to anatomy instruction were also found. In light of the results, it was recommended that imaging should be incorporated into anatomy courses with caution, and, as far as possible, not at the expense of dissection time. It was advised that medical imaging has to be taught as a separate course, parallel to a traditional anatomy course. This will allow anatomical principles to be appreciated, which in turn will serve the students when they study radiology. “And we proceed in the following order: in front walks Nikolai with the slides or atlases, I come after him, and after me, his head humbly lowered, strides the cart horse; or else, if necessary, a cadaver is carried in first, after the cadaver walks Nikolai, and so on. At my appearance, the students rise, then sit down, and the murmur of the sea suddenly grows still. Calm ensues.” —From “A Boring Story: From the Notebook of an Old Man” by Anton Chekhov. Clin. Anat. 28:980–984, 2015. © 2015 Wiley Periodicals, Inc.     

Adequacy of medical school gross anatomy education as perceived by certain postgraduate residency programs and anatomy course directors

In light of the many changes that have been made in medical gross anatomy instruction, an attempt was made to determine the adequacy of medical student preparation in gross anatomy upon arrival at a postgraduate residency program and whether the adequacy of preparation had changed in the last 10 years. To address these questions, a survey was mailed to all of the programs in four postgraduate residencies in the United States. This survey requested information about the importance of gross anatomy to the discipline, the adequacy of resident preparation, how today's residents compare to those of 10 years ago, and in what areas they are deficient. Another survey was mailed to all medical school anatomy departments to follow changes in curriculum, teaching methods, curriculum hours, and staffing in gross anatomy. Overall, of the surveys mailed, 79% were returned, 78% from the residency programs, and 81% from the anatomy departments. A majority of the residency programs report that gross anatomy is either extremely important or very important to mastery of their discipline and rank it as the most important basic science. Overall, 57% of the residency program directors felt that residents need a refresher in gross anatomy upon arrival, 29% felt that they were adequately prepared, whereas 14% felt they were seriously lacking. Fifty‐six percent of the residency programs indicated that the residents are as prepared as those of 10 years ago, 41% indicated that they are less prepared, and only 4% said that they were better prepared. There were significant differences in the responses between the different residency programs. The residency programs indicated that residents need to arrive more proficient in clinical applications, general knowledge, and cross‐sectional applications. Anatomy departments continue to modify their curriculum and teaching methods, decrease the curriculum hours and faculty devoted to gross anatomy, and foresee problems obtaining qualified gross anatomy teachers in the future. Clin. Anat. 12:55–65, 1999. © 1999 Wiley‐Liss, Inc.     

Workshop in clinical anatomy for residents in gynecology and obstetrics

A workshop in the clinical anatomy of the female pelvic viscera has been part of the training program for the first year residents in Gynecology and Obstetrics at the University of Padova since the 1999-2000 academic year. The purpose of the workshop is to offer a direct experience of practical anatomy despite a shortage of cadavers. It is designed for six residents who work in three teams on three specimens. The anatomical specimens are unembalmed, unfixed, female pelvic visceral blocs that are harvested from the cadavers 24 hr after death. They are stored at -12 degrees C and removed from the freezer 12 hr before the workshop. The workshop is 3 hr in length and has two parts: one on theory and one practical. In the theoretical section (30 min), the teacher presents the topographical anatomy of the specimens and the residents analyze a clinically oriented worksheet. In the practical section (2 hr), the residents identify viscera, vessels, and nerves through inspection and palpation, and then a step-by-step dissection is carried out. In the last section (30 min), the workshop includes presentations on the three specimens that illustrate anatomical variability and assess knowledge of topographical anatomy. For many residents, this is the first practical experience of the anatomy of the female pelvic viscera because the anatomical courses for medical students do not include direct dissection by students. The unfixed viscera preserves the natural characteristics of the different tissues that exhibit the aspects of living organs, such as color, softness, and pliability, enhancing the knowledge of anatomy. The worksheet is structured as a guide to the anatomical basis of physical examination through inspection and palpation of the viscera. It also introduces the residents to the surgical anatomy of the female pelvis through a brief and selective dissection focused on the relationship between the different regional systems.