The anatomy lesson of the SARS-CoV-2 pandemic: irreplaceable tradition (cadaver work) and new didactics of digital technology

AimTo compare the efficacy of different components of online and contact anatomy classes as perceived by medical students.MethodsAn anonymous course evaluation survey was conducted at the end of the academic year 2019/2020. The organization of classes due to the SARS-CoV-2 pandemic provided our students with a unique opportunity to compare online and contact classes. Students’ responses were analyzed according to the type of obtained data (ratio, ordinal, and categorical).ResultsThe response rate was 95.58%. Approximately 90% of students found anatomical dissection and practical work in general to be the most important aspect of teaching, which could not be replaced by online learning. During online classes, students missed the most the interaction with other students, followed by the interaction with student teaching assistants and teaching staff. Very few students found contact lectures useful, with most students reporting that they could be replaced with recorded video lectures. In contrast, recorded video lectures were perceived as extremely helpful for studying. Regular weekly quizzes were essential during online classes as they gave students adequate feedback and guided their learning process. Students greatly benefitted from additional course materials and interactive lessons, which were made easily available via e-learning platform.ConclusionsAnatomical dissection and interaction during contact classes remain the most important aspects of teaching anatomy. However, online teaching increases learning efficiency by allowing alternative learning strategies and by substituting certain components of contact classes, thus freeing up more time for practical work.

From the middle of the last century, lecturers in anatomy courses for medical students have faced two major challenges. The first has been how to incorporate the rapidly expanding new medical knowledge into the curricula. This required a reorganization of the existing curricula, and anatomy in particular was under pressure to reduce teaching hours and the student load (1-3). The second challenge has been how to modernize the teaching approach and didactically redesign the anatomy course. There has been pressure to replace cadaver work due to high expenses and high organizational demands. In many medical schools, authorities have advocated the idea that cadaver work can be replaced by other learning approaches with identical final outcomes (4). This pressure has become particularly notable in recent years and has been advocated by advancements in new digital technologies such as augmented and virtual reality (5).Anatomy is one of the fundamental and most demanding courses in any medical school curriculum. A frequent point of discussion is how to approach teaching anatomy and facilitate students’ comprehension of difficult concepts and memorization of vast amounts of new information. Universities worldwide adopt different teaching approaches. Modern teaching usually includes a combination of teaching methods within integrated and multimodal approaches to anatomy teaching (6,7). Six techniques for anatomy education have been proposed: in-person lectures, cadaveric dissection, inspection of prosected specimens, models, radiological and living anatomy teaching, and computer-assisted learning (8). Some universities have implemented curricular changes, especially since the time allotted to anatomy education in Europe, the United States of America, and Australia has considerably declined (9). The majority of schools have switched from a completely traditional cadaver-based curriculum toward more interactive custom-made approaches that better fit the learning strategies of new generations and that appreciate technologies such as augmented and virtual reality, social networks, and imaging for a better understanding (7,10,11). Cadaver dissection, considered a gold standard for teaching anatomy (12), still remains widely used. While occasionally contested, its importance in different aspects of anatomy education has been proven by schools that returned to cadaver dissection after having temporarily abandoned it (3,13). However, meta-analyses suggest that educators should appreciate and reevaluate each instructional method in order to meet all the students’ needs, since none has so far been proven superior to any other (14).At the University of Zagreb School of Medicine (UZSM), we teach a cadaver dissection-oriented teaching curriculum, with the use of additional teaching methods/tools, such as prosection and instructions/demonstrations on cadavers and artificial anatomical models. In recent years, we have enhanced the provided e-learning by vastly expanding the materials and activities available on our online platform for communication and teaching. We have also implemented a new, functionally oriented textbook (15,16). These changes aimed to enhance the awareness of the subject''s clinical relevance and to raise the students’ active involvement in the course.Our Department has been systematically assessing students'' satisfaction with the Anatomy course through anonymous surveys (student evaluation of teaching) after the course completion. The Anatomy course is taught during two semesters in the first year of medical school. In the first semester of the academic year 2019/2020, we finished the planned curricular activities as scheduled using our usual multimethod approach. In the second semester, the SARS-CoV-2 (COVID-19) pandemic forced us to switch to exclusively online teaching for an extended period of time (17,18). Online teaching was prolonged because of the heavy damage sustained by the UZSM buildings in an earthquake that hit Zagreb on March 22, 2020 (19), immediately after the introduction of the first lock-down. We organized only a very short practical revision on cadavers and models in June, at the end of the academic year.Such an organization of classes in the academic year 2019/2020 allowed our students to provide unique feedback about the perceived advantages and disadvantages of different components of contact and online classes. It also allowed them to evaluate the significance of these classes for meeting the anatomy course’s aims and give feedback on the overall teaching approach of the faculty. Thus, we conducted a survey with the aim of analyzing information on the efficacy of contact and online classes in covering the anatomy course material. We also analyzed how students’ success on continuous assessment during the academic year related to the way they responded to different survey questions and whether there were significant differences in those responses.