Benefit of Pre‐Matriculation Anatomy Courses on Medical Student Performance in an Integrated Curriculum

Abstract

Background Gross Anatomy has long been regarded as one of the most challenging content areas for first year medical students. To gain a potential advantage, many medical students choose to take pre-matriculation courses in anatomy. Prior research has studied the impact of these courses on medical student performance in a traditional curriculum with mixed results. The purpose of this investigation was to evaluate the benefit of different types of pre-medical anatomy courses in the setting of an integrated curriculum. Methods Using a mixed methods design, a total of 220 students from three separate medical school cohorts were surveyed regarding pre-matriculation coursework as well as perceptions about preparation and stress, and those results were compared with student performance on anatomy exams. Students from the final cohort of a traditional anatomy curriculum (10-week block) as well as two cohorts from an integrated curriculum (18-month systems-based blocks) were included. Study data were collected and managed using the REDCap electronic data capture tool and analyzed with SAS software. Results More students in the integrated curriculum took pre-matriculation anatomy courses than in the traditional curriculum (66.7% vs. 59.1%), supporting the increasing trend of this education. In both the traditional and integrated curricular groups, those with prior anatomy experience felt more prepared for the course (58% vs. 6% traditional and 65% vs. 5% integrated felt prepared, p<0.0001). A greater number of students in the integrated curriculum reported that their prior anatomy experience lowered their stress level than in the traditional curriculum (69% vs. 48%). Students who took graduate-level anatomy courses had the highest exam performance (p<0.001) and reported the best preparation and lowest stress. Those with cadaver experience also reported higher levels of preparation than those with non-cadaver courses (p<0.001). While there was a significant difference in performance on the first exam (p<0.0001) in both groups, scores on anatomy exams stabilized such that no significant difference was found on the final anatomy exams in either curricular structure. However, the difference in performance on the first exam was more profound in the integrated curriculum versus the traditional curriculum and led to an overall higher mean on all anatomy exams combined (p<0.0001). In addition, greater than 90% of all students recommended anatomy as a pre-requisite to medical school. Conclusions Pre-matriculation anatomy courses, especially graduate-level and cadaveric anatomy, appear to increase student confidence, lower student anxiety, and increase student performance on initial anatomy exams. The difference in initial exam performance between students with and without prior anatomy experience was more pronounced in the integrated curriculum than in the traditional curriculum which may reflect decreased time for content delivery. The results of this investigation support the recommendation and potential requirement of pre-matriculation anatomy courses for medical student applicants, particularly in institutions with integrated curricula.