Medical students' examinations during the pandemic: Performance and perceptions of anatomy teaching and learning before, during, and after COVID-19 lockdowns.

Gross anatomy is considered by many the backbone of medical education. While learning anatomy has a reputation of requiring mainly rote memorization, modern day anatomy education often involves instruction and assessment at cognitive levels that foster higher-order thinking. In many instances, these higher-order anatomical concepts are taught to graduate students in healthcare-related fields, such as medicine. At this level, students are expected to apply and analyze anatomical information since that is what will ultimately be expected of them as professionals. In contrast, undergraduate anatomy education is typically more introductory in nature and often takes place in the setting of a large-enrollment course that serves as a prerequisite for many health sciences degree programs. In this study, variables related to the assessment of higher-order concepts in clinical anatomy were compared between first-year medical students and undergraduate students enrolled in an upper-level human gross anatomy course. Results demonstrate that undergraduate students perform lower than medical students overall, but the degree of difference in how they perform on higher- versus lower-order questions is comparable. The most notable exception is on practical examinations, where undergraduate students tend to struggle more with applying and analyzing information. Exploration of additional variables provides insight into how the cognitive level being assessed affects the time it takes to answer a question and how different practical examination question types and formats influence student performance. Findings presented in this study have implications for designing anatomy courses and underscore the importance of blueprinting assessments.

Introduction As a medical student's first encounter with human anatomy, cadaveric dissection facilitates a comprehensive, three-dimensional (3D) understanding of the human body. We believe that this interaction is vital for future clinicians' ability to interpret medical imaging, specifically when the anatomy may be viewed in different planes, such as in Magnetic Resonance Imaging (MRI). In this study, we evaluated how learning anatomy through cadaveric vs. virtual dissection software programs affected medical students' ability to interpret medical imaging, as well as the impact it had on student satisfaction with their anatomical education. Methods Twenty first year medical students and 8 senior-level pre-medical students were recruited for this study, each of them having no prior experience with cadaveric dissection. The first year medical students learned anatomy via virtual dissection software, while the pre-medical students performed in-person dissections. After both groups completed the musculoskeletal system in their respective program, each student was given a 16-question agree/neutral/disagree survey with questions regarding their confidence and satisfaction with their anatomical education, as well as questions about respecting human dignity and empathizing with future patients. Following the survey, each student was asked to complete a 30-question open-answer assessment which asked them to identify various musculoskeletal structures on MRI scans. Both cohorts received identical assessments and were given the same time restrictions. Two months later, each student was asked to complete a second, identical 30-question assessment in order to evaluate anatomical knowledge retention. Results The pre-medical students who were enrolled in a human anatomy dissection course scored higher than the first year medical students learning anatomy virtually on both assessments in this study. The pre-medical students had average scores of 43.3% (SD 9.4) and 41.7% (SD 10.8) for the initial and 2-month assessments, respectively. The first-year medical students had average scores of 37.5% (SD 12.6) and 32.2% (SD 13.4) for the initial and 2-month assessments, respectively. Additionally, the survey results demonstrated that the majority of first-year medical students (90%) felt that the virtual software was inadequate compared to in-person dissection. The survey also revealed that those who participated in cadaveric dissection developed more respect for the dignity of human beings and empathy for future patients (87.5% and 100%, respectively) compared to those who did not (25% and 5%, respectively). Conclusion This study demonstrates that cadaveric dissection provides several benefits to future physicians. In-person dissection facilitates a deeper understanding of the anatomy, and provides a 3D awareness of the human body that enables future physicians to comprehend anatomy on multiple planes. Additionally, this study demonstrates that cadaveric dissection not only improves student satisfaction, but it develops intangible characteristics in future physicians such as respect and empathy for human beings.

Not "How Should I Learn?" or "How Should I Act?" but, "Who Shall I Become?": A Précis on the Roots of Early Professional Identity Formation in the Anatomy Course.

Recruiting Medical Students to Neurosurgery Through a Focused Neuroanatomy Lab Initiative

Memorial: Roy Reed Peterson (1924 –2010), Emeritus Professor of Anatomy at Washington University School of Medicine

Reconsidering laboratory-based anatomy within the backdrop of digital transformation: Bringing an old practice into a new world.

The affordances of technology-based assessments, like the objectively structured practical examination, have become an integral part of gross anatomy courses. The Department of Anatomy Faculty of Medicine at the University of Warmia and Mazury developed and introduced an application for tablet devices which has been implemented in student examinations and assessments, called the tablet-assisted objective structured spotter practical examination. It was created to simplify the educational process and to build a rich learning environment, facilitating deep learning for students through examination and feedback data. The method consists of cadaver stations with traditional corresponding pin spotters in an expanded tablet application. It not only provides instant feedback on various observations of teaching-learning skills but has also positively affected the entire process of education. The method provides an unbiased evaluation of knowledge and understanding of the anatomy course, ensuring objectivity and standardization. The current study was performed on a total of 608 first-year medical students in Polish and English divisions and focused on the observed advantages since the new method was introduced. Outcomes indicate that after the implementation of the method for both the Polish and English divisions' first-year medical students, the mean score of examinations significantly increased compared to other teaching-learning methods. The study highlights that students were excited about the implementation of the new method and identified its many benefits. It is recognized that technological development and the digital environment offer a range of opportunities and added value versus traditional assessment activities, methods, and processes.

A recent article by John Farey and his colleagues on behalf of the Australian Medical Students' Association1 has rekindled the debate as to how, when and what anatomy to teach medical students. In recent years, the teaching of anatomy within the medical curriculum has undergone major changes, including a reduction in teaching hours – mainly the cadaveric dissection component – in order to accommodate emerging disciplines such as genetics and molecular biology, and an increased emphasis in public health, epidemiology and communication skills. Introduction of problem-based learning (PBL) has led to the fragmentation of anatomy teaching, which is a sequential subject that requires basic knowledge as its foundation. The consequences of these changes to recent medical graduates and postgraduate students have been highlighted in several recent publications.1, 2 The observations regarding the examination results of surgery fellowship trainees (where a high failure rate in the basic sciences occurred within the University of Sydney graduate cohort upon the drastic reduction in anatomy teaching at that school,2 a trend now reversed by a very substantial increase in anatomy teaching3) is a sentinel wake-up call for all medical schools. In the current climate, there is a need for more effective pedagogy to develop a clinical anatomy course with emphasis on understanding rather than endless memorization, which is the common belief among students.4 A core course of clinical topographical anatomy (including regional and systemic approaches), coupled with an appropriate process of assessment, should precede the students' progress to a PBL model that supports a preferred process of inquiry-based learning. Students profit most when multiple, problem-oriented modalities are integrated.5 The core anatomy course should also be vertically integrated and reinforced with PBL during the entire undergraduate curriculum. The call for a core National Anatomy Curriculum1, 6 requires critical consideration. This is already occurring, though not in Australia, but in the American Association of Clinical Anatomists7 and the Anatomical Society of Great Britain and Ireland.8 As ‘the anatomy and anatomical problems of safe clinical practice, even at a junior level, are similar everywhere’1 – there is no need to reinvent the wheel. However, there is a need to define with clarity the depth of core knowledge, skills, values and attitude required by the graduating medical students that must be possessed for safe clinical practice. This is a daunting but I believe, is attainable goal, if we, the anatomical educators, work collaboratively in a format similar to the Stanford Medicine 25.9 The continuing argument between dissection and prosection is unlikely to bring back old methods of dissection-based anatomy teaching, especially within the context of ‘time-poor, four-year graduate programs’.1 The elective Anatomy by Whole Body Dissection Course at the University of Sydney10 is commendable but unlikely to be replicated in all medical schools for the entire cohort of students. Topp11 suggested prosected cadaver materials for undergraduate teaching and presented convincing arguments in favour of this. The dissection-based anatomy teaching may suit those pursuing postgraduate training in the surgical specialties. The latter idea seems to be the reasonable approach. The teaching of anatomy by surgeons, surgical trainees and near-peer tutors has multiple benefits including the teaching of anatomy in the context.12 Near-peer teaching also provides a strategy for vertical integration and encourages deeper learning in anatomy.13 The College of Surgeons can promote the teaching of anatomy to undergraduates by trainee surgeons by formalizing this process as part of its training requirements, as suggested earlier.14 The tertiary hospitals can also contribute in this regard by following the example described by Taylor and Keay.15 After all, improved anatomical knowledge leads to safe patient care and reduces medical litigation. The concern expressed regarding the assessment of anatomy1, 6 deserves serious consideration. Assessment is known to increase students' motivation to learn anatomy,16 and anatomy assessment through integration of factual knowledge with the principles of problem-solving in different formats should be considered.17 Also, a national Annotated Multiple Choice Question bank facilitated by the Australian and New Zealand Association of Clinical Anatomists would be an important step in the right direction.6 Finally, more research is needed to provide sufficient evidence underpinning most of the claims alleged to be exerting negative influence on anatomical knowledge of medical students.18

A section devoted to profiles of renowned teachers and to the recognition and accomplishments of physiology teachers within the society

Coronavirus disease 2019 (COVID-19) pandemic has undoubtedly impacted anatomy education. This has led to a vast shift from a face to face (F2F) session to a complete online session and practical demonstration. Nonetheless, this pandemic provides an opportunity for anatomy educationists to embark on an alternative delivery of anatomy education via an online platform. The aim of this study was to evaluate the students’ perception of the online teaching and learning in anatomy course delivery among the first-year medical students in Universiti Sains Islam Malaysia (USIM). A total of 90 first-year medical students partook in an online questionnaire-based survey after semester completion of online anatomy course delivery. Synchronous online lectures conferred positive responses from the students with 73.0% of the students perceived effective communication with lecturers through the online platform. Out of these, 71.6% inclined towards online lectures as it allows them the flexibility to record the lecture and revisit it. Gross anatomy practical sessions were executed asynchronously via pre-recorded video with an additional supplementary quiz on USIM’s Global Open Access Learning system (GOALS) while histology practical was executed synchronously via virtual slide demonstration. A total of 80.1% students felt convenient with histology practical, however, only 48.3% students responded positively to the gross practical. Overall, 76.4% students favoured the conventional practical compared to the online sessions. Meanwhile, an online examination had disputable responses between the different exam formats whereby 71.9% students perceived that Multiple Choice Questions (MCQ) were conducted conveniently contradictory to the Modified Essay Questions (MEQ) in which only 34.9% students responded positively. In addition, 57.3% students disclosed multiple setbacks during the Objective Structures Practical Exam (OSPE). The extensive and impromptu changes in the study technique have received multiple responses from the students. Overall, the students preferred an online platform for didactic sessions but a real live classroom for practical sessions.

INTRODUCTIONDue to the rigor and pace of undergraduate medical anatomy courses, it’s not uncommon for medical students to struggle and fail initially. However, repetition of failed coursework places an additional burden on the time, energy, and resources on both the student and the institution. The purpose of this study was to compare the exam preparation strategies of repeating and non‐repeating students to identify areas where struggling students can be supported prior to course failure.METHODSAs part of their integrated anatomy course, first‐year medical students at Indiana University completed a metacognitive Practice‐Based Learning and Improvement (PBLI) assignment prior to and after their first exam. In the pre‐exam PBLI, students were asked to reflect on their grasp of the material, study strategies and resources, confidence, and predicted exam score. The post‐exam PBLI asked students to reflect on their exam satisfaction, study strategies, resources, and plans for future exams. PBLIs and course grades from repeater and non‐repeater students between 2016 to 2020 were compared using the Mann‐Whitney U test. PBLIs and grades from the repeaters’ first and second attempts were compared using Wilcoxon Ranked Signed test and Spearman’s correlation. Open‐ended responses from repeater PBLIs were thematically analyzed using inductive coding.RESULTSA total of 1803 medical students were included in this study. Non‐repeaters (n=1752) exhibited significant positive correlations between their actual and expected exam scores, confidence, and satisfaction (p<0.001). Conversely, repeaters (n=51) did not show any significant correlations between these factors in their first attempt (p>0.05). However, in their second attempt, expected score positively correlated with confidence (r=0.34, p=0.003). The repeaters also significantly increased their actual exam score, confidence, and satisfaction between their first and second attempts (p<0.001). When compared to non‐repeaters, repeaters’ first and second attempts had significantly lower actual exam scores and exam confidence (p<0.05) but did not significantly differ in their expected exam score. Several specific themes were also identified. For example, repeaters relied consistently on lectures to determine their learning needs and noted poor time management to be a major flaw in their exam preparations. On their second attempt, however, many repeaters felt more confident in their study strategies and opted not to modify them further.CONCLUSIONUnlike their non‐repeater counterparts, medical students who failed and repeated coursework demonstrated a disconnect between their actual and expected exam performances, confidence, and satisfaction. This suggests repeaters may lack metacognitive awareness of their own exam preparedness when compared to non‐repeaters.SIGNIFICANCEThese insights into repeater and non‐repeater exam preparation practices can help anatomy educators better support struggling students before they fail a course. These students may benefit from more opportunities to self‐assess their progress and improve their metacognitive awareness.

The role of a military medical officer (MMO) is complex. Therefore, it is essential that military medical students formulate their professional identity early on in medical school in order to prepare them for their first deployment. At the Uniformed Services University, students are challenged to progressively develop their professional identity through yearly high-fidelity military medical field practicums (MFPs). One of these MFPs, Operation Bushmaster, consists of an innovative "Patient Experience" in which first-year medical students portray patients cared for by fourth-year medical students in a simulated operational environment. The purpose of this qualitative study was to examine how participating in the Patient Experience impacted first-year medical students' professional identity formation. Our research team used a phenomenological, qualitative research design to analyze the end-of-course reflection papers of 175 first-year military medical students who participated in the Patient Experience during Operation Bushmaster. Our research team members individually coded each student's reflection paper and then came to consensus on how to organize these codes into themes and subthemes. Two themes and seven subthemes emerged from the data regarding the first-year medical students' understanding of the MMO: (1) multiple roles of the MMO (educator, leader, diplomat, and advisor) and (2) role of the MMO in the operational environment (navigates hazardous environment, adaptability, and position within health care team). As they participated in the Patient Experience, the first-year medical students not only recognized the complexity of the MMO's multiple roles within the operational environment but also envisioned themselves in these roles. The Patient Experience provided first-year medical students with a unique opportunity to formulate their professional identity as they portrayed patients during Operation Bushmaster. This study's results hold implications for both military and civilian medical schools regarding the benefits of innovative military MFPs for professional identity formation in junior medical students, preparing them early on in medical school for their first deployment.

<b>Introduction:</b> Medical education faces increasing content demands, and digital anatomy atlases have become valuable adjuncts to traditional anatomy courses. However, most available atlases are limited to two-dimensional displays, restricting the interactive, spatial learning that is essential for deep anatomical understanding. In response, we developed and implemented a year-long anatomy course for first-year medical students at Jagiellonian University Medical College that integrated a mixed reality-based holographic anatomy software suite with mixed reality (MR) technology. This curriculum aimed to complement traditional anatomy education by offering interactive 3D holographic representations of anatomical structures, allowing realtime exploration and manipulation in a spatial context. <br><b>Methods:</b> A series of MR-enhanced anatomy lessons was created in alignment with the existing first-year anatomy curriculum. Sessions were conducted in a dedicated mixed reality laboratory, each led by an anatomy instructor trained in MR equipment and accommodating up to 9 students (with the instructor present as the 10<sup>th</sup> person). A total of 98 first-year medical students participated in the course. After each session, students were asked to complete a structured survey evaluating their experiences and perceptions of the MR learning environment. Ninety-four students (96% of participants) responded to at least one survey, and complete data from 85 students were included in the final analysis. <br><b>Results:</b> The vast majority of participants reported positive experiences with the MR-based curriculum. Students indicated that the MR sessions enhanced their understanding of anatomical structures and spatial relationships. No significant differences in overall satisfaction were observed between student subgroups. For example, when grouped by prior anatomy coursework, 100% of students without prior anatomy experience and 95% of those with prior experience reported that they could identify anatomical structures after the MR sessions. Similarly, 90% vs. 93% of these groups, respectively, noted improved recognition of anatomical spatial relationships. When grouped by prior use of 3D visualization tools, some differences emerged in self-assessed proficiency: students with previous 3D experience reported greater ease in identifying structures (95% vs. 81%, <i>p</i> = 0.03) and understanding anatomical relationships (97% vs. 81%, <i>p</i> = 0.03), compared to those without such experience. In contrast, students without prior 3D experience found certain MR features more useful than did experienced students – for instance, 88% vs. 70% rated the layer toggle function as helpful (<i>p</i> = 0.048). Despite these subgroup variations, there was broad agreement on the value of MR: 71.8% of all respondents preferred a hybrid learning model combining MR with traditional methods, unanimously emphasizing that MR should supplement rather than replace cadaveric dissection. <br><b>Discussion:</b> Our findings suggest that MR technology is a valuable tool for enhancing anatomy education, particularly by enabling visualization of spatial relationships that are difficult to achieve with textbooks or cadaveric dissection alone. Students appreciated the interactive 3D features of the MR software, which fostered engagement and helped them explore complex anatomical details more intuitively. At the same time, participants recognized the continued importance of hands-on cadaveric labs for tactile learning experiences, indicating that an optimal approach is a hybrid, model integrating MR with traditional anatomy instruction. Notably, this study’s conclusions are drawn from self-reported student data, so any assumptions about long-term learning outcomes must be made cautiously. Future research should evaluate the impact of MR on objective learning measures (such as exam performance and knowledge retention over time) and explore best practices for integrating MR technology into anatomy curricula in diverse educational settings. <br><b>Conclusions:</b> Mixed reality technology was well-received by first-year medical students and effectively enhanced their spatial understanding of anatomical structures. MR sessions were found to be engaging, intuitive and supportive of traditional cadaveric dissection. Students strongly favored a hybrid learning model, suggesting that MR should supplement – not replace – classical methods in anatomy education.

The outbreak of COVID-19, resulting from widespread transmission of the SARS-CoV-2 virus, represents one of the foremost current challenges to societies across the globe, with few areas of life remaining untouched. Here, we detail the immediate impact that COVID-19 has had on the teaching and practice of anatomy, providing specific examples of the varied responses from several UK, Irish and German universities and medical schools. Alongside significant issues for, and suspension of, body donation programmes, the widespread closure of university campuses has led to challenges in delivering anatomy education via online methods, a particular problem for a practical, experience-based subject such as anatomy. We discuss the short-term consequences of COVID-19 for body donation programmes and anatomical education, and highlight issues and challenges that will need to be addressed in the medium to long term in order to restore anatomy education and practice throughout the world.

Anatomy is the important first big subject in medical school. It is a true basic science, because all the other later subjects are dependent on the knowledge of what are the different parts of the body. Gross anatomy looks at the body parts as we observe them in actual life. Histology looks at what are the types of tissues that form these body parts, and how these structures get to work together. Biomolecular studies now look at the basic cellular components and functions at even smaller aspects. Having a firm understanding of what the body parts are gives us better knowledge of how they function, how and where disease develops, and how to manage them. The basic structure of the human body does not change, at least in our lifetimes. Thus, there was the belief and understanding that the science of anatomy may be static. There may not be much excitement in the study of anatomy and thus in the teaching of it. Competent clinicians, however, particularly those in the surgical specialties, need a deep understanding of anatomy for safe clinical procedures. Students may have had very limited exposure to anatomy during clinical training. There is a concern that medical students are ill-prepared in anatomy when entering clerkships and residency programs. 1 It was thus very challenging to teach it and to learn it. A literature review and analysis by Kumar et al. showed that there were deficiencies in anatomical schedule, curriculum, teaching methodologies, and evaluation system in present medical education programs. 2 In recent years, the development of technology and the creative crop of faculty members have made the teaching and learning of anatomy very exciting. This special issue is about the teaching of Anatomy, with articles based on the experiences and research of the faculty of the Department of Anatomy of the University of the Philippines (UP) College of Medicine. A lead article describes a short history of the department, which was actually one of the first departments established in the medical school. The article focuses on its rich experience in the teaching of anatomy which has definitely evolved through the years (Genuino et al., The Department of Anatomy in the University of the Philippines College of Medicine: Dissecting the History). Department most particular. How would the usual teaching of practical anatomy, which generally used a hands-on approach, be done in the period of strict quarantines, and social and physical distancing? The pandemic caused an abrupt transition from face-to-face to online anatomy teaching, learning, and assessment. Although online education has ensured the continuity of anatomy education during the pandemic, its implementation has been challenging, and its effectiveness has been questioned. 3 The Department developed Learning Enhancement in Anatomy Program or LEAP which would address this great need, and prevented any major delay in the teaching and learning activities of batches of medical students (Tecson et al., Student Evaluation of a Learning Enhancement in Anatomy Program (LEAP) during the COVID-19 Pandemic: A Retrospective Study). Online classes for lectures, demonstrations, and group discussions were conducted. A survey among students looked at their impressions and satisfaction when studying histology using virtual and actual light microscopy (Mantaring and Tecson, Satisfaction of Medical Students in Studying Histology Using Virtual and Light Microscopy: A Cross-sectional Study). An overall assessment of the teaching and learning experiences of faculty and students during the pandemic period was also conducted and reported (Mantaring et al., Students and Faculty Experiences, Perceptions and Knowledge on Distress during the COVID-19 Pandemic: A Descriptive Cross-sectional Study). The innovations, changes, and adjustments made either intentionally or serendipitously during the pandemic have made good progress in improving Anatomy education in the Department. There were innovations in teaching materials, using better or different models and specimen. It cannot be thought anymore of as a "dead" subject dealing with "dead people". There were also innovations in teaching strategies and approaches, using various platforms and technology. Learning has now become more interactive, more exciting, and definitely more interesting. It has become an "alive" teaching experience. The best way to teach modern anatomy is by combining multiple pedagogical resources to complement one another. Students appear to learn more effectively when multimodal and system-based approaches are integrated. 1 The Department is on the right track with the modern trends in anatomy education. The traditional anatomy education based on topographical structural anatomy taught by didactic lectures and complete dissection of the body with personal tuition, has been replaced by a multiple range of special study modules, problem-based workshops, computers, plastic models, and many other teaching tools. 4 With a set of motivated, creative, and dedicated faculty in the Department of Anatomy, new approaches were established, more research on using new types of models and innovations in teaching/learning were done, much to the benefit of the students. Significant landmarks can now be added to the history of the Department.