Predictors of confidence in anatomy knowledge for work as a junior doctor: a national survey of Australian medical students

Sandra Carr,Chris Roberts,David T. Bui,John E. Farey,David Townsend,Premala Sureshkumar

doi:10.1186/s12909-018-1280-5

Abstract

BackgroundMajor changes to the teaching of anatomy associated with the integration of basic and clinical sciences in modern medical curricula have coincided with students reporting concern over achievement of learning outcomes in anatomy. Little guidance exists for medical educators designing anatomy courses that account for factors that positively influence medical student confidence in their own anatomy knowledge. We sought to determine what factors are associated with medical students’ self-reported confidence in their anatomy knowledge in preparation for clinical practice.MethodsCross-sectional national survey of Australian medical students distributed using social media. We performed univariate and multivariable ordinal regression to determine the factors in anatomy learning and teaching that influence medical student self-reported confidence to have sufficient anatomy knowledge by the time of graduation, for practice as a junior doctor.ResultsOf 1309 surveyed, 1101 (84%) responded, representing 6.5% of the Australian medical student population. Mean age was 23.9 years (SD 4.8 years), a majority were female (644, 58.5%), and students in all years of both undergraduate (52%, 575) and graduate entry courses (48%, 529) were represented. Items associated with increased self-reported confidence in anatomy knowledge included adequate assessment of anatomy (Odds Ratio 2.17 [95% CI 1.69–2.81]), integration of anatomy with other basic sciences (OR 1.97 [1.52–2.56]) and clinical teaching (OR 1.90 [1.46–2.48]), male gender (OR 1.89 [1.48–2.42]), anatomy education prior to medical school (OR 1.46 [1.14–1.87]) and exposure to dissection (OR 1.39 [1.08–1.78]). Medical students in their clinical years reported lower confidence in their anatomy knowledge (OR 0.6 [0.47–0.77], p < 0.0001). Age and career intention were not significant predictors of confidence.ConclusionsMedical educators can enhance student confidence in their own anatomy knowledge by developing curricula that vertically integrating anatomy learning and teaching, integrate anatomy teaching with other basic sciences, and providing consistent assessment through both the pre-clinical and clinical stages of medical training. Anatomy education should also incorporate dissection as a teaching method, and students could benefit from completion of anatomy education prior to medical school. Consideration should also be given to further investigate the confidence of female students in their anatomy knowledge.

Highlights

Major changes to the teaching of anatomy associated with the integration of basic and clinical sciences in modern medical curricula have coincided with students reporting concern over achievement of learning outcomes in anatomy
Factors that predict confidence in anatomy knowledge after graduation Univariate analysis demonstrated six elements to be significantly positively associated with medical student’s having increased confidence that they would have sufficient anatomy knowledge by the time they graduated, for practice as a junior doctor. These were a) vertical integration of anatomy instruction with clinical teaching, b) increased frequency of assessment of anatomy knowledge, c) integration of anatomy teaching with other basic sciences teaching, d) male gender, e) formal anatomy instruction prior to medical school and f ) exposure to dissection (p < 0.0001) (Table 2)
These in decreasing order were; 1) vertical integration of anatomy instruction with clinical teaching, 2) increased frequency of assessment of anatomy knowledge, 3) integration of anatomy teaching with other basic sciences, 4) male gender, 5) formal anatomy instruction prior to medical school, 6) exposure to dissection, and 7) being in the pre-clinical years of the medical degree

Summary

Introduction

Major changes to the teaching of anatomy associated with the integration of basic and clinical sciences in modern medical curricula have coincided with students reporting concern over achievement of learning outcomes in anatomy. Many clinicians and anatomists internationally have expressed concern over a perceived deficiency in the anatomy knowledge of recent medical graduates [4,5,6,7,8,9] Various explanations for this phenomenon have been offered by researchers, including generational conflict, teaching of anatomy by non-medically qualified teachers, decreased use of dissection as a teaching tool and the use of integrated curricula such as problem based learning. Bergman et al, proposed four promising research areas in anatomy education, which would positively impact medical student knowledge of anatomy These included: the vertical integration of anatomy education throughout the medical program; consistent assessment of anatomy knowledge to drive learning behaviour; and the teaching of anatomy in context to aid knowledge retention and diagnostic reasoning. Students in PBL courses may be more likely to perceive deficiencies in their anatomy knowledge, leading to anxiety in their ability to achieve the intended learning outcomes [11, 13]

Methods

Results

Discussion

Conclusion