Acquisition Of Anatomical Knowledge Research Articles

Integrating Clinical Reasoning Skills in a Pre-professional Undergraduate Human Anatomy Course.

Clinically integrated curricula in health science education has been shown to promote the development of problem-solving schema and positively impact knowledge acquisition. Despite its' purported benefits, this type of curricula can impose a high cognitive load, which may negatively impact novice learners' knowledge acquisition and problem-solving schema development. Introducing explicit clinical reasoning instruction within pre-professional undergraduate basic science courses may limit factors that increase cognitive load, enhance knowledge acquisition, and foster developing clinical problem-solving skills. This study, conducted over the Fall and Spring semesters of the 2018-2019 school year, sought to evaluate whether the implementation of a clinical reasoning instructional intervention within a clinically integrated pre-professional undergraduate general human anatomy course influenced students' acquisition of anatomical knowledge and development of clinical problem-solving skills. Results of the study were mixed regarding the acquisition of anatomical knowledge. Both the intervention and comparison groups performed similarly on multiple choice examinations of anatomical knowledge. However, the clinical reasoning intervention positively impacted students' ability to apply clinical reasoning skills to anatomically based clinical case studies. Results from M\mixed between-within subjects analysis of variance comparing scores on Written Clinical Reasoning Assessments revealed a significant interaction between time and group affiliation, with the groups receiving the interventions outperforming the comparison groups: Fall, P<0.001; Spring, P<0.001. The results of this study may imply that explicit clinical reasoning instruction within a clinically integrated undergraduate Human Anatomy course could hold potential for fostering students' early clinical reasoning skills.

Ex Vivo Ovine Model for Surgical and Microsurgical Training on Parotidectomy and Facial Nerve Reanimation: Proposal of Structured Training Program.

Facial nerve palsy has a great physical and psychological impact on patients, so the avoidance of facial nerve damage during surgery and its reanimation are important for Otolaryngologists and head and neck surgeons. The acquisition of anatomical knowledge and surgical training regarding the parotid surgery and facial nerve is mandatory, but not easy to achieve. Surgical simulation is a reliable alternative to the on-the-job learning. In the study, we tested an ex vivo animal model to obtain the basic and advanced skills of parotid gland surgery and facial nerve reconstruction/reanimation. A prospective cohort study has been conducted on ovine head and neck specimen. A junior resident, a senior resident, and an expert surgeon were involved in a step-by-step preplanned dissection, divided in macroscopic and microscopic. Each procedure was recorded and evaluated by an expert surgeon following an adapted rating scale. A statistically significant improvement in terms of execution times and quality of the work was show in most of the surgical steps and for many quality items by the junior and senior residents, while the expert surgeon, as expected, did not show any improvement. Our ex vivo ovine model provided the trainee with close-to-real tissues in term of elastic resistance and consistency, to learn the skills requested in a head and neck surgery, on a reproducible environment. It is mandatory to have a feedback, which focuses on the quality of the work through valid and reliable assessment of technical skills. The judgment parameters should be reproducible and focused on the specific surgical procedure. Some limitations to this study are present, such as anatomical differences between ovine and human and the limited number of study participants. This proposal of training program on the ex vivo ovine model for the acquisition of skills needed in head and neck surgery proved to be feasible, effective, repeatable, and cheap.

Stereoscopic three-dimensional visualisation technology in anatomy learning: A meta-analysis.

ObjectivesThe features that contribute to the apparent effectiveness of three‐dimensional visualisation technology [3DVT] in teaching anatomy are largely unknown. The aim of this study was to conduct a systematic review and meta‐analysis of the role of stereopsis in learning anatomy with 3DVT.MethodsThe review was conducted and reported according to PRISMA Standards. Literature search of English articles was performed using EMBASE, MEDLINE, CINAHL EBSCOhost, ERIC EBSCOhost, Cochrane CENTRAL, Web of Science and Google Scholar databases until November 2019. Study selection, data extraction and study appraisal were performed independently by two authors. Articles were assessed for methodological quality using the Medical Education Research Study Quality Instrument and the Cochrane Collaboration's tool for assessing the risk of bias. For quantitative analysis, studies were grouped based on relative between‐intervention differences in instructional methods and type of control conditions.ResultsA total of 3934 citations were obtained of which 67 underwent a full‐text review. Ultimately, 13 randomised controlled trials were included in the meta‐analysis. When interactive, stereoscopic 3D models were compared to interactive, monoscopic 3D models within a single level of instructional design, for example isolating stereopsis as the only true manipulated element in the experimental design, an effect size [ES] of 0.53 (95% confidence interval [CI] 0.26‐0.80; P < .00001) was found. In comparison with 2D images within multiple levels of instructional design, an effect size of 0.45 (95% CI 0.10‐0.81; P < .002) was found. Stereopsis had no effect on learning when utilised with non‐interactive 3D images (ES = −0.87, 95% CI −2.09‐0.35; P = .16).ConclusionStereopsis is an important distinguishing element of 3DVT that has a significant positive effect on acquisition of anatomical knowledge when utilised within an interactive 3D environment. A distinction between stereoscopic and monoscopic 3DVT is essential to make in anatomical education and research.

Three-dimensional printing in anatomy teaching: current evidence.

The critical literature review investigates the extent to which the current evidence supports that three-dimensional printing (3DP) could play an important role in human anatomy education. PubMed, ERIC, and Cochrane databases were searched for papers dealing with the outcomes of 3DP implementation in human undergraduate anatomy education. The following data were extracted from each paper: authors, year of publication, type of study (comparative or not), number of participants, level of outcome according to Kirkpatrick hierarchy, influence of 3DP on acquisition of anatomical knowledge and skills, as well as perceptions about the 3DP use in anatomy teaching. Eight papers were eligible for analysis. All of them comprised comparison of 3DP with other anatomy teaching tools. Two papers evaluated only students' perceptions about 3DP, while six papers explored its impact on students' knowledge. The 3DP was statistically significantly superior to two-dimensional images in terms of the investigated parameters. However, comparison between 3DP and cadavers' dissection by students did not take place in any study. The 3DP implementation in anatomy education showed promising outcomes. However, the lack of studies which compared the educational effectiveness of 3DP with that of cadavers' dissection is highlighted. It seems that 3DP could certainly be used as an adjunct to cadavers' dissection. Further research could clarify if 3DP could obtain a more prominent role in anatomy pedagogy compared to other anatomy teaching modalities.

Integrating Clinical Reasoning Skills in an Undergraduate Human Anatomy Course

Contextualized instruction in pre‐baccalaureate undergraduate anatomy courses has the potential to improve knowledge acquisition and retention, and promote the development of problem‐solving schema. However contextualized learning requires a high cognitive load, which may negatively impact novice learners in health science education programs. The first phase of our quasi‐experimental longitudinal study sought to evaluate whether the introduction of explicit clinical reasoning instruction concurrently with contextualized instruction in an undergraduate human anatomy course 1) impacted students’ acquisition of anatomical knowledge 2) promoted the development of clinical reasoning skills. The second phase of this study examined whether that pedagogical approach 3) bolstered students’ retention of anatomical knowledge 4) provided students with transferable foundational clinical reasoning skills. Phase one, conducted over two semesters in an undergraduate human anatomy course, included 462 participants. Each semester, one section of the course was designated the intervention group and received explicit clinical reasoning instruction. The other section was designated the comparison group, and received identical curriculum sans explicit clinical reasoning instruction. Results from independent t‐tests showed that intervention did not change student’s acquisition of anatomical knowledge as measured by four multiple‐choice exams (Fall 2018: p=1.00; Spring 2019: p=.146). However, the intervention positively influenced student’s development of clinical reasoning skills as measured by four Written Assessments. Mixed between‐within subjects ANOVA demonstrated a significant difference between the intervention sections and comparison sections (Fall 2018: p&lt;.001; Spring 2019: p=.010). In the second phase of the study, a cohort of 112 first‐semester students enrolled in a BSN program agreed to be participants. Phase two participants will complete a general anatomy assessment and a written clinical reasoning assessment, similar to the written assessments used in phase one. Mean scores from the assessments will be compared between those who had been in either the intervention or comparison groups during in phase one, as well as against scores of students in the cohort who were not part of phase one. Data collection for phase two is near completion. Results from both phases of the study may guide further research and recommendations regarding pedagogical practices in undergraduate anatomy courses. Our findings will also be of interest to educational professionals concerned with the preparation of students matriculating into professional level health science education programs. We hope to initiate a conversation in regards to the role undergraduate anatomy courses play in the health science education ecosystem.Support or Funding InformationThe first author for this study was awarded the 2019 American Association of Anatomy Education Research Scholarship. There were no other external funding sources.

Sex‐based Differences in Visual‐Spatial Reasoning Do Not Impact Exam Performance in Musculoskeletal Anatomy Among Physical Therapy Students

IntroductionPrevious research has investigated visual‐spatial reasoning in the acquisition of anatomical knowledge and has identified sex‐based differences in this reasoning among various student populations. However, to date, no studies have evaluated if sex‐based differences exist in visual‐spatial reasoning among doctor of physical therapy (DPT) students and if these differences impact examination performance in musculoskeletal (MSK) gross anatomy.AimThe purpose of this study was to (1) investigate sex‐based differences in visual‐spatial reasoning and (2) determine if these differences impacted exam performance among DPT students enrolled in a MSK anatomy course. We hypothesized, visual‐spatial reasoning would be greater in male DPT students versus female DPT students, and positively correlate with exam performance.MethodsFifty first‐year DPT students were voluntarily recruited during the first week of a 10‐week MSK anatomy course to complete the Vandenberg Mental Rotation Test (VMRT), rate their level of confidence in MSK anatomy (1=low, 5=high confidence), and provide demographic information (self‐identified gender, sex, age) in this IRB‐approved study. At the end of the course, scores on written (n=3) and practical (n=3) examinations were collected. A total examination score was determined, and a ratio was calculated for the total number of correct to the total number of attempted VMRT questions. Groups were dichotomized by sex and data were checked for normality with the Shapiro‐Wilk test. Comparisons between groups were analyzed with the Mann–Whitney U‐test. Sex‐based correlations were assessed with Spearman’s rho. Alpha&lt;0.05.ResultsNo significant differences in age were found between male (n=16) and female (n=34) DPT students (M: 25.6±4.2 vs. F: 25.9±4.6, p=0.71). VMRT scores among males were significantly higher than females (M: 17.8±3.9 vs. F: 11.0±3.9, p&lt;0.0001). The number of VMRT questions attempted was also significantly higher among males compared to females (M: 21.9±3.6 vs. F: 15.8±3.8, p&lt;0.0001). No significant differences between the groups were found in the number of questions answered incorrectly on the VMRT (M: 4.13±2.7 vs. F: 4.84±3.75, p=0.69) or the ratio number of VMRT questions correct to the number attempted (M: 0.81±0.11 vs. F: 0.70±0.19, p=0.082). Scores for practical exam (M: 67.3±4.3 vs. F: 67.0±4.3), written exam (M: 68.9±3.6 vs. F: 68.9±3.4), and combined total score (M: 136.2±6.7 vs. F: 135.9±7.0) did not differ between groups (p&gt;0.05). There was a significant correlation between age and total exam score in females (r=−0.42, p=0.013), but not in males (r=−0.29, p=0.27). No other significant correlations were detected.Discussion/ConclusionThese results demonstrate that visual‐spatial reasoning is higher among first‐year male DPT students compared to female DPT students, but do not impact exam performance in a MSK anatomy course. Understanding sex‐based differences in anatomical knowledge acquisition may help anatomy instructors improve learning outcomes. Future research is needed to determine if female PT students compensate with alternate learning strategies and whether these strategies are sex‐specific.

Model pedagogy of human anatomy in medical education.

The falling standard of medical education evidenced by patient dissatisfaction causing rapidly heaping medico-legal cases, some of them may be due to 'anatomical ignorance' leading to tremendous concern by both clinicians and anatomists, encouraged the author to design a pedagogical model of teaching of anatomy in medical education. So, the aim of the study is to propose a suitable pedagogical model from review of literature and author's own experience and analysis. The literature survey (online) has been carried out using the phrases, decline of anatomy, contribution of anatomy to medical education, prevalent curriculum and teaching methodology, causatives of acquisition of inadequate anatomy by medical trainees. The literature and our own analysis highlight the deficiencies in anatomical schedule, curriculum, teaching methodologies and evaluation system in present medical education. A pedagogical model has been designed to improve the delivery and acquisition of anatomical knowledge. The evolved pedagogical model of anatomy in the present study aims at sufficient delivery and acquisition of anatomical knowledge if applied, not only to curb failure cases and, consequently, litigations but also to boost the confidence of trainees, patients and society on health care system.

Acquiring Clinical Knowledge from an Online Video Platform: A Randomized Controlled Experiment on the Relevance of Integrating Anatomical Information and Clinical Practice.

Basic subjects in medical education, such as anatomy, are often taught through teaching formats that do not always sufficiently demonstrate the relevance of this basic information for clinical practice. Accordingly, it is a recent trend in anatomy education to link anatomical information more explicitly to clinical practice. This article presents an online video platform (Tuebingen's Sectio Chirurgica [TSC]) as one means of explicitly integrating preclinical anatomical knowledge and clinical application. The purpose of the study presented here was to examine the effects of videos through which medical students were educated about Anterior Cruciate Ligament reconstruction. A TSC video about this surgical procedure was compared to a video with a traditional lecture providing the identical information. Participants (n=114) perceived the TSC video to be superior in comprehensibility of the presentation (P=0.003) and conceivability of the surgical procedure (P=0.027), and to be more entertaining (P<0.001). Moreover, participants in the TSC condition acquired more clinical knowledge than in the lecture condition (P=0.043) but did not differ in their acquisition of anatomical knowledge. Mediation analyses indicated that the effect on the acquisition of clinical knowledge was mediated by comprehensibility, conceivability, and entertainment. These findings are discussed regarding their implications for medical education in terms of contributing to the general trend of linking preclinical anatomical knowledge to clinical application. A discussion about the limitations of the study and suggestions for future research are also provided.

The Anatomy of Traditional and E‐Learning Education: How the spatial ability of learners can impact learning outcomes

Technological innovation is changing the landscape of higher education, and the competing interests and responsibilities of today's learners have propelled the movement of post‐secondary courses into the online environment. In the anatomical sciences, computer‐aided instruction and online learning tools have become a critical component of teaching the intricacies of the human body when physical classroom space and cadaveric resources are limited. Our previous research (n=70) compared a simple 2‐dimensional e‐learning tool (A.D.A.M. Interactive Anatomy) to a more complex tool that allows for a more 3‐dimensional perspective (Netter's 3D Interactive Anatomy). Despite the differences in how these e‐learning tools present information, student ability to learn anatomical material, and their mental effort while doing so, known as cognitive load, were identical between e‐learning tools. However, when students with low spatial ability studied anatomical content with the more complex tool (Netter's 3D Interactive Anatomy), their performance scores were significantly lower than those students with high spatial ability (p=0.007). These results indicate that e‐learning tool software design can differentially influence students based on their spatial ability, but it remains to be determined if traditional kinesthetic‐tactile learning approaches, such as manipulating a skeleton, are also impacted by a student's spatial ability. Using a novel dual‐task methodology with a cross over design, undergraduate anatomy students from The University of Western Ontario, Canada (n=71) were evaluated as they studied a bony joint using a physical skeleton as well as a simple commercial software program (A.D.A.M. Interactive Anatomy). We hypothesized that the acquisition of anatomical knowledge by students, regardless of their spatial ability, would be superior when learning is associated with a real model, rather than currently available e‐learning tools. Students were assessed using a baseline knowledge test, Stroop observation task response times (a measure of cognitive load), MRT scores (a measure of spatial ability) and an anatomy post‐test (a measure of learning). Results suggested that while students may experience more cognitive load while studying using a physical skeleton (p&lt;0.001), it does not detrimentally impact their performance; in fact student performance was significantly higher when they studied using the skeleton (p&lt;0.001, R=0.46). Furthermore our results also demonstrated that students with low spatial ability are at a significant disadvantage when they learn the bony anatomy of a joint and are tested on images of the contralateral joint (p=0.023, R=0.326). This study highlights a major weakness in the strategy to move traditional anatomical education online, and suggests that students should be taught the anatomy of both sides of the human body, regardless of the reality that human limbs are mirror images of each other. These results can be further applied to the training of future surgeons and medical specialists, where surgical and medical procedures should be taught and practiced on both sides of the human body, to ensure that all students, regardless of spatial ability, can take their anatomical knowledge into the clinic and perform successfully.Support or Funding InformationSocial Science and Humanities Research Council, Government of Canada

Anatomical-Ultrasound Visor for Regional Anaesthesia.

Regions considered optimal for performing peripheral nerve blocking have been well documented. However identify and perform regional anesthesia in those regions from ultrasound images remains a challenge. This study aims to develop a virtual environment for the simulation of ultrasound exploration of the neck nerves and both the upper and lower limbs for regional anesthesia. Cross-sectional images were obtained from Magnetic Resonance Imaging for puncture regions involved in ultrasound-guided nerve block. A three-dimensional digital viewer was developed for the anatomical and ultrasound identification of key structures involved in peripheral nerve block in neck, upper and lower limbs. This study provides a virtual environment software used to simulate ultrasound exploration of nerve neck and upper and lower limbs for regional anesthesia. Potential implications of this tool for improving the ultrasound exploration for regional anesthesia and acquisition of anatomical knowledge are further discussed.

Sexual Knowledge: Feeling, Fact, and Social Reform in Vienna, 1900–1934 by Britta McEwen (review)

Reviewed by: Sexual Knowledge: Feeling, Fact, and Social Reform in Vienna, 1900–1934 by Britta McEwen Michael Boehringer Britta McEwen, Sexual Knowledge: Feeling, Fact, and Social Reform in Vienna, 1900–1934. Austrian and Habsburg Studies 13. New York: Berghahn Books, 2012. 232 pp. In this monograph, based on her 2003 dissertation, Britta McEwen has written a sensitive and thorough examination of the way in which knowledge about sex and sexuality was constructed, negotiated, and distributed in Vienna. Her timeframe is well chosen, beginning with the rapid development of the sexual sciences in the late nineteenth century and ending in February 1934 when the reform efforts in the Social Democrat–governed “Red Vienna” came to a halt in the violent conflicts with the police and the army. McEwen argues convincingly that Vienna occupied a special status during the post–World War I years, not only as the only socialist-run capital in Europe but also as a social-progressive island within a conservative nation. As such, the city-state of Vienna made for a fascinating social laboratory for the construction of sexuality and its meanings in society. While separating her study methodologically from those that link sexuality and nationalism, McEwen does frame it within supra-national discourses on sexuality, Social Darwinism and eugenics, and social pedagogy to form her central thesis, namely that sexual knowledge underwent a fundamental shift from a “form of scientific inquiry practiced largely by medical specialists to a social reform issue engaged by and intended for a wide audience” (2). In order to substantiate her claims, McEwen analyzes a myriad of mostly published yet hitherto largely unexamined texts by public servants and sex reformers close to the Social-Democratic Workers’ Party of Austria and as well as those with allegiances to the Roman Catholic Church, such as sex manuals, [End Page 125] children’s sexual education texts, or municipal reports. She uses a number of analytical tools that can broadly be subsumed under the label of poststructuralist cultural studies: Foucauldian discourse analysis, cultural history of mentalités in the manner of Lucien Febvre or Carlo Ginzburg, and William Reddy’s concept of “emotional regimes,” the cultural process by which emotions are managed and shaped. Common to all these methodologies is their emphasis on the constructedness of knowledge, which McEwen employs for a process-oriented rather than a purely descriptive approach to her topic: “I have sought to understand how people in Vienna thought about sex, what they did with the knowledge, and how that knowledge changed over time” (5). McEwen’s text is made up of six largely self-contained chapters (plus introduction and conclusion), each of which approaches her central theme from a different angle: Chapter 1 focuses on Julius Tandler’s tenure as the minister of public health after World War I and his central role in the creation of Vienna’s health and hygiene system. Tandler promoted a specifically Viennese form of eugenics called “productive population politics” (44) to bring about the repair of national health and a national regeneration through state-prescribed sexual hygiene as well as support for families, unwed mothers, and illegitimate children. In the process, McEwen argues, Tandler created an official language of sexual knowledge that would find widespread use and initiated the shift away from private doctors to public servants in the delivery of sexual health services. Chapter 2 analyzes various approaches to sexual education during the interwar period. McEwen outlines the efforts of sexual reformers to replace religious doctrine with scientifically based knowledge about the body and sexuality and the resulting counter-discourse put forward by the Catholic Church. McEwen demonstrates that the respective positions were not monolithic but allowed for considerable overlap, especially around the themes of the naturalness of (heterosexual) desire, its sublimation through self-restraint and individual responsibility, marriage, and motherhood. These last two aspects also form the central focus of the third chapter. Here McEwen argues that the heterosexual couple was the principal object of the sexual reform movement, with women having a special role in protecting their reproductive capacities (and that of their partners) through the acquisition of anatomical knowledge and the prevention of disease and unwanted pregnancy. The literary model of the...

Role of a computer-generated three-dimensional laryngeal model in anatomy teaching for advanced learners

(1) To investigate the efficacy of a computer-generated three-dimensional laryngeal model for laryngeal anatomy teaching; (2) to explore the relationship between students' spatial ability and acquisition of anatomical knowledge; and (3) to assess participants' opinion of the computerised model. Forty junior doctors were randomised to undertake laryngeal anatomy study supplemented by either a three-dimensional computer model or two-dimensional images. Outcome measurements comprised a laryngeal anatomy test, the modified Vandenberg and Kuse mental rotation test, and an opinion survey. Mean scores ± standard deviations for the anatomy test were 15.7 ± 2.0 for the 'three dimensions' group and 15.5 ± 2.3 for the 'standard' group (p = 0.7222). Pearson's correlation between the rotation test scores and the scores for the spatial ability questions in the anatomy test was 0.4791 (p = 0.086, n = 29). Opinion survey answers revealed significant differences in respondents' perceptions of the clarity and 'user friendliness' of, and their preferences for, the three-dimensional model as regards anatomical study. The three-dimensional computer model was equivalent to standard two-dimensional images, for the purpose of laryngeal anatomy teaching. There was no association between students' spatial ability and functional anatomy learning. However, students preferred to use the three-dimensional model.

Twelve tips for running a successful body painting teaching session

Body painting in the medical education context is the painting of internal structures on the surface of the body with high verisimilitude. Body painting has many educational benefits, from the obvious acquisition of anatomical knowledge, to the less obvious benefits of improved communication skills and greater body awareness. As with any activity, which involves physical examination and undressing, sensitive delivery is imperative. The 12 tips given in this article offer advice on the practicalities of running a successful body painting session in a supportive environment, thus promoting maximum student participation.