Anatomy Classroom Research Articles

Flipping the anatomy classroom: a comparative analysis of 16-week and 8-week courses in a community college

Flipping the anatomy classroom: a comparative analysis of 16-week and 8-week courses in a community college

Beyond the Comfort Zone

The primary objective of this autoethnographic study is to investigate how lecturers’ attempts to use augmented reality (AR) in the vocational educational context contribute to their transformative learning (TL) journey. The first author of this paper, referred to using the pronoun ‘her/she’, is a vocational lecturer pursuing her doctoral degree in technology-enhanced learning (TEL), has examined the evolution of her pedagogical perspectives by critically analysing and reflecting on her experiences learning and adopting AR technology in her anatomy classrooms. She also explored and unpacked her educational experiences in the past and the social and cultural contexts in which they occurred to gain deeper insight into her previous and current beliefs about TEL. Her autoethnographic writing in this paper shares her struggles and growth, underscoring the significance of scaffolding and professional networked learning opportunities in nurturing transformative learning in lecturers. In collaboration with the second author, her doctoral supervisor, the first author has drawn more meaningful and robust findings from collecting and comparing other lecturers’ experiences implementing AR in similar pedagogical situations. The authors’ discussion sheds light on the often obscure process of how educational professionals challenge and change their long-held pedagogical perspectives on the usefulness of technology for their teaching and student learning. The paper also reveals the cognitive, emotional, and social dimensions of professional learning and highlights the role of professional networks in facilitating transformative learning experiences. The findings, derived from personal reflective narratives, self and member-checking interviews, and TL analysis, suggest that a strong sense of ownership, extensive classroom experiences, and commitment to critical reflection played crucial roles in supporting the learning journey. However, this experience transcended the mere acquisition of new knowledge; the study depicts a transformative journey wherein theory recognised a fundamental shift in perception through instrumental learning, emphasising the evaluation of cause-and-effect relationships via critical reflection of actions. Therefore, within the realm of TL, this study may contribute to theory by asserting that critical reflection not only serves as a medium for learning but also functions as a tool for shaping the process of learning itself. The dissemination of such pivotal insights becomes imperative for educators, empowering them to make judicious and well-informed decisions, thereby fortifying their preparedness for a transformative journey that, if embarked on without adequate support, may prove elusive.

Improving student learning and performance through a continuous flipped anatomy teaching model.

The flipped classroom teaching model has been widely used in anatomy education to embrace a blended learning strategy. However, the impact that a continuous flipped classroom teaching model exerts on student learning of human topographic anatomy remains unclear. To address this question, student learning experience and performance were compared between third-year undergraduate students who participated in a continuous flipped anatomy classroom teaching since their first year (n = 65, experimental group) and those under the flipped anatomy teaching model only in their third year (n = 45, control group). A five-point Likert scale learning and teaching survey was conducted to evaluate students' perceptions of the flipped classroom model. Students under a continuous flipped classroom teaching model rated significantly higher on the impact of the flipped model on learning difficult anatomy concepts than the control group (*p = 0.0346). The rating on independent learning remained not statistically different between the two groups, although a trend difference was detected (p = 0.0604). Analysis of learning performance revealed that the experimental group significantly outperformed the control group when answering questions focusing on regional anatomy (*p = 0.0207). No significant difference was identified in students' marks of case-based studies between the two groups. In summary, the results of this study indicate that the flipped classroom model implemented over a long term continues to advance students' learning experience and performance in anatomy, indicating a "dose" effect on active learning. The findings of this study will assist the best practices of the flipped anatomy classroom and develop evidence-informed approaches to advance anatomy education in the future.

Virtual reality experiences in medical education: A systematic literature review

Background: Some studies suggested that teaching anatomy with a virtual reality simulator would greatly enhance medical education. The purpose of this work is to analyze the available literature to determine the effectiveness of virtual reality as a learning tool for anatomy teaching in medical schools. Materials and Methods: This literature review was completed in accordance with preferred reporting items for systematic reviews and meta-analyses guidelines on September 07, 2022. The three databases that were utilized were Google Scholar, Cochrane, and PubMed. After performing the search utilizing the listed guidelines, two independent researchers shared and debated their individual lists, ultimately combining them and applying further exclusion criteria. This resulted in two remaining articles which addressed the research question. Results: One of the most notable findings in both articles is that students who utilized virtual reality in their anatomy learning demonstrated improvement in their understanding of structure locations and spatial relationships. In addition, students ability to read and understand diagnostic imaging markedly improved for images presented both on examinations and in face-to-face settings following virtual reality-based learning interventions. Virtual reality technology also increased interest in anatomy when utilized in the anatomy classroom, though this interest was limited to the anatomic region(s) in which the virtual reality sessions focused. Discussion/Limitations: Due to the scarcity of topically relevant results, this particular systematic review is unable to express anything beyond potential promise in the use of virtual reality-based interventions in the medical school anatomy classroom. As virtual reality technologies have been shown to potentially add benefit in these applications, there is reason to believe that new literature will become available in the near future. Conclusion: This particular review analyzed the available literature from the last 4.5 years on virtual reality learning in the medical school anatomy classroom. The authorial team found that very little has been written on the topic and that further research should be performed to determine the level of effect that this has on student learning other than that virtual reality increases student interests in the topics and specific anatomical regions of study.

Flipped anatomy classroom integrating multimodal digital resources shows positive influence upon students' experience and learning performance.

Anatomy is shifting toward a greater focus on adopting digital delivery. To advance digital and authentic learning in anatomy, a flipped classroom model integrating multimodal digital resources and a multimedia group assignment was designed and implemented for first-year neuroanatomy and third-year regional anatomy curricula. A five-point Likert scale learning and teaching survey was conducted for a total of 145 undergraduate health science students to evaluate students' perception of the flipped classroom model and digital resources. This study revealed that over two-thirds of participants strongly agreed or agreed that the flipped classroom model helped their independent learning and understanding of difficult anatomy concepts. The response showed students consistently enjoyed their experience of using multimodal digital anatomy resources. Both first-year (75%) and third-year (88%) students strongly agreed or agreed that digital tools are very valuable and interactive for studying anatomy. Most students strongly agreed or agreed that digital anatomy tools increased their learning experience (~80%) and confidence (> 70%). The third-year students rated the value of digital anatomy tools significantly higher than the first-year students (p=0.0038). A taxonomy-based assessment strategy revealed that the third-year students, but not the first-year, demonstrated improved performance in assessments relating to clinical application (p=0.045). In summary, a flipped anatomy classroom integrating multimodal digital approaches exerted positive impact upon learning experience of both junior and senior students, the latter of whom demonstrated improved learning performance. This study extends the pedagogy innovation of flipped classroom teaching, which will advance future anatomy curriculum development, pertinent to post-pandemic education.

The effect of repetition- and scenario-based repetition strategies on anatomy course achievement, classroom engagement and online learning attitude

Anatomy is known to be the oldest and most fundamental branch among medical sciences. That is the reason why it is given at the beginning of medical education to form the basis for other medical sciences. Students who newly begin medical education need to spare plenty of time outside the course hours to study Anatomy which involves different and a lot of terminology. In this study, online repetitions were done outside the class using the repetition (classical presentation) and scenario-based repetition methods and the knowledge levels, course engagement statuses and online learning attitudes of the students were compared quantitatively and qualitatively between the groups.The study was conducted with 162 medical school year 2 students. These 162 students were randomized to experimental and control groups. The data were obtained with “Anatomy Achievement Test (AAT)”, “Classroom Engagement Inventory (CEI)” and “Medical School Students’ Attitudes Towards Online Learning Scale (MSSATOLS)”. After administering the experimental procedure to the students who were randomized to the experimental and control groups, focus group interviews were held with 16 students from the experimental group, 8 who received the highest scores and 8 who received the lowest scores from the data collecting instruments. The collected research data determined that the affective engagement (AE) and the anatomy achievement test (AAT) performed pre- and post-study were higher in the group in which the scenario-based repetition strategy was applied. AAT pre-test (mean = 27.16) and post-test (mean = 27.15) scores of the repetition group were very close to each other. However, the AAT post-test (mean = 32.33) average of the scenario-based repetition group was above the mean pre-test scores (mean = 26.79) (p < .05). Similarly, the mean AE pre-test (mean = 17.79) and post-test (mean = 17.91) scores of only the repetition group were very close to one another. However, the AE post-test (mean = 19.46) mean score of the scenario-based repetition group was above the mean pre-test score (mean = 17.82) (p < .05). In summary, pre-test and post-test scores changed the anatomy achievement and affective engagement scores, and this change was in favour of experimental group and increasing the post-test scores.The responses given to the questions in the scales and the impressions obtained from qualitative interviews indicated that the students did not find adequate the lectures given in the form of presentations alone and thought that various methods and primarily scenario-based education should be used as part of anatomy education to be able to establish a good connection with clinical sciences and Anatomy education should be provided not only at the beginning of the medical education but also in the following years.

Anatomy Classroom

Human anatomy is a fundamental area for the training of health professionals, presenting itself as a foundation in their formation. However, the methodological path adopted in teaching practice in the course of this discipline is based on traditional methodologies. However, contemporaneity calls for new form and approach in the pedagogical course, inquiring and rethinking the anatomy classroom through different practices and active methodologies with the insertion of technological resources. Thus, the present research aims to investigate the different teaching practices applied in the anatomy classroom through an integrative review. An integrative review of the literature was performed through research in electronic databases: Science Direct and SciELO. The inclusion criteria were: studies that answered the guide question, research with human beings, published from 2015 to 2021, in English, Spanish and Portuguese. It was verified that there are a number of tools and strategies that can be used to teach the most attractive of human anatomy, stimulating the development of the skills and competencies of health students.

Assessing Racial Consciousness in Anatomy Educators

Anatomy teaching faculty have the ability to affect how race is discussed and portrayed in the curriculum, such as choosing which images to use, which textbooks to assign and reference, and whether to include race or other social determinants of health in discussions of clinical correlates of anatomy. Inclusive learning materials can impact medical students’ self‐perception and either reinforce or dismantle implicit and explicit biases that may be held toward future patients and colleagues. Using a mixed methods approach, we surveyed faculty teaching anatomy at a variety of levels in order to assess the materials, resources, and concepts that are currently taught in anatomy classrooms, and the barriers that anatomy faculty face in creating diverse and inclusive teaching materials.Survey results show that of 162 total respondents, only 17.86% of anatomy faculty are satisfied with the diversity represented in their anatomy textbook, while 50.89% are not satisfied. Overall, it appears that while race is at least sometimes discussed in the majority of curricula surveyed here (39.69 % “sometimes”, 17.46% “often,” 3.05% “always”), it appears to be less frequently discussed in the anatomy classroom (37.40% “sometimes,” 6.11% “often,” 0.0% “always”).Qualitative data collected from survey participants suggests that some anatomy faculty (18) feel that race is outside of the scope of discussion in an anatomy course. However, 17 educators felt that discussion of race is within scope for an anatomy course. Interestingly, describing race as a social construct was used both to justify its exclusion in the anatomy curriculum (2 respondents) as well as its inclusion (4 respondents).Our preliminary data that most educators desire to be more inclusive in their instructional materials, however, they feel restricted by the lack of diverse resources at their disposable. We hope the insights from this study will help us understand information gaps and create a more racially conscious anatomy curriculum.

The Cognitive Load of Learning Anatomy in a Virtual World

IntroductionCognitive load refers to the amount of working memory that is being used in a task, like memorizing the anatomical landmarks on distinct boney specimens. Critically, cognitive load may be compromised when the load imposed by the environment and the content to be learned together exceeds a student’s capacity. Previous research shows that stereoscopic materials delivered in virtual reality (VR) can be more mentally taxing compared to desktop (i.e., two dimensional) delivery but may be similar to that encountered in real life. There is no data on the cognitive load of autostereoscopic displays. Given the increased reliance upon digital media for teaching in learning in anatomy classrooms, it is prudent to better understand the cognitive load imposed on learners across a variety of modalities employed.MethodsCognitive load will be compared across three different learning modalities: immersive virtual reality (VR, displayed on the Oculus Quest 2TM), autostereoscopic (displayed on the AlioscopyTM screen), and an identical printed, physical model. During a four‐minute learning phase, undergraduate students, with no prior formal anatomy education, will learn 10 anatomical landmarks on a displayed bony model (calcaneus, zygomatic bone, or hemipelvis) in each of the three modalities. A Stroop test will be administered as a secondary task throughout the learning phase to evaluate cognitive load. Stroop test reaction time, and accuracy of the participants' responses to the Stroop test will be recorded. After the learning phase, an untimed, recognition‐based test will be administered wherein participants will be asked to recall the ten landmarks learned with the aid of a 3D‐printed bone identical to the one used in the learning phase. Performance will be evaluated based on landmarks correctly identified and the results will be correlated with cognitive load measured in each learning modality.ResultsWe hypothesize that the cognitive load will be highest for VR when compared to the cognitive load on the AlioscopyTM and physical model modalities which would manifest as lower reaction times and/or accuracy on the Stroop test. Further, we hypothesize that cognitive load will inversely correlate with the recognition test performance.ConclusionThe results of this study will allow educators and students to make informed decisions when deciding which learning modalities should be used for anatomy education or any other education that requires nominative learning on complex objects. Understanding which modalities minimize cognitive load and improve learning will help improve outcomes and allow for more efficient anatomical education.

Flipping the Anatomy Classroom with Clinical Cases and Teamwork at a Large Medical School

Students participating in active and collaborative learning understand concepts better, perform better in coursework, and have better attitudes toward teamwork. But, the rise of the digital age has had a negative effect on classroom engagement—a topic of international concern. At UT Southwestern Medical School, voluntary attendance at didactic anatomy sessions is at an all‐time low. Because we believe contact time with students is a valuable commodity, our objective is to develop an anatomy teaching approach that will improve student engagement and teamwork. As content hours are limited, time‐efficiency is essential to the approach we seek to develop. In a pilot study, we developed two face‐to‐face case‐based active learning sessions that were conducted within the time slots formerly scheduled for two face‐to‐face anatomy lecture sessions. Content formerly covered in these didactic sessions was converted into video format and offered on‐demand through our institution’s learning management system. Students were given instructions for pre‐session preparation (i.e., review of the videos and other course materials) several days prior to each session. Due to computer technology limitations in our cadaver lab, a virtual cadaver model (Complete Anatomy, 3D4Medical from Elsevier) was used in place of human cadavers for the two case‐based sessions. During the sessions, each laboratory dissection team of 6‐7 students worked at a table outfitted with a 42‐inch monitor capable of wireless connection to student laptops. The exercises focused on the anatomical basis for several clinical cases involving cranial nerve lesions (Session 1) and abdominal hernias (Session 2). Students were allotted 45 minutes for each mandatory session at the end of which teams were required to electronically submit a completed worksheet for credit. Following each session, students were invited to participate in a brief survey with two open‐ended questions that asked them to name one thing about the exercise they would change and one thing they would keep the same. Results of the surveys revealed that the two most commonly perceived benefits of the exercises were 1) application of anatomy to real cases (41 of 131 responses) and 2) opportunity to work in teams with other students (28 of 131 responses). The most commonly perceived challenge was insufficient time to work through the exercises as a team (95 of 131 responses). Student performance on exam questions directly related to the content of the pilot sessions was higher than in years prior to the pilot; however, this difference was not statistically significant in this high‐performing group of students. The survey results demonstrate that our students perceive value in teamwork and the opportunity to practice applying their theoretical knowledge to real‐world problems. The results also highlight the importance of carving out adequate time in the curriculum for these experiences. In the future, we aim to increase opportunities, outside of dissection and didactic sessions, for our students to practice these important, career‐relevant skills.

NOMENs land: The place of eponyms in the anatomy classroom.

The law of Non-Original Malappropriate Eponymous Nomenclature (NOMEN) states that no phenomenon is named after its discoverer. However, eponymous terms are rife in the anatomical and medical literature. In this viewpoint commentary, the authors discuss the history of anatomical eponyms, explain the additional cognitive load imposed by eponyms that can negatively impact student learning and explore the view that eponyms are "pale, male and stale" in the socially conscious 21st century. The authors probe two of the most common arguments used to keep eponyms in anatomy education: (1) clinicians use them because they are easy, and (2) eponyms remind us of anatomy's history. Educators, clinicians and students need to work together to progress this movement and bring a modern lens to this discussion. Based on the arguments presented in this commentary, the authors propose that eponyms should be removed from anatomy curricula, textbooks and have no place in the anatomy classroom.

Cultivating Community in the Virtual Classroom: Using Showcases and Symposia to Share Lessons Learned in Anatomy and the Human Connection

Introduction In 2020, as classroom environments shifted abruptly from in-person offerings to largely Zoom-mediated learning spaces in response to COVID-19 restrictions, educators were challenged to engage students behind the box. Moreover, the unplanned and sustained lack of physical classroom interaction disrupted the learning community, a factor that contributes to higher student satisfaction and achievement. Our objective was to engage students with their peers and class material in the virtual learning environment. Methods: Zoom was used to deliver two distinct classroom events: a virtual showcase in an undergraduate systems-based anatomy course and a student symposium on sociocultural influences on gastrointestinal (GI) diseases and conditions in a second-year integrated medical GI & Nutrition course. The undergraduate virtual showcase featured abstract art of neurodegenerative diseases that correlated with topics in nervous system anatomy. Students used a variety of media, such as canvas paintings, sketches, and clay molds, to communicate the anatomy relevant to their disease topic and their interpretation of the effects of this disease on the patient and their families. During the virtual showcase, students viewed a rotating slide-show of the work of their peers and completed a reflection assignment. For the second project, students were organized into small groups of 5 or 6 and asked to interview multiple stakeholders involved in the diagnosis, treatment, and management of a disease of their choosing within predetermined categories, such as oral/pharyngeal health or chronic liver disease. Each student interviewed a person with a unique narrative related to the disease and the group creatively synthesized their findings. For example, one group role-played the experience of the patient from initial diagnosis of colon cancer with their doctor to the follow-up with the healthcare team and support groups. They presented perspectives from a patient, physician, family caretaker, support therapist, dietician, and colon cancer researcher. Results: The top 30 (of 135) art submissions were featured in an undergraduate anatomy showcase on Zoom. Student feedback was mostly positive, with 64% (n=135) indicating strongly agree (39%) or agree (25%) when asked if they enjoyed opportunities to be creative in the anatomy classroom. Additional artforms were requested by students. The student symposium was designed as a two-hour mini-conference with 206 medical students organized into 36 groups. Six groups presented concurrently every 20 minutes among six different Zoom accounts. Additionally, students signed up to attend five peer presentations. Preliminary feedback revealed several themes including a deeper appreciation of GI anatomy and the lived experience of the patient, the importance of supportive healthcare roles in patient treatment (e.g. dieticians, caregivers, community support), and pride in their peers' creative presentations.Conclusions: These projects highlight ways to foster a thriving learning community in a virtual environment. During a particularly difficult period for student engagement these activities provided students with connections to the lecture content, to each other as peers, and to their wider communities.

Comparing the roles and correlates of emotions in class and during online video lectures in a flipped anatomy classroom

The present study compares the structure, the longitudinal relation, and the predictive roles of emotions in-class and emotions while watching online video lectures outside of class. Participants (N = 269) reported their emotions, attentional control, and behavioral engagement associated with in-class activities and online lecture viewing at two time points in a large “flipped” undergraduate anatomy course. Overall, the longitudinal and cross-contextual relations among emotions, from emotions to learning behaviors, and from emotions to achievement were similar, whereas distinct patterns of relations were found for learning behaviors, and from learning behaviors to academic achievement. These findings are discussed within the Control-Value Theory and provide implications for supporting adaptive emotions and learning in flipped classrooms.

Improvement in Student Performance and Perceptions through a Flipped Anatomy Classroom: Shifting from Passive Traditional to Active Blended Learning.

One of the major challenges facing anatomy educators is delivering the anatomy materials in fewer hours with a reduction of anatomy courses in the integrated curricula. The flipped classroom modality may be an innovative solution. However, its effectiveness remains under debate due to a lack of outcome-based research and the mixed results of students' performance. The present study aimed to determine the outcome of the flipped classroom based upon the level of student cognition. The study investigated performance on 17 multiple-choice anatomy questions as a part of the final examination of the musculoskeletal system module. The results were compared between the first-year female students of Qassim Medical College, specifically the flipped classroom group (46 students) of the academic year (2018-2019) and the traditional group (49 students) of the academic year (2017-2018). The mean differences in the students' grades on the anatomy questions at the level of knowledge, application, and analysis using Cohen's d test were 0.43, 1.41, and 1.01, respectively. These results suggest the positive impact of flipping the students' classrooms on improving their levels of thinking according to Bloom's taxonomy. Perception surveys also revealed students' enthusiasm for the pre-class activities, leading to a better performance in the class with more engagement with their peers and teachers. The present study suggested that the flipped classroom modality can be performed to compensate for the reduction of anatomy educational hours. However, further studies are recommended to investigate the best practices of the flipped classroom that fit with the students' needs and workloads.

Assessing understanding of structural relationships: early lessons in a large scale virtual reality deployment

The study and practice of medicine requires a comprehensive understanding of interactions and an accurate perception of spatial relationships within the body. Existing diagnostic, classroom, and patient education materials are limited by 2‐dimensional representations of these 3‐ dimensional associations. Virtual reality is an emerging technology that creates a more lifelike and intuitive learning experience by allowing users to interact with 3D data. This technology can be used to advance the efficiency of understanding the 3‐dimensional associations that constitute the human body.BananaVision is a networked, multiuser virtual reality tool that renders human anatomical structures for the creation of instructional content. It allows users to quickly explore structural relationships as well as identify and dissect in a virtual environment. Here we describe a large‐scale virtual reality deployment and examine its efficacy as a tool to engage students and aid in preparation for a human dissection course.Human gross anatomy dissection students were randomly assigned to three groups. Each group was provided different study tools; an anatomy atlas, autonomous use of BananaVision virtual reality, or autonomous use of BananaVision virtual reality along with a pre‐recorded instructional module. After the study period, students were required to complete an assessment of their knowledge of structural relationships. Students found the BananaVision to be an engaging and useful tool. Additionally, the study group given access to BananaVision along with the module were more efficient in their preparation. However, performance on assessments was similar between groups.As virtual reality technology is implemented in education, the field is in the early stages of evaluating meaningful processes and procedures that demonstrate measurable outcomes. This study begins to address some of the early challenges when integrating a virtual reality deployment in anatomy curriculum. As demands on gross anatomy classrooms continue to increase, it is important to identify technologies and strategies that improve efficiency.

Techniques for Successfully Flipping a Gross Anatomy Classroom for Graduate and Undergraduate Students

Many institutions are moving away from lecture‐based courses and are moving towards more active learning techniques. Re‐designing a course that is entirely lecture‐based to be focused on active learning can be a daunting task. One way to accomplish this is flipping a classroom by using technology to provide information outside of class time, and thus having more class time for active learning activities. An anatomy course at Tulane University for graduate and undergraduate students was completely redesigned as a flipped classroom course. Students were provided with pre‐recorded lectures and corresponding lecture documents prior to class. Students were expected to complete a homework assignment associated with the pre‐recorded lecture video before class to reinforce the information. During class, students participated in a variety of active learning activities including both individual work and group work. Video analytics were examined to see how often the students viewed the pre‐recorded videos and how early the students watched the video prior to coming to class. This presentation will discuss the steps involved in re‐designing an anatomy course to be a flipped classroom, including the challenges, time involved, strengths, and outcomes. Instructions and demonstration for creating quality pre‐recorded videos will be presented.

Dissect or not to dissect? Easy solution

Throughout the recorded past (from Edwin Smith Surgical Papyrus) anatomy education did not experience dramatic changes. Practically until the last 5–10 years we were using only a text and a cadaver. Only did generation Z start to experience an intervention of AI and VR in our dissection rooms and lecture halls. Literature research exhibits convincing evidence of the positive impact of these new pedagogical tools on student’s success and overall performance (Freeman et al. 2014; Michael 2006). Some new methods of active learning, however, have been proven to be more effective than others. Lombardi et al. (2014) observed that students who used plastic models, rather than prosected specimens or virtual dissections, scored considerably higher on both initial and follow‐up exams despite student perceptions that the different forms of actual dissections were of more value. Fancovicova et al. (2014) observed that students who had admittance to multiple forms of active learning performed at a higher level than students who had access to only one form (including dissection). Herur et al. (2011) reported that students who utilized multiple forms of active learning had significantly higher levels of retention at 15 and 30 days after the class than those who learned by passive means.There is a perception that dissection continues to be recommended as the golden standard of anatomical education. Our presentation will present our experience of exploration of the possibilities to improve student’s success through the creation of a technologically advanced anatomy classroom that allows the learning anatomy of living human beings, not only cadavers. First‐time students are able to hold their own 3D printed organs during lab exercises. We can observe anatomical variations and their effects on living specimens in real time. At the same time, traditional cadaver dissections allow us to appreciate the complexity of the human body.

Implementing a Competency-Based Approach to Anatomy Teaching: Beginning With the End in Mind.

Background:The shift in the medical education system from a time-based to a competency-based model has encouraged its adoption and application in competency-based education in anatomy classrooms, such as team-based learning models and flipped classroom models. This pilot study aimed to build on previous work of the linkages between anatomy-based learning (a flipped classroom model inspired by a modified team-based learning) and student learning and engagement, and further to assess the linkage between anatomy-based learning and academic performance.Methods:A sequential mixed-methods design was employed to first gather and analyse quantitative data, including confidential student first semester scores in anatomy: gender, stream, anatomy-based learning, and final anatomy overall mark. The quantitative phase was followed by a qualitative phase in which a series of 8 anatomy laboratories were observed (4 anatomy-based learning and 4 traditional). Thematic analysis was performed on the observation data.Results:Aggregate anatomy-based learning and traditional stream tests, and final unit scores were compared. The anatomy-based learning and final unit scores showed little difference between students in the anatomy-based learning and students in the traditional stream. Students using anatomy-based learning had an aggregate score of 1.15 and final aggregate mark of 72, whereas students in the traditional section had an aggregate score of 1.19 and final mark of 79. Qualitative phase was undertaken to try to assess the linkages between anatomy-based learning and student learning. Observations showed that students in the anatomy-based learning section spent more time on task as compared with their peers in the traditional stream. The anatomy-based learning students also seemed to practice more self-directed learning and employed more multimodal learning strategies than the traditional section stream.Discussion/conclusions:Although the quantitative results of this study showed no significant difference in mean scores between anatomy-based learning and traditional designs, it was possible to observe the potential of flipped classroom model in engaging students in individual preparation, in team-based learning, and in consensus-based learning approaches.

Axillary artery variation: The rule not the exception

Introduction: Anatomic morphology commonly depicted in atlases or textbooks is often emphasized in gross anatomy classrooms; however, considerable variation may be observed in cadavers during dissection, particularly in the vascular system. This study statistically assesses the frequency of the classic versus variant axillary artery branching pattern and compares these observations to the incidence of variation described in the literature. Material and Methods: Axillary artery branching pattern was studied in 62 cadaver limbs. A Chi square goodness of fit test with post hoc analyses on the adjusted standardized residuals was used to evaluate branching patterns. Results: A statistically significant difference existed between the observed and expected frequencies of the classic presentation (P < 0.001). The axillary artery branching pattern exhibited the classic presentation in 17.7% of this sample; 82.3% of the limbs displayed a variant in at least one major axillary artery branch. The lateral thoracic and posterior circumflex humeral arteries were significantly variable branches observed in their textbook locations in 40.3% and 61.3% of cases, respectively. The superior thoracic, thoracoacromial, and subscapular arteries were significantly conserved branches documented in their textbook locations in 97%, 98.3%, and 98.3% of cases, respectively. Discussion and Conclusion: While anatomy educators and students understand that anatomic structure has an inherent range of variability, the classic axillary artery branching pattern students expect to find in cadavers and patients rarely occurs. Educators must present a realistic picture of anatomic complexity and emphasize the clinical and surgical implications of anatomical variation.

A Human Paradox: The Nazi Legacy of Pernkopf’s Atlas

Eduard Pernkopf’s Atlas of Topographical and Applied Human Anatomy is a four-volume anatomical atlas published between 1937 and 1963, and it is generally believed to be the most comprehensive, detailed, and accurate anatomy textbook ever created. However, a 1997 investigation into “Pernkopf’s Atlas,” raised troubling questions regarding the author’s connection to the Nazi regime and the still unresolved issue of whether its illustrations relied on Jewish or other political prisoners, including those executed in Nazi concentration camps. Following this investigation, the book was removed from both anatomy classrooms and library bookshelves. A debate has ensued over the book’s continued use, and justification for its use has focused on two issues: (1) there is no definitive proof the book includes illustrations of concentration camp prisoners or Jewish individuals in particular, and (2) there is no contemporary equivalent to this text. However, both points fail to address the central importance of the book, not simply as part of anatomy instruction, but also as a comprehensive historical narrative with important ethical implications. Having encountered a first edition copy, these authors were given a unique opportunity to engage with the text through the respective humanities lenses of history, ethics, and narrative. In doing so, an instructive and profound irony has surfaced: Nazis, including Pernkopf, viewed specific groups of people as less than human, giving rise to unthinkable atrocities perpetuated against them. However, these same individuals became the sources for the creation of the Atlas, which served as the model for primary instruction on the human form for more than half of the twentieth century. In this article, we recount the difficult and somewhat opaque provenance of this book, engage the ethical questions surrounding both its creation and its use, and ultimately propose a pedagogical methodology for its continued use in medical education.