Anatomy Practical Examinations Research Articles

The Use of an Audience Response System in a Dental Gross Anatomy Practical Exam

Background: Traditional methods for administering and scoring gross anatomy practical laboratory examinations are time and resource-intensive and can be susceptible to errors in grading. Alternative approaches, such as audience response systems (e.g., clickers) and computerized scoring, appear to hold promise to improve the examination experience for students and improve the efficiency and accuracy of grading. Method: To assess perceptions of using such systems, two cohorts of students who completed the gross anatomy practical examination using clicker technology at the University of Detroit Mercy School of Dentistry were invited to complete the survey. Results: A total of 155 students completed the study. Responses reflect a mostly positive appraisal of the use of clicker technology by most students. In particular, students reported that submitting responses was easier and that the speed of grading and feedback on examination performance improved considerably. Conclusion: Based on the survey results, the use of audience response systems appears to have more benefits than liabilities and seems to be a worthwhile technology to use for practical laboratory examinations. KEYWORDS: Gross Anatomy, Practical Examination, Clickers, Audience Response System.

What is the evidence for biology as the ‘heart of eligibility’ to study medicine? A retrospective analysis

The first, sometimes the only, selection tool for entry into undergraduate medicine is prior educational attainment (PEA). This is often further specified to include certain subjects, for example, biology is a prerequisite for entry into medicine in many Asian countries. However, there seems no clear evidence base for this prerequisite. Our aim, therefore, was to carry out a retrospective quantitative study comparing the performances of five cohorts of students (2015–2019 entry; n = 588) with and without biology PEA in Years 1 and 2 Bachelor of Medicine and Bachelor of Surgery (MBBS) integrated written assessments (n = 3) and anatomy practical examinations (APE) (n = 5). The study was conducted at one of Singapore’s three medical schools. Data were analyzed using independent t-tests and Mann–Whitney U with p values of less than 0.05 were considered significant. There were no significant differences in performance on any Years 1 or 2 integrated written assessments. Similarly, in one of the APE, a significant difference was found for one cohort (academic year [AY] 2015–2016) out of five assessments. These results suggest that having a prior biology qualification does not make a difference in assessment performance in the early years of medical school. This information may help stakeholders and admissions committees decide whether biology is required for medical school entrance.

Which Performs Better: Open Book Versus Closed Book Online Gross Anatomy Practical Examination

The COVID‐19 pandemic resulted in rapid changes to delivery of medical school exams during the height of the pandemic. Remote, online exams quickly became the norm, with many schools initially allowing open book (OB) exams due to a lack of policies and resources to monitor for cheating and as a means of reducing student anxiety that was heightened by the uncertainty of the pandemic and its effect on their education. A 2016 review by Durning, et al. concluded that there was no significant difference in exam performance between OB and closed book (CB) exams; however, a recent study found significantly higher scores on an OB exam, compared to a CB exam (Eurboonyanun, et al., 2021).At Cooper Medical School of Rowan University (CMSRU), gross anatomy practical examinations are taken using cadavers and are CB. As a result of the pandemic, the Class of 2023 was administered the Skin and Musculoskeletal (SMS) midcourse and final practical examinations as remote, online OB exams. The next year, the Class of 2024 took the same exams remotely online, as CB exams. The aim of this study was to evaluate the impact of OB exam conditions on students' online practical exam performance. We hypothesized that the Class of 2023’s mean score on both exams would be significantly higher than the Class of 2024.We compared the Class of 2023’s (n = 111) remote, online OB mean scores for the midcourse and final gross anatomy practical summative exams to the Class of 2024’s (n = 110) remote, online CB exam scores for the same practical exams. The SMS course is the last course for 1st year medical students at CMSRU. For both classes, the midcourse and final practical exam questions were delivered remotely online using cadaveric atlas images. Questions were open‐ended and consisted of a mixture of 1st, 2nd and 3rd order questions. The number of questions on the midcourse and final practical exams for both classes were equivalent. A one‐tailed, non‐paired t‐test was used to compare mean class performance on both the midcourse and final practical exams.The Class of 2023 had a significantly higher summative mean score on the midcourse practical exam, compared to the Class of 2024 (96.91 v 90.24, p<0.000). The summative mean score for the final practical exam was significantly higher for the Class of 2023 compared to the Class of 2024 (93.21 v 89.26, p<0.000).First year medical students who took remote online OB midcourse and final practical exams in the SMS course outperformed 1st year medical students who took equivalent exams that were CB.The COVID‐19 pandemic has opened a window for educators to give greater consideration to and allow for exploration of the use of OB exams in anatomy, regardless of whether exams are delivered online or in‐person. In a world where knowledge is available instantaneously with just a few strokes of a keypad, why is it we still expect students to commit detailed anatomical knowledge to memory for testing? As practicing clinicians, they will have access to resources to help them answer questions they are unsure about. Why not afford students the same opportunity when taking an exam? The time has come to determine the feasibility of OB exams in anatomical sciences education and determine how best they can be used to enhance the learning and long‐term retention of anatomical knowledge.

Flipped spotters learning model: An innovative student activity-based strategy. A preparation tool for anatomy practical examinations in medical education.

The flipped spotters learning model is a modern student activity-based and learner-centered method in medical education. The aim of the study was to determine if the flipped spotters learning model improves students' learning. Participants were 1214 medical students of Polish (PD) and English (ED) divisions between 2013 and 2019 academic years at the University of Warmia and Mazury in Olsztyn, Poland. They were divided into a traditional group (control group) and a flipped spotters learning group (treatment group). Each flipped spotters learning group was asked to label anatomical structures on various specimens according to the structures name list prepared by the teacher on the multiple stations. The flipped spotters learning group leaders were instructed to take pictures with the appropriately marked structures on each of the human body prosections. After completion of the class, each flipped spotters team received photos for evaluation. In the flipped spotters learning model, the students strengthened their skills and knowledge by matching specimens independently as a form of practical laboratory activities. Students' performance in gross anatomy practical examinations between the group utilizing the flipped spotters learning model, and the group with the traditional teaching model was compared. Students participating in the treatment group achieved, on average 9.9 percentage points higher among PD students, and 13.0 percentage points higher among ED students than the control group in all nine practical examinations (the effect size ranging from 0.47 to 0.95). The results suggest the positive impact of flipped spotters model on improving student's performance in the practical examinations.

Combining Science and Humanities to Assess and Promote the Development of Visual‐Spatial Skills in Medical Learners

Skillful observation and interpretation of visual information is key to practicing medicine, not only in specialties that emphasize anatomy but also for effective physical examination and recognizing patients’ emotional states and needs. Since visual analysis appears to depend heavily on tacit knowledge, often it is difficult for learners to develop and educators to teach appropriate skills. Recently, efforts to integrate the humanities into medical training have generated interest in using pedagogical methods adapted from visual art practices to teach medical learners how to analyze and interpret visual information. Such efforts are predicated on the idea that cognitive processes involved in analyzing visual information are to some extent independent of the specific nature of the visual information. As part of our ongoing efforts to develop novel approaches to promote the development of visual analysis skills in medical students, one current goal is to test whether facility in analyzing medically relevant images covaries with facility in analyzing art images and whether pedagogical approaches that are used to teach art students can increase the ability of medical learners to analyze medically relevant images. We developed a custom assessment of visual spatial ability that is based on a simple task in which subjects must identify the two similar images in groups that include two similar images and one dissimilar image. Half of the questions use histological images, while the other half of the questions use images representing fine art or furniture design (Figure 1). Sixteen experienced (3rd and 4th year) medical students completed the assessment in an initial study. The results from this cohort revealed significant, positive correlations between the subjects’: 1) past performance in 1st- and 2nd-year biomedical science courses or anatomy practical examinations and their scores on histology-based questions, 2) self-reported level of previous art instruction and time spent taking the assessment, and 3) time spent taking the assessment and overall score. Thus, as expected, in this group of experienced medical learners, those who previously demonstrated stronger performance in biomedical science courses and specifically on anatomy examinations performed better when analyzing medically relevant images. Previous experience with art instruction increased the time subjects spent taking the study assessment, and taking more time increased overall performance on the assessment. In ongoing studies, the performance of early and advanced medical learners and art students will be compared to test the effects of experience in art- and medical curricula on the ability to analyze similar and disparate images. The early medical learners will be retested after completing the histology discipline in the medical curriculum, and half of those learners also will receive explicit training in evaluation of visual images using methods drawn from art education. This will test directly the effects of 1) experience with the histology curriculum and 2) adding explicit, art-based training on visual analysis skills.

Evaluation of undergraduate medical students’ preference to human anatomy practical assessment methodology: a comparison between online and traditional methods

PurposeCOVID 19 pandemic has brought crucial changes in the field of medical education. Ad mist university examinations in India medical schools have switched to online assessment methods to avoid student gatherings. In this context, we conducted online anatomy practical evaluation and we have aimed at quantifying the students’ experience on virtual assessment.MethodsA total of 250 first year MBBS students appeared for online anatomy practical examinations. Immediately after the completion of exams electronic feedback about their experience, in questionnaire format was obtained after getting informed consent. Their feedback was analysed and quantified.ResultsCompleted feedback forms were submitted by 228 students. More than 50% of students favoured online anatomy spotter examinations. Only 32.8% of students were comfortable with soft parts discussion using images. For image based viva voce 61.4%, 80% & 82% of students responded that the features and orientation of osteology, radiology and embryology images, respectively, were good. For surface marking 55% of the participants preferred online verbal evaluation. Finally, more than 60% of the students preferred the conventional over online assessment methods.ConclusionsThe inclination of students’ preference for traditional anatomy examination methods mandates adequate training of both students and teachers for virtual examination. The superiority of conventional anatomy practical examination methods is unbiased but pandemic situations warrant adequate preparedness. In the future the anatomy teaching and evaluation methodology in Indian medical schools have to be drastically reviewed in equivalence with global digitalization.

Tracking medical student emotionality in relation to whole body dissection and donation.

For students studying anatomy, dissection of the human body can elicit a wide range of intellectual and emotional responses that are subject to change over the duration of a course. The purpose of this study was to determine how overall emotional responses change over time, if there are differences in responses by gender and previous laboratory exposure, and if these responses impact course performance. First-year medical students enrolled in the Human Structure and Function course at the University of Vermont, and in the Organ Systems 1, 2, and 3 courses at Morehouse School of Medicine were given a series of four surveys across the first-year curriculum. Data were gathered regarding age, gender, and previous laboratory exposure. Students were asked to rate their level of 15 positive and negative emotions, and their desire to avoid or approach the laboratory and donors. These responses were translated to three measures: (a) a positive response index (PRI), (b) a negative response index (NRI), and (c) an avoid-approach index (AAI). Responses were followed longitudinally and matched with anatomy practical examination grades. Gender and previous laboratory exposure status were both significantly related to emotional responses at different points throughout the year, and unique patterns of responses across the year emerged within each group. Higher PRI and AAI were positively correlated with some practical examination scores. Data suggest that gender and previous laboratory exposure status influence emotional responses to dissection, and that these responses may have an effect on course performance.

Transitioning from Traditional Fill‐In to Multiple Choice Question (MCQ) Format for Anatomy Practical Examinations: Should We?

United States medical schools are moving to multiple choice‐style assessments, away from traditional fill‐in, for anatomy practical exams. Practical exams for medical students have long consisted of identifying anatomical structures and writing the answer on an answer sheet. This study reports several aspects of this change at two medical schools: New York Medical College and SUNY Downstate Health Sciences University. The report also documents the evolution of opinion of faculty, teaching assistants [TAs] and students with respect to the benefits of each testing modality. Student t‐tests were used to compare test score data between the two testing modalities employed at each institution. Results showed there were no statistically significant differences between fill‐in and MCQ mean scores for NY Med (5 years of fill‐in vs 5 years of MCQ) and Downstate (5 years of fill‐in vs one year of MCQ), 0.5 and 0.7 (p < 0.05), respectively. Resistance and support for the transition from faculty, TAs and students were common from both schools irrespective of constancy in student performance between the two testing formats. The quantitative results were surprising as an expected increase in the statistical mean in the MCQ format did not occur. Logistical and pedagogical merits of each exam format were assessed. Faculty and TAs resistant to MCQ exams predicted that offering choices would provide an advantage, as there would be a 25% chance of having a correct choice against the binary of a correct or incorrect written answer. TAs felt that a fill‐in format tapped into a higher cognitive level to reach the correct answer. Students with English as their second language, on the other hand, strongly supported the MCQ exam format. MCQ exams had the benefit of being corrected within 10 minutes of submission with Item Analysis accompanying the report allowing identification of poorly tagged questions and providing the opportunity to make corrections in real time for the entire class. Effectively assessing medical student competence must be addressed in contemporary curriculum design but is MCQ a reliable way to do so?

Utilizing Medical Students as Internal Assets to Enhance Gross Anatomy Laboratory Learning.

Identification of cadaveric structures during anatomy summative practical examinations is a challenge for first-year medical students. To assist in cultivating this skill, we offered 12 formative laboratory activities (anatomy boot camps [ABCs]) that approximated the summative practical examination format using reciprocal and near-peer teaching. Students assisted in crafting the formative practical examination, then engaged in a self-review by scoring their individual answer sheets. Students performing below designated thresholds (≤60%) were offered laboratory review sessions led by medical student upperclassmen. Mann-Whitney U tests were used to compare the performance of participants who attended the ABC sessions leading up to each summative examination. Correlation analysis was utilized to examine the relationship between student participation in ABCs summative examinations. Voluntary surveys were administered to assess the perceived value of the experience. Mann-Whitney U tests indicated students who attended the ABC review preceding three of the four summative practical and two of the four written examinations scored consistently higher on these examinations than students who chose not to attend. Correlation analysis revealed that as the overall frequency of ABC attendance increased, students' performance on the summative practical and written examinations increased significantly (P < 0.001). These findings suggest that the provision of supplemental learning experiences, such as the ABCs, contributes to improved student learning outcomes. This sentiment was echoed in student surveys. This activity, which combines multiple peer teaching approaches, appears to be an effective strategy for guiding and enhancing student success in the anatomy practical examinations. Clin. Anat. 33:286-292, 2020. © 2019 Wiley Periodicals, Inc.

Dissection Versus Prosection: a Comparison of Laboratory Practical Examinations.

There is insufficient evidence supporting complete dissection as essential for medical student education. Due to physical constraints, we employed a hybrid teaching method. Gross anatomy practical examinations from two medical student classes were analyzed to determine performance on dissected versus student-prosected material. Overall, student performance on questions pertaining to personally dissected material was similar to performance on questions learned by studying student-prosected material. We found dissection time can be reduced without impacting medical student examination performance.

The Utilization of ExamSoft®-iPad® Technology in Administering and Grading Anatomy Practical Examinations.

This article provides a detailed, step-by-step description of the introduction of technology (iPad® use of ExamSoft® web-based assessment software) for administering and grading cadaver-oriented anatomy practical examinations. We explain the advantages of computer-based testing in the delivery and grading of practical examinations, including minimizing human error inherent in hand grading, improving the efficiency of reporting, and mapping the examination to course objectives. Furthermore, item analysis (including item difficulty, discrimination indices, and point biserial correlations) allows evaluation of laboratory teaching and testing and monitoring of the curriculum. We also address how the advantages of this format override any limitation, such as cost. In conclusion, we describe our future directions and how others could adopt this approach.

Retrospective analysis of prevalent anatomy spotter’s examination: an educational audit

PurposeThe spotter’s (objectively structured practical examination) is an assessment tool which is widely used to test the practical knowledge of anatomy extensively. In Indian context it is used as an inclusive model in the gross anatomy practical examination and the marks allotted to it varies. The traditional spotter examination often has been blamed for only incorporating the initial levels of revised Bloom’s taxonomy. This study retrospectively analysed the pre-professional spotter’s examination score and tested its efficacy in terms of reliability, internal consistency, validity, educational impact, and resource intensiveness.MethodsThe summative data of student’s score on four different days of unrepeated spotter’s examination and final theory examination score was collected and tabulated. These four group of students acted as independent cohorts. The difficulty index (DI), point biserial correlation (PBC), Cronbach α (CA) and descriptive statistics of each cohort were calculated. Revised bloom taxonomy rating was applied to spotter’s.ResultsWe found heterogenous distribution of spotter’s in each cohort according to DI. The PBCs and CA of each cohort were acceptable. The majority of spotter’s tested the cognitive and comprehension domain of revised bloom’s taxonomy. There was nonsignificant difference between mean scores of cohorts but we found low positive significant correlation between theory and spotter’s score.ConclusionWe concluded that the construct of spotter’s was reliable, internally consistent, had fair validity, variable educational impact, and sustainable resource intensiveness. We propose urgent redesigning of spotter’s to include higher level of taxonomy to comply with emerging curricular changes.

Comparison of First Year Medical Students' Performance on First and Second Order Questions on Gross Anatomy Practical Examinations

The goal of this study was to determine how first year medical (M1) students perform on different question types, first and second order, during gross anatomy practical examinations. In this study first order are simple “identify the tagged structure” questions. Second order questions require students to identify a structure, and apply their knowledge of it to answer correctly. An example of a second order question is “What spinal nerve levels does the tagged nerve originate from?” To conduct this investigation, laboratory practical examination questions (N=114) were coded as either first order (N=96) or second order (N= 18). Responses from the 2018 M1 class (N=167) were entered (1= correct, 0= incorrect) for analysis. The responses were added up and averaged for a first order, second order and overall examination grade. The overall average for the first half of the course was 80.66%. Averages for first and second order questions were 81.95% and 73.75% respectively. This resulted in an overall difference of 8.2% between the two different question types. A further break down shows a difference of 8.42% on block 1 and 6.45% on block 2. Data collection for the second half of the course is ongoing and will be added as it is obtained. These preliminary findings suggest that M1 students have a lower performance rate on second order questions. This may be an indicator that M1 students are not learning the material in a way that allows them to apply content effectively to answer second order questions. This apparent difficulty in students' ability to answer these questions is important for faculty to consider both in assessing instructional design and students' knowledge. Further investigation may yield more conclusive answers as to what may cause this disparity and how to address it.This abstract is from the Experimental Biology 2019 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.

The Effectiveness of Anatomy Laboratory Videos on Osteopathic Medical Students’ Performance

This article was migrated. The article was not marked as recommended. Introduction: The usage of audio-visual aids in medical education has always been rewarding. This study aimed at evaluating the efficacy of supplementing traditional dissection based laboratories with the video demonstration of specimens. Methods: The study was conducted among first-year osteopathic medical students of two consecutive years. The laboratory demonstration videos were recorded and provided to the experimental group and the previous class served as the historical controls. Two Likert scale based questionnaires were completed by the experimental group before and after their final examination. The students' performance in the Anatomy practical examinations were compared between the two groups. Results: The students' response showed that the videos added value to their knowledge. The videos helped them in understanding the structures in the dissection lab with ease they felt more confident about the examinations. The experimental group scored significantly higher grades in the practical examinations than the control group. The results confirm that the video demonstration has a positive impact on the traditional dissection method. Conclusion: The effect on the student's perception is impressive and the positive outcome in the examination grades adds on to the significance of this teaching methodology. Integration of multimedia with dissection is suggested as a helpful model to improve Anatomy learning process.

The Effectiveness of Anatomy Laboratory Videos on Osteopathic Medical Students' Performance.

This article was migrated. The article was marked as recommended. Introduction: The usage of audio-visual aids in medical education has always been rewarding. This study aimed at evaluating the efficacy of supplementing traditional dissection based laboratories with the video demonstration of specimens. Methods: The study was conducted among first-year osteopathic medical students of two consecutive years. The laboratory demonstration videos were recorded and provided to the experimental group and the previous class served as the historical controls. Two Likert scale based questionnaires were completed by the experimental group before and after their final examination. The students' performance in the Anatomy practical examinations were compared between the two groups. Results: The students' response showed that the videos added value to their knowledge. The videos helped them in understanding the structures in the dissection lab with ease they felt more confident about the examinations. The experimental group scored significantly higher grades in the practical examinations than the control group. The results confirm that the video demonstration has a positive impact on the traditional dissection method. Conclusion: The effect on the student's perception is impressive and the positive outcome in the examination grades adds on to the significance of this teaching methodology. Integration of multimedia with dissection is suggested as a helpful model to improve Anatomy learning process.

Mixed-Method Evaluation of a Cadaver Dissection Course for General Surgery Interns: An Innovative Approach for Filling the Gap Between Gross Anatomy and the Operating Room

To evaluate an innovative whole cadaver dissection curriculum designed to focus on teaching procedure-relevant anatomy and surgical skills to surgery interns. A mixed methods explanatory sequential design incorporating both quantitative and qualitative evaluations was used to evaluate the cadaver dissection course. Quantitative data were prospectively collected and retrospectively reviewed in order to compare anatomy knowledge and operative skills before and after the course. In the qualitative phase, open-ended telephone interviews were conducted in order to explore the major strengths and weaknesses of the course and gain a more in-depth understanding of resident perceptions and attitudes toward the course. All UCLA categorical surgery interns who have undergone the cadaver dissection curriculum between the years 2010 to 2016 were recruited for evaluation and interview. From 2010 to 2016, 6 to 7 categorical surgery interns were enrolled in the cadaver dissection course each year. Anatomy practical examination scores increased following implementation of the course from 50.5% to 83.5% (p < 0.01). Faculty ratings of operative skills improved as well (average Likert scale rating for technical skills improved from 4.1 ± 0.4 to 4.4 ± 0.3, p = 0.06). Almost all interviewees (96%) reported that the course improved their knowledge of anatomy, and 78% of respondents believed the course was conducive to improving technical skills. We believe that cadaver dissection courses offer a superior educational model for teaching clinically relevant anatomy as well as surgical skills. We found improvements in anatomy knowledge and technical skills, and trainees expressed strongly favorable views of the program.

Dissection Opportunity Affects Student Performance on Gross Anatomy Practical and Lecture Examination Questions

The University of Cincinnati College of Medicine offers a Special Master's Program (SMP) designed to strengthen the academic credentials of students preparing to apply to U.S. medical schools. In this program, approximately 32 students each year participate in a select portion of the first year medical school curriculum with the M1 medical students. The intention is to provide an identical educational experience for both groups; however, logistical challenges have resulted in small curricular differences. One notable example is that SMP students study gross anatomy by viewing dissections that the medical students have already completed. Because SMP and medical students take identical examinations, there is an opportunity to evaluate the potential affect this difference had on examination performance. To investigate this, two years of practical and lecture‐based written examination data were considered. Anatomy lecture examination questions were classified into the following categories: information covered only in lecture (not part of any dissection), information covered only in the laboratory, and information presented in both contexts. Aptitude was controlled by comparing medical and SMP students' examination scores using Analysis of Covariance with MCAT scores entered as a covariate. This was possible because MCAT scores are required for both the SMP and medical program. Results showed that medical students scored significantly higher on gross anatomy practical examinations (F(1, 402)= 36.9, P&lt;0.01). This trend continued on anatomy lecture examination questions, where medical students performed significantly better on questions derived from information covered only in the laboratory (F(1, 402)= 51.9, P&lt;0.01). However, performance between SMP and medical students was not significantly different among questions derived from information presented only in lecture (P=0.94) or in lecture and laboratory (P=0.14). While other potential factors are discussed, these results suggest that the dissection experience is important not only for learning cadaveric material, but also for understanding anatomical relationships tested conceptually during lecture‐based written examinations.

Assessment Driven Learning: the Use of Higher-Order and Discipline-Integrated Questions on Gross Anatomy Practical Examinations

Gross anatomy practical examinations have traditionally been composed of primarily free-response identification questions. Because student learning and study habits are influenced by testing, it is important that curricular design and objectives are reflected in all types of assessments, including those that take place in a laboratory setting. The use of higher-order and discipline-integrated questions on gross anatomy practical examinations reinforces the importance that anatomy knowledge has in clinical reasoning and assesses students’ ability to apply foundational information from an early point in their medical career. In this study, gross anatomy practical examinations were analyzed to assess the impact that higher-order and discipline-integrated testing modalities have on various measures of student performance. Two years of examinations (N = 338 questions) were reviewed and categorized by question type, Bloom’s taxonomy and discipline. Difficulty, discrimination index (DI) and point-biserial correlations were calculated for each question. These statistics were then compared between categories using Kruskal-Wallis tests with post-hoc pairwise comparisons (Dunn’s method). Results demonstrate that higher-order and discipline-integrated questions were significantly more difficult than traditional identification questions and tended to have higher mean DIs and point-biserials. Questions that targeted higher Bloom’s taxonomic levels were also found to be more difficult. This study demonstrates that integrated examinations can be incorporated into the gross anatomy laboratory, but suggests that this be done carefully as these changes can impact student performance.

Performance statistics of structures: does the anatomical region or structure type impact item difficulty or discrimination on gross anatomy practical examinations?

Student examination performance is likely influenced by a number of factors, including (but not limited to) student learning, student approaches to studying, teacher emphasis, and clarity of objectives. Gross anatomy practical examinations are somewhat unique in that assessment has traditionally been achieved through free‐response identification questions. Variation in student examination performance on free‐response items, both within and between anatomical regions, is often accounted for by the casual observation that certain regions and/or structures are more “difficult” than others, but that explanation can be subjective and is of limited use from a pedagogical standpoint. The goal of this study was to directly assess the influence that anatomical region and structure type have on gross anatomy practical examination performance on free‐response items by coding and analyzing several years of question item data (i.e. difficulty and point biserial). This information can help with quality improvement of gross anatomy laboratory teaching and assessment.Five years of examination data (N&gt;500 items) were categorized by structure type (e.g. vessel, muscle, bone, nerve, organ, etc.) and anatomical region. Within‐structure patterns were also explored, such as branching level and physical size. Difficulty and point bi‐serial correlations (PBS) were calculated for each item and then compared across categories with Wilcoxon tests. Results indicate that, overall, vessels, nerves, and ligaments tend to be the most difficult structure types, while bones, muscles, and organs are the easiest. Evaluation of vessel branching revealed that main vessels are typically easier than subsequent branches (various p&lt;0.05). The general size of a nerve did not have a significant influence on difficulty. These patterns were generally consistent within each anatomical region, although vessels in the head and neck region are significantly more difficult than nerves (p=0.0176). Limited differences in PBS were exhibited. These results provide insight into several factors that influence examination performance and are useful for improving assessments in the gross anatomy laboratory.

Online dissection audio-visual resources for human anatomy: Undergraduate medical students' usage and learning outcomes.

In an attempt to improve undergraduate medical student preparation for and learning from dissection sessions, dissection audio-visual resources (DAVR) were developed. Data from e-learning management systems indicated DAVR were accessed by 28% ± 10 (mean ± SD for nine DAVR across three years) of students prior to the corresponding dissection sessions, representing at most 58% ± 20 of assigned dissectors. Approximately 50% of students accessed all available DAVR by the end of semester, while 10% accessed none. Ninety percent of survey respondents (response rate 58%) generally agreed that DAVR improved their preparation for and learning from dissection when used. Of several learning resources, only DAVR usage had a significant positive correlation (P = 0.002) with feeling prepared for dissection. Results on cadaveric anatomy practical examination questions in year 2 (Y2) and year 3 (Y3) cohorts were 3.9% (P < 0.001, effect size d = -0.32) and 0.3% lower, respectively, with DAVR available compared to previous years. However, there were positive correlations between students' cadaveric anatomy question scores with the number and total time of DAVR viewed (Y2, r = 0.171, 0.090, P = 0.002, n.s., respectively; and Y3, r = 0.257, 0.253, both P < 0.001). Students accessing all DAVR scored 7.2% and 11.8% higher than those accessing none (Y2, P = 0.015, d = 0.48; and Y3, P = 0.005, d = 0.77, respectively). Further development and promotion of DAVR are needed to improve engagement and learning outcomes of more students. Anat Sci Educ 9: 545-554. © 2016 American Association of Anatomists.