Medical Anatomy Course Research Articles

Links between Evolution, Development, Human Anatomy, Pathology, and Medicine, with A Proposition of A Re-defined Anatomical Position and Notes on Constraints and Morphological "Imperfections".

Surprisingly the oldest formal discipline in medicine (anatomy) has not yet felt the full impact of evolutionary developmental biology. In medical anatomy courses and textbooks, the human body is still too often described as though it is a "perfect machine." In fact, the study of human anatomy predates evolutionary theory; therefore, many of its conventions continue to be outdated, making it difficult to study, understand, and treat the human body, and to compare it with that of other, nonbipedal animals, including other primates. Moreover, such an erroneous view of our anatomy as "perfect" can be used to fuel nonevolutionary ideologies such as intelligent design. In the section An Evolutionary and Developmental Approach to Human Anatomical Position of this paper, we propose the redefinition of the "human standard anatomical position" used in textbooks to be consistent with human evolutionary and developmental history. This redefined position also simplifies, for students and practitioners of the health professions, the study and learning of embryonic muscle groups (each group including muscles derived from the same/ontogenetically closely related primordium/primordia) and joint movements and highlights the topological correspondence between the upper and lower limbs. Section Evolutionary and Developmental Constraints, "Imperfections" and Sports Pathologies continues the theme by describing examples of apparently "illogical" characteristics of the human body that only make sense when one understands the developmental and evolutionary constraints that have accumulated over millions of years. We focus, in particular, on musculoskeletal functional problems and sports pathologies to emphasize the links with pathology and medicine. These examples demonstrate how incorporating evolutionary theory into anatomy education can be helpful for medical students, teachers, researchers, and physicians, as well as for anatomists, functional morphologists, and evolutionary and developmental biologists.

Evaluation of Role of Dissection in Medical Education: A Case Study of Imo State University Nigeria

INTRODUCTION: The medical anatomy course has become a complex and complicated educational experience, in which dissection of the human body instructs not only in structure and function, but also in psychosocial areas critical to the development of the whole physician. Dissection is being sidelined in medical education. Computers and other alternative teaching tools are replacing cadavers in the modern anatomy curriculum.AIMS AND OBJECTIVE: To evaluate and compare the role of cadaveric dissection with other teaching tools in anatomic education.METHOD: This study took place at the college of medicine, Imo state university Nigeria. Two hundred and sixty eight (268) preclinical medical students participated in this study. A matrix‐grid questionnaire was used and participants were asked to score five methods of anatomy teaching used in the college (lectures, dissection, prosection, models and PC software/TV packages) using a 5‐point Likert type scale on the ability to achieve learning objectives. The data was analysed using the Krusekal‐Wallis and Mann‐Whitney methods to evaluate differences in scores between teaching methods.RESULTS: Results showed that the most suitable tool for learning anatomy is cadaveric dissection having scored highest in cumulative objectives while PC software/TV package was the least method. Prosection, lectures and models appear in between.CONCLUSIONTraditional cadaveric dissection remains the best method of teaching anatomy. The other methods of learning play complementary roles. Efforts should be made to device means of regular supply of cadavers to medical institutions rather than withdrawing cadaveric dissection from medical curriculum.

Use of a Rotating Gross Dissection‐Clinical Training Schedule to Incorporate Ultrasound Training in a Medical Anatomy Course

Increased use of clinical ultrasound (US) has fostered its integration early in the medical curriculum. Our objective was to smoothly integrate fundamental hands‐on US training to over 100 students in a first year medical human structure course without overwhelming students or compromising anatomy study. For the past 2 years, we taught US as a pass/fail component to our combined gross anatomy/histology course. Students attended 6 US lectures and 6 lab sessions covering limbs, thorax/abdomen, pelvis/kidney and US procedures. US and gross anatomy labs coincided and a database system was used to make assignments, assuring that each dissection group of 5 students never had more than 2 team members simultaneously attending US lab. Dissection groups rotated 3 times a semester so it was essential to proctor students to ensure they adhered to assignment. US labs consisted of facilitator‐mediated hands‐on practice using standard patients. Appropriate assessment of US skills in a basic science course was challenging and raised the most student debate. Anatomy‐based case study exam questions that required US interpretation counted towards their final anatomy grade while a separate pass/fail grade was based on quizzes and final practical covering US theory and technique. Some students felt US material should have been assessed separately while others felt the time commitment warranted recognition as part of the anatomy grade. Year‐end surveys indicated that students enthusiastically accepted the extra time commitment and highly rated the US experience. It reinforced their gross anatomy learning and provided their first patient encounter.

Associations between formative practice quizzes and summative examination outcomes in a medical anatomy course

Formative practice quizzes have become common resources for self-evaluation and focused reviews of course content in the medical curriculum. We conducted two separate studies to (1) compare the effects of a single or multiple voluntary practice quizzes on subsequent summative examinations and (2) examine when students are most likely to use practice quizzes relative to the summative examinations. In the first study, providing a single on-line practice quiz followed by instructor feedback had no effect on examination average grades compared to the previous year or student performances on similar questions. However, there were significant correlations between student performance on each practice quiz and each summative examination (r = 0.42 and r = 0.24). When students were provided multiple practice quizzes with feedback (second study), there were weak correlations between the frequency of use and performance on each summative examination (r = 0.17 and r = 0.07). The frequency with which students accessed the practice quizzes was greatest the day before each examination. In both studies, there was a decline in the level of student utilization of practice quizzes over time. We conclude that practice quizzes provide some predictive value for performances on summative examinations. Second, making practice quizzes available for longer periods prior to summative examinations does not promote the use of the quizzes as a study strategy because students appear to use them mostly to assess knowledge one to two days prior to examinations.

Driving Deeper Learning by Assessment: An Adaptation of the Revised Bloom's Taxonomy for Medical Imaging in Gross Anatomy

As medical imaging continues to grow as a central modality by which physicians of all specialties visualize anatomy, so, too, is its role in medical student education. However, no study to our knowledge has attempted to categorize the necessary cognitive skills. Here, we assess a tool to identify those skills and their possible hierarchical nature that reflects deeper understanding of radiological anatomy. We adapted the revision of Bloom's Taxonomy of Educational Objectives to create examination questions and teaching points for normal radiological anatomy in a medical anatomy course in 2008. All six previously established levels of cognitive processes were adapted, ranging from Remembering to Create. Reliability and validity were assessed. Of 102 eligible students, 98 (98%) consented to participate, and 108 examination questions were assessed. Cronbach α assessing reliability ranged from poor (.197) to moderate (.571) with most categories being moderate. Score means for the levels of cognitive processes were statistically distinct [F(4, 102) = 180.63, P < .001] and tended to decrease as the level of cognitive process increased [Spearman ρ(5) = -.800, P = .104], consistent with a valid hierarchical structure. A radiological anatomy adaptation of the revised taxonomy demonstrated generally adequate reliability and acceptable validity to establish evaluations that test different depths of cognitive processes. This is a critical first step to create a fundamental curricular tool by which medical imaging education-both normal and pathological-may be taught and assessed in the future.

Exploring the learning environment in a medical school anatomy course: does group emotional intelligence affect team performance?

Emotional intelligence (EI), the ability to perceive and respond to emotions, has been shown to increase academic achievement and team performance. Studies to support this association exist largely in the business world, but its impact in medical education is relatively unexplored. The purpose of this study was to determine whether emotional intelligence correlates with individual or team academic performance in the anatomy course. This study hypothesizes that individuals or teams with higher emotional intelligence will score higher in the course and that team‐based learning will increase emotional intelligence scores. Medical students were asked to complete the Self‐report Emotions Intelligence Test (SSEIT) at the beginning and the end of the 7‐ week anatomy course. Average EI scores for each team were compared to final course grades as well as cumulative daily quiz grades. Individual EI scores were also compared to individual grades, and change in EI scores over the course was assessed. Preliminary analysis of initial EI scores vs. averaged quiz scores at the midpoint of the course does not appear to show significant correlations. Final results, to be analyzed at the end of the course, may hold stronger predictive value in determining association between EI and team performance. This research is supported by the Department of Anatomy at the Mayo Clinic, Rochester, MN.Grant Funding Source: Department of Anatomy, Mayo Clinic

Improved Understanding of Human Anatomy through Self-guided Radiological Anatomy Modules

To quantifiably measure the impact of self-instructed radiological anatomy modules on anatomy comprehension, demonstrated by radiology, gross, and written exams. Study guides for independent use that emphasized structural relationships were created for use with two online radiology atlases. A guide was created for each module of the first year medical anatomy course and incorporated as an optional course component. A total of 93 of 96 eligible students participated. All exams were normalized to control for variances in exam difficulty and body region tested. An independent t-test was used to compare overall exam scores with respect to guide completion or incompletion. To account for aptitude differences between students, a paired t-test of each student's exam scores with and without completion of the associated guide was performed, thus allowing students to serve as their own controls. Twenty-one students completed no study guides; 22 completed all six guides; and 50 students completed between one and five guides. Aggregate comparisons of all students' exam scores showed significantly improved mean performance when guides were used (radiology, 57.8% [percentile] vs. 45.1%, P < .001; gross, 56.9% vs. 46.5%, P = .001; written, 57.8% vs. 50.2%, P = .011). Paired comparisons among students who completed between one and five guides demonstrated significantly higher mean practical exam scores when guides were used (radiology, 49.3% [percentile] vs. 36.0%, P = .001; gross, 51.5% vs. 40.4%, P = .005), but not higher written scores. Radiological anatomy study guides significantly improved anatomy comprehension on radiology, gross, and written exams.

University of Pittsburgh School of Medicine

University of Pittsburgh School of Medicine

Daily Mini Quizzes as Means for Improving Student Performance in Anatomy Course

To evaluate daily-written 10-question quizzes in a medical anatomy course as a way to integrate assessment into the course and to evaluate their effect on the course success. Students answering correctly 8/10 or more questions were awarded 0.5 points per quiz. There were 34 quizzes with a maximum point score 17. Measurable outcomes of academic progress in anatomy course (pass rates on 4 examination terms, total pass rate, and average marks) were calculated, and 2007/08 academic year was compared with the previous academic year in which daily written quizzes were not a part of the course. The relationship between cumulative points on daily quizzes and 3 components of the final examination (written, practical, and oral) for 2007/08 academic year was assessed by non-parametric correlation testing. Individual scores on quizzes ranged from 1.5 to 13.5 points. There was a positive correlation between scores on quizzes and grades on 3 components of the final examination: written (Spearman rho=0.784, P<0.001, n=79), practical (Spearman rho=0.342, P<0.002, n=79), and oral (Spearman rho=0.683, P<0.001, n=79) part. Compared with students in the previous academic year, students attending the course with daily quizzes significantly improved their academic achievement, expressed as the pass rate at the first examination term (39% vs 62%, respectively, chi(2) test, P=0.006, ) and the average course grade (2.71+/-1.08 vs 3.38+/-1.26, respectively; t test, P<0.001). Despite their frequency and possible associated stress, daily quizzes were associated with better academic success in the anatomy course.

Nerve injury during uterosacral ligament fixation: a cadaver study

The objective of this study was to identify nerve(s) vulnerable to entrapment during uterosacral ligament fixation (USLF), which could cause postoperative lower extremity pain previously described in the literature. Preserved cadavers in a medical anatomy course were used. Before the students' pelvic dissections, a 2-0 prolene suture was placed in the middle third of each left uterosacral ligament visualized. The sutures were re-evaluated at the end of the course. Nine sutures remained in place after the course, and one entrapped a nerve. It was part of the inferior hypogastric plexus, included fibers from S2 and S3, and radiated to the bladder and rectum. The posterior femoral cutaneous nerve was lateral and posterior to this nerve. The inferior hypogastric plexus is vulnerable during USLF. Entrapment of S2 and S3 fibers could cause pain in their respective dermatomes and could be responsible for the postoperative pain previously described.

The impact of alternating dissection on student performance in a medical anatomy course: Are dissection videos an effective substitute for actual dissection?

The way in which anatomy is taught to first year medical students at the University of North Carolina at Chapel Hill was recently changed, so that first year students are now divided into two groups that dissect alternately. The effect of this change on both written and practical test performance was analyzed by comparing grades from 2004 with those from the previous year (2003), when students performed all the dissections. A statistically significant decrease (P < or = 0.05) from 2003 was noted on three of the four written test scores in 2004, while practical examination scores in 2004 fluctuated from lower to higher than those in 2003, depending on the unit of material being covered. However, the number of students failing each of the examinations (written and practical combined) was statistically greater on only one of the four examinations in 2004. Scores of the two groups dissecting alternately in 2004 were essentially the same on the practical examinations. There was no difference in the number of questions answered incorrectly between these two groups in the two practical examinations where comparisons were made. Furthermore, students who dissected a particular structure did not score significantly better on practical questions concerning that structure than students who had not dissected it. The effect of the availability of step-by-step dissection videos on student practical examination scores is also discussed. We conclude that the change in the curriculum had a significant impact on the students' written examination performance, given the same material in the course. The reasons for this include student course load, increased need for self-study, and a loss of a learning opportunity in the dissection laboratory, all of which affect student comprehension and retention of the material and their ability to use it in problem solving.

Undergraduate coursework in anatomy as a predictor of performance: Comparison between students taking a medical gross anatomy course of average length and a course shortened by curriculum reform

The performance of students taking medical gross anatomy at the University of California at Davis during a 4-year period (1999-2002) was correlated with prior undergraduate anatomy coursework. Significant correlations were observed between class rank in medical anatomy and taking any undergraduate anatomy as well as the total number of undergraduate anatomy units (P<0.01). Taking human gross anatomy and an anatomy laboratory course were significantly correlated with medical anatomy class rank (P<0.01) as were grades in human anatomy, comparative vertebrate anatomy and anatomy laboratory courses (P<0.05). The medical anatomy course offered in 1999-2000 was 172 hr long, and the course offered in 2001-2002 was 135 hr long, with most of the difference made by decreasing lecture time while sparing the dissection laboratory. The reduction in course length was the consequence of a curriculum-wide cap in weekly contact hours. In the 172-hr medical anatomy course there were significant correlations between the students who took undergraduate anatomy and both class rank and the score on the final examination (P<0.01). These correlations did not exist for the 135-hr course. This may be explained by previous anatomy experiences helping students learn from lecture more than from dissection laboratory, as well as the extra study time available to students in the reformed medical curriculum. Pre-medical students and health science advisors need to consider that the benefits of taking anatomy as an undergraduate may be dependent on the configuration of a medical school's curriculum.

Dissection laboratory is vital to medical gross anatomy education

Dissection laboratory is vital to medical gross anatomy education

The standard medical microscopic anatomy course: Histology circa 1998

The standard medical microscopic anatomy course: Histology circa 1998

The standard medical microscopic anatomy course: Histology circa 1998

The standard medical microscopic anatomy course: Histology circa 1998

The Visible Human Dataset: the anatomical platform for human simulation.

One goal of a medical school education is to teach the anatomy of the living human. With the exception of some surface anatomy, the morphology education that goes on during a surgical procedure, and patient observation, live human anatomy is most often taught by simulation. Medical anatomy courses utilize cadavers to approximate the live human. Case-based curricula simulate a patient and present symptoms, signs, and history to mimic reality for the future practitioner. Radiology has provided images of the morphology, function, and metabolism of living humans but with images foreign to most novice observers. With the Visible Human database, computer simulation of the live human body will provide revolutionary transformations in anatomical education.