Retention Of Anatomical Knowledge Research Articles

Anatomical knowledge retention in Obstetrics and Gynaecology residents and impact of an e-learning tool.

Anatomical knowledge of medical students and residents is insufficient and further anatomical sciences throughout medical curriculum may be necessary. The first aim of this study was to assess pelvic and perineal anatomical knowledge retention of Obstetrics and Gynaecology (Ob/Gyn) residents. The second was to assess the impact of an e-learning tool on anatomical knowledge. A survey was sent by mail to medical students and Ob/Gyn residents. After completion, Ob/Gyn residents were randomised to "e-learning" group or to "Control" group. "E-learning" group had an unlimited access to a tool about female pelvic and perineum anatomy, implemented by iMAIOS society in their online platform. A second assessment of residents' anatomical knowledge was done 2months after randomisation. Ob/Gyn residents (N = 23) had a significant lower global score than third-year medical students (N = 103) (22.1% (± 10.2) vs 43.8% (± 12.1), p < 0.0001). Two months after randomisation, residents of "control" group demonstrated no significant difference between the two questionnaires (3.6%, p = 0.31), whilst the "e-learning" group demonstrated a significant increase overall (10.6%, p = 0.09). There was no significant difference on the post-intervention questionnaire between control and "e-learning" group (25.4% vs 33% respectively, p = 0.34). Knowledge of pelvic and perineal anatomy is poor. This e-learning tool aimed at improving anatomical knowledge retention but is not sufficient. A combination of traditional approaches and innovative solutions should be proposed throughout medical school and residency to maintain anatomical knowledge.

Does Immersive Virtual Reality with the Use of 3D Holography Improve Learning the Anatomy of the Heart?: Results of a Preliminary Study

Immersive virtual reality with the use of 3D holography is a new method that is being currently introduced for teaching anatomy, yet the actual educational benefits associated with its use remain unclear. Here, we present our preliminary observations and conclusions after the pilot phase of the study on a 3D holographic human heart. The study was conducted on a group of 96 students of medical faculty. Students were randomly divided into two groups: 57 students who were taught anatomy using traditional methods (plastinated human hearts, anatomical models, and atlases) and 39 students who were taught using 3D holographic hearts. Assessment of knowledge retention of the heart anatomy comprised 3 tests, which were performed 1 week and 3 and 6 months after the classes on heart anatomy. We have found that although anatomical classes with the use of immersive virtual reality were attractive for students; still, unsupervised teaching with the use of 3D holograms was not superior to traditional medical education. Differences between the groups in terms of anatomical knowledge retention were not statistically significant. Results of this pilot study suggest that in order to achieve better knowledge retention and understanding of the anatomy of the heart, classes should be precisely planned and strictly supervised by academic teachers. Moreover, students should get familiar with the use of virtual reality goggles before the classes.

Third-Year Nursing Student's Physiological Knowledge Retention

Anatomy and physiology are considered foundational courses in medical, nursing and allied-health care programs. However, there is a growing concern that students struggle to retain this essential knowledge over time. Numerous studies have demonstrated the difficulty of medical, nursing and allied healthcare students to retain and apply anatomical knowledge as they progress through their programs of study (Doomernik et al., 2017). However, physiological knowledge retention has not been studied as extensively as anatomical knowledge retention in health care disciplines, with very few studies focusing on nursing students (Aari et al., 2004). Of those studies, most are conducted after graduation (Aari et al., 2004) or are focused on a single or a limited number of organ systems (Pourshanazari et al., 2013). The present study aims to determine the level of physiological knowledge retained by nursing students in the third year between completing their physiology course in first-year nursing and third-year Nursing Care of Families with Young Children course. To answer this question, nursing students were quizzed on ten organ systems using the online quizzing system Kahoot. Each Kahoot quiz included nine to eleven knowledge and comprehension-level multiple-choice questions. These scores were compared to first-year quiz scores on the same content to determine overall knowledge retention over two years. Data were statistically analyzed using SPSS II, and means were compared using 2-sample t-tests. The scores are described for each organ system by reporting the mean and standard deviation (±SD). Statistical significance was set at P &lt; 0.05 for all tests. The mean score of questions from all organ systems in year one was 62.89 ± 10.49 (±SD). Comparing that score to matched test items evaluated in the Nursing Care of Families with Young Children course, there is a decrease in the overall mean score from 62.89 ± 10.49 (±SD) to 50.95 ± 13.02 (±SD). This equates to an 88.06% retention rate, or 11.94% knowledge loss within two years. Organ-specific knowledge retention was highest for inflammation (100%), respiratory physiology (99.10%), and vascular physiology (95.01%), followed by blood (89.16%), digestive physiology (86.28%), endocrinology (83.76%), defences (82.50%) and renal physiology (82.19%). Retention was comparatively lower for fluid and electrolyte balance (79.36%) and reproductive physiology (77.54%). These results demonstrate a high level of knowledge retention overall, with variations in retention being system specific. The level of knowledge retention in this study was significantly higher than previous rates reported in medical and allied-health students (Pourshanazari et al., 2013) and higher than anatomical knowledge retention levels in the same population (Narnaware and Neumeier, 2021). However, knowledge retention in the third year is not significantly different from the second year (Narnaware et al., 2021). This is the full abstract presented at the American Physiology Summit 2023 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Attitudes and usage of visual-aids in graduate student learning of gross anatomy at Makerere University.

The increasing numbers of students studying human anatomy at Makerere University are beginning to overwhelm available resources, which presents challenges in learning and necessitates an evaluation of alternative ways to enhance anatomy learning.The increasing numbers of students overwhelm resources available and presents challenges in learning. This necessitates an evaluation of alternatives to enhance gross anatomy learning at Makerere University College of Health Sciences. The study aimed to assess the usage of visual aids and generate necessary information to enhance learning. A cross-sectional study employing a concurrent triangulation mixed method design was conducted among 44 graduate students actively participating in cadaveric dissection. Data was collected using self-administered questionnaires and two focus group discussions. Descriptive statistics and thematic analysis were used to summarize data. Most participants were male (77.3%) with a mean age of 31.5 years (SD 3.9, Range, 27-45 years). A majority of graduate students reported using non-traditional methods (online sources) to supplement learning. Students commonly used hard copies of Cunningham Manual of Practical Anatomy (88.6%) supplemented with well-illustrated textbooks (79.5%) and online dissection videos (72.7%). Students expressed most satisfaction with the use of videos and well-illustrated text books in supplementing learning. The availability of these electronic resources was limited by factors such as poor internet connectivity and the need to pay for online licenses and subscription fees. Graduate students in the Department of Anatomy at MakCHS are using non-traditional methods to supplement their learning. However, there are several challenges to accessing digital resources. There is a need to support students with accessing visual aids through integrating newer teaching modalities and modern technology to promote interest and retention of anatomical knowledge.

Improving Medical Student Anatomy Knowledge and Confidence for the Breast Surgical Oncology Rotation.

The anatomy curriculum has undergone considerable reductions in class time, resulting in decreased student anatomical knowledge retention and confidence during their surgical rotations. To counter this deficit in anatomy knowledge, a clinical anatomy mentorship program (CAMP) was developed by fourth-year medical student leaders and staff mentors in a near-peer teaching fashion prior to the surgical clerkship. This study analyzed the impact this program had on third-year medical students (MS3s) self-assessed anatomical knowledge and confidence in the operating room on the Breast Surgical Oncology rotation after this near-peer program. A single-center prospective survey study was performed at an academic medical center. Pre- and post-program surveys were administered to all students who participated in the CAMP and rotated on the breast surgical oncology (BSO) service during the surgery clerkship rotation. A control group of individuals who did not rotate on the CAMP was established, and this group was administered a retrospective survey. A 5-point Likert scale was used to assess surgical anatomy knowledge, confidence in the operating room, and comfort in assisting in the operating room. Control group versus post-CAMP intervention group and pre- versus post-CAMP intervention groups survey results were compared using the Student's t-test with a p-value of <0.05 statistically significant. All CAMP students rated their surgical anatomy knowledge (p < 0.01), confidence in the operating room (p < 0.01), and comfort in assisting in the operating room (p < 0.01) as greater than those who did not participate in the program. Additionally, the program improved the ability of third-year medical students to prepare for operating room cases going into their third-year breast surgical oncology clerkship (p < 0.03). This near-peer surgical education model appears to be an effective way to prepare third-year medical students for the breast surgical oncology rotation during the surgery clerkship by improving anatomic knowledge and student confidence. The program can serve as a template for medical students, surgical clerkship directors, and other faculty interested in efficiently expanding surgical anatomy at their institution.

Teaching, Learning and Assessing Anatomy with Artificial Intelligence: The Road to a Better Future.

Anatomy is taught in the early years of an undergraduate medical curriculum. The subject is volatile and of voluminous content, given the complex nature of the human body. Students frequently face learning constraints in these fledgling years of medical education, often resulting in a spiraling dwindling academic performance. Hence, there have been continued efforts directed at developing new curricula and incorporating new methods of teaching, learning and assessment that are aimed at logical learning and long-term retention of anatomical knowledge, which is a mainstay of all medical practice. In recent years, artificial intelligence (AI) has gained in popularity. AI uses machine learning models to store, compute, analyze and even augment huge amounts of data to be retrieved when needed, while simultaneously the machine itself can be programmed for deep learning, improving its own efficiency through complex neural networks. There are numerous specific benefits to incorporating AI in education, which include in-depth learning, storage of large electronic data, teaching from remote locations, engagement of fewer personnel in teaching, quick feedback from responders, innovative assessment methods and user-friendly alternatives. AI has long been a part of medical diagnostics and treatment planning. Extensive literature is available on uses of AI in clinical settings, e.g., in Radiology, but to the best of our knowledge there is a paucity of published data on AI used for teaching, learning and assessment in anatomy. In the present review, we highlight recent novel and advanced AI techniques such as Artificial Neural Networks (ANN), or more complex Convoluted Neural Networks (CNN) and Bayesian U-Net, which are used for teaching anatomy. We also address the main advantages and limitations of the use of AI in medical education and lessons learnt from AI application during the COVID-19 pandemic. In the future, studies with AI in anatomy education could be advantageous for both students to develop professional expertise and for instructors to develop improved teaching methods for this vast and complex subject, especially with the increasing paucity of cadavers in many medical schools. We also suggest some novel examples of how AI could be incorporated to deliver augmented reality experiences, especially with reference to complex regions in the human body, such as neural pathways in the brain, complex developmental processes in the embryo or in complicated miniature regions such as the middle and inner ear. AI can change the face of assessment techniques and broaden their dimensions to suit individual learners.

Systematic Approach of Using Body Painting Method for Anatomy Teaching and Practical via Online Platform

In the context of medical education, body painting refers to the schematic portrayal of internal organs on the body’s surface. Body painting session has been reported to be fun and engaging, and it encourages learning through easy visualisation of underlying anatomical structures. Besides improving anatomical knowledge retention, body painting is particularly effective for learning surface anatomy and complementing the teaching of clinical skills and peer assessment procedures such as palpation. Indeed, the clinical relevance of the gross anatomy can be conveyed to students by bringing cadaveric anatomy to life body painting. In educational perspective, the delivery of body painting method is in line with the active learning approach and collaborative learning principle; and its instructional design follows the principles of the cognitive load theory. In this article, we provide a systematic approach for a successful body painting session for anatomy teaching via online platform, which cater for remote learning needs amidst the COVID-19 pandemic.

Gross Anatomical Knowledge Loss in Fourth‐Year Nursing Students

Human anatomy and physiology are considered a cornerstone of health‐related professional education and serve as a prerequisite for future nursing courses (McVicar et al., 2015). Numerous research studies show great difficulty in transferring fundamental knowledge of these courses to clinical and subsequent years of these disciplines (Bhangu et al., 2010; Narnaware and Neumeier, 2020; Narnaware, Y. 2021a). However, most of the knowledge acquisition, transfer/lost, and retention studies have been carried out in medical and allied health students and have been assessed rarely in nursing students. We have previously shown that the second‐and third‐year nursing students lose approximately 29.0% and 31.0% of their second and third‐year anatomical knowledge, retaining about 71.0% and 69.0% within two years (Narnaware and Neumeier, 2020; Narnaware and Neumeier, 2020b). However, anatomical knowledge transfer/loss, retention, and application in fourth‐year nursing students have not been assessed yet. The present study's main objective, therefore, is to assess the anatomical knowledge loss among fourth‐year nursing students and determine if the retention level is organ system‐specific. To evaluate the knowledge loss in fourth‐year nursing students, they were quizzed on eleven anatomy organ systems using the online quizzing system Kahoot. Each Kahoot quiz included nine to eleven knowledge and comprehension level multiple‐choice questions. These scores were compared to first‐year quiz scores on the same content to determine overall knowledge loss over the fourth year. Data were statistically analyzed using SPSS II, and means were compared using two‐way ANOVA. The scores are shown for each organ system by reporting the mean and standard deviation (±SD). Statistical significance was set at P &lt; 0.05 for all tests. The results show that there was a significant decrease in the overall mean score from 83.05 ± 8.34 (± SD) in the first year to 53.9 ± 9.4 (±SD) in the fourth year (P=0.0001) (Figure 1). This equates to a 29.6% loss and 70.4% overall retention of anatomical knowledge over two years. However, there was no significant difference in mean scores between the third‐year and four‐year nursing students. The mean score in fourth‐year nursing students was higher by approximately 3.4% than the third‐year students. System‐specific knowledge loss shown in table 1 was highest for the head and neck lymphatic (55.7%), cranial nerves (44.1%), lymphatic (37.6%), and special senses (37.0%). This system‐specific knowledge loss was followed by the integumentary system (28.2%), vascular system (27.6%), muskulo‐skeletal (26.6%), and nervous system (25.1%). The loss was the lowest for the genitourinary system (21.2%), respiratory system (13.9%), and gastrointestinal system (12.0%). The present study reveals that nursing students lost more knowledge in the fourth‐year than first‐year and comparatively less than third‐year but retained much higher anatomical knowledge than medical and allied health students reported. This study provides knowledge retention for different body systems. It also identifies where nursing students' knowledge retention gaps exist so that those can be addressed by developing a robust interventional strategy for nursing students in the future.

Content Reinforcement of the Cardiovascular Physiology Improves Knowledge Retention in Nursing Students

There is growing concern over the loss of anatomical and physiological knowledge in medical, allied‐health &amp; nursing students over time (Narnaware &amp; Neumeier, 2020a, Narnaware, Y. 2021). Numerous studies have demonstrated the difficulty of the students in these disciplines to retain and apply anatomical knowledge as they progress through their programs of study (Narnaware and Neumeier, 2020a). However, physiological knowledge retention has not been studied as extensively as anatomical knowledge retention in health care disciplines, with very few studies focusing on nursing students (Aari et al., 2004). Of those studies, most are carried out after graduation (Aari et al., 2004) or are focused on a single or limited number of organ systems (Pourshanazari et al., 2013). We have previously shown that physiology students retained approximately 86.6% of their first‐year physiological knowledge over four months (Narnaware et al., 2020b). To improve the acquisition and retention of physiological knowledge, the present study aims to develop an interventional strategy that includes the repeated assessment of cardiovascular physiology and defenses knowledge over eight weeks. Nursing students were quizzed on two components of cardiovascular physiology (vascular system and blood) and defenses using the online quizzing system Kahoot. Each Kahoot quiz included 9‐11 knowledge and comprehension level multiple‐choice questions, and new sets of questions were used for each week’s Kahoot quiz. Data were statistically analyzed using SPSS II, and means were compared using 2‐sample t‐tests. The scores are described as the mean and standard deviation (SD) and are presented in figure 1 and table 1. Statistical significance was set at P &lt; 0.05 for all tests. Compared to week 1, repeating knowledge of the vascular physiology and defenses yielded a significantly higher (P&lt;0.05) knowledge retention at week 2 (8.4% &amp; 11.7%). However, this retention was highest at weeks 3 (18.7% &amp; 16.9%) and weeks 4 (21.6% &amp; 14.3%), P&lt;0.001) in both organ systems, with less significant improvement (P&lt;0.05) at week 6 (13.3%) and no significant difference in defenses (4.6%). No significant differences in knowledge retention were found between vascular and defenses at week 8. However, compared to vascular physiology and defenses, content reinforcement of blood was highly significant at all weeks. Compared to week 1, knowledge retention of blood was highest at week 4 (69.5%), week 6 (55.2%), and week 8 (54.7%), P&lt;0.0001), with less significant retention at week 2 (27.8%) and week 3 (31.2%), P&lt;0.001). Although organ system‐specific improvements in knowledge retention were found, the study results show that repeated knowledge assessment can significantly improve knowledge retention of cardiovascular physiology and defenses in nursing students and agrees with previously reported studies in medical students (Pourshanazari et al., 2013). Therefore, content reinforcement should be used as one of the interventional strategies to improve knowledge retention in nursing students, and further research should be conducted to explore effective ways to maintain increased retention over more extended periods.

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&lt;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&lt;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.

The effect of Snapchat on learner satisfaction and anatomical knowledge retention: Preliminary observations.

Biomedical educators have turned to technologies, like social media, to supplement progressive reductions in time spent in class. Many studies of social media have been limited to quantifying learner satisfaction and studies on the effects on learning outcomes are sparse. The purpose of this study was to examine the effects of using Snapchat on learner satisfaction and learning outcomes. A Snapchat account was used to share blood flow diagrams during the anatomy course of a physical therapist education program. Viewing statistics were recorded, a survey was distributed, and learning outcomes quantified at the end of the course and 12 months later were compared with a control group that did not have access to the account. Eighty‐two percent of the class subscribed to the Snapchat account and 86.7% of the subscribers completed viewing of the five drawings posted. Learners rated the account as extremely accurate, were quite interested in more content presented, and felt quite confident in the diagrams. Performance on blood flow questions on the end of course examinations were similar between experimental and control groups. Assessments administered 12 months later revealed greater scores for the Snapchat group (90.7% correct) compared with the control group (86.7% correct, p = 0.04). These findings suggest that Snapchat is an effective way to deliver educational content and that learners found the content useful, accurate, and helpful in preparing them for the assessment. The ephemeral nature of disappearing content has potential to garner greater student attention and can be leveraged to improve knowledge retention.

Application and Relevancy of Anatomy Curriculum in the Clinical Years: A Malaysian University Experience

Human anatomy is one of the fundamental subjects in medical and health education. In recent years, anatomy teaching in Universiti Sains Islam Malaysia (USIM) has undergone a major transition from a highly detailed, didactic method to student-centred pedagogy and clinical correlations. Hence, this study aimed to assess the perception of the anatomy curriculum amongst USIM clinical students and to evaluate the clinicians’ cognisance of their students’ anatomical knowledge and application. A cross-sectional study was conducted on 232 clinical students (fourth-, fifth- and final-year) and 32 clinicians from various disciplines with the validated questionnaires. Descriptive analysis was performed to analyse the findings regarding students’ and clinicians’ perceptions. The majority of the students agreed that the anatomy curriculum was adequately covered in the pre-clinical years except for the imaging and clinical correlation classes. In terms of the teaching method, most of the students perceived that the tutorials (99.2%), practical sessions (98.7%), lectures (97.4%) and problembased learning (PBL) (96.1%) were the best approaches in understanding anatomy comprehensively. Results also indicated that the practical sessions (99.1%), lectures (94.8%), tutorials (94.8%) and PBL (93.9%) were the best methods in retaining anatomy knowledge. Besides, 62.9% of students strongly agreed that objective structured practical examination (OSPE) was the most helpful assessment for their anatomical knowledge retention. The majority of the clinicians perceived their clinical year students had a satisfactory level of anatomical knowledge (n = 21, 65.6%) and also believed that the anatomical correlation classes were essential for their disciplines. Students recognised the value of the current teaching methodology for their knowledge retention and comprehension. However, both clinicians and students felt there were limited opportunities for clinical application during teaching and learning. It is therefore imperative to implement appropriate restructuring to the current anatomy curriculum to address students’ needs and preferences for their future medical practice.

Anatomical Knowledge Retention in Third‐Year Nursing Students

Human anatomy and physiology are fundamental courses in medical, allied health and nursing disciplines, and serve as a prerequisite for future clinical (Turney et al., 2007). The mounting evidence suggests great difficulty in transferring fundamental knowledge of these courses to clinical and coming years of these disciplines (Bhangu et al., 2010; Narnaware and Neumeier, 2019, 2020). However, most of the knowledge acquisition, transfer/lost, and retention studies have been carried out in medical students and allied health students and have been assessed rarely in nursing students. We have previously shown that the second-year nursing students retained approximately 71.0% of their first anatomical knowledge, losing about 29% within a year (Narnaware and Neumeier, 2020). However, anatomical knowledge transfer/loss, retention, and its application in third-year nursing students has not been assessed yet. Therefore, the present study's main objective is to assess the anatomical knowledge retention among third-year nursing students and determine if the retention level is organ system-specific. To assess the knowledge retention in third-year, nursing students were quizzed on eleven anatomy organ systems using the on-line quizzing system Kahoot. Each Kahoot quiz included nine to eleven knowledge and comprehension level multiple-choice questions. These scores were compared to first-year quiz scores on the same content to determine overall knowledge retention over the third-year. Data were statistically analyzed using SPSS II, and means were compared using two-way ANOVA. The scores are described for each organ system by reporting the mean and standard deviation (±SD). Statistical significance was set at P < 0.05 for all tests. The results show that there was a significant decrease in the overall mean score from 83.05 ± 8.34 (± SD) in the first year to 51.6 ± 12.5 (±SD) in the third-year (P=0.001). This equates to a 31.4% loss andd 68.6% overall retention of anatomical knowledge over two years. However, there was no significant difference in mean scores between the second and third-year nursing students. The mean score in third-year nursing students was lower by approximately 3.0% than the second-year students. System-specific knowledge retention was highest for the gastrointestinal (87.4%), respiration (86.0%), special senses (82.7%). This system-specific retention was followed by the genitourinary system (78.9%), integumentary system (76.0%), and nervous system (74.9%). Retention was lowest for the musculoskeletal (59.7%), lymphatic (system plus head & neck) (57.5 - 58%), cranial nerves (57.4%) and vascular system (50.9%). The present study reveals that nursing students retain less knowledge than first-year and second-year students but retain much higher anatomical knowledge than reported in medical and allied health students. The researchers are now investigating knowledge retention and its application in fourth-year nursing students. This study provides knowledge retention for different body systems. It also identifies where nursing students' knowledge retention gaps exist so that those can be addressed by developing a robust interventional strategy for nursing students in the future.

Physiological Knowledge Retention in Second‐Year Nursing Students

Despite anatomy and physiology being foundational courses in medical, nursing, and allied -health care programs, there is growing concern that the knowledge in these courses is not being retained by students over time. Numerous studies have demonstrated the difficulty of medical, allied health, and nursing students to retain and apply anatomical knowledge in their future years of study (Doomernik et al., 2017). However, physiological knowledge retention has not been studied as extensively as anatomical knowledge retention in health care disciplines, with very few studies focusing on nursing students (Aari et al., 2004). Of those studies, most are carried out after graduation (Aari et al., 2004) or are focused on a single or limited number of organ systems (Pourshanazari et al., 2013). We have previously shown that nursing students retained 92.0% of their first-year physiological knowledge, losing 8.% within 4-months (Narnaware and Neumeier, 2020a). The present study aims to determine the level of physiological knowledge retained by nursing students in the second year. To answer this question, nursing students were quizzed on ten organ systems using the on-line quizzing system Kahoot. Each Kahoot quiz included nine to eleven knowledge and comprehension level multiple-choice questions. These scores were compared to first-year quiz scores on the same content to determine overall knowledge retention over a year. Data were statistically analyzed and means were compared using 2-sample t-tests. The scores are described for each organ system by reporting the mean and standard deviation (±SD). Statistical significance was set at P < 0.05 for all tests. The mean score of questions from all organ systems in year one was 62.9 ± 10.5 (±SD). Comparing that score to matched test items evaluated in the pathophysiology course, there is a decrease in the overall mean score from 62.9 ± 10.5 (±SD) to 47.9 ± 9.2 (±SD). This equates to an 85.0% retention rate, or 15.0% knowledge loss within a year. Organ-specific knowledge retention was highest for digestive physiology (97.37%), respiratory physiology (92.32%), fluid and electrolyte physiology (90.41%), inflammation (85.99%), reproductive physiology (83.55%), and vascular physiology (85.22%). This was followed by renal physiology (83.37%) and blood (82.49%). Retention was comparatively lower for endocrine physiology (79.47%) and defenses (70.42%). These results demonstrate a high level of knowledge retention overall, with variations in retention being system-specific. The level of knowledge retention in this study was significantly higher than previous rates reported in medical and allied-health students (Pourshanazari et al., 2013) and is significantly higher than anatomical knowledge retention levels in the same population (Narnaware and Neumeier, 2020b). This study identifies where nursing students' knowledge retention gaps exist which will help to develop an interventional strategy for nursing students in the future.

Student Competency in Interpreting Medical Imaging: How Virtual vs. In‐Person Cadaveric Dissection Influences Student Perception and 3D Awareness of the Human Body

Introduction As a medical student's first encounter with human anatomy, cadaveric dissection facilitates a comprehensive, three-dimensional (3D) understanding of the human body. We believe that this interaction is vital for future clinicians' ability to interpret medical imaging, specifically when the anatomy may be viewed in different planes, such as in Magnetic Resonance Imaging (MRI). In this study, we evaluated how learning anatomy through cadaveric vs. virtual dissection software programs affected medical students' ability to interpret medical imaging, as well as the impact it had on student satisfaction with their anatomical education. Methods Twenty first year medical students and 8 senior-level pre-medical students were recruited for this study, each of them having no prior experience with cadaveric dissection. The first year medical students learned anatomy via virtual dissection software, while the pre-medical students performed in-person dissections. After both groups completed the musculoskeletal system in their respective program, each student was given a 16-question agree/neutral/disagree survey with questions regarding their confidence and satisfaction with their anatomical education, as well as questions about respecting human dignity and empathizing with future patients. Following the survey, each student was asked to complete a 30-question open-answer assessment which asked them to identify various musculoskeletal structures on MRI scans. Both cohorts received identical assessments and were given the same time restrictions. Two months later, each student was asked to complete a second, identical 30-question assessment in order to evaluate anatomical knowledge retention. Results The pre-medical students who were enrolled in a human anatomy dissection course scored higher than the first year medical students learning anatomy virtually on both assessments in this study. The pre-medical students had average scores of 43.3% (SD 9.4) and 41.7% (SD 10.8) for the initial and 2-month assessments, respectively. The first-year medical students had average scores of 37.5% (SD 12.6) and 32.2% (SD 13.4) for the initial and 2-month assessments, respectively. Additionally, the survey results demonstrated that the majority of first-year medical students (90%) felt that the virtual software was inadequate compared to in-person dissection. The survey also revealed that those who participated in cadaveric dissection developed more respect for the dignity of human beings and empathy for future patients (87.5% and 100%, respectively) compared to those who did not (25% and 5%, respectively). Conclusion This study demonstrates that cadaveric dissection provides several benefits to future physicians. In-person dissection facilitates a deeper understanding of the anatomy, and provides a 3D awareness of the human body that enables future physicians to comprehend anatomy on multiple planes. Additionally, this study demonstrates that cadaveric dissection not only improves student satisfaction, but it develops intangible characteristics in future physicians such as respect and empathy for human beings.

Evaluation of a 3D-MC examination format in anatomy

IntroductionThe quality of education in medical anatomy is a fundamental pillar of good clinical practice. Current reforms of the medical curriculum have resulted in major methodological changes in the teaching and testing of anatomy. A number of recent studies have however described a decrease in positive metrics of anatomical knowledge among students so taught. It has been suggested that the reduced anatomical knowledge measured in these studies may endanger patient safety. As proxy measures of exam quality, evaluation of the levels of students ‘achievement in the examinations, assessment of the subjectively perceived level of question difficulty and analysis of exam satisfaction are each suitable parameters of investigation of medical education. Material and methodsTo address these issues with regard to medical education at the Charité-Universitätsmedizin Berlin, we have analyzed students’ levels of achievement in the anatomical Three Dimensional Multiple Choice (hereafter, 3D-MC)-examination of 2,015 students matriculated in medical studies from Summer Semester of 2014 through Summer Semester of 2017. We either compared students’ achievement levels of identical 3D-MC questions using models or prepared anatomical specimen. Furthermore, we have analyzed the type and frequency of cognitive levels used in the anatomical questions in relation to the students’ level of achievement. Finally, we conducted an anonymous survey to measure students’ (n = 207) and instructors’ (n = 16) satisfaction with the 3D-MC-examination in comparison to other employed anatomical testing strategies. ResultsStudents’ achievement is significantly enhanced with anatomical questions using models relative to those utilizing anatomical specimen. Over 80% of the anatomical questions in the 3D-MC-examinations assessed the lowest cognitive levels and higher cognitive question levels were accompanied by a significant decrease of the levels of students’ performance. Our survey further revealed that both, students and instructors preferred the practical examinations in anatomy and that the difficulty levels of the 3D-MC-examination was perceived as being the lowest in comparison to the other anatomical testing strategies. DiscussionTesting levels of anatomical understanding using anatomical models is not comparable to human specimen, and thus using specimen before models should be preferred to learn and test close to an authentic medical situation. The application of anatomical models and low cognitive question levels in the examination reduces the subjectively perceived level of difficulty, encourages superficial learning, and therefore decreases the retention of anatomical knowledge. ConclusionAlthough students and instructors prefer practical examinations in anatomy, the current development does not reflect these results. Therefore, it would be recommendable to rethink the development of anatomical testing strategies based on the existing evidence.

Visualising the Link Between Carpal Bones and Their Etymologies.

It has been observed through published studies, as well as anecdotally, that medical students struggle with retention of anatomical knowledge. Studies have found that having an established understanding of classical Greek or Latin languages, which underpin medical terminology, can result in higher anatomy test scores by medical students. It has also been established that three-dimensional (3D) visualisation tools can aid in student learning. This chapter will examine the research conducted at the University of Glasgow, which focused on the creation of a mobile application that visualises the etymology of the carpal bones for the purpose of aiding medical students in their learning and retention of knowledge of anatomy. The chapter will first build a body of knowledge by reviewing previous studies in which a carpal bone test was used as a measure of medical students' anatomy knowledge, as well as the relevance of etymology in medicine and its use in the study of anatomy, and the current teaching methods of anatomy, with a focus on how 3D visualisation tools can aid learning. It then outlines a methodological and technical framework to create anatomically accurate 3D models of the carpal bones and develop the final mobile application. It also discusses the methodology used to carry out suitable user testing and collect user feedback. This chapter concludes by discussing the results of user testing, where feedback was analysed to improve the mobile application design for further use in anatomy teaching. Limitations and future outlooks of the study, along with the future of integrating 3D visualisation tools as teaching methods to aid in student learning of anatomy, are also explored.

New York University Grossman School of Medicine.

New York University Grossman School of Medicine.

The process of curricular integration and its effects on anatomical knowledge retention.

Integration has been recognized as an important aspect of medical education. After transitioning from a discipline-specific to a systems-based preclinical curriculum, we examined faculty perceptions of the integrated approach and also whether it would lead to better anatomy knowledge retention. To understand faculty perspectives, we reviewed curricular materials, interviewed block directors, and observed educational sessions. We analyzed knowledge retention through a 27-question anatomy test, comparing scores from the last class of the discipline-based curriculum and the first two classes of the integrated curriculum. Planning integrated content involves purposeful ordering, is challenging for faculty, and requires additional resources. Evaluation of the integrated approach for anatomy content demonstrated a significant increase in knowledge retention (p = .012; 56.28% vs. 63.98% for old vs. new curriculum). This study helps the understanding of what is required for curricular integration. Our anatomy evaluation results corroborated the view that contextually embedded information is easier to learn and retain.

Integrating Clinical Reasoning Skills in an Undergraduate Human Anatomy Course

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