Medical Education in the Anatomical Sciences: The Winds of Change Continue to Blow.
TL;DR: Comparison between the data sets suggests several key points some of which include: decreased total hours in gross anatomy and neuroscience/neuroanatomy courses, increased use of virtual microscopy in microscopic anatomy courses, and decreased laboratory hours in embryology courses.
Abstract: At most institutions, education in the anatomical sciences has undergone several changes over the last decade. To identify the changes that have occurred in gross anatomy, microscopic anatomy, neuroscience/neuroanatomy, and embryology courses, directors of these courses were asked to respond to a survey with questions pertaining to total course hours, hours of lecture, and hours of laboratory, whether the course was part of an integrated program or existed as a stand-alone course, and what type of laboratory experience occurred in the course. These data were compared to data obtained from a similar survey in 2002. Comparison between the data sets suggests several key points some of which include: decreased total hours in gross anatomy and neuroscience/neuroanatomy courses, increased use of virtual microscopy in microscopic anatomy courses, and decreased laboratory hours in embryology courses.
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TL;DR: Alternative resources and strategies are discussed in an attempt to tackle genuine concerns of diminished allotted dissection time and the number of qualified anatomy instructors, which will eventually deteriorate the quality of education.
Abstract: Anatomy has historically been a cornerstone in medical education regardless of nation or specialty. Until recently, dissection and didactic lectures were its sole pedagogy. Teaching methodology has been revolutionized with more reliance on models, imaging, simulation, and the Internet to further consolidate and enhance the learning experience. Moreover, modern medical curricula are giving less importance to anatomy education and to the acknowledged value of dissection. Universities have even abandoned dissection completely in favor of user-friendly multimedia, alternative teaching approaches, and newly defined priorities in clinical practice. Anatomy curriculum is undergoing international reformation but the current framework lacks uniformity among institutions. Optimal learning content can be categorized into the following modalities: (1) dissection/prosection, (2) interactive multimedia, (3) procedural anatomy, (4) surface and clinical anatomy, and (5) imaging. The importance of multimodal teaching, with examples suggested in this article, has been widely recognized and assessed. Nevertheless, there are still ongoing limitations in anatomy teaching. Substantial problems consist of diminished allotted dissection time and the number of qualified anatomy instructors, which will eventually deteriorate the quality of education. Alternative resources and strategies are discussed in an attempt to tackle these genuine concerns. The challenges are to reinstate more effective teaching and learning tools while maintaining the beneficial values of orthodox dissection. The UK has a reputable medical education but its quality could be improved by observing international frameworks. The heavy penalty of not concentrating on sufficient anatomy education will inevitably lead to incompetent anatomists and healthcare professionals, leaving patients to face dire repercussions. Anat Sci Educ 3: 83–93, 2010. © 2010 American Association of Anatomists.
739 citations
TL;DR: Both VR and AR are as valuable for teaching anatomy as tablet devices, but also promote intrinsic benefits such as increased learner immersion and engagement that show great promise for the effective use of virtual and augmented reality as means to supplement lesson content in anatomical education.
Abstract: Although cadavers constitute the gold standard for teaching anatomy to medical and health science students, there are substantial financial, ethical, and supervisory constraints on their use. In addition, although anatomy remains one of the fundamental areas of medical education, universities have decreased the hours allocated to teaching gross anatomy in favor of applied clinical work. The release of virtual (VR) and augmented reality (AR) devices allows learning to occur through hands-on immersive experiences. The aim of this research was to assess whether learning structural anatomy utilizing VR or AR is as effective as tablet-based (TB) applications, and whether these modes allowed enhanced student learning, engagement and performance. Participants (n = 59) were randomly allocated to one of the three learning modes: VR, AR, or TB and completed a lesson on skull anatomy, after which they completed an anatomical knowledge assessment. Student perceptions of each learning mode and any adverse effects experienced were recorded. No significant differences were found between mean assessment scores in VR, AR, or TB. During the lessons however, VR participants were more likely to exhibit adverse effects such as headaches (25% in VR P < 0.05), dizziness (40% in VR, P < 0.001), or blurred vision (35% in VR, P < 0.01). Both VR and AR are as valuable for teaching anatomy as tablet devices, but also promote intrinsic benefits such as increased learner immersion and engagement. These outcomes show great promise for the effective use of virtual and augmented reality as means to supplement lesson content in anatomical education. Anat Sci Educ 10: 549-559. © 2017 American Association of Anatomists.
513 citations
Cites background from "Medical Education in the Anatomical..."
...An update on the status of anatomical sciences education in United States medical schools....
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...Survey of gross anatomy, microscopic anatomy, neuroscience, and embryology courses in medical school curricula in the United States....
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...In 2009 the amount of time dedicated to teaching gross anatomy was found to have decreased by 55% over the span of the past 49 years within the medical curriculum in universities within the United States (Drake et al., 2002, 2009, 2014)....
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TL;DR: 3D printing offers many advantages over plastination as it allows rapid production of multiple copies of any dissected specimen, at any size scale and should be suitable for any teaching facility in any country, thereby avoiding some of the cultural and ethical issues associated with cadaver specimens either in an embalmed or plastinated form.
Abstract: The teaching of anatomy has consistently been the subject of societal controversy, especially in the context of employing cadaveric materials in professional medical and allied health professional training. The reduction in dissection-based teaching in medical and allied health professional training programs has been in part due to the financial considerations involved in maintaining bequest programs, accessing human cadavers and concerns with health and safety considerations for students and staff exposed to formalin-containing embalming fluids. This report details how additive manufacturing or three-dimensional (3D) printing allows the creation of reproductions of prosected human cadaver and other anatomical specimens that obviates many of the above issues. These 3D prints are high resolution, accurate color reproductions of prosections based on data acquired by surface scanning or CT imaging. The application of 3D printing to produce models of negative spaces, contrast CT radiographic data using segmentation software is illustrated. The accuracy of printed specimens is compared with original specimens. This alternative approach to producing anatomically accurate reproductions offers many advantages over plastination as it allows rapid production of multiple copies of any dissected specimen, at any size scale and should be suitable for any teaching facility in any country, thereby avoiding some of the cultural and ethical issues associated with cadaver specimens either in an embalmed or plastinated form. Anat Sci Educ 7: 479–486. © 2014 American Association of Anatomists.
480 citations
Cites background from "Medical Education in the Anatomical..."
...In contrast, some institutions in the United Kingdom and Europe have abandoned dissection-based learning (McLachlan and Patten, 2006) and in the United States many rely on combinations of prosection and dissection (Drake et al., 2009)....
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TL;DR: The range of teaching resources and strategies used in anatomy education are reviewed with the aim of coming up with suggestions about the best teaching practices and it is suggested that certain professions would have more benefit from certain educational methods or strategies than others.
Abstract: In this report we review the range of teaching resources and strategies used in anatomy education with the aim of coming up with suggestions about the best teaching practices in this area. There is much debate about suitable methods of delivering anatomical knowledge. Competent clinicians, particularly surgeons, need a deep understanding of anatomy for safe clinical procedures. However, because students have had very limited exposure to anatomy during clinical training, there is a concern that medical students are ill-prepared in anatomy when entering clerkships and residency programs. Therefore, developing effective modalities for teaching anatomy is essential to safe medical practice. Cadaver-based instruction has survived as the main instructional tool for hundreds of years, however, there are differing views on whether full cadaver dissection is still appropriate for a modern undergraduate training. The limitations on curricular time, trained anatomy faculty and resources for gross anatomy courses in integrated or/and system-based curricula, have led many medical schools to abandon costly and time-consuming dissection-based instruction in favour of alternative methods of instruction including prosection, medical imaging, living anatomy and multimedia resources. To date, no single teaching tool has been found to meet curriculum requirements. The best way to teach modern anatomy is by combining multiple pedagogical resources to complement one another, students appear to learn more effectively when multimodal and system-based approaches are integrated. Our review suggests that certain professions would have more benefit from certain educational methods or strategies than others. Full body dissection would be best reserved for medical students, especially those with surgical career intentions, while teaching based on prosections and plastination is more suitable for dental, pharmacy and allied health science students. There is a need to direct future research towards evaluation of the suitability of the new teaching methodologies in new curricula and student perceptions of integrated and multimodal teaching paradigms, and the ability of these to satisfy learning outcomes.
457 citations
TL;DR: This study sought to identify the approaches taken in the United Kingdom and Republic of Ireland to deliver anatomical education through online means and compared adopting a thematic analysis approach.
Abstract: The Covid-19 pandemic has driven the fastest changes to higher education across the globe, necessitated by social distancing measures preventing face-to-face teaching. This has led to an almost immediate switch to distance learning by higher education institutions. Anatomy faces some unique challenges. Intrinsically, anatomy is a three-dimensional subject that requires a sound understanding of the relationships between structures, often achieved by the study of human cadaveric material, models, and virtual resources. This study sought to identify the approaches taken in the United Kingdom and Republic of Ireland to deliver anatomical education through online means. Data were collected from 14 different universities in the United Kingdom and Republic of Ireland and compared adopting a thematic analysis approach. Once themes were generated, they were collectively brought together using a strength, weakness, opportunity, threat (SWOT) analysis. Key themes included the opportunity to develop new online resources and the chance to engage in new academic collaborations. Academics frequently mentioned the challenge that time constrains could place on the quality and effectiveness of these resources; especially as in many cases the aim of these resources was to compensate for a lack of exposure to cadaveric exposure. Comparisons of the actions taken by multiple higher education institutions reveal the ways that academics have tried to balance this demand. Discussions will facilitate decisions being made by higher education institutions regarding adapting the curriculum and assessment methods in anatomy.
299 citations
Cites background from "Medical Education in the Anatomical..."
...The decline in the priority of cadavers, and indeed anatomy as a subject, within medical curricula is well documented (Drake et al., 2002; Drake et al., 2009)....
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TL;DR: In this article, the authors examined the response rates for surveys used in organizational research and identified 490 different studies that utilized surveys, which covered more than 100,000 organizations and 400,000 individual respondents.
Abstract: This study examines the response rates for surveys used in organizational research. We analysed 1607 studies published in the years 2000 and 2005 in 17 refereed academic journals, and we identified 490 different studies that utilized surveys. We examined the response rates in these studies, which covered more than 100,000 organizations and 400,000 individual respondents. The average response rate for studies that utilized data collected from individuals was 52.7 percent with a standard deviation of 20.4, while the average response rate for studies that utilized data collected from organizations was 35.7 percent with a standard deviation of 18.8. Key insights from further analysis include relative stability in response rates in the past decade and higher response rates for journals published in the USA. The use of incentives was not found to be related to response rates and, for studies of organizations, the use of reminders was associated with lower response rates. Also, electronic data collection efforts (e.g. email, phone, web) resulted in response rates as high as or higher than traditional mail methodology. We discuss a number of implications and recommendations.
2,922 citations
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01 Jan 1910
TL;DR: The Carnegie Foundation at their meeting in November, 1908, authorized a study and report upon the schools of medicine and law in the United States and appropriated the money necessary for this undertaking as mentioned in this paper.
Abstract: A REPORT TO THE CARNEGIE FOUNDATION FOR THE ADVANCEMENT OF TEACHING WITH AN INTRODUCTION BY HENRY S. PRITCHETT PRESIDENT OF THE FOUNDATION ... the trustees of the Carnegie Foundation at their meeting in November, 1908, authorized a study and report upon the schools of medicine and law in the United States and appropriated the money necessary for this undertaking. The present report upon medical education, prepared, under the direction of the Foundation, by Mr. Abraham Flexner, is the first result of that action. No effort has been spared to procure accurate and detailed information as to the facilities, resources, and methods of instruction of the medical schools. They have not only been separately visited, but every statement made in regard to each detail has been carefully checked with the data ill possession of the American Medical Association, likewise obtained by personal inspection, and with the records of the Association of American Medical Colleges, so far as its membership extends. The details as stated go forth with the sanction of at least two, and frequently more, independent observers. In making this study the schools of all medical sects have been included. It is clear that so long as a man is to practise medicine, the public is equally concerned in his right preparation for that profession, whatever he call himself,--allopath, homeopath, eclectic, osteopath, or whatnot. It is equally dear that he should be grounded in the fundamental sciences upon which medicine rests, whether he practises under one name or under another.... The report which follows is divided into two parts. In the first half the history of medical education in this country and its present status are set forth. The story is there told of the gradual development of the commercial medical school, distinctly an American product, of the modern movement for the transfer of medical education to university surroundings, and of the effort to procure stricter scrutiny of those seeking to enter the profession. The present status of medical education is then fully described and a forecast of possible progress in the future is attempted. The second par of the report gives in detail a description of the schools in existence in each state of the Union and in each province of Canada. It is the purpose of the Foundation to proceed at once with a similar study of medical education in Great Britain, Germany, and France, in order that those charged with the reconstruction of medical education in America may profit by the experience of other countries.... The significant facts revealed by this study are these: (1) For twenty-five years past there has been an enormous over-production of uneducated and ill trained medical practitioners. This has been in absolute disregard of the public welfare and without any serious thought of the interests of the public. Taking the United States as a whole, physicians are four or five times as numerous in proportion to population as in older countries like Germany. (2) Over-production of ill trained men is due in the main to the existence of a very large number of commercial schools, sustained in many cases by advertising methods through which a mass of unprepared youth is drawn out of industrial occupations into the study of medicine. (3) Until recently the conduct of a medical school was a profitable business, for the methods of instruction were mainly didactic. As the need for laboratories has become more keenly felt, the expenses of an efficient medical school have been greatly increased. The inadequacy of many of these schools may be judged from the fact that nearly half of all our medical schools have incomes below $10,000, and these incomes determine the quality of instruction that they can and do offer. Colleges and universities have in large measure failed in the past twenty-five years to appreciate the great advance in medical education and the increased cost of teaching it along modern lines. …
1,538 citations
TL;DR: In this paper, a study was conducted to explore what could and should be a reasonable response rate in academic studies and the average response rate was 55.6 with a standard deviation of 19.7.
Abstract: A study was conducted to explore what could and should be a reasonable response rate in academic studies. One hundred and forty-one papers which included 175 different studies were examined. They were published in the Academy of Management Journal, Human Relations, Journal of Applied Psychology, Organizational Behavior and Human Decision Processes, and Journal of International Business Studies in the years 1975, 1985, and 1995, covering about 200,000 respondents. The average response rate was 55.6 with a standard deviation of 19.7. Variations among the journals such as the year of publication and other variables were discussed. Most notable is the decline through the years (average 48.4, standard deviation of 20.1, in 1995), the lower level found in studies involving top management or organizational representatives (average 36.1, standard deviation of 13.3), and the predominance of North American studies. It is suggested that the average and standard deviation found in this study should be used as a norm ...
1,488 citations
TL;DR: Directors of courses in the basic anatomical sciences in allopathic and osteopathic medical schools in the United States were surveyed regarding the present composition of their courses, and results indicate the majority of gross anatomy courses are in the range of 126 to 200 total course hours, and that laboratory dissection is a key component of these courses.
Abstract: Directors of courses in the basic anatomical sciences in allopathic and osteopathic medical schools in the United States were surveyed regarding the present composition of their courses. Results indicate the majority of gross anatomy courses are in the range of 126 to 200 total course hours, and that laboratory dissection is a key component of these courses. The majority of microscopic anatomy courses are in the range of 61 to 100 total course hours, generally divided equally between lecture and laboratory components. Additionally, despite the availability of computer technology, microscopes are still used in the vast majority of microscopic anatomy courses. The majority of neuroscience courses are in the range of 71 to 90 total course hours, with most of these hours devoted to lectures. Embryology is usually taught in conjunction with gross anatomy, although some schools present it with the microscopic anatomy course or as a separate course. Most embryology courses are in the range of 6 to 20 total course hours, with only a few having a laboratory component.
195 citations
"Medical Education in the Anatomical..." refers background or result in this paper
...Using only this segment of data allowed a direct comparison to the results from a previously reported survey (Drake et al., 2002), focused on programs with similar objectives and removed any type of specifically directed or government mandated educational programs....
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...Microscopic anatomy courses showed minimal changes when the current survey results were compared with the previous survey (Drake et al., 2002)....
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...Courses in the neuroscience/neuroanatomy discipline had the largest drop in total course hours when compared with the previous survey (Drake et al., 2002)....
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...We do feel that the lower response rate in this survey compared with the previous survey (Drake et al., 2002) may be due to a decrease in the number of Departments of Anatomy around the United States and the more integrated nature of the curriculum at many medical schools....
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...Figure 6 shows the distribution of total microscopic anatomy course hours (Berry et al., 1956; Kahn et al., 1966; Hightower et al., 1999; Drake et al., 2002; Gartner, 2003)....
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TL;DR: It is found that a TBL approach in teaching anatomy allowed us to create an active learning environment that helped to improve students' performances, and based on the experience, other preclinical courses are now piloting TBL.
Abstract: Team-based learning (TBL) is an instructional strategy that combines independent out-of-class preparation for in-class discussion in small groups. This approach has been successfully adopted by a number of medical educators. This strategy allowed us to eliminate anatomy lectures and incorporate small-group active learning. Although our strategy is a modified use of classical TBL, in the text, we use the standard terminology of TBL for simplicity. We have modified classical TBL to fit our curricular needs and approach. Anatomy lectures were replaced with TBL activities that required pre-class reading of assigned materials, an individual self-assessment quiz, discussion of learning issues derived from the reading assignments, and then the group retaking the same quiz for discussion and deeper learning. Students' performances and their educational experiences in the TBL format were compared with the traditional lecture approach. We offer several in-house unit exams and a final comprehensive subject exam provided by the National Board of Medical Examiners. The students performed better in all exams following the TBL approach compared to traditional lecture-based teaching. Students acknowledged that TBL encouraged them to study regularly, allowed them to actively teach and learn from peers, and this served to improve their own exam performances. We found that a TBL approach in teaching anatomy allowed us to create an active learning environment that helped to improve students' performances. Based on our experience, other preclinical courses are now piloting TBL.
169 citations
"Medical Education in the Anatomical..." refers background in this paper
...Instead of lecture-based presentation styles, current trends suggest using interactive approaches such as team-based learning (Vasan et al., 2008), small group interactive sessions (Chan and Ganguly, 2008), and problem-based and case-based learning (Yiou and Goodenough, 2006; Philip et al., 2008)....
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