Yoga asanas as an effective form of experiential learning when teaching musculoskeletal anatomy of the lower limb

Physical movement as a conduit for experiential learning within the academic context of anatomy is a strategy currently used in university dance education. This same approach can be applied to other movement‐based practices, for example, yoga. The primary purpose of this study was to pilot a novel teaching curriculum to yoga practitioners, based on Bruner's Theory of Instruction, which incorporated the four adaptive modes of Kolb's Theory of Experiential Learning. The secondary purpose was to assess the applicability of anatomical knowledge within the participants' yoga practice. Following the development of a curriculum appropriate for a spectrum of academic backgrounds, participants were recruited to attend a 2‐hour learning session within the Department of Anatomy at Queen's University in Kingston, Ontario, Canada. The learning session guided participants through the bones and muscles of the lower limb pertaining to five specific yoga poses. Based on participant feedback, the sessions were positively received and consistent. In addition, learning session participants were able to apply the anatomical information they were taught to their yoga practice 1‐month later. Bruner and Kolb's independent theories on curriculum design and effective learning practice were successfully incorporated to create a 2‐hour learning session. The potential use of experiential learning to compliment and/or enhance traditional didactic teaching in the academic context of anatomy should be further explored. Anat Sci Educ. © 2012 American Association of Anatomists.     

Determination of clinically relevant content for a musculoskeletal anatomy curriculum for physical medicine and rehabilitation residents

To address the need for more clinical anatomy training in residency education, many postgraduate programs have implemented structured anatomy courses into their curriculum. Consensus often does not exist on specific content and level of detail of the content that should be included in such curricula. This article describes the use of the Delphi method to identify clinically relevant content to incorporate in a musculoskeletal anatomy curriculum for Physical Medicine and Rehabilitation (PM&R) residents. A two round modified Delphi involving PM&R experts was used to establish the curricular content. The anatomical structures and clinical conditions presented to the expert group were compiled using multiple sources: clinical musculoskeletal anatomy cases from the PM&R residency program at the University of Toronto; consultation with PM&R experts; and textbooks. In each round, experts rated the importance of each curricular item to PM&R residency education using a five‐point Likert scale. Internal consistency (Cronbach's alpha) was used to determine consensus at the end of each round and agreement scores were used as an outcome measure to determine the content to include in the curriculum. The overall internal consistency in both rounds was 0.99. A total of 37 physiatrists from across Canada participated and the overall response rate over two rounds was 97%. The initial curricular list consisted of 361 items. After the second iteration, the list was reduced by 44%. By using a national consensus method we were able to objectively determine the relevant anatomical structures and clinical musculoskeletal conditions important in daily PM&R practice. Anat Sci Educ 7: 135–143. © 2013 American Association of Anatomists.     

Effects of image‐based and text‐based active learning exercises on student examination performance in a musculoskeletal anatomy course

Research on the benefits of visual learning has relied primarily on lecture‐based pedagogy, but the potential benefits of combining active learning strategies with visual and verbal materials on learning anatomy has not yet been explored. In this study, the differential effects of text‐based and image‐based active learning exercises on examination performance were investigated in a functional anatomy course. Each class session was punctuated with an average of 12 text‐based and image‐based active learning exercises. Participation data from 231 students were compared with their examination performance on 262 questions associated with the in‐class exercises. Students also rated the helpfulness and difficulty of the in‐class exercises on a survey. Participation in the active learning exercises was positively correlated with examination performance (r = 0.63, P < 0.001). When controlling for other key demographics (gender, underrepresented minority status) and prior grade point average, participation in the image‐based exercises was significantly correlated with performance on examination questions associated with image‐based exercises (P < 0.001) and text‐based exercises (P < 0.01), while participation in text‐based exercises was not. Additionally, students reported that the active learning exercises were helpful for seeing images of key ideas (94%) and clarifying key course concepts (80%), and that the image‐based exercises were significantly less demanding, less hard and required less effort than text‐based exercises (P < 0.05). The findings confirm the positive effect of using images and active learning strategies on student learning, and suggest that integrating them may be especially beneficial for learning anatomy. Anat Sci Educ 10: 444–455. © 2017 American Association of Anatomists.     

Team-based learning in anatomy: an efficient, effective, and economical strategy

Team-based learning (TBL) strategy is being adopted in medical education to implement interactive small group learning. We have modified classical TBL to fit our curricular needs and approach. Anatomy lectures were replaced with TBL that required preparation of assigned content specific discussion topics (in the text referred as "discussion topics"), an individual self-assessment quiz (IRAT), analysis of the discussion topics, and then the team retaking the same quiz (GRAT) for discussion and deeper learning. Embryology and clinical correlations were given as lectures. Unit examinations consisted of graded IRAT and GRAT. The National Board of Medical Examiners (NBME) Subject Examination was the comprehensive final examination. To evaluate the effect of TBL on student performance we compared the departmental and NBME subject examination scores between the traditional and TBL curricula. We collected five years of data on student performance in TBL-based anatomy and lecture-based preclinical courses. Our results show that departmental and NBME subject examination scores for TBL-based anatomy were higher than those for lecture-based anatomy. We subsequently compared average NBME scores for anatomy with those in other preclinical courses that were lecture-based. Average NBME anatomy scores were significantly higher than those for all the lecture-based preclinical courses. Since the introduction of TBL in anatomy, student performance has progressively improved in the NBME subject examination. Students perceived TBL as a motivator to be a responsible team member and to contribute to collective learning by the team. Further, it reinforced self-directed learning and fostered an appreciation for peer respect. Interestingly, these perceptions were uniform irrespective of student course performance.     

Anatomy integration blueprint: A fourth‐year musculoskeletal anatomy elective model

Current undergraduate medical school curricular trends focus on both vertical integration of clinical knowledge into the traditionally basic science‐dedicated curricula and increasing basic science education in the clinical years. This latter type of integration is more difficult and less reported on than the former. Here, we present an outline of a course wherein the primary learning and teaching objective is to integrate basic science anatomy knowledge with clinical education. The course was developed through collaboration by a multi‐specialist course development team (composed of both basic scientists and physicians) and was founded in current adult learning theories. The course was designed to be widely applicable to multiple future specialties, using current published reports regarding the topics and clinical care areas relying heavily on anatomical knowledge regardless of specialist focus. To this end, the course focuses on the role of anatomy in the diagnosis and treatment of frequently encountered musculoskeletal conditions. Our iterative implementation and action research approach to this course development has yielded a curricular template for anatomy integration into clinical years. Key components for successful implementation of these types of courses, including content topic sequence, the faculty development team, learning approaches, and hidden curricula, were developed. We also report preliminary feedback from course stakeholders and lessons learned through the process. The purpose of this report is to enhance the current literature regarding basic science integration in the clinical years of medical school. Anat Sci Educ 7: 379–388. © 2014 American Association of Anatomists.     

"Digit anatomy": a new technique for learning anatomy using motor memory

Gestural motions of the hands and fingers are powerful tools for expressing meanings and concepts, and the nervous system has the capacity to retain multiple long-term motor memories, especially including movements of the hands. We developed many sets of successive movements of both hands, referred to as "digit anatomy," and made students practice the movements which express (1) the aortic arch, subclavian, and thoracoacromial arteries and their branches, (2) the celiac trunk, superior mesenteric artery and their branches, and formation of the portal vein, (3) the heart and the coronary arteries, and (4) the brachial, lumbar, and sacral plexuses. A feedback survey showed that digit anatomy was helpful for the students not only in memorizing anatomical structures but also in understanding their functions. Out of 40 students, 34 of them who learned anatomy with the help of digit anatomy were "very satisfied" or "generally satisfied" with this new teaching method. Digit anatomy that was used to express the aortic arch, subclavian, and thoracoacromial arteries and their branches was more helpful than those representing other structures. Although the movements of digit anatomy are expected to be remembered longer than the exact meaning of each movement, invoking the motor memory of the movement may help to make relearning of the same information easier and faster in the future.     

Human cadavers Vs. multimedia simulation: A study of student learning in anatomy

Multimedia and simulation programs are increasingly being used for anatomy instruction, yet it remains unclear how learning with these technologies compares with learning with actual human cadavers. Using a multilevel, quasi‐experimental‐control design, this study compared the effects of “Anatomy and Physiology Revealed” (APR) multimedia learning system with a traditional undergraduate human cadaver laboratory. APR is a model‐based multimedia simulation tool that uses high‐resolution pictures to construct a prosected cadaver. APR also provides animations showing the function of specific anatomical structures. Results showed that the human cadaver laboratory offered a significant advantage over the multimedia simulation program on cadaver‐based measures of identification and explanatory knowledge. These findings reinforce concerns that incorporating multimedia simulation into anatomy instruction requires careful alignment between learning tasks and performance measures. Findings also imply that additional pedagogical strategies are needed to support transfer from simulated to real‐world application of anatomical knowledge. Anat Sci Educ 7: 331–339. © 2014 American Association of Anatomists.     

Loosely‐guided,self‐directed learning versus strictly‐guided,station‐based learning in gross anatomy laboratory sessions

Anatomy students studying dissected anatomical specimens were subjected to either a loosely‐guided, self‐directed learning environment or a strictly‐guided, preformatted gross anatomy laboratory session. The current study's guiding questions were: (1) do strictly‐guided gross anatomy laboratory sessions lead to higher learning gains than loosely‐guided experiences? and (2) are there differences in the recall of anatomical knowledge between students who undergo the two types of laboratory sessions after weeks and months? The design was a randomized controlled trial. The participants were 360 second‐year medical students attending a gross anatomy laboratory course on the anatomy of the hand. Half of the students, the experimental group, were subjected without prior warning to station‐based laboratory sessions; the other half, the control group, to loosely‐guided laboratory sessions, which was the course's prevailing educational method at the time. The recall of anatomical knowledge was measured by written reproduction of 12 anatomical names at four points in time: immediately after the laboratory experience, then one week, five weeks, and eight months later. The strictly‐guided group scored higher than the loosely‐guided group at all time‐points. Repeated ANOVA showed no interaction between the results of the two types of laboratory sessions (P = 0.121) and a significant between‐subject effect (P ≤ 0.001). Therefore, levels of anatomical knowledge retrieved were significantly higher for the strictly‐guided group than for the loosely‐guided group at all times. It was concluded that gross anatomy laboratory sessions with strict instructions resulted in the recall of a larger amount of anatomical knowledge, even after eight months. Anat Sci Educ. © 2012 American Association of Anatomists.     

Reflections as near‐peer facilitators of an inquiry project for undergraduate anatomy: Successes and challenges from a term of trial‐and‐error

Near‐peer facilitators (senior students serving as facilitators to their more junior peers) bring a unique student‐based perspective to teaching. With fewer years of teaching experience however, students who become involved in a facilitator role typically develop related skills quickly through a process of trial‐and‐error within the classroom. The aim of this paper is to report on the authors' own experiences and reflections as student near‐peer facilitators for an inquiry‐based project in an undergraduate anatomy course. Three areas of the facilitator experience are explored: (1) offering adequate guidance as facilitators of inquiry, (2) motivating students to engage in the inquiry process, and (3) fostering creativity in learning. A practical framework for providing guidance to students is discussed which offers facilitators a scaffold for asking questions and assisting students through the inquiry process. Considerations for stimulating intrinsic motivations toward inquiry learning are made, paying attention to ways in which facilitators might influence feelings of motivation towards learning. Also, the role of creativity in inquiry learning is explored by highlighting the actions facilitators can take to foster a creative learning environment. Finally, recommendations are made for the development of formalized training programs that aid near‐peer facilitators in the acquisition of facilitation skills before entering into a process of trial‐and‐error within the classroom. Anat Sci Educ. 7: 64–70. © 2013 American Association of Anatomists.     

A cross‐cultural comparison of anatomy learning: Learning styles and strategies

Cultural influences on anatomy teaching and learning have been investigated by application of a questionnaire to medical students in British and Chinese Medical Schools. Results from the responses from students of the two countries were analyzed. Both groups found it easier to understand anatomy in a clinical context, and in both countries, student learning was driven by assessment. Curriculum design differences may have contributed to the British view wherein students were less likely to feel time pressure and enjoyed studying anatomy more than their Chinese counterparts. Different teaching approaches resulted in British students being more likely to recite definitions to learn, and the Chinese students found learning from cross‐sectional images easy. Cultural differences may account for the observation that British students were more inclined to ask questions in class, and the preference of Chinese students to study in small groups. The findings give evidence to show how ‘cultures of learning’ influence students' approaches and indicate the importance of cultural influences as factors amongst international and home learner groups. Anat Sci Ed 2:49–60, 2009. © 2009 American Association of Anatomists.     

Testing to enhance retention in human anatomy

Recent work in cognitive psychology has shown that repeatedly testing one's knowledge is a powerful learning aid and provides substantial benefits for retention of the material. To apply this in a human anatomy course for medical students, 39 fill-in-the-blank quizzes of about 50 questions each, one for each region of the body, and four about the nervous system, were developed. The quizzes were optional, and no credit was awarded. They were posted online using Blackboard, which provided feedback, and they were very popular. To determine whether the quizzes had any effect on retention, they were given in a controlled setting to 21 future medical and dental students. The weekly quizzes included questions on regional anatomy and an expanded set of questions on the nervous system. Each question about the nervous system was given three times, in a slightly different form each time. The second quiz was given approximately half an hour after the first one, and the third was given one week after the second to assess retention. The quizzes were unpopular, but students showed robust improvement on the questions about the nervous system. The scores increased by almost 9% on the second quiz, with no intervention except viewing the correct answers. The scores were 29% higher on the third quiz than on the first, and there was also a positive correlation between the grades on the quizzes and the final examination. Thus, repeated testing is an effective strategy for learning and retaining information about human anatomy.     

A psychometric evaluation of the anatomy learning experiences questionnaire and correlations with learning outcomes

The Anatomy Learning Experiences Questionnaire (ALEQ) was designed by Smith and Mathias to explore students' perceptions and experiences of learning anatomy. In this study, the psychometric properties of a slightly altered 34‐item ALEQ (ALEQ‐34) were evaluated, and correlations with learning outcomes investigated, by surveying first‐ and second‐year undergraduate medical students; 181 usable responses were obtained (75% response rate). Psychometric analysis demonstrated overall good reliability (Cronbach's alpha of 0.85). Exploratory factor analysis yielded a 27‐item, three‐factor solution (ALEQ‐27, Cronbach's alpha of 0.86), described as: (Factor 1) (Reversed) challenges in learning anatomy, (Factor 2) Applications and importance of anatomy, and (Factor 3) Learning in the dissection laboratory. Second‐year students had somewhat greater challenges and less positive attitudes in learning anatomy than first‐year students. Females reported slightly greater challenges and less confidence in learning anatomy than males. Total scores on summative gross anatomy examination questions correlated with ALEQ‐27, Pearson's r = 0.222 and 0.271, in years 1 and 2, respectively, and with Factor 1, r = 0.479 and 0.317 (all statistically significant). Factor 1 also had similar correlations across different question types (multiple choice; short answer or essay; cadaveric; and anatomical models, bones, or radiological images). In a retrospective analysis, Factor 1 predicted poor end‐of‐semester anatomy examination results in year 1 with a sensitivity of 88% and positive predictive value of 33%. Further development of ALEQ‐27 may enable deeper understanding of students' learning of anatomy, and its ten‐item Factor 1 may be a useful screening tool to identify at‐risk students. Anat Sci Educ 10: 514–527. © 2017 American Association of Anatomists.     

Near-peer teaching in an anatomy course with a low faculty-to-student ratio

Near-peer teaching is an educational format which utilizes tutors who are more advanced in a curriculum's content to supervise students' activities and to act as instructors in laboratory settings. This format is often used in anatomy laboratory courses. The goal of the present study is to describe the design and implementation of near-peer teaching in an anatomy course and to evaluate students' perceptions of the program. A total of 700 students were registered for this anatomy course which employed near-peer instructors. Of enrolled students, 558 (79.7%) agreed to participate in this study. In general, the practical section (e.g., the clinical hour, image-based anatomy session, and gross anatomy laboratory) of the course was viewed more favorably compared to the theory section (54.8%, n = 306), with dissection and prosection in the laboratory rated as the most valued experiences (34.9%, n = 195). Near-peer teaching is a viable option that satisfies the demands of modern curricula using small groups. This format stimulates learning within courses that have large numbers of students and low faculty-to-student ratios.     

Application of flipped classroom pedagogy to the human gross anatomy laboratory: Student preferences and learning outcomes

To improve student preparedness for anatomy laboratory dissection, the dental gross anatomy laboratory was transformed using flipped classroom pedagogy. Instead of spending class time explaining the procedures and anatomical structures for each laboratory, students were provided online materials to prepare for laboratory on their own. Eliminating in‐class preparation provided the opportunity to end each period with integrative group activities that connected laboratory and lecture material and explored clinical correlations. Materials provided for prelaboratory preparation included: custom‐made, three‐dimensional (3D) anatomy videos, abbreviated dissection instructions, key atlas figures, and dissection videos. Data from three years of the course (n = 241 students) allowed for analysis of students' preferences for these materials and detailed tracking of usage of 3D anatomy videos. Students reported spending an average of 27:22 (±17:56) minutes preparing for laboratory, similar to the 30 minutes previously allocated for in‐class dissection preparation. The 3D anatomy videos and key atlas figures were rated the most helpful resources. Scores on laboratory examinations were compared for the three years before the curriculum change (2011–2013; n = 242) and three years after (2014–2016; n = 241). There was no change in average grades on the first and second laboratory examinations. However, on the final semi‐cumulative laboratory examination, scores were significantly higher in the post‐flip classes (P = 0.04). These results demonstrate an effective model for applying flipped classroom pedagogy to the gross anatomy laboratory and illustrate a meaningful role for 3D anatomy visualizations in a dissection‐based course. Anat Sci Educ 11: 385–396. © 2017 American Association of Anatomists.     

Introduction of vertical integration and case-based learning in anatomy for undergraduate physical therapy and occupational therapy students

The purpose of the present pilot study was to evaluate the benefits of innovative teaching methodologies introduced to final year occupational and physical therapy students in Christian Medical College in India. Students' satisfactions along the long-term retention of knowledge and clinical application of the respiratory anatomy have been assessed. The final year undergraduate physical therapy and occupational therapy students had respiratory anatomy teaching over two sessions. The teaching involved case-based learning and integrated anatomy lectures (vertical integration) with the Anatomy department. Pretest and immediate and follow-up post-tests were conducted to assess the effectiveness of the innovative methods. A feedback questionnaire was marked to grade case-based learning. The method of integrated and case-based teaching was appreciated and found to be useful in imparting knowledge to the students. Students retained the gained knowledge adequately and the same was inferred by statistically significant improvement in both post-test scores. Vertical integration of anatomy in the final year reinforces their existing knowledge of anatomy. Case-based learning may facilitate the development of effective and clinically sound therapists.     

Development of a supported self-directed learning approach for anatomy education

The ability to deliver sufficient core anatomical knowledge and understanding to medical students with limited time and resources remains a major challenge for anatomy educators. Here, we report the results of switching from a primarily didactic method of teaching to supported self-directed learning for students studying anatomy as part of undergraduate medicine at the University of Edinburgh. The supported self-directed approach we have developed makes use of an integrated range of resources, including formal lectures and practical sessions (incorporating gross anatomy specimens, medical imaging technologies, anatomical models, clinical scenarios, and surface anatomy workstations). In practical sessions, students are provided with a custom-made workbook that guides them through each session, with academic staff, postgraduate tutors, and near-peer teaching assistants present to deal with misunderstandings and explain more complicated topics. This approach retains many of the best attributes of didactic teaching but blends them with the advantages associated with self-directed learning approaches. The switch to supported self-directed learning-initially introduced in 2005-resulted in a significant improvement in anatomy examination scores over the subsequent period of five years, manifesting as an increase in the average anatomy practical spot examination mark, less students failing to obtain the pass mark and more students passing with distinction. We conclude that the introduction of supported self-directed learning improved students' engagement, leading to deeper learning and better understanding and knowledge of anatomy.     

Learning surgically oriented anatomy in a student-run extracurricular club: an education through recreation initiative

Didactic and laboratory anatomical education have seen significant reductions in the medical school curriculum due, in part, to the current shift from basic science to more clinically based teaching in North American medical schools. In order to increase medical student exposure to anatomy, with clinical applicability, a student-run initiative called surgically oriented anatomy prosectors (SOAP) club was created within the extracurricular program at the Schulich School of Medicine and Dentistry, The University of Western Ontario, London, Canada. SOAP invites surgeons and residents from various surgical specialties to demonstrate, on a cadaver, a surgical procedure of their choosing. During the demonstration, the anatomy, as it relates to the surgical procedure, is discussed. The students then break into smaller groups to examine the relevant anatomy on the cadavers, during which time the discussion is broadened. The group continues the conversation in a social environment with refreshments. SOAP is one of the most popular extracurricular clubs with 65% of first and second year medical students registered as members. The high demand for SOAP, along with the positive participant feedback, may be due to its utilization of the principle of education through recreation, which seeks to provide opportunities for learning seamlessly throughout all facets of life. It also demonstrates the desire, amongst certain medical students, to learn applied anatomy, particularly within a surgical context.     

A simple and efficient device for demonstrating cross‐sectional anatomy of the head

Described in this article is a novel device that facilitates study of the cross‐sectional anatomy of the human head. In designing our device, we aimed to protect sections of the head from the destructive action of handling during anatomy laboratory while also ensuring excellent visualization of the anatomic structures. We used an electric saw to create 15‐mm sections of three cadaver heads in the three traditional anatomic planes and inserted each section into a thin, perforated display box made of transparent acrylic material. The thin display boxes with head sections are kept in anatomical order in a larger transparent acrylic storage box containing formaldehyde solution, which preserves the specimens but also permits direct observation of the structures and their anatomic relationships to each other. This box‐within‐box design allows students to easily view sections of a head in its anatomical position as well as to examine internal structures by manipulating individual display boxes without altering the integrity of the preparations. This methodology for demonstrating cross‐section anatomy allows efficient use of cadaveric material and technician time while also giving learners the best possible handling and visualization of complex anatomic structures. Our approach to teaching cross‐sectional anatomy of the head can be applied to any part of human body, and the value of our device design will only increase as more complicated understandings of cross‐sectional anatomy are required by advances and proliferation of imaging technology. Anat Sci Educ 2010. © 2010 American Association of Anatomists.     

Ultrasound imaging in medical student education: Impact on learning anatomy and physical diagnosis

Ultrasound use has expanded dramatically among the medical specialties for diagnostic and interventional purposes, due to its affordability, portability, and practicality. This imaging modality, which permits real‐time visualization of anatomic structures and relationships in vivo, holds potential for pre‐clinical instruction of students in anatomy and physical diagnosis, as well as providing a bridge to the eventual use of bedside ultrasound by clinicians to assess patients and guide invasive procedures. In many studies, but not all, improved understanding of anatomy has been demonstrated, and in others, improved accuracy in selected aspects of physical diagnosis is evident. Most students have expressed a highly favorable impression of this technology for anatomy education when surveyed. Logistic issues or obstacles to the integration of ultrasound imaging into anatomy teaching appear to be readily overcome. The enthusiasm of students and anatomists for teaching with ultrasound has led to widespread implementation of ultrasound‐based teaching initiatives in medical schools the world over, including some with integration throughout the entire curriculum; a trend that likely will continue to grow. Anat Sci Educ 10: 176–189. © 2016 American Association of Anatomists.