Many medical schools have transitioned to teaching anatomy with prosections and models1. The efficacy of these curricular approaches as they compare to the gold standard of dissection anatomy has ...been evaluated2. In addition to helping students acquire professional competencies3, students who participate in dissection achieve higher scores on written examinations than students who participate in prosection1,4. Dissection helps students develop integrated three‐dimensional models of the human body, which is fundamental to clinical practice2.
In a typical year, medical students at our university take Clinical Morphology which includes histology, embryology, imaging, and dissection anatomy. In 2020, due to the global COVID‐19 pandemic, laboratory access was significantly restricted, requiring a shift to a prosection and virtual learning hybrid model. All other components of the course were retained. This necessary change in curriculum provided a natural experiment to investigate the impact of eliminating dissection anatomy on students’ academic performance. We hypothesized a negative impact.
Students in the 2020 cohort worked in small groups to complete a weekly two‐hour online simulated dissection, and attended an optional weekly in‐person prosection lab. Faculty‐produced prosection videos were available to view asynchronously. Virtual office hours were held in the laboratory. In contrast, the 2019 cohort participated in a traditional dissection anatomy lab that included six hours of instructor‐supported dissection each week and 24‐hour lab access. All other course components were comparable.
Respectively, for the 2020 and 2019 cohorts, mean quiz scores were 86.2 and 85.6; lab practical averages were 92.5 and 86.3; mean NBME scores were 80.9 and 82.2; and course numeric score means were 84.7 and 84.8 (no significant differences, t‐test). The frequency of passing and failing scores followed a similar pattern with no differences identified between the two cohorts (Chi Square). All 2020 students had a passing average for lab practicals; significantly better than the 2019 cohort (p < 0.05, Chi Square). Pairwise Pearson r correlation coefficients showed a strong relationship (r > 0.75) for quiz, NBME, and lab practical scores in the 2019 cohort. For the 2020 cohort, there was a strong relationship (r = 0.72) only for quiz and NBME scores.
Dissection anatomy correlates strongly with quizzes and the NBME exam performance, while virtual‐prosection anatomy does not. The lack of strong pairwise correlations between virtual anatomy with either NBME or quiz performance suggest that the virtual‐prosection model did not align well with academic objectives. These data support the continued inclusion of dissection in medical school anatomy.
1. Eppler E, Serowy S, Link K, Filgueira L. Anat Sci Educ. 2018;11:32‐43. doi:10.1002/ase.1707
2. Keerti Singh, Uma Gaur, Kiana Hall, Keisha Mascoll, Damian Cohall, Md Anwarul Azim Majumder. Advances in human biology. 2020;10(3):90‐94. doi:10.4103/AIHB.AIHB_87_20
3. McDaniel KG, Brown T, Radford CC, et al. Anat Sci Educ. 2020;10.1002/ase.2000. doi:10.1002/ase.2000
4. Thompson AR, Marshall AM. Anat Sci Educ. 2020;13(1):30‐36. doi:10.1002/ase.1859
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Purpose
The COVID‐19 pandemic has created extensive disruptions for medical education, causing urgency to implement and develop solutions to combat this disturbance. For students to pursue learning ...opportunities, the education system must improve. Augmented (AR) and virtual reality (VR) provide a promising future for the enhancement of medical education. This review article aims to evaluate the benefits and efficacy of AR and VR, especially during the COVID‐19 pandemic.
Methods
Multiple peer‐reviewed, randomized trials were synthesized into a review study investigating the efficacy, benefit, and use of VR and AR for medical education. The reviewed studies included medical and graduate‐level students as participants and aimed to support the use of AR and VR as an educational adjunct. The results of these trials support the use of additional technology in medical education.
Results
The COVID‐19 pandemic propelled medical schools, educators, and students into a world of total computerized learning. This pandemic acted as a necessary push to implement novel, untested technologies into the educational sector. Previous research demonstrates that AR and VR can confront these unfamiliar challenges and allow for a safe and beneficial COVID‐19 education, consisting of socially‐distanced and low‐risk patient‐care practice.
Conclusions
The benefits of continuous, safe learning outweigh the potential technological challenges of implementing AR and VR into medical education. During the pandemic, the medical community is faced with teaching students many skills necessary to become adept medical practitioners. Although the COVID‐19 pandemic offers a unique opportunity for the implementation of new technologies, virtual instruction does not have to end beyond this crisis. Virtual technology can teach medical students interpersonal skills such as empathy, engaging in difficult conversations, and delivering bad news. Because students have traditionally been exposed to passive teaching styles, it is time to look toward expanding medical students’ repertoire and allow them to personalize their education.
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INTRODUCTION & OBJECTIVE:
Traditional gross anatomy lab assessment involves in‐person examination using cadavers or models. Covid‐19 related restrictions introduced challenges to gross anatomy ...education due to the discipline's reliance on lab‐based learning and assessment. Therefore, the objective of this study was to assess changes made by anatomy educators to gross anatomy lab assessments during May‐August 2020.
MATERIALS & METHODS:
A 20‐item survey assessed gross anatomy pedagogy, teaching resources, and assessment before and during the pandemic. The survey was distributed online to anatomy educators through professional associations and listservs in June 2020. Data were obtained from two survey items that asked respondents for narrative descriptions of their lab‐based assessment before and during Covid‐19. Open coding was used to apply descriptive codes relating to 3 categories: (1) setting of the assessment, (2) format of the assessment, and (3) materials used for the questions. The last author coded the data, while the first author reviewed the coding. Both authors reconciled and re‐coded discrepancies. Code frequencies and percentages were calculated. Chi‐square or Fisher's exact test was used to assess differences in frequencies before and during Covid‐19. Alpha<5%.
RESULTS:
Of the 61 respondents who described lab assessment, the use of the physical lab setting decreased (before: 82%, during: 20%; P<0.001) while computer‐based platforms increased (before: 9%, during: 61%; P<0.001). The use of medical imaging and other anatomical images were maintained (before: 11%, during: 51%; P=0.37), but there were decreases in the use of cadavers (before: 63%, during: 14%; P<0.001) as well as bones, plastic models, and plastinates (before: 12%, during: 0%; P<0.001). There were no significant changes in assessment structure, with the majority of participants maintaining a practical examination (i.e. “bell ringer”) format during Covid‐19 (before: 66%, during: 62%; P=0.39).
CONCLUSION:
Anatomy educators continued the use of “bell ringer” style lab assessments during the early part of the Covid‐19 pandemic. The setting shifted towards computer‐based examinations due to Covid‐19 restrictions; thus, the use of digital images was maintained while cadaver use decreased.
SIGNIFICANCE/IMPLICATION:
The early adaptations made by anatomy educators to their lab assessments during Covid‐19 provide insight into how assessment may be offered in dire circumstances when the physical lab is unavailable, when accommodating students with extenuating circumstances preventing them from attending in‐person lab assessments, and for remediation assessments.
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Purpose
First‐year medical students (M1s) at the Icahn School of Medicine at Mount Sinai begin their year with Structures course, which opens their medical education, covering gross anatomy, ...embryology, and histology. Second‐year medical students (M2s) serve as teaching assistants (TAs) for this course and their responsibilities include leading comprehensive review sessions prior to each set of exams. Historically, such reviews have taken place in small‐group classrooms, with groups of 10‐18 M1s rotating through a series of rooms, each hosting a rapid‐fire review of a specific topic, conducted by several TAs. In 2020, the virtual setting imposed by COVID‐19 restrictions demanded creativity to rethink the format of these review sessions, leading to the implementation of a large‐group, interactive format, with all M1s in the same remote video session, covering material at a slower pace. We here examine the effectiveness of this large‐group, interactive format. Methods: The first two review sessions of Structures 2020 mimicked the traditional style, with groups of M1s rotating through a series of 20‐minute Zoom sessions led by M2s TAs. For the last two review sessions, all students remained in one 3‐hour Zoom session, and TAs covered certain material at certain times, with more or less time allotted depending on the difficulty and amount of material. TAs also incorporated more interactivity with real time quizzes on high‐yield topics and direct practical questions through the review. We surveyed M1s regarding which format they preferred and also solicited qualitative feedback from M1s and TAs throughout Structures. Results: 55% of M1s preferred the large‐group format, with 23% preferring the traditional format and 23% expressing no preference. Many TAs also expressed preferences for the large‐group format. Qualitative feedback from M1s indicated that they appreciated the interactivity with quizzes and practical questions. Conclusion: In the remote environment, most students preferred a large‐group, interactive format over the small‐group rotation format. Main advantages observed were: 1) time flexibility: complex components of the session addressing challenging topics were covered more extensively and in‐depth; 2) In the large group, all M1s experience the session equally, including the answers to all questions from their classmates. Such interactivity is not compatible with the small group format and can be challenging in its compressed timeframe. 3) optimization of M2 TAs workforce: in the large session TAs are assigned with a section of the review and lead the review of their only once, for a short period of time, while in the small group format, TAs are required to repeat the review of their topic multiple times. The effectiveness of this format may have implications once in‐person instruction resumes; for example, review sessions could be conducted in a lecture hall, in an in‐person setting, or virtually, in a hybrid learning system, to facilitate the advantages of the large‐group interactive format.
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The SARS‐CoV‐2 (COVID‐19) outbreak adversely affected medical school education and drastically reduced in‐person learning, specifically affecting gross anatomy laboratory dissection. Depending on the ...academic calendar schedule, some schools were interrupted in the middle of anatomy teaching while others had more lead time to prepare but schools suddenly faced an imposed demand for a transition to distance learning. SUNY Downstate had its anatomy education interrupted due to the Covid‐19 shut down. To gap the previous laboratory experience of students and complete the semester anatomy curriculum, a series of dissected abdominal videos were created and distributed to all first‐year medical students (n=208). The video‐based curriculum and the current student experience taking anatomy without cadaveric dissections were assessed via pre/post‐tests and a five‐question survey. A paired single tailed t‐test comparing student responses (n=164) in the pre‐ versus post‐test was statistically significant (P < 0.002) while 92% of students (n=136) reported that their previous time dissecting prepared them to learn through videos without the benefit of hands‐on dissection. Icahn School of Medicine adopted digital Grant's Dissector utilizing their accompanying narrated videos. Faculty voiced over the narration, however, permitting emphasis of material, directing pacing of course, and tying content to lecture and physical exams. Complete anatomy was used to augment the experience, with 3D virtual dissections and enhance the visualization of the structures, however the videos remained as the driver of content delivery. Weill Cornell Medicine created, and customized anatomy prosected material videotaping the show and tell sessions integrating powerpoint slides to tie in lecture content and clinical correlates. Results from all three schools highlight the technical success of implementing an anatomy video‐based curriculum in response to COVID‐19. Survey findings describe a unique cohort of students who were compelled to participate in a video‐based curriculum after having learned anatomy in a donor body laboratory environment and student performance on summative exams in general equaled or exceeded scores from previous years. Overall, anatomy education through videos, digital platforms, and apps can offer a reliable stop‐gap solution in the absence of traditional cadaveric dissection in a short‐term, provisional model. However, the experience of learning anatomy from a human body in laboratory is irreplaceable and the future now seems to point to a combination of these modalities, and others, such as virtual reality or augmented reality, yet to be adapted and customized to our educational settings.
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Hypothesis
Incorporating 3D Anatomy Platforms with prosected cadavers improves understanding of gastrointestinal and genitourinary anatomy and pathology compared to only using only prosected ...cadavers.
Introduction
When considering anatomy in medical school, one challenge facing medical education is integrating preclinical anatomy knowledge with the procedural experiences and pathology encounters of clerkship years.1,2 COVID‐19 has further exacerbated this challenge by forcing medical school institutions to maintain social‐distancing through reshaping their approach to teaching anatomy. The most notable changes include limiting on‐site anatomy laboratory experiences and increasing virtual didactic anatomy sessions. By integrating a virtual 3D anatomy platform into a prosection driven lab curriculum, the possible quality impacts to anatomy medical education may be lessened and even improved.3‐9
Materials and Methods
First‐year medical students at HWCOM (CO 2024) participated. Groups of 4‐10 students rotated through six 20‐minute stations. Two of the six 20‐minute stations were facilitated by a fourth year medical teaching assistant (TA). In each station led by the TA, the TA utilized a didactic teaching model to teach select gastrointestinal and genitourinary anatomy and pathology topics using a prosected cadaver and prosected 3D virtual anatomy models on the Complete Anatomy application. The first ten to fifteen minutes of teaching involved using the prosected cadaver and the final five to ten minutes involved the 3D virtual prosected models. The 3D virtual prosected models were used to further explain anatomical features or pathologies identified on the cadaver. Prior to or after the station was completed, students rotated at the four 20‐minute self‐learning stations that contained plastinated models, plastic models, or wet organ specimens of gastrointestinal anatomy. At these stations, students completed a worksheet based on the lab objectives for gastrointestinal and genitourinary anatomy. A five‐question end‐of‐course survey (5‐point Likert Scale) will be administered to all first‐year medical students who participated in the wet lab session.
Results
We expect the results of our end‐of‐course survey to support our hypothesis that the integrated didactic anatomy teaching model would improve first year medical students’ understanding of the course material. Additionally, we expect the students to recommend incorporating the Complete Anatomy app with the prosected models for the first‐year anatomy lab curriculum. Final data analysis of the variables will be completed after obtaining IRB exemption.
Conclusion and Significance/Implication
Despite the limitations to human anatomy medical education due to the COVID pandemic, we believe this novel integrated virtual 3D and cadaver prosection approach to the traditional anatomy curriculum will not only lessen the impacts to quality but also improve the baseline quality of anatomy medical education, become a permanent inclusion within our institution's curriculum, and serve as a model for novel approaches to first‐year anatomy curriculum.
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Introduction
The COVID‐19 pandemic forced many schools to adopt more online teaching than they would normally have chosen for 2020. While many medical schools canceled laboratory teaching sessions in ...the anatomical sciences, a minority maintained laboratory teaching, including ours. Due to the pandemic, students had far fewer opportunities to interact with their peers and faculty, and students may have experienced greater non‐academic stress, all of which would be expected to negatively impact student academic performance. Also, some faculty members feel that virtual vs. in‐person lectures hinder student learning. Taken together, these issues led to significant concern about lower academic performance by first‐year medical students in 2020. Our curriculum changed very little between 2019 and 2020, presenting the opportunity to assess the impact of online lectures while keeping the laboratory component essentially unchanged. We hypothesized that maintaining laboratory‐based teaching minimized the negative effects of online lectures and student stress in 2020.
Methods
Academic performance in the anatomical sciences between 2019 (98 students) and 2020 (143 students) was compared using scores from five written and five laboratory exams from Medical Gross Anatomy (MGA) and four histology laboratory exams from the Foundations of Medicine I course (FOM‐I). In addition, course evaluation data for the two courses between 2019 and 2020 was compared.
Results
The exam scores between 2019 and 2020 differed significantly overall (one‐way PERMANOVA for non‐parametric data, p = 0.003, 9999 permutations). In pairwise comparisons of specific exams between the two years, students in 2020 performed significantly better on one gross anatomy written exam, one gross anatomy laboratory exam, and one histology laboratory exam, whereas 2019 students performed significantly better on one histology laboratory exam (Mann‐Whitney U tests, dfs = 239, p‐values = 0.02 or less). The mean scores from student course evaluations for both MGA and FOM‐I were slightly higher in 2020 compared to 2019, although the differences were not statistically significant (Independent Sample t‐tests, dfs = 213, p = 0.23, 0.13, respectively).
Discussion
These results indicate that the change to all‐online lectures with standard in‐person laboratory sessions in 2020 did not harm student academic performance in the anatomical sciences. The one lower exam score in histology in 2020 may be due to two additional topics being included on that exam in 2020. If the likely extra‐academic stressors that some students may have experienced due to the pandemic (whether from social isolation or direct impact of the disease on family, friends, or themselves) are factored in, the similarity in academic performance in 2019 and 2020 suggests that online lectures paired with in‐person laboratory learning may in fact be beneficial for student academic performance, although this would need further investigation. This study will enable comparisons with medical schools that had entirely virtual courses, with either virtual or no laboratory sessions.
This study of human subjects was approved by the Texas A&M University Institutional Review Board.
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In the Fall of 2020, substantial revisions were required for A215: Basic Human Anatomy due to the COVID‐19 pandemic.All lecture materials were pre‐recorded and delivered entirely online.While labs ...were still held in person, the time for the labs was cut in half to decrease the number of students in the room at one time and more structured activities were developed and implemented to limit student movement around the room.The present study is focused on investigating the outcomes in A215 during the Fall 2020 semester compared to the Fall 2019 semester.This research was approached via retrospective analysis of exam, quiz, lab assignment, and online analytics data.Analyses show that there were not significant differences in the lecture exam scores, however lab exam scores did trend lower in 2020 than they had been in 2019.Lecture quizzes were also comparable with the previous fall scores.However, online analytics data did not support the idea that students were making up for the lost lab time by spending additional time outside of class with the available materials.These analyses provide invaluable data to help improve this course, and potentially others, moving forward.
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Introduction
Although COVID‐19 related teaching restrictions have impacted all aspects of medical curricula, gross anatomy has been disproportionately affected. To decrease in‐person contact many ...medical schools have adapted their curricula by reducing or eliminating gross dissection. The Indiana University School of Medicine (IUSM), believing gross dissection to be a critical foundational curricular component, retained cadaveric dissection in 2020 but in a reduced capacity (i.e., fewer labs and fewer student per lab). In an effort to address this shortfall in dissection experience and to increase student preparedness, 24 pre‐lab demonstration videos covering 26 individual dissections were prepared for the 2020 cohort.
Research Aim
To determine if individual student performance is correlated with viewing pre‐lab videos.
Methods
Pre‐lab videos were available to all first‐year students at IUSM (n=378 students across 9 campuses). Viewership data (total views, total duration) were aggregated from the Kaltura online video platform. Student exam performance data (practical and written exams) were compared to viewership data using the Pearson correlation test.
Results
91.5% of student course evaluation respondents (n=329) report that they viewed pre‐lab videos. Pearson's correlation tests revealed a positive correlation between viewership activity and overall performance on all exams. The strongest correlation (0.182) was between total views and overall practical exam performance. Correlation coefficients for individual block exams vary and range between 0.13 (back, upper limb and thorax) and 0.253 (Head and Neck). Likewise, correlation coefficients varied across campuses with several campuses exceeding the statewide values.
Conclusion
Pre‐lab videos are an effective tool for exporting traditional lab‐based learning from the lab environment when access and dissection time are limited. Their most immediate and significant impact is on practical exam performance although positive correlations between viewership data and performance on written exams with NBME‐style questions suggests pre‐lab videos effectively reinforce foundational anatomical relationships and concepts. While not directly addressing questions of overall cohort performance, particularly when dissection access is not limited, future directions for this research will include direct comparisons of overall class performance in multiple cohorts with and without full dissection schedule and with or without the aid of pre‐lab videos. Likewise, student evaluation comments suggest that pre‐lab videos were used in a variety of contexts (i.e., lab prep, peer‐teaching, general study). An online survey exploring how students use the pre‐lab videos was sent to the 2020 cohort at course end to better understand how students are using them.
Implications
Medical educators are increasingly asked to teach more with fewer contact hours. COVID‐19 has exacerbated this situation. This study provides new data suggesting that pre‐lab videos are an effective tool for exporting traditional lab‐based learning when lab contact time is decreased.
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The highly complex structure of the human brain is strongly shaped by genetic influences. Subcortical brain regions form circuits with cortical areas to coordinate movement, learning, memory and ...motivation, and altered circuits can lead to abnormal behaviour and disease. To investigate how common genetic variants affect the structure of these brain regions, here we conduct genome-wide association studies of the volumes of seven subcortical regions and the intracranial volume derived from magnetic resonance images of 30,717 individuals from 50 cohorts. We identify five novel genetic variants influencing the volumes of the putamen and caudate nucleus. We also find stronger evidence for three loci with previously established influences on hippocampal volume and intracranial volume. These variants show specific volumetric effects on brain structures rather than global effects across structures. The strongest effects were found for the putamen, where a novel intergenic locus with replicable influence on volume (rs945270; P = 1.08 × 10(-33); 0.52% variance explained) showed evidence of altering the expression of the KTN1 gene in both brain and blood tissue. Variants influencing putamen volume clustered near developmental genes that regulate apoptosis, axon guidance and vesicle transport. Identification of these genetic variants provides insight into the causes of variability in human brain development, and may help to determine mechanisms of neuropsychiatric dysfunction.
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