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
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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Streaming of faculty anatomy dissections was utilized to teach clinically relevant gross anatomy to first‐year Physician Assistant students during the summer of 2020 to address Covid‐19 pandemic ...social distancing guidelines. The online anatomy dissections by faculty replaced the traditional practice of onsite dissection laboratory periods by the students.
MATERIAL AND METHODS
The PA gross anatomy course was scheduled for six weeks, Monday through Thursday. The PA students were offsite and, therefore, viewed the dissections via zoom sessions. Each online session was scheduled for three hours. At the beginning of each session, ten quiz questions relative to prior sessions were asked to enhance students’ retention and recall. Following the daily online practical quizzes, students watched step by step dissections by the faculty. These dissections were integrated with relevant power‐point slides and/or cross‐sections. During last 35 minutes of each daily session, students were divided into small groups to discuss the dissected anatomy region for that day with one faculty member per group. The PA students from the Class of 2022 completed an anonymous electronic survey at the conclusion of the course.
RESULTS
The online survey of the enrolled PA students (n=60) in their first‐year training identified that the online dissections and the teaching format were extremely beneficial to their learning. Ninety percent of the students strongly agreed or agreed that online gross anatomy course augmented their learning. Eighty percent of the students strongly agreed or agreed that the streaming of anatomy dissections was helpful in learning the assigned anatomy. Ninety percent of the students strongly agreed or agreed that integrated power point presentations were beneficial, and ninety percent of the students strongly agreed or agreed that daily integrated quizzes (self‐assessment modules) were beneficial for their retention and recall. Although setting up online dissections and integrating the streaming dissections with relevant power points were time‐intensive, the teaching faculty viewed the online teaching experiences as efficient means to further develop students’ knowledge base of anatomy while addressing university and CDC guidelines.
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INTRODUCTION/OBJECTIVE:
Covid‐19 has led to sudden changes to gross anatomy education when traditional dissection‐based laboratories had to shift towards virtual modalities due to physical distancing ...and remote learning requirements. The purpose of this study was to determine how the use of digital teaching resources in gross anatomy education changed from before to during Covid‐19.
MATERIAL/METHODS:
Data were obtained from an IRB‐approved survey distributed to professional associations and listservs targeting anatomy educators from June to November 2020. Respondents were asked to select the digital resources they used before and during Covid‐19. Data were analyzed during the early and latter parts of the pandemic as May‐August (T1) and August‐December (T2), as well as overall (T3). T2 data were classified into five categories: 2D illustrations, dissection media, interactive software, in‐house, and open access. Total usage for each timepoint, the proportions of digital resources, and the 5 categories before and during Covid‐19 were compared using McNemar's test with alpha<5%. Data are presented as percent increase (+value) or decrease (‐value).
RESULTS:
60 and 208 responses were received for T1 and T2, respectively. The total number of digital resources used for anatomy education increased from before to during COVID‐19 as seen in the data analysis from T1 (+47%), T2 (+41%), and T3 (+43%) (P≤0.003). In T1, the use of BlueLink (+122%) and Complete Anatomy (+140%) software increased (P<0.04), while Acland's Anatomy (+68%), Anatomy.TV (+1300%), Complete Anatomy (+89%), and BlueLink (+148%) increased in T2 (P≤0.03). During T3, the usage of Acland's Anatomy (+60%), Anatomy.TV (+750%), Complete Anatomy (+102%), BlueLink (+143%), and VisibleBody (+100%) increased (P≤0.03). All other digital resources did not change (P>0.05). When data for T2 were categorized, dissection media (+44%), interactive software (+87%), and open‐access (+100%) content increased (P≤0.008), while 2D illustrations (‐3%) and in‐house content (‐23%) decreased (P>0.05).
CONCLUSIONS:
This study demonstrates sustained increases in digital resource usage for gross anatomy education during Covid‐19. This was particularly pronounced for interactive software, open access resources and dissection media that allowed educators to mimic features of a dissection lab.
SIGNIFICANCE:
These rapid shifts in both commercial and free digital resources are likely to drive innovation in anatomy education for years to come. It remains unknown if the current findings are transient Covid‐19‐related changes or if they will persist long‐term.
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INTRODUCTION/OBJECTIVE
Covid‐19 created immediate challenges to anatomy education. The traditional format of gross laboratory sessions experienced a direct impact and few reports documented ...curricular delivery changes specific to laboratory format. The purpose of this study was to assess the adaptations incorporated in gross anatomy laboratories by anatomists, during May‐August 2020, in response to Covid‐19.
MATERIALS/METHODS
Data were collected through the IRB‐approved Virtual Anatomy During Covid‐19 survey that consisted of 20 questions, including open‐ended prompts asking participants to describe the structure of a “typical” laboratory session during Covid‐19. Responses were solicited from professional anatomy associations during June 2020. Open‐ended responses describing anatomy laboratory teaching methods used during Covid‐19 were coded. Descriptive codes were applied to the data according to published methods to summarize verbatim responses. Responses were tabulated and converted to frequencies and percentages. Chi square test assessed differences among the responses when applicable. Alpha<5%.
RESULTS
Descriptions of gross anatomy lab teaching during Covid‐19 were coded into four categories : (1) delivery format, (2) format of laboratory practice, (3) type of anatomy digital resources used, and (4) format of student teaching groups. In the first category, synchronous (46.7%), asynchronous (15.6%), and/or a combination of the two (18.8%) were the most frequent laboratory delivery formats (P<0.001). In the second category, student‐led dissection (17.2%), prosection (10.9%), and/or utilization of commercial and/or in‐house anatomical resources (26.2%) were the most frequent laboratory practices (P<0.001). Within this category, a subcategory was discovered in which physical distancing and personal protective equipment practices were reported (15.6%). Concerning the third category, anatomy digital resources (26.2%) were used for asynchronous laboratory preparation and laboratory sessions. In the final category, student small groups (29.7%) were used in remote sessions where “breakout rooms” permitted students to meet with peers and/or faculty. Large groups (9.4%) were used for faculty to review and present the assigned laboratory topic.
CONCLUSION
Anatomists largely taught through a remote, synchronous delivery format that relied on cadaveric specimens and digital anatomy resources, as well as small group learning.
SIGNIFICANCE/IMPLICATION: This study shows that anatomists were able to adapt the gross anatomy laboratory sessions to synchronous, virtual mediums; however, the impact of these changes to the learner during this unconventional time remains to be determined.
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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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Introduction
The COVID‐19 pandemic posed significant challenges to the instruction of in‐person cadaveric dissection. Compared to previous years, there was a 66% reduction in student lab dissection ...times for the first‐year medical students (MS1s) at Texas Tech University Health Sciences Center. Complete Anatomy (CA), a three‐dimensional (3D) anatomy atlas, was provided as an additional educational resource to supplement the in person cadaveric dissection labs. The aim of this study is to increase student engagement by producing tailored anatomical modules in CA and to evaluate their effects on students’ stress levels and summative practical exam performance throughout the Clinically Oriented Anatomy (COA) block. We hypothesized that the CA modules would allow current MS1s to perform to the same academic standard as students who did not have these COVID‐19 limitations and reduce their exam stress.
Methods
Learning modules were created that displayed 3D anatomical structures corresponding to each of the 27 COA in person dissection labs. The CA modules consisted of content and quizzes that MS1s could access either outside or inside the lab. At the end of each of the three COA units and at the end of the COA block, students were surveyed about their participation and satisfaction with the modules. Students’ performance on module quizzes was compared to their performance on summative practical exams. Additionally, the Class of 2023’s performance in COA was compared to the Class of 2024’s, with the latter taking the block under pandemic restrictions.
Results
Throughout the block, 82%‐95% (unit 1 n=97/102, unit 2 n=67/72, unit 3 n=107/130) of survey respondents reported using the modules as a study aid and 55%‐79% used the modules for all 27 anatomy labs. Additionally, 75%‐87% of MS1s rated the modules as “very useful” or higher on a Likert‐scale survey, with a majority of surveyed students using both the content and quizzes. At the end of the block a second survey showed 74% (n=70/94) of students “strongly agreed” or “agreed” that using the modules reduced their stress, and 80% (n=75/94) “strongly agreed” or “agreed” that modules allowed them to continue their learning outside of the lab. MS1 performance in the COA block was positively correlated with performance on CA quizzes (r=0.46, p<0.0001). Further, there was no significant difference between the 2023 and 2024 MS1 classes in summative practical exam scores for units 1 and 3, as well as in the National Board of Medical Examiners (NBME) exam. However, there was a significant increase in summative practical exam performance in the Class of 2024 for unit 2 (p<0.0001) as compared to the Class of 2023.
Conclusion
Findings suggest that the CA modules facilitated student engagement in anatomy and positively enhanced their medical education throughout the COA block. Although dissection time and lab access were limited, the CA modules benefitted the students and could have potentially compensated for that lost time.
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Introduction/Objective
While both asynchronous (ASYNCH) and synchronous (SYNCH) approaches have been used for online medical anatomy teaching during the COVID‐19 pandemic, it is unclear how ASYNCH ...vs. SYNCH approaches are differentially perceived by medical students, or whether these methods have any differential impact on anatomy learning. The purpose of this study was to compare first year (M1) and second year (M2) medical student perceptions and exam performance between ASYNCH and SYNCH‐delivered anatomy content.
Materials/Methods
University of Ottawa M1 and M2 perceptions were surveyed (with both close‐ and open‐ended items) regarding musculoskeletal (MSK; delivered to M1) and gastrointestinal/reproductive (GI/REPRO; delivered to M2) anatomy content delivery in Fall 2020. In both cohorts, approximately 50% of the sessions were delivered in each of ASYNCH (prerecorded lectures) and SYNCH (real‐time Microsoft Teams lectures) formats. Final examinations were also analyzed, comparing items that related to content from ASYNCH and SYNCH formats, with 50% of exam items tied to each approach. For both M1 and M2 cohorts, both ASYNCH‐ and SYNCH‐related examination components featured image‐based, multiple choice question (MCQ) items, with similar proportions of structure identification items and clinical application items.
Results
In M1 (n=101; response rate = 62%) and M2 (n=66; response rate = 40%) groups, the percentage of students indicating a preference for ASYNCH, a preference for SYNCH, or no preference regarding content delivery, was 45%, 38%, and 18%, for M1 students, and 48%, 32%, and 20% for M2 students, respectively. Thematic analysis of open‐ended feedback revealed strengths (more engaging formative assessment; being part of a learning community) and limitations (technical issues; time‐inefficient; more difficult to review) of SYNCH delivery. Similarly, commentary also revealed strengths (time efficiency; flexibility/control) and limits (less engaging formative assessment) of ASYNCH delivery. Commentary also revealed that many students were fine with either approach. While some students noted their preferred approach was beneficial to their learning, assessment data revealed no statistical differences in class performance between ASYNCH‐ vs. SYNCH‐delivered content, for either M1 (MSK) or M2 (GI/REPRO) anatomy.
Conclusion
While medical students may have indicated a slight preference for ASYNCH (vs. SYNCH) anatomy learning, medical students were generally satisfied with both approaches. While open‐ended commentary revealed strengths and limitations regarding both formats, the perceived notion that either SYNCH or ASYNCH was more beneficial to student learning was not supported by assessment data.
Significance/Implication
This study provides evidence to suggest that both ASYNCH and SYNCH approaches are appropriate for delivering anatomy content to medical students, given unique strengths attributed to each format, and that both approaches lead to similar performance on knowledge assessments. As such, medical anatomy educators should feel confident in choosing either ASYNCH and/or SYNCH formats when delivering their lectures.
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In the middle of March last year, many faculties of Medicine around the world faced the difficult and unprecedented decision to either stop completely face to face education or reduce it to the ...minimum possible. Faculty and students encountered many challenges to ensure the integrity and continuity of the medical education process. Going completely online seemed unachievable.
There are still many Schools of Medicine worldwide with the traditional curriculum where live lectures are the center of the instruction. In the USA most of the schools of medicine have moved to a more integrated curriculum, some of them have stopped given lectures and others moved to video‐casted lectures.
Many courses in the preclinical medical curriculum were easier to transition to Virtual learning in the majority of the universities. Good examples are physiology, histology and pathology.
Unfortunately, in the other hand Anatomy presented more difficulties everywhere. Outside the USA most Universities had to stop dissections and prosections. Instructors had to rapidly adapt to the changes. This crisis has highlighted the necessity to have the medical educators trained to use the technology available and the creation of their own multimedia teaching materials. The schools which were already using more technology and having access to a reliable internet connection were much prepared to succeed. Remarkably few universities were able to use prosections and allowed the students to review them taking all the necessary precautions. Nevertheless to achieve this the instructors have to prepare 3 or more times the prosections needed in a normal year.
Unfortunately, only during the clerkships especially in the course of surgical rotations we will know the consequences of missing the opportunity to have dissected a body. However there is always time for improvement and also time to prepare for a post pandemic curriculum adjustments.
The opinions or assertions contained herein are the private ones of the author/speaker and are not to be construed as official or reflecting the views of the Department of Defense, the Uniformed Services University of the Health Sciences or any other agency of the U.S. Government.
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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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