Introduction/Objective
Covid‐19 created challenges to anatomy education, particularly gross anatomy given the traditional in‐person format of lectures and lab. The objective of this study was to ...assess the changes in lecture methods and lab materials used in anatomy courses that ran between May‐August (T1) and August‐December (T2) 2020 responding to Covid‐19 restrictions.
Materials/Methods
A survey was distributed to anatomy educators through professional associations from June‐November 2020. Respondents indicated (1) their institution; (2) programs taught (professional health (PH), medicine (MED), or undergraduate (UG)); (3) course type (integrated or stand‐alone); (4) percentage of lab time before and during Covid‐19 that utilized cadaveric, plastic, and/or other teaching materials; and (5) lecture format. Institutions were classified as public or private via institution websites. Mann‐Whitney U and Wilcoxon signed‐rank tests with Bonferroni correction compared responses before and during Covid‐19 across programs, course type, and institution. Data are presented as percent increase (+value) or decrease (‐value). Alpha<5%.
Results
T1 and T2 received 67 and 191 responses, respectively. During T1 and T2, cadaver use decreased in PH (‐58% & ‐28%), MED (‐55% & ‐34%), and UG (‐57% & ‐55%) programs (P≤0.045); stand‐alone (‐58% & ‐33%,P<0.001) and integrated (‐48% & ‐28%, P≤0.004) courses; and private (‐49% & ‐25%, P<0.001) and public (‐65% & ‐34%, P<0.001) institutions. During T1 and T2, plastic use did not change for programs, institutions, or courses (P>0.05), except UG decreased plastic usage during T2 (‐20%; P=0.033). During T1 and T2, use of other teaching materials increased in PH (+1180% & +278%), MED (+385% & +1000%), and UG (+285% & +246%) (P≤0.015); stand‐alone (+920% & +540%, P<0.001) and integrated (+330% & +500%, P≤0.002) courses; and private (+1233% & +667%, P<0.001) and public (+415% & +400%, P<0.001) institutions. For T1 and T2, in‐person lecture decreased (‐89% & ‐72%, P≤0.001), while remote lecture increased (+509% & +533%, P≤0.001) during Covid‐19.
Conclusion
Reduction in cadaver use and in‐person lecture were most pronounced in T1, but remained diminished through both time points, suggesting a shift from the initial pandemic response to teaching to more complex hybrid programs as regulations permitted.
Significance/Implication
This study provides evidence to better understand how anatomy educators adapted their gross anatomy teaching due to Covid‐19 across programs. In addition, this study provides first of its kind insight into how anatomy was taught across programs prior to Covid‐19. Future studies need to determine whether the findings characterized here were pandemic‐based or if they represent long‐term changes for anatomy education.
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.
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.
In March 2020, TTUHSC opened a new 20,000sf Institute of Anatomical Sciences for human gross anatomy. When the COVID‐19 pandemic struck and many schools shifted from in person to online teaching, we ...hypothesized that if safety measures were used, in person cadaveric anatomy could be safely taught without a decrease in student performance. To test this, we reduced onsite attendance to less than 25% of room capacity. Masks were required at all times and students were instructed to social distance. Six students were assigned per cadaver, but only two students dissected at a time. The other four students reviewed and completed dissections and/or reviewed in groups of two at other allotted times. Thus, students dissected only every third lab. Dissection and lab review attendance was mandatory and students were nearly 100% compliant. Teaching assistants recorded dissected prosections reviews, and these videos were uploaded to password protected course files for independent learning. Students were provided iPads in the laboratory and access to three software packages for use on and off site. All students had access to multiple formative quizzes and exams, and three new online practice practical exams were created. To help reduce testing anxiety, a pass/fail system replaced categorical grading. However, all written and practical exams were conducted on site and in person. At TTUHSC, we have developed an exam question database to track historical student performance including a 25‐question optional pre‐block practice exam used to assess incoming student anatomical aptitude. In 2020, 90% of incoming students (93% in 2019) took the pre‐block exam and scored an average of 28% (24% in 2019). In 2020, despite vastly different content delivery approaches (>80% of lectures were on Zoom) and reduced in‐person dissection requirements, students modestly outperformed their 2019 counterparts. Overall exam averages were 89% in 2020 compared to 87% in 2019. If a categorical system was in place, 66% of students would have earned Honors or High Pass in 2020 compared to 61% in 2019. Our formative assessments were highly predictive of summative exam performance, and students reported that they reduced exam stress. Furthermore, summative exam averages correlated strongly with NBME performance (p<0.0001, r2=0.63). TTUHSC medical students estimated that a majority of their peers at other medical schools did not have any in person dissection in 2020. Our students ranked in person laboratory dissection as the most useful learning activity, 88% reported that our COVID‐19 preparations were very good to outstanding, and 97% were satisfied with the quality of their anatomy education. We conclude that 1) When using appropriate precautions, in person cadaveric anatomy can be taught safely during a pandemic; 2) cadaveric dissection is essential for mastery of anatomical concepts; and 3) coupling online learning modalities with rigorous formative assessments prevented a modest reduction in cadaveric dissection opportunities from negatively impacting student performance.
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.
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.
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.
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.
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.
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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