Rethinking Undergraduate Anatomy Education

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Title of Abstract: Rethinking Undergraduate Anatomy Education

Name of Author: Elizabeth Spudich
Author Company or Institution: Thomas Jefferson University
PULSE Fellow: No
Applicable Courses: Physiology & Anatomy
Course Levels: Upper Division Course(s)
Approaches: Mixed Approach
Keywords: Assessment based Learning-centered Fostering curiosity Real-world application Cooperative education

Name, Title, and Institution of Author(s): Jennifer S. Stanford, Drexel University Victoria M. Egerton, University of Manchester (UK)

Goals and intended outcomes of the project or effort, in the context of the Vision and Change report and recommendations: Students majoring in biological sciences often seek careers in a clinical field. An undergraduate course in Anatomy and Physiology (A&P) is a requirement for many nursing or PT programs and often taken as an elective by those interested in medical school or veterinary medicine. Often, undergraduate A&P is set up to teach each system in relative isolation. Conversely, in a graduate level curriculum anatomy is taught in a regional fashion with intensive focus on how structures interact and how those interactions impact clinical outcomes. This relies heavily on spatial abilities to conceptualize and understand the contributions from each of the systems to a given region. As each requires different types of thinking, it is not surprising a 2009 Australian study by Green, et al (Anat Sci Ed, 2009, 2:113) found performance in systems-based A&P courses was not predictive of success in a regional anatomy course in their Health Science curriculum. This suggests the systems-based approach to anatomy in U.S. undergraduate institutions may not adequately prepare students for success in graduate level clinical programs. Several factors may be contributing to the problem: systems v. regional perspective, scheduling over two 15-week terms v. a first year grad course taught in an intensive 8-12 week block, sparse integration other disciplines, lack of real world scenarios, overly structured labs that inhibit growth as self-learners and too few opportunities where assessment is used to foster learning. A course was designed at Drexel University within the Department of Biology to introduce students to several things: i) increased pace and content, ii) 3-dimensional nature of regional anatomy, iii) student driven design and pacing of learning. More comprehensive goals included a course design that integrated other aspects of the curriculum, helped foster student curiosity with real world applications and focused on the learning rather than the content.

Describe the methods and strategies that you are using: The course ran over 10 weeks with three-lecture hours/week and covered eight major regions and clinical application using Moore’s Essential Clinical Anatomy as the textbook. Regional dissections of cats or dogs were completed using veterinary textbooks as reference. The design incorporated many of the components recommended in the original Vision and Change Report; including multiple modes of instruction, active and cooperative learning while providing students with frequent feedback in multiple contexts. Labs were largely unstructured and students could proceed through dissection, manipulation of models, osteology stations, web-searches, peer-review and quizzing, etc., as they desired. Students had access to lab during scheduled times with additional open times as dictated by the availability of Teaching Assistants (TAs). Instructors and/or TAs were available during all labs but tasked to assist through inquiry. Continual assessment was featured in the course. Students were subjected to a weekly practical quiz, after which, instructors or TA’s went reviewed answers to correct misconceptions and help students find different approaches, hence, providing grades and constructive feedback immediately. Larger, more summative assessments for the lab component were administered twice a term in the form of timed practical examinations. The lecture component featured a weekly cumulative exam. Question format consisted of a mix of multiple choice, true/false, matching and fill-ins and up to 25% comprised of short answer/essay questions, often subjective or integrative in nature. Students received written feedback on each essay answer from the instructor.

Describe the evaluation methods that you used (or intended to use) to determine whether the project or effort achieved the desired goals and outcomes: A Qualtrix survey was developed using a series of 5-point Likert scale questions and open-ended comment sections. It was delivered to all 145 students who had completed the course between 2007 and 2012. The survey addresses the how the student’s perception of the course may have changed over time and the impact the course had on students’ post-baccalaureate experiences. Though data is still being collected over 40% of the students have responded to date.

Impacts of project or effort on students, fellow faculty, department or institution. If no time to have an impact, anticipated impacts: Responses show students’ attitudes changed dramatically after moving on to post-graduate work. During the course only 13% of respondents felt the content amount was ‘just right’ with 86% feeling it was too much. After completion, 63% of student felt the content load was ‘just right’ with 5% feeling it was too light. Similar trends were seen with course pace. Most students (61%) felt the pace too fast during the course while 69% felt the pace was just right or too slow upon later reflection. Students who had gone on to clinical programs were asked about how our course design impacted their confidence level, competitiveness and performance. Over 75% of respondents felt more confident going into their anatomy course, they felt better able to handle the anatomy material and more competitive with their peers in anatomy courses. Performance was also enhanced with over 70% of this group of respondents feeling exposure to this course during their undergraduate years helped them perform better than their peers. Surprisingly, students also reported an enhanced confidence and performance in other courses as well. Over 70% of students in clinical programs felt more confident in their overall ability to learn all the program’s material and felt they outperformed their peers in all aspects. When asked which components of the course made the most impact students consistently ranked teaching the discipline by regions v. systems, the 3-D and integrative approach to the material and continual assessment as the most important features. Student were also given the opportunity to comment on the course and its effects on their later learning. These were especially informative. “It not only taught useful things, it taught us how to study and think,” “it was definitely eye-opening and caused all of us to reevaluate our learning preferences and styles.” “Has absolutely made me a better learner.” “ the facility to learn and relearn is what this course helped me develop.”

Describe any unexpected challenges you encountered and your methods for dealing with them: Several aspects of the course needed to be addressed as it was developed. Initially, the students received small weekly quizzes and 3 major exams. Material was isolated and only the final was cumulative. It became apparent student were not using the quizzes as effective learning aids. We switched to weekly cumulative exams with supportive weekly practicals. Most assessment material focused on the topics covered the week prior but all material was ‘up for grab.’ Students were always reviewing older material and integrating it with new topics making learning more effective. Another issue was fighting the desire to finish everything on the syllabus. Students and instructors alike were anxious to get everything in. This raised stress and inhibited learning. Instead, pace was adjusted to suit the personality of each class; some moved more quickly, some focused more on integration; some needed more time with relationships. Students were told to focus on what they were learning and how they were learning it, not how much they were learning. After the first two terms it was clear some students were not becoming comfortable with spatial aspects and 3-D relationships, hampering their practical scores. To address this, instructors and TA’s designed some ‘ice-breaker’ exercises for the first lab session. These forced the students to deal with their spatial abilities (or lack thereof) and gave them useful tools to hone those skill sets at the start of the course. Another hindrance to learning anatomy in a regional fashion turned out to be computer usage during lecture. Students would listen and try to transcribe the lecture in real time or watch the slide show at their desks, never looking up from the keyboard and never seeing what was shown. Classes were told the instructor reserved the right to ban computer usage during lecture if it was felt to negatively impact performance and was forced to do so on occasion.

Describe your completed dissemination activities and your plans for continuing dissemination: Data from the student survey continues to be collected. Preliminary data was presented at EB2013 in April 2013. Spudich, EA, and JS Stanford. 2013. Teaching regional anatomy to undergrads: Too much or more relevant preparation for postgraduate clinical education. Experimental Biology 2013, Boston, Ma. As data is finalized we anticipate writing 1-2 peer reviewed journal articles to be submitted to Anatomical Sciences Education.

Acknowledgements: The authors would like to acknowledge the Department of Biology at Drexel University for support in developing this course and the Department of Pathology, Anatomy and Cell Biology at Thomas Jefferson University for support during survey design and data evaluation.