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Journal of Human Anatomy Research Article 10 min read

Reshaping Anatomy Education The Need of the Hour

Dinesh Kumar V*
* Corresponding author
ISSN: 2578-5079  10.23880/jhua-16000111  Received: August 12, 2017  Published: August 21, 2017
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Silver Linings and Path Ahead

The dissociation, because of which the students can’t transfer the knowledge provided by the curriculum to solve clinical problems, can be rectified to an extent by teaching in relevance to context. The contexts that are commonly used in anatomy teaching are 1) clinical skills (physical examination) 2) interpreting radiological images (cross sectional anatomy) 3) anatomical diagnosis of diseases 4) surgical procedures [8].

Clinical Skills (Physical Examination)

Students might understand anatomy if they know the ‘meaning’ of what is learnt. Understanding the relationships of structures and clinical manifestations (contextualization) may make anatomy more meaningful [9]. For example, the clinical signs and symptoms of acute appendicitis if contextualized with regional anatomy of appendix could make lecture sessions more meaningful. Understanding how surface features can reveal details of underlying structures (topographical anatomy) serves as an introduction to patient examination [10]. It has been said that, anatomy correlation course developed to offer first year students an opportunity to learn basic physical examination methods correlated with anatomical structures was also found to be effective [11]. This can be extended to examination of peripheral pulses, testing of ligaments and tendons related to joints and percussion skills. Use of in vivo imaging, can enhance the understanding of the surface anatomy and its relationship to underlying tissues [12]. This can be taught to the students using ultrasonography, which enables visualizing the organs and their dynamic features of physical examination [12]. Ultrasound can thus be an effective teaching methodology to revisit basic concepts especially in abdomen and musculoskeletal system. The disadvantage is it needs certain level of technical expertise to make students perceive the nuances (knobology) associated with the modality.

Interpreting Radiological Images (Sectional Anatomy)

The rapid development of technologies and techniques for minimally invasive surgery has transformed the knowledge of anatomy required for clinical practice [13]. The ‘eye of medicine’ is a resource with the potential to fill such gaps between basic sciences and clinical medicine. It can provide the future doctors with a succinct and true- to-life view of the normal as well as the disease processes in a non-invasive manner [14, 15]. The inclusion of sectional anatomy training in medical school curricula has been found to have a great impact on subsequent CT interpretations [16]. In a study [17], where system based approach of incorporating radiology to review anatomy in different imaging modalities was administered, 95% of students felt that including radiological images helped link anatomical knowledge to the clinical picture Thus, inclusion of sectional anatomy can provide a different perception of the structures which the students had perceived using their “tactile” sensation in routine cadaveric dissection. Branstetter, et al. [18] found that following radiology teaching, medical graduates were more likely to request appropriate radiological investigations and interpret them correctly. Thus incorporating radiology teaching in anatomy curriculum not only helps the “future physicians” to interpret radiological images, but also serves as a tool to make them understand about the spatial relationships and three dimensional orientations of viscera.

Case Based Learning

Drake [19] describes a clinically orientated approach to introduce concepts and facts of anatomy called ‘case- directed anatomy’. Case-based learning can be positioned between structured and guided learning [20]. This may aid the students to: 1) analyse acquired anatomical knowledge more in depth 2) working with peers to come with solutions to the given realistic scenarios (collaborative learning) 3) recognize the need to critically evaluate the information provided 4) promote experiential learning and specific skills such as ability to brainstorm, connect, and recall information [21]. The teacher has to play a different role as he /she is not considered as a repository of knowledge. By throwing open ended questions, making the critical thinking process visible and promulgating students in active group process, the teacher should be able to provide anchored instructions. This demands a lot from the facilitators of case based learning sessions as they need to be aware of the subtle transitory signs (positive and negative) then and there, and synchronise active learning process. Hmelo-Silver [22], an expert in facilitating PBL sessions, found that he had accomplished his role largely through metacognitive questioning and elicited causal explanations (via hypothetical-deductive reasoning). Case based learning is thus an effective paradigm to 1) learn anatomy content within a clinical context 2) develop critical thinking skills, and (3) expose to clinical scenarios in first year of medical training. In an interesting quasi- experimental study [23], where students adhering to traditional teaching format and PBL format were longitudinally followed, it was found that students in the PBL curriculum were more likely to produce accurate hypotheses and coherent explanations than students in the traditional curriculum. This is because they can apply concepts rather than facts. Their basic science knowledge was flexible in that they were able to transfer it to new problem situations [23]. It can be concluded that, PBL if effectively implemented encourage deep approach to learning. Instead of learning in discrete parts, a student gets an integral knowledge of a particular structure, illuminated from different angles and also gets exposed to underlying anatomical basis of a disease at hand.

Surgical Procedures (Surgical / Laparoscopic Anatomy)

It has been said that excessive amount of redundant material taught without relevance in the first year of medical education is unsound as it encourages superficial learning [24]. Largely content driven gross anatomy course, over-stuffed with facts, results in students being overwhelmed with learning complex details with very little understanding of its relevance [25]. The rationale behind the call for pre-integrating anatomy and surgery is to expose the students the way clinicians think. The ‘traditionalists’ who strongly adhere to discipline based curriculum and favour cadaveric dissection as the ultimate teaching modality and the ‘modernists’ who are mostly medical educationalists often debate in this issue, as to “how much” and “when” this integration should be done [26]. With the advent of modern surgical techniques, non- invasive diagnostic procedures and interventional devices, the anatomical knowledge (often minute) required by students to become efficient clinicians has changed [27, 28]. For example, the knowledge and viewpoint offered by traditional dissection on para-nasal sinuses and lateral wall nose is different from that offered by nasal endoscopy; the same holds for abdominal anatomy and laparoscopic view. In this respect, the concepts of basic anatomy are not modified, but horizons for the interpretation of anatomic structures are significantly expanded [29]. Dozois EJ [30] had mentioned that “demonstration of laparoscopic procedures is a great way to reinforce the importance of learning anatomy and it will excite medical students about how to apply their knowledge of anatomy”. In a study by Fitzpatrick, et al. [31] it has been reported that 78% of students felt a laparoscopy demonstration enhanced learning and Glasgow, et al. [2] found that more than 95% of responding students agreed that cadaver-based laparoscopy demonstrations enhanced their understanding of abdominal anatomy. Surgical / laparoscopic anatomy requires far different conceptualization compared to traditional gross anatomy course because the surgeon must learn to rely more on visual cues to perform an appropriate anatomical dissection [33]. This would be of immense help to identify proper tissue planes and avoid excess traction. When a student observes these operative procedures being performed at this much slower pace, under video directed magnification, has a much greater opportunity to fully conceptualize surgical anatomy [33]. In essence, anatomy educators should consider including surgical / laparoscopic anatomy videos in existing curriculum which would be a form of vertical integration.

Conclusion

The place of anatomy education in medical curriculum remains a topic of considerable controversy in terms of content and relevance. Absence of rigorous and pedagogic research regarding the different methods [34] and ideological dichotomy between “traditionalists” and “modernists” add fuel to the fire. Nevertheless, multimodal integration of teaching methodologies (Hybrid teaching model) possibly improves the clinical anatomy knowledge in a progressive way. Teaching methodologies should be tested to examine whether the methods applied promote retention of material and the ability to link knowledge to the clinical setting, any assessment of the course would need to continue up through clinical training [35]. In the era of evidence based medicine, institutions should test whether these innovative methods suit their educational philosophy and micro-analyse the learning environment, so that it can be ensured that students are able to meet the growing demands in future.

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@article{dinesh2017,
  title   = {Reshaping Anatomy Education The Need of the Hour},
  author  = {Dinesh Kumar V},
  journal = {Journal of Human Anatomy},
  year    = {2017},
  volume  = {1},
  number  = {2},
  doi     = {10.23880/jhua-16000111}
}
Dinesh Kumar V (2017). Reshaping Anatomy Education The Need of the Hour. Journal of Human Anatomy, 1(2). https://doi.org/10.23880/jhua-16000111
TY  - JOUR
TI  - Reshaping Anatomy Education The Need of the Hour
AU  - Dinesh Kumar V
JO  - Journal of Human Anatomy
PY  - 2017
VL  - 1
IS  - 2
DO  - 10.23880/jhua-16000111
ER  -