An intensive anatomy by whole-body dissection elective: A longitudinal study.

Whole body dissection, once a long-held method of learning and teaching in anatomy medical education, has largely been replaced by cost and time-reduced methods of teaching. This paper reports on a longitudinal study of student knowledge acquisition and retention, following six annual intensive eight-week elective anatomy by whole body dissection (AWBD) courses implemented between 2010 and 2015, utilizing a modified team-based learning (TBL) pedagogy. A total of 160 students completed the intensive full-time courses. During each course, students, in groups of five or six, completed the dissection of a whole cadaver. Students were assessed by a standardized practical test involving the accurate identification of 20 different tagged anatomical structures. All students (n = 160) completed pre-course and end-course individual assessments. Seventy students were assessed again 1 month after the course ended. A further 71 students were assessed 7 months later. A marked increase in topographical relational anatomical knowledge was demonstrated. The median pre-course score was 9/20 (interquartile range 5). The median end-course score was 19/20 (IQR 2), a statistically significant increase (p < 0.001). The assessments for the 70 students reassessed 1 month after the course ended showed no significant statistical change. The assessments for the further 71 students assessed 7 months later also showed no significant statistical change. The results of this study demonstrate that AWBD, provides significant acquisition and maintenance of three-dimensional regional relational anatomical knowledge. As an elective, AWBD has a place in the medical curricula, particularly for students interested in a surgical or procedural based specialty career.

Elective anatomy by whole body dissection course: what motivates students?

BACKGROUND: Students' motivation provides a powerful tool to maximise learning. The reasons for motivation can be articulated in view of self-determination theory (SDT). This theory proposes that for students to be motivated and hence benefit educationally and professionally from courses, three key elements are needed: autonomy, competence, and relatedness. In this paper we apply SDT theory to consider medical students' motivation to participate throughout a 2014 optional summer intensive eight week elective anatomy by whole body dissection course. The course was designed and facilitated by surgeons, and required small group, active learning. METHODS: At the end of the course, data were collected from all (24/24) students by means of an open ended survey questionnaire. Framework analysis was used to code and categorise data into themes. RESULTS: Utilising self-determination theory as a theoretical framework, students' motivation and experiences of participation in the course were explored. Elements that facilitated students' motivation included the enthusiasm and expertise of the surgeons, the sense of collegiality and community within the course, the challenges of group activities, and sense of achievement through frequent assessments. CONCLUSION: The team learning course design, and facilitation by surgeons, provided an enriched learning environment, motivating students to build on their knowledge and apply a surgical context to their learning.

Diffusion tensor imaging to aid subgenual cingulum target selection for deep brain stimulation in depression.

BACKGROUND: The most investigated target for deep brain stimulation in depression is the subgenual cingulate gyrus (Cg25) which has been shown to be a critical hub for signalling in the condition. Diffusion tensor imaging (DTI) is a form of MR sequence that can visualise white matter connections and potentially aid target selection. OBJECTIVES: To assess whether targets selected using DTI to find the area of maximal tract crossover (maximal isotropy) underlying the subgenual cingulum differ significantly in location from those selected using standard T(2) sequences. METHODS: Fifty-nine non-depressed adult volunteers underwent MR imaging using T(1), T(2) and DTI sequences of the brain. Each patient had targets selected for both hemispheres using both T(2) and DTI sequences. The significance of the differences in coordinates in all three dimensions was tested using the paired t test. RESULTS: There was a significant difference in the mediolateral (x) and dorsoventral (z) coordinates of DTI targets when compared with T(2) targets (p < 0.001). CONCLUSIONS: Targets within Cg25 selected using DTI are significantly different in location from those selected using T(2) sequences and have the potential to enhance treatment outcome by reducing the impact of interindividual variability.

Triangle of Marcille: the anatomical gateway to lateral pelvic exenteration.

BACKGROUND: To perform more radical surgery for complex pelvic malignancies and recurrent colorectal cancer, the surgeon must increasingly operate outside the conventional anatomical planes. Published in 1963 the 'Triangle of Marcille' (lumbosacral triangle) remained primarily of intellectual interest being found lateral to the traditional operating field. However, with the advancement of complex colorectal and gynaecological surgery it now provides a schema to assist surgeons in becoming acquainted with a complex and poorly understood anatomical region. Additionally, it prepares the surgeon for the extent of lateral dissection required to achieve the 'holy grail' for oncological surgery in pelvic malignancy, the complete resection (R0). METHODS: To prosect a preserved cadaver in order to demonstrate, in vivo, the contents and borders of the Triangle of Marcille for the purposes of teaching surgeons and future surgeons. RESULTS: The Triangle of Marcille is both described and demonstrated in vivo, illustrated with diagrams and photographs. The importance of this region to the surgical management of complex colorectal and gynaecological surgery is discussed. CONCLUSION: The Triangle of Marcille is a vital anatomical region for advanced pelvic surgery, particularly in the current era of pelvic exenteration, and especially for those that include the lateral pelvic compartment.

Anatomy by whole body dissection: a new Masters of Surgery course.

BACKGROUND: In 2012, a new anatomy by whole body dissection-Masters of Surgery (WBD-MS) course was introduced as a subject within the MS degree at Sydney Medical School. The purpose of this study, based on two iterations of the course, implemented in 2012 and 2013, was to investigate the participants' knowledge acquisition of clinical topographical anatomy and perceptions of the course. METHODS: During 2012 and 2013, a total of 26 postgraduate surgical trainees enrolled in the WBD-MS course. Each cohort participated in a 34-day dissection course over 12 weeks. Within each course, two groups of six to seven students were allocated to two cadaver subjects. A rigid teaching, assessment and dissection schedule was followed. Supervision was by nine specialist surgeons, who were present for their areas of expertise. The effectiveness of the course was assessed by knowledge acquisition and retention. Students' perception of the course was assessed by questionnaire and focus groups. RESULTS: The course produced a marked increase in participants' topographical anatomical knowledge. Results of assessments of participants in a standardized practical examination were 8/20 median pre-course, and 19/20 median at the end of the course. These results were statistically significant. Participants identified three outstanding features of the course: (i) the presence of surgeons as supervisors; (ii) the course structure and design; and (iii) the small class size and team learning methods. CONCLUSION: The dissection course provided a significant increase in the acquisition of three-dimensional regional relational topographical anatomical knowledge. The presence of surgical specialists as supervisors, and the course design prompted effective student engagement in learning and understanding.

Anatomy by whole body dissection: a focus group study of students' learning experience.

BACKGROUND: The social construction of knowledge within medical education is essential for learning. Students' interactions within groups and associated learning artifacts can meaningfully impact learning. Situated cognition theory poses that knowledge, thinking, and learning are located in experience. In recent years, there has been a reported decline in time spent on anatomy by whole body dissection (AWBD) within medical programs. However, teaching by surgeons in AWBD provides unique opportunities for students, promoting a deeper engagement in learning. In this study, we apply situated cognition theory as a conceptual framework to explore students' perceptions of their learning experience within the 2014 iteration of an 8-week elective AWBD course. METHODS: At the end of the course, all students (n=24) were invited to attend one of three focus groups. Framework analysis was used to code and categorize data into themes. RESULTS: In total, 20/24 (83%) students participated in focus groups. Utilizing situated cognition theory as a conceptual framework, we illustrate students' learning experiences within the AWBD course. Students highlighted opportunities to create and reinforce their own knowledge through active participation in authentic dissection tasks; guidance and clinical context provided by surgeons as supervisors; and the provision of an inclusive learning community. CONCLUSION: Situated cognition theory offers a valuable lens through which to view students' learning experience in the anatomy dissection course. By doing so, the importance of providing clinical relevance to medical teaching is highlighted. Additionally, the value of having surgeons teach AWBD and the experience they share is illustrated. The team learning course design, with varying teaching methods and frequent assessments, prompting student-student and student-teacher interaction, was also beneficial for student learning.

What motivates surgeons to teach dissection anatomy to medical students and surgical trainees?

INTRODUCTION: Although a fading tradition in some institutions, having clinicians teach anatomy by whole-body dissection provides a clinical context to undergraduate and postgraduate medical students, increasing their depth of learning. The reasons for a clinician's motivation to teach may be articulated in accordance with self-determination theory (SDT). SDT proposes that for individuals to be intrinsically motivated, three key elements are needed: 1) autonomy, 2) competence, and 3) relatedness. MATERIALS AND METHODS: Data were collected through semistructured interviews with eight surgeons who were supervisors/facilitators in the anatomy by whole-body dissection course for undergraduate students in the Bachelor of Medicine, Bachelor of Surgery program and postgraduate students in the Master of Surgery program at the University of Sydney. Qualitative analysis methods were used to code and categorize data into themes. RESULTS: Our study used SDT as a conceptual framework to explore surgeons' motivation to supervise students in the anatomy by whole-body dissection courses. Elements that facilitated their desire to teach included satisfaction derived from teaching, a sense of achievement in providing students with a clinical context, a strong sense of community within the dissection courses, and a sense of duty to the medical/surgical profession and to patient welfare. CONCLUSION: The surgeons' motivation for teaching was largely related to their desire to contribute to the training of the next generation of doctors and surgeons, and ultimately to future patient welfare.

Retention of topographical anatomical knowledge following surgeon-facilitated whole-body dissection.

BACKGROUND: Topographical anatomy has been taught to medical students by cadaver-based dissection for centuries. However, there is a void in the literature assessing the long-term retention of anatomical knowledge by medical students following teaching by whole-body dissection. The purpose of this paper was to assess both the acquisition and retention of topographical anatomical knowledge gained by medical students undertaking an elective whole-body dissection course. METHODS: This is a retrospective review of prospectively gathered data. A total of 24 students completed the elective 8-week Anatomy by Whole Body Dissection course at the University of Sydney in 2013. Surgeons and surgical trainees acted as demonstrators and anatomical knowledge was assessed on four occasions: pre, mid, end and 8 months post-course in the form of a 20-question wet specimen tag test. RESULTS: There was strong evidence of a significant difference (P < 0.001) in the students' pre-course scores (median = 8 out of 20, IQR = 6) compared with their end-course scores (median = 19 out of 20, IQR = 2). Similarly, there was a highly significant difference (P < 0.001) between students' pre-course scores and the 8-month follow-up post-course test (median = 18, IQR = 3), with a median difference of 10 points. There was no significant difference (P > 0.2) between the students' end-course assessment results and the 8 months post-course assessment indicating retention of knowledge. CONCLUSION: Surgeon-facilitated anatomical teaching to medical students by whole-body dissection significantly improves topographical anatomical knowledge which is maintained in the long term.

Team-based learning methods in teaching topographical anatomy by dissection.

BACKGROUND: While the effectiveness of teaching human topographical anatomy by groups of medical students carrying out embalmed cadaver dissections has been recognized for centuries, the mechanisms by which this teaching is so effective have not been well described. METHODS: In the recently reintroduced 7-week elective anatomy by whole body dissection course for senior medical students at Sydney Medical School, team-based learning (TBL) principles were used in the course design and implementation. In the 2011 course, 42 senior medical students participated. The effectiveness of TBL pedagogy was assessed by knowledge acquisition and retention and by administration of a questionnaire to evaluate the impact of the principles of this pedagogy. RESULTS: The course produced a marked increase in topographical anatomical knowledge. The median pre-course assessment score was 9/20 (interquartile range 5) and the median post-course assessment score was 19.5/20 (interquartile range 1.75). The difference was statistically significant (P < 0.001). There was near universal agreement by students that five key principles of TBL (small groups, instructor selected allocation to groups, regular assessments, inter- and intra-group competitiveness, and prescribed out-of-class preparation), contributed to this knowledge acquisition. CONCLUSION: The application of TBL methodology to teaching human anatomy by dissection enables a large group of students to have small group experiences without a large number of teachers. It results in effective acquisition of topographical anatomical knowledge and appears to provide better acquisition of such knowledge than the previous methods of anatomy teaching to which these students had been exposed.

Back to the future: teaching anatomy by whole-body dissection.

OBJECTIVE: To evaluate the 2010 "Anatomy by whole body dissection" course, a 7-week elective course offered to senior medical students at the University of Sydney at the end of their third year. DESIGN, SETTING AND PARTICIPANTS: In the 2010 course, 29 students divided into eight groups carried out whole-body dissections on eight cadavers over a 34-day period. Surgical trainees acted as demonstrators, and surgeons and anatomists as supervisors. The students were assessed by practical tests involving the identification of 20 tagged structures in four wet specimens before, during, at the end of, and 1 month after the course. In addition, students were asked to complete an anonymous feedback questionnaire about the course. MAIN OUTCOME MEASURE: Acquisition of topographical anatomical knowledge, and student feedback on the usefulness of the course. RESULTS: A significant increase in topographical clinical anatomical knowledge was demonstrated among the participants and was maintained in the short term. The median pre-course assessment score was 8/20 (interquartile range [IQR], 4) and the median post-course assessment score was 19/20 (IQR, 1). This difference was statistically significant (P<0.001). All students rated the course as "very good", and unanimously recommended that the course be available to all students as part of the medical curriculum. CONCLUSION: Students' knowledge of anatomy improved significantly between the pre-course and post-course assessments, and all students rated the course very favourably. This supports our view that dissection anatomy should be an integral component of medical education.