Essential anatomy for core clerkships: A clinical perspective.

Clerkships are defining experiences for medical students in which students integrate basic science knowledge with clinical information as they gain experience in diagnosing and treating patients in a variety of clinical settings. Among the basic sciences, there is broad agreement that anatomy is foundational for medical practice. Unfortunately, there are longstanding concerns that student knowledge of anatomy is below the expectations of clerkship directors and clinical faculty. Most allopathic medical schools require eight "core" clerkships: internal medicine (IM), pediatrics (PD), general surgery (GS), obstetrics and gynecology (OB), psychiatry (PS), family medicine (FM), neurology (NU), and emergency medicine (EM). A targeted needs assessment was conducted to determine the anatomy considered important for each core clerkship based on the perspective of clinicians teaching in those clerkships. A total of 525 clinical faculty were surveyed at 24 United States allopathic medical schools. Participants rated 97 anatomical structure groups across all body regions on a 1-4 Likert-type scale (1 = not important, 4 = essential). Non-parametric ANOVAs determined if differences existed between clerkships. Combining all responses, 91% of anatomical structure groups were classified as essential or more important. Clinicians in FM, EM, and GS rated anatomical structures in most body regions significantly higher than at least one other clerkship (p = 0.006). This study provides an evidence-base of anatomy content that should be considered important for each core clerkship and may assist in the development and/or revision of preclinical curricula to support the clinical training of medical students.

Medical students' perceptions of medical education research and their roles as participants.

PURPOSE: To better understand whether medical students perceive medical education research as important to their medical training and whether published opinions about why medical students participate in research are accurate. METHOD: In 2003-04, 896 first- through fourth-year medical students at Kansas City University of Medicine and Biosciences College of Osteopathic Medicine were asked to complete an online eight-item questionnaire by responding Yes or No to each question. Responses were tallied by year of medical training and converted into numbers and percentages. Chi-square analysis was used to compare response rates among first- through fourth-year students and responses between preclinical and clinical students. RESULTS: A total of 524 students (58.5%) completed the questionnaire. A total of 488 (93%) medical students believed medical education research should be conducted to improve their medical training, 477 (91%) did not feel coerced to participate in studies because of faculty members' positions of authority, and 398 (76%) did not believe they would receive better grades, recommendations, and/or other favors. Four hundred sixty-eight (89%) students were not concerned with their confidentiality as study participants, while 326 (62%) wanted special protections. Response rates by year of medical school were not significantly different (p > .05). Responses of preclinical and clinical students for six of the eight questions were significantly different (p < .05). CONCLUSIONS: Medical school decisionmakers should recognize that students value medical education research. Published opinions about why medical students participate in studies are incongruent with medical students' views. Full review of medical education studies by Institutional Review Boards may be unnecessary and inappropriate.

Health Professions Scholarship Program: are the armed forces getting quality osteopathic physicians?

To compare the medical knowledge and reasoning of osteopathic medical students in the Health Professions Scholarship Program (HPSP) with corresponding civilian students, we analyzed their performance on the Comprehensive Osteopathic Medical Licensing Examination (COMLEX-USA) levels 1 and 2. The results from this study showed no significant difference between that HPSP medical students (COMLEX-USA level 1, N = 37; COMLEX-USA level 2, N = 34) and civilian students (COMLEX-USA level 1, N = 507; COMLEX-USA level 2, N = 492) on COMLEX-USA level 1 (p = 0.24) and COMLEX-USA level 2 (p = 0.50). Moreover, no significant difference was observed between Air Force (COMLEX-USA level 1, N = 8; COMLEX-USA level 2, N = 6), Army (COMLEX-USA level 1, N = 13; COMLEX-USA level 2, N = 13), and Navy (COMLEX-USA level 1, N = 16; COMLEX-USA level 2, N = 15) HPSP students for COMLEX-USA level 1 (p = 0.42) and COMLEX-USA level 2 (p = 0.75). Therefore, we conclude that, upon graduation from medical school, the medical knowledge and reasoning of HPSP osteopathic graduates as determined by COMLEX-USA are equivalent to those of their civilian counterparts.

Effects of an alternate dissection schedule on gross anatomy laboratory practical performance.

The current medical curricula reform that is taking place in many medical schools throughout the world has resulted in less time for gross anatomy laboratory instruction. In response, anatomists are using a variety of approaches (e.g., peer teaching, prosections, plastinated anatomical models, etc.) to adapt to these changes. To accommodate recent curricular reform at the University of Health Sciences College of Osteopathic Medicine, an alternating dissection schedule was implemented. The purpose of this study is to examine the effects of the alternating schedule on gross anatomy laboratory practical performance. Using a Mann-Whitney Rank Sum test, back and upper limb (back-upper limb), and lower extremity laboratory practical performance for students who dissected in every laboratory (EL group; n = 227) is compared to students who dissected in every other laboratory (EOL group; n = 254). For the back-upper limb part of the anatomy laboratory practical, the mean percentage scores for the EL and EOL groups were 74.5% and 68.1%, respectively (P < 0.001). The mean percentage scores for the EL and EOL groups on the lower limb portion of the anatomy lab practical were 75.9% and 75.6%, respectively (P = 0.994). These data suggest that the use of an alternating dissection schedule had an equivocal effect on the students' gross anatomy laboratory practical performance for these two sections. The reasons for these conflicting results may have been related to regional complexity or volume of information, and the sequence in which the regions were taught.

The relationship between premedical coursework in gross anatomy and histology and medical school performance in gross anatomy and histology.

Many premedical students enroll in courses whose content will be encountered again during their medical education. Presumably, students believe this practice will lead to improved academic performance in corresponding medical school courses. Therefore, this study was undertaken to determine whether a premedical gross anatomy and/or histology course resulted in increased performance in corresponding medical school courses. A second aim of the study was to examine whether the type of premedical gross anatomy and/or histology course differentially affected medical school performance. A survey that assessed premedical gross anatomy and histology coursework was administered to 440 first-year medical students. The results from this survey showed that students with premedical gross anatomy (n = 236) and/or histology (n = 109) earned significantly more points in the corresponding medical school course than students without the premedical coursework (P < 0.05). Analysis of premedical course types revealed that students who took a gross anatomy course with prosected specimens (n = 35) earned significantly more points that those students without premedical gross anatomy coursework (P < 0.05). The results from this study suggest: 1) premedical gross anatomy and/or histology coursework improves academic performance in corresponding medical school courses, and 2) a premedical gross anatomy course with prosected specimens, a specific type of undergraduate course, significantly improves academic performance in medical gross anatomy.

Effects of four supplemental instruction programs on students' learning of gross anatomy.

Many researchers have reported that supplemental instruction programs improve medical students' performance in various basic sciences. This study was conducted to evaluate the summative effects of four supplemental instruction programs (i.e., second-year medical student teaching assistant program; directed study program; weekly instructor laboratory reviews; and a web-based anatomy program) on medical students' gross anatomy laboratory practical performance. First-year medical students from the graduating class of 2006 (n = 223) received the four supplemental instruction programs (Experimental Group). The Control Group consisted of first-year medical students from the graduating class of 2005 (n = 254) who did not receive the four supplemental learning methods. Mann-Whitney rank sum tests were used to compare the two groups' median percentages for the back-upper limb (B-UL) and the lower limb (LL) parts of a gross anatomy laboratory practical. The Experimental Group's median percentages for both the B-UL (77.78%) and LL (83.33%) were significantly greater than that of the Control Group (B-UL = 69.00%; LL = 81.00%; P < 0.05). Results from a post-hoc student survey showed that more students both rated and ranked the weekly instructor laboratory reviews as extremely useful and most beneficial, respectively. A greater number of students rated and ranked the web-based anatomy program as not useful and least beneficial, respectively. The results from this study suggest that the four supplemental instruction programs improved students' learning of gross anatomy as measured by laboratory practical performance. In addition, students most valued the additional time in the gross anatomy laboratory with the instructors.