Investigating the impact of remote neuroanatomy education during the COVID-19 pandemic using online examination performance in a National Undergraduate Neuroanatomy Competition.

Neuroanatomy is a notoriously challenging subject for medical students to learn. Due to the coronavirus disease-19 (COVID-19) pandemic, anatomical education transitioned to an online format. We assessed student performance in, and attitudes toward, an online neuroanatomy assessment compared to an in-person equivalent, as a marker of the efficacy of remote neuroanatomy education. Participants in the National Undergraduate Neuroanatomy Competition (NUNC) 2021 undertook two online examinations: a neuroanatomically themed multiple-choice question paper and anatomy spotter. Students completed pre- and post-examination questionnaires to gauge their attitudes toward the online competition and prior experience of online anatomical teaching/assessment. To evaluate performance, we compared scores of students who sat the online (2021) and in-person (2017) examinations, using 12 identical neuroradiology questions present in both years. Forty-six percent of NUNC 2021 participants had taken an online anatomy examination in the previous 12 months, but this did not impact examination performance significantly (p > 0.05). There was no significant difference in examination scores between in-person and online examinations using the 12 neuroradiology questions (p = 0.69). Fifty percent of participants found the online format less enjoyable, with 63% citing significantly fewer networking opportunities. The online competition was less stressful for 55% of participants. This study provides some evidence to suggest that student performance is not affected when undertaking online examinations and proposes that online neuroanatomy teaching methods, particularly for neuroradiology, may be equally as effective as in-person approaches within this context. Participants perceived online examinations as less stressful but raised concerns surrounding the networking potential and enjoyment of online events.

Creating evidence-based engaging online learning resources in neuroanatomy.

Online anatomical resources are rising in popularity since the COVID-19 pandemic, but the pedagogical principles and effectiveness of their use remain unclear. This article aims to demonstrate evidence-informed ways in which fellow educators can create engaging online learning resources in clinical neuroanatomy and compare the effectiveness of text-based and online learning resources. Data were analyzed from the Soton Brain Hub (SBH) YouTube page. Separately, a cross-sectional study comparing the learning gain of using text-based and video resources was done. The knowledge gain and retention were compared between groups using a pre-teaching and post-teaching multiple choice questions. YouTube analytics showed the average time a viewer spends on a video was found to be highly correlated to the length of the video, r = 0.77, p < 0.001 (0.69-0.82). The cross-sectional study indicated a significant difference in mean normalized learning gain of video resources 61.9% (n = 53, CI 56.0-67.7%) versus text resources 49.6% (n = 23, CI 39.1-60.1%) (p = 0.030). However, there was no difference in retained learning gain between video resources 39.1% (n = 29, CI 29.2-49.0%) versus text-based 40.0% (n = 13, CI 23.9-56.1%) (p = 0.919). Students engage most with short videos less than 5 min which reduces the intrinsic load of learning. Online resources are as effective as text-based resources in providing learning gain and retention. In the future, the continued rise in popularity of online learning resources may result in further reduction in traditional face-to-face teaching.

Exploring the Application of Peer-Assisted Learning in Practical Neuroanatomy Classes: A Cohort Comparison Within a Medical Curriculum.

Despite well-documented benefits, the effectiveness of some aspects of near-peer (NP) teaching in medical education within anatomy curricula remains unclear. Here, we explored the impact of various permutations of staff/student laboratory-based co-teaching in neuroanatomy by determining the optimal staff and student teaching combination. We assessed student perceptions and knowledge acquisition using three different co-teaching strategies. Second-year medical students at the University of Southampton were co-taught neuroanatomy by faculty staff and third-year medical students (NP teachers). Three cohorts, 2016/2017, 2017/2018, and 2018/2019, were included in the study. Subsequent cohorts experienced increasingly structured NP teaching with more NP teachers. Students completed evaluations for anatomy sessions, which were statistically compared. The 2017/2018 and 2018/2019 cohorts completed lunchtime quizzes matched to the learning outcomes of each practical session, which were analysed. A focus group involving six students was transcribed and thematically analysed. Anatomy practical ratings were significantly higher when both session structure and NP teacher numbers increased from 3 to 5-6 (p = 0.0010) and from 3 to 7-8 (p = 0.0020). There were no significant differences in anatomy practical ratings using 5-6 and 7-8 NP teachers (p > 0.9999). There were no significant differences between the knowledge scores of students who experienced 5-6 and 7-8 NP teachers. Themes detailing the benefits of NP teaching and the importance of faculty involvement were identified, demonstrating that students appreciated NP teaching within a co-teaching environment. Therefore, increased NP teaching may augment students' perceptions and knowledge acquisition. In this context, the optimal number of NP teachers may sit between 5 and 8.

Can Synchronous Online Near-Peer Teaching Offer the Same Benefits as the Face-to-Face Version When Used in Clinical Neuroanatomy Education?

COVID-19 sparked massive educational change and dictated that traditional courses rapidly transitioned online. This presented a unique challenge for anatomy, a visually orientated subject that has conventionally relied heavily on face-to-face teaching. Near-peer teaching (NPT) is one method with the potential to address this challenge. When given more responsibility, student-teachers are more likely to deliver effective teaching sessions and include the most appropriate resources for the learners. Current literature surrounding the use of NPT in both frontline and supplementary settings have already demonstrated its potential, however, its efficacy in an online environment is still largely unknown. The Faculty of Medicine at the University of Southampton has a well-established NPT programme as part of its 5 year undergraduate course (BM5). A quasi-experimental cohort study was conducted to determine whether the benefits associated with NPT are preserved when delivered online. Two cohorts of second year BM5 students received cranial nerve NPT as part of their formal clinical neuroanatomy module, one face to face (N = 150) and the other online (N = 168). Knowledge tests were undertaken by participants to assess knowledge gain and retention, and an established Likert style survey instrument was administered to assess student perceptions. Both online and face-to-face NPT sessions resulted in significant increases in student knowledge gain (p < 0.0001), yet the difference between the two was insignificant (p = 0.2432). Subsequent knowledge retention tests were also shown to be similar (p = 0.7732). Students perceived both methods of NPT delivery positively but found online NPT less enjoyable (p < 0.0001) and considered it to be a more inefficient use of time (p = 0.0035). This research suggests that online NPT can be deployed without a detrimental risk to learning when compared to traditional NPT applications in pre-clinical neuroanatomy teaching.

A Multicentre Analysis of Approaches to Learning and Student Experiences of Learning Anatomy Online.

Introduction: The approaches to learning students adopt when learning anatomy online could yield important lessons for educators. Dissection room teaching can encourage students to adopt a deep approach to learning anatomy. It was therefore hypothesized that the proportion of students adopting a deep approach to learning would be lower in a population learning anatomy online. This research aims to investigate the experiences of students learning anatomy online during the COVID-19 pandemic and the approaches to learning they adopted. Methods: A survey was distributed to medical students at 7 universities across the UK and Ireland. The survey included two previously validated questionnaires: Approaches and Study Skills Inventory for Students and Anatomy Learning Experience Questionnaire. Results: The analysis included 224 unique student responses. Students' approach to learning mirrored reports from previous studies conducted during face-to-face tuition with 44.3% adopting deep, 40.7% strategic, 11.4% surface, and 3.6% combined learning approaches. The university (p = 0.019) and changes to formative (p = 0.016) and summative (p = 0.009) assessments significantly impacted approach to learning. Students reported that online resources were effective but highlighted the need for clearer guidance on how to find and use them successfully. Conclusion: It is important to highlight that students value in-person opportunities to learn from human cadaveric material and hence dissection room sessions should remain at the forefront of anatomical education. It is recommended that future online and/or blended provisions of anatomy teaching include varied resources that maximize engagement with media featuring cadaveric specimens. Supplementary Information: The online version contains supplementary material available at 10.1007/s40670-022-01633-7.

Assessing the Impact of Interactive Educational Videos and Screencasts Within Pre-clinical Microanatomy and Medical Physiology Teaching.

Modern medical curricula adopt the use self-directed learning approaches, which frequently include the use of technology enhanced learning resources. Often, students prefer those which are available via mobile devices because it can facilitate flexibility and autonomy with their learning, more so than with traditional modalities. Although the production value of resources may be appealing to users, those that work most effectively for education align well to existing pedagogies. One such pedagogy is the cognitive theory of multimedia learning. It is a framework that can be used to facilitate the construction of educational video, that can benefit learning gain through reducing the cognitive load.Although much research has been conducted on how information should be presented in video resources, there is very limited evidence within the subject of clinical anatomy and physiology or when applying different types of educational video, such as screencasts, or interactive video. In the field of anatomy education recent approaches have sought to standardize a robust methodology to evaluate digital resources. This procedure utilizes a combination of normalized learning gain and learner perceptions to gain an accurate picture of educational impact.The current study investigated the impact of both interactive educational videos and screencasts compared with traditional teaching techniques in the challenging subjects of histology and pain physiology. A quasi-randomized, cross-sectional study was conducted with 135 medical students enrolled at the University of Southampton. Sixty fourth- and fifth-year students assessed the histology resources, and 75 second-year students assessed the pain histology resources. Participants were randomly assigned to either a text-based resource, interactive video, or screencast group. Outcomes measured were: 1. Normalized knowledge gain (and retention) assessed using one-best-answer multiple choice question tests 2. Student perceptions using 1-10 Likert-scale style questionnaires. A significant improvement in mean normalized knowledge gain was observed for all teaching modalities. For pain physiology, the means were: Text-49.0% (n = 23), interactive video-70.1% (n = 26), and screencast-53.8% (n = 26). For all learning gains, P < 0.001. For histology, there was a mean normalized learning gain for text-80.0% (n = 20), interactive video-74.4% (n = 20), and screencast groups-68.3% (n = 20). For all learning gains, P < 0.001.For pain physiology resources, interactive videos significantly improved learning gain compared to the screencast (P < 0.05) and the text resource groups (P < 0.01). There was no significant difference between those who used the text or screencast resources. There was also no significant difference in knowledge retention between the different teaching methods for each subject.Following teaching, all three teaching modalities had similar effects on student confidence in the subjects, desire for educational channels dedicated to each topic, and preference for locally produced vs. externally produced videos. These findings have the potential to inform educators on which types of resources to create or to select for their students to have the best impact on learning.

The neuroanatomical consequences and pathological implications of bilingualism.

In recent years, there has been a rise in the number of people who are able to speak two or more languages. This has been paralleled by an increase in research related to bilingualism. Despite this, much of the neuroanatomical consequences and pathological implications of bilingualism are still subject to discussion. This review aims to evaluate the neuroanatomical structures related to language and to the acquisition of a second language as well as exploring how learning a second language can alter one's susceptibility to and the progression of certain cerebral pathologies. A literature search was conducted on the Medline, Embase, and Web of Science databases. A total of 137 articles regarding the neuroanatomical or pathological implications of bilingualism were included for review. Following analysis of the included papers, this review finds that bilingualism induces significant gray and white matter cerebral changes, particularly in the frontal lobes, anterior cingulate cortex, left inferior parietal lobule and subcortical areas, and that native language and acquired language largely recruit the same neuroanatomical structures with however, subtle functional and anatomical differences dependent on proficiency and age of language acquisition. There is adequate evidence to suggest that bilingualism offsets the symptoms and diagnosis of dementia, and that it is protective against both pathological and age-related cognitive decline. While many of the neuroanatomical changes are known, more remains to be elucidated and the relationship between bilingualism and other neurological pathologies remains unclear.

Introduction of the Modified Neuroanatomy Motivation Questionnaire and Its Role in Comparing Medical Student Attitudes Towards Learning Neuroanatomy Between Neuro-enthusiasts and Standard Students.

BACKGROUND: Neurophobia has been identified as a potential barrier to adequate knowledge of neurology in the medical community, and therefore to patient safety. There is a drive to identify the source of neurophobia, in the hope of tackling it. Comparing the learning motivations of standard medical students with those who enjoy neuroanatomy may be a way of doing this. METHODS: The science motivation questionnaire (SMQ) was modified for neuroanatomy. It was distributed to three cohorts of second year medical students and students attending the extracurricular National Undergraduate Neuroanatomy Competition (NUNC). Cohen's D test for effect size was used to compare standard medical students and those attending the NUNC. RESULTS: Five hundred ninety-seven questionnaires were completed by second year students, and 320 by NUNC attendees. The differences in motivation to learn neuroanatomy between the 2 groups mainly fell into themes of career motivation, personal relevance, intrinsic motivation and assessment anxiety. CONCLUSION: This study has demonstrated the use of the SMQ in neuroanatomy, and found differences in motivators to learn neuroanatomy between self-selecting "neurophiles" and standard medical students, mainly relating to intrinsic motivation and its role in their lives. More research is needed to further explore these differences and how they might apply to interventions in medical school curricula.

Evaluating the Efficacy and Optimisation of the Peer-Led Flipped Model Using TEL Resources Within Neuroanatomy.

The flipped classroom (where students prepare before and then develop understanding during class) and technology-enhanced learning (audio-visual learning tools) are increasingly used to supplement anatomy teaching. However, the supporting literature lacks robust methodology and is conflicting in demonstrating efficacy outcomes. Contrastingly, near-peer teaching (where senior students teach juniors on the same academic programme) is well researched and reported to be both effective and versatile. This provides an ideal vehicle in which to investigate and potentially optimise these approaches.This study aims to assess educational impact of the peer-led flipped model and student engagement and perceptions regarding traditional and TEL resources.A quasi-randomised, cross-sectional study was conducted with 281 second-year University of Southampton medical students. Students were randomly allocated to 3 groups: traditional lecture (control), flipped text resource, or flipped video resource. The first group received no pre-teaching material, but the flipped groups received a text or video pre-teaching resource. Objective outcomes measured were: Knowledge gain and retention via multiple-choice questionnaires and formative exams Student perceptions and engagement using questionnaires and 2 focus groups All groups demonstrated significant knowledge gain post-teaching (p < 0.0001). However, regardless of engagement with pre-teaching material, no significant difference was found in knowledge gain or retention between the groups. Students engaged 21.1% more with the text rather than video resource (p = 0.0019), but spent equal time using both (p = 0.0948). All resources and teaching approaches were perceived 'very useful' with no significant differences found between groups. A qualitative approach utilising thematic analysis of focus groups identified 4 themes, including 'Attitudes towards flipped classroom', which revealed mixed reviews and perceptions from participants.This study has found the peer-led flipped model is of no detriment to educational impact compared to peer-led traditional approaches in a well-established peer teaching programme in undergraduate medicine at the University of Southampton. Students value traditional and video resources but engage with them differently. Additionally, it was reported that in this experiment, NPT did not seem well suited to the flipped classroom, suggesting a rare limitation of the utility of NPT application within an anatomy curriculum.

The Efficacy of Interdisciplinary Near-Peer Teaching Within Neuroanatomical Education-Preliminary Observations.

Near-Peer Teaching (NPT) is increasingly becoming an integral part of the medical curriculum. When considered alongside the increasing popularity of interdisciplinary education, it seems appropriate to explore NPT within an interdisciplinary context. In these observations, 3rd-year medical students taught 2nd-year psychology students neuroanatomy. The session was evaluated using three objective and subjective assays. A knowledge assessment test showed significant improvement after teaching, and there were significant improvements on self-perceived knowledge/attitudes towards neuroanatomy, as well as positive feedback on the use of NPT. These observations evidence the successful use of Interdisciplinary Near-Peer Teaching (INPT) within a neuroanatomical curriculum. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s40670-021-01238-6.

Working in Creative Partnership with Students to Co-Produce Neuroanatomy e-Learning Resources in a New Era of Blended Learning.

Anatomists are well placed to tackle the transition from face-to-face to blended learning approaches as a result of the rapidly forced changes brought about by Covid-19. The subject is extremely visual and has, therefore, previously been a target for the development of technology-enhanced learning initiatives over the last ten years. Today's students have come to expect the integration of technology in the classroom and remotely. They adjust quickly to the innovative use of new applications and software and have begun to integrate it within their own workflow for note taking and study aids. Given the intense drive toward blended deliveries of anatomy as a result of the Covid-19 pandemic, it is easy to picture how the benefits of working in partnership with students (in order to achieve many of these aims) would be possible, particularly in difficult subjects like neuroanatomy. In doing so, it provides anatomists with new opportunities to engage students in a way that aligns well with best practice frameworks for engaging students through partnership. The current United Kingdom guidelines set out by Advance HE (a professional membership organization for promoting excellence in higher education) strongly encourages the higher education community to seek out appropriate academic contexts where a balance of power can be struck between staff and student to create a community of practice. If such an approach can be fully embraced by anatomists, a strong argument can be made for seizing the opportunity to optimize the benefits of student partnership work in this discipline.

Multiple-Choice versus Open-Ended Questions in Advanced Clinical Neuroanatomy: Using a National Neuroanatomy Assessment to Investigate Variability in Performance Using Different Question Types.

Methods of assessment in anatomy vary across medical schools in the United Kingdom (UK) and beyond; common methods include written, spotter, and oral assessment. However, there is limited research evaluating these methods in regards to student performance and perception. The National Undergraduate Neuroanatomy Competition (NUNC) is held annually for medical students throughout the UK. Prior to 2017, the competition asked open-ended questions (OEQ) in the anatomy spotter examination, and in subsequent years also asked single best answer (SBA) questions. The aim of this study is to assess medical students' performance on, and perception of, SBA and OEQ methods of assessment in a spotter style anatomy examination. Student examination performance was compared between OEQ (2013-2016) and SBA (2017-2020) for overall score and each neuroanatomical subtopic. Additionally, a questionnaire explored students' perceptions of SBAs. A total of 631 students attended the NUNC in the studied period. The average mark was significantly higher in SBAs compared to OEQs (60.6% vs. 43.1%, P < 0.0001)-this was true for all neuroanatomical subtopics except the cerebellum. Students felt that they performed better on SBA than OEQs, and diencephalon was felt to be the most difficult neuroanatomical subtopic (n = 38, 34.8%). Students perceived SBA questions to be easier than OEQs and performed significantly better on them in a neuroanatomical spotter examination. Further work is needed to ascertain whether this result is replicable throughout anatomy education.

TEL Methods Used for the Learning of Clinical Neuroanatomy.

Ubiquity of information technology is undoubtedly the most substantial change to society in the twentieth and twenty-first centuries and has resulted in a paradigm shift in how business and social interactions are conducted universally. Information dissemination and acquisition is now effortless, and the way we visualise information is constantly evolving. The face of anatomy education has been altered by the advent of such innovation with Technology-Enhanced Learning (TEL) now commonplace in modern curricula.With the constant development of new computing systems, the temptation is to push the boundaries of what can be achieved rather than addressing what should be achieved. As with clinical practice, education in healthcare should be evidence driven. Learning theory has supplied educators with a wealth of information on how to design teaching tools, and this should form the bedrock of technology-enhanced educational platforms. When analysing resources and assessing if they are fit for purpose, the application of pedagogical theory should be explored and the degree to which it has been applied should be considered.

The Career Impact of the National Undergraduate Neuroanatomy Competition.

BACKGROUND: Neurosurgery is a notoriously difficult career to enter and requires medical students to engage in extracurricular activities to demonstrate their commitment to the specialty. The National Undergraduate Neuroanatomy Competition (NUNC) was established in 2013 as a means for students to display this commitment as well as academic ability. METHODS: A bespoke 22-item questionnaire was designed to determine career outcomes and the role of competition attendance in job applications. It was distributed using the SurveyMonkey website to the 87 attendees at the 2013 and 2014 competitions. RESULTS: Responses were received by 40 competitors (response rate, 46.0%). Twenty-four responders (60.0%) intended to pursue a career in either neurosurgery (n = 18) or neurology (n = 6). This included 10 responders (25.0%) who had successfully entered either neurosurgery (n = 9) or neurology (n = 1). The performance of these 10 was significantly better than the other responders (57.0 ± 13.6% vs. 46.5 ± 13.5% [n = 30]; P = 0.036). Seventeen responders (42.5%) either included their attendance at NUNC in a post-Foundation job application or intend to. CONCLUSIONS: The NUNC provides the opportunity for medical students to demonstrate their interest in neurosurgery. It has the potential to be used as a tool for recognizing medical students suitable for neurosurgery training.

Assessing the Role of Screencasting and Video Use in Anatomy Education.

The subject of anatomy, commonly taught with applied clinical focus on medical programmes, is frequently brought to life alongside art, imagery and visualization. Yet, despite being continually hailed as the cornerstone of medicine, the cyclic revalidation of its curricula has often found its educators in the unenviable position of maintaining knowledge standards in the face of reduced contact time. However, the gravity of such challenges has created an opportunity for creative and innovative solutions to these problems. The ease by which educational technology can now be used by non-experts is constantly increasing and the use of technology enhanced learning has now become universal within Higher Education. Many anatomical science educators have turned to building bespoke interactive and engaging online supplementary material which can be blended with face to face delivery as a way to circumvent the time pressure issues. Today's students appear to have a growing preference for visualising moving images and audio explanations as opposed to older traditional static resources, underpinned by vast pages of unattractive dense text and pictures. One such technique being used to provide flexible and student-centred learning is screencast videos. These digital recordings of screen captured drawings, with accompanying narration are overwhelmingly popular with students and on the ascendance. However, as new tools emerge, it becomes increasingly important to determine their impact on both the student experience and knowledge gain. It is also valuable for educators to share their classroom experiences or instructional techniques to optimise their use for learning. This chapter explores the rise of this application in anatomy education and discusses the evidence available investigating student engagement and learning outcomes in the context of well-established learning theories.

Reviewing the Role of Instagram in Education: Can a Photo Sharing Application Deliver Benefits to Medical and Dental Anatomy Education?

Instagram is an increasingly popular social media site tailored towards sharing photos and videos. An audit investigating current Instagram accounts focusing on anatomy education found a variety of successful teaching styles, including clinical images, descriptive videos, multiple-choice questions, and cartoons. Utilising Instagram for educational purposes, benefits such as ease of use, hashtags, and its effectiveness in conveying visual topics should be weighed against limitations such as passive learning and the requirement of committed staff to oversee its use.

The Efficacy of Frontline Near-Peer Teaching in a Modern Medical Curriculum.

Within medical education a reduction in curriculum time for subjects, such as anatomy puts pressure on educators to ensure the same learning outcomes are conveyed in less time. This has the potential to impact negatively on student experience. Near-peer teaching (NPT) is often praised as an effective revision tool, but its use as a frontline teaching resource remains unreported. The study explores the potential for NPT to promote delivery of learning outcomes and maximize student experience within a neuroanatomy module for second year medical students. The study occurred in three educational settings, (1) frontline NPT of cranial nerves, (2) revision session NPT of cranial nerves, and (3) NPT alongside faculty staff in laboratory-based neuroanatomy practical exercises. For the first and second components, knowledge was measured using a pre- and post-session test and student perception was ascertained with a questionnaire. For the third component, student perception was assessed with an end-of-module survey. The results show that overall, NPT was well received by learners. A significant knowledge gain was seen between the pre- and post-session test of the frontline NPT session. The study presents evidence in favor of using NPTs to supplement the delivery of learning outcomes in a time and resource constrained curriculum. In particular, for the effective delivery of frontline material. Anat Sci Educ 0: 1-9. © 2018 American Association of Anatomists.

The National Undergraduate Neuroanatomy Competition: Lessons Learned from Partnering with Students to Innovate Undergraduate Neuroanatomy Education.

Undergraduates often perceive neuroscience to be a challenging discipline. As the scope of neuroscience continues to expand, it is important to provide undergraduates with sufficient opportunities to develop their knowledge and skills with the aim of encouraging the future generation of basic and clinical neuroscientists. Through our experience of developing the National Undergraduate Neuroanatomy Competition (NUNC), we have accrued an extensive volume of performance data and subjective insight into the delivery of undergraduate neuroanatomy education, which has the potential to inform how to better engage students within this field. More broadly, our group has implemented a technology enhanced learning platform alongside a peer-assisted teaching program. These achieve the dual purpose of compensating for the reduction in dedicated neuroanatomy teaching hours and encouraging undergraduates to develop an interest in the neurosciences. Here, we consider how improving the learning experience at an undergraduate level encourages further engagement in the neurosciences and the importance of this within the wider neuroscience community.