Resources for innovative learning of anatomy and foot ossification: Graphic design and virtual reality.

INTRODUCTION: This study addresses the ossification process of the foot, a topic of great relevance within podiatry courses. Understanding the chronology of foot bone formation is essential for evaluating pathological processes and establishing appropriate therapeutic actions to improve patient quality of life. The main objectives of this work are to understand the ossification process of the foot bones and to propose an appropriate didactic methodology for effective learning of this process. MATERIALS AND METHODS: The individual ossification sequences of the foot bones were established and virtually recreated to make these processes more didactic and usable as teaching aids. The literature search was conducted using the PRISMA statement, focusing on terms, such as "bone ossification," "foot," and "bone development," and included relevant studies from medical databases. RESULTS: Updating the ossification ages and providing previously unavailable visual teaching material offers a useful tool for improving the teaching of this subject. It was found that, in general, the tarsal bones show significant differences in ossification ages between sexes, with later and slower ossification in males. These differences are statistically analyzed and presented in detailed comparative tables. CONCLUSIONS: The use of innovative teaching tools, such as virtual anatomical models, helps students to better understand the ossification process of foot bones. Implementing these tools in the podiatry curriculum not only facilitates knowledge acquisition but also enhances the quality of teaching and, consequently, the future clinical practice of students.

An exploration of metacognitive practices in medical educators.

Metacognition is the ability to monitor and evaluate one's thoughts about learning and has been shown in some studies to improve the effectiveness of instructors. With dissection-based gross anatomy, instructors dynamically use their metacognition to monitor student learning and adapt their teaching at tableside. This study explored the metacognition of instructors as they taught in an anatomy course for allied health students. All instructors in a doctoral-level gross anatomy course at a single institution, including faculty, associate instructors (AIs), and teaching assistants (TAs), were invited to participate. At the start and end of the course, participating instructors completed pre- and post-questionnaires, which included the Teacher Metacognition Inventory (TMI), a 28-item survey that assesses metacognition as it relates to teaching. After labs, instructors completed reflective journals to provide deeper insight into their metacognition. Reflective journals were then thematically analyzed. Thirteen (52%) instructors participated in this study, including five faculty, three AI, and five TAs. Between the start and end of the course, total TMI score increased from 108.8 to 114.3 (p = 0.046). TAs exhibited the greatest change in total TMI score (Δmean = +11.4) followed by faculty (Δmean = +3.2) and AIs (Δmean = -0.7). Several themes were also identified. For example, TAs were more internally focused on content mastery, whereas faculty were externally focused on interpersonal factors (e.g., inclusive language). These insights into the metacognition of anatomy instructors, though limited in reliability and generalizability, may inform how to best support their professional development. Novices may benefit from content reviews, while experienced instructors may benefit from inclusivity or communications training.

Perspective or Spectacle? Teaching thoracic aortic anatomy in a mixed reality assisted educational approach- a two-armed randomized pilot study.

PURPOSE: Anatomical understanding is an important basis for medical teaching, especially in a surgical context. The interpretation of complex vascular structures via two-dimensional visualization can yet be difficult, particularly for students. The objective of this study was to investigate the feasibility of an MxR-assisted educational approach in vascular surgery undergraduate education, comparing an MxR-based teaching-intervention with CT-based material for learning and understanding the vascular morphology of the thoracic aorta. METHODS: In a prospective randomized controlled trial learning success and diagnostic skills following an MxR- vs. a CT-based intervention was investigated in 120 thoracic aortic visualizations. Secondary outcomes were motivation, system-usability as well as workload/satisfaction. Motivational factors and training-experience were also assessed. Twelve students (7 females; mean age: 23 years) were randomized into two groups undergoing educational intervention with MxR or CT. RESULTS: Evaluation of learning success showed a mean improvement of 1.17 points (max.score: 10; 95%CI: 0.36-1.97). The MxR-group has improved by a mean of 1.33 [95% CI: 0.16-2.51], against 1.0 points [95% CI: -0.71- 2.71] in the CT-group. Regarding diagnostic skills, both groups performed equally (CT-group: 58.25 ± 7.86 vs. MxR-group:58.5 ± 6.60; max. score 92.0). 11/12 participants were convinced that MxR facilitated learning of vascular morphologies. The usability of the MxR-system was rated positively, and the perceived workload was low. CONCLUSION: MxR-systems can be a valuable addition to vascular surgery education. Further evaluation of the technology in larger teaching situations are required. Especially regarding the acquisition of practical skills, the use of MxR-systems offers interesting application possibilities in surgical education.

Anatomage virtual dissection versus traditional human body dissection in anatomy pedagogy: insights from Ghanaian medical students.

BACKGROUND: Although traditional human body dissection has been the mainstay method for gross anatomy pedagogy, the popularity of virtual teaching methods has increased in recent years. The Anatomage table offers a life-size digital representation of the human body and allows visualization, manipulation, and virtual dissection. This study investigated the perception of medical students towards virtual dissection vis-à-vis traditional dissection in anatomy pedagogy. METHODS: The cross-sectional survey included medical students at the University of Ghana who completed an internet-based questionnaire administered using Google® Forms. The questionnaire comprised 20 close-ended questions that solicited information on demographics, experience with traditional human body dissection and virtual dissection, and perception of virtual dissection. Data was summarized as frequencies and percentages with 95% confidence intervals. RESULTS: Of the 297 participants, 295 [99.4% (95% CI = 97.3-99.9)] participated in human body dissection from which 93.2% had a positive and 6.8% had poor experiences. Whereas 223 [75.1% (95% CI = 69.7-79.8)] of the participants would participate in dissection again given the opportunity, 74 [24.9% (95% CI = 20.2-30.3)] were unwilling. Of 297 participants, 205 [69.0% (95% CI = 69.7-74.2)] had used Anatomage table, while 92 [31.0% (95% CI = 25.8-36.6)] had not. About 68% (95% CI = 60.8-74.0) of the 205 agreed with the relative ease of operation and use of the Anatomage table compared to traditional human body dissection while 9.4% disagreed. Inadequate operational skills [51% (95% CI = 48.9-53.4)] and limited accessibility [39% (95% CI = 35.2-42.3)] were limitations to Anatomage use. 66.8% (95% CI = 59.9-73.1) of participants agreed virtual dissection had a positive influence on learning anatomy while 6.6% disagreed. Of the 205, 87.9% (95% CI = 82.3-91.8) discouraged virtual anatomy dissection completely replacing traditional human body dissection. CONCLUSION: Virtual dissection is an effective supplement to traditional body dissection but not a replacement. Its use alongside traditional methods improves anatomy learning. Integrating technology into anatomy education will enhance student engagement and learning.

Changes in high school students attitudes toward health sciences following a hands-on outreach STEM program.

Despite attempts to diversify healthcare workplaces and education, racial and ethnic minorities (REM) remain underrepresented in these fields. This study investigated changes in high school students' health science interest following a single exposure, hands-on anatomy laboratory visit. One hundred and eighty-eight high school students participated in a single day, one-hour visit to a human anatomy laboratory on a university campus. Participants engaged in hands-on activities centered around both human and animal specimens led by university mentors. Using a modified Science Technology Engineering and Mathematics-Career Interest Survey (STEM-CIS) questionnaire, health science STEM interest was calculated before and after the visits and compared using a paired t-test (α = 0.05). A 2 × 2 ANOVA (α = 0.05) was run on pre-to-post-visit interest score differences with factors of Race (White/REM) and Gender (Male/Female) to determine if race/ethnicity and/or gender moderated the gains observed. Overall, health science STEM interest increased significantly from pre- to post-visit (p < 0.001), and these gains were greater in REM students (p < 0.05) but did not differ as a function of gender. These findings indicate that a single visit to an anatomy laboratory with hands-on activities can be used as a tool to engage high school aged students in STEM and may be particularly beneficial for racial/ethnic minority students, potentially influencing health science STEM interest.

Perspectives of a non-medically and a medically qualified early career anatomy academic on facilitating case-based learning sessions for undergraduate medical students.

Case-based learning (CBL) is a student-centered pedagogy where medical students are given a real-world clinical problem. At St George's University of London (SGUL), anatomy academics can volunteer to facilitate CBL sessions for pre-clinical undergraduate medical students. The major benefits of facilitating CBL sessions from the perspective of a non-medically qualified early career anatomy academic (ECAA) include exposure to clinical cases that help the academic develop an understanding over key clinical cases at the context of clinical anatomy and other disciplines including physiology, pathology, and pharmacology. Furthermore, facilitating CBL sessions assists in the acquisition of basic knowledge over history taking, the conduction of clinical examinations, the investigations performed for the diagnosis of a condition as well as how it is managed. The major benefits of facilitating CBL sessions from the perspective of a medically qualified ECAA include staying in touch with the clinical aspect of medicine and becoming familiar with the country's healthcare system and its professional standards. Perceived benefits shared by both the non-medically and medically qualified ECAA include the opportunity to become familiar with the structure and key elements of the pre-clinical medical curriculum as well as gain experience in facilitating small group teaching sessions. Overall, facilitating CBL sessions can help non-medically and medically qualified ECAAs in different contexts that may help them with their individual career goals, can encourage collaborative discussions between clinical and non-clinical anatomy academics as well as help bridge the gap between the anatomy teaching approaches employed by non-medically qualified and medically qualified anatomy academics.

General skills amidst the details: alternative learning objectives and a framework of competencies for human anatomy.

The field of anatomy is often seen by nonanatomists as concerned primarily with the tasks of locating, naming, and describing structures; these tasks, in turn, are often assumed to require only lower-order cognitive skills (LOCSs), i.e., the Knowledge or Comprehension levels of Bloom's taxonomy. Many nonanatomists may thus believe that studying anatomy does not develop transferable higher-order cognitive skills. Published lists of anatomy learning objectives (LOs) might reinforce this view by focusing attention on numerous details of specific structures and regions. To explore this issue further, we have analyzed the structure of published peer-reviewed LOs by characterizing their organization (single-tiered or multi-tiered), inclusion of function, use of action verbs, and dependence on or independence of context. Our results suggest that previously published LO lists, despite their value, may not fully showcase opportunities for students to develop higher-order skills. In the hope of stimulating further discussion and scholarship, we present here a two-tiered framework of human anatomy competencies, i.e., generalizable skills beyond straightforward recognition and memorization. This framework, which is intended to be both student-facing and faculty-facing, illustrates how anatomy courses may be reframed as opportunities to think critically and develop sophisticated, professionally relevant skills.NEW & NOTEWORTHY Although skilled anatomists know that anatomy is much more than memorization, nonanatomists are often unsure how to emphasize general skills and problem-solving in their teaching of the subject. Here we show how a multi-tiered approach to defining and assessing learning objectives (LOs) can reframe anatomy courses as more than long lists of structures to remember.

Influence of learning strategies and motivation on anatomy test performance of undergraduate medical students.

To learn and comprehend the large amount of information in gross anatomy, undergraduate students must self-regulate their learning to be properly prepared for the exams within the available time. Even though there are many studies on learning strategies and their influence on test results and motivation, the aim of this study is to investigate characteristics of learning strategies in detail and in relation to the anatomy course of first semester students and how their use is related to anatomy test performance. For assessing the learning strategies, we used the short version of the questionnaire "Learning Strategies of University Students" (LIST-K) (Klingsieck, 2018). Further, we investigated potential influences of motivation and resources used during the self-regulated learning process. The participants in this study (N = 108) filled in the above-mentioned questionnaire LIST-K and a written multiple-choice anatomy test. A k-means cluster analysis revealed three groups of students differing in their self-reported use of learning strategies. Students used either (1) predominantly metacognitive and resource-related strategies, (2) predominantly cognitive strategies, or (3) no specific learning strategies at all. We found no significant overall relationships between the use of learning strategies and test performance. A stepwise linear regression identified the use of cognitive learning strategies (ß =.269) as a significant predictor for test performance (R² =.149, p =.003), possibly as these specific learning strategies help with a systematic and effective approach while studying anatomy and retrieving large amount of memorized information. Further, motivation was identified as a negative predictor (ß = -.277), which might be a result of the short time periods students have to study for exams. Overall findings underline the importance of self-regulated learning as a positive predictor for academic performance. By understanding these factors, a more student-centered approach could be adopted by educators to improve medical education and equip students with valuable approaches for their continuous education, even beyond university.

Haptic experience to significantly motivate anatomy learning in medical students.

BACKGROUND: Currently, multiple tools exist to teach and learn anatomy, but finding an adequate activity is challenging. However, it can be achieved through haptic experiences, where motivation is the means of a significant learning process. This study aimed to evaluate a haptic experience to determine if a tactile and painting with color marker interactive experience, established a better learning process in comparison to the traditional 2D workshop on printed paper with photographs. METHODS: Plaster bone models of the scapulae, humerus and clavicle were elaborated from a computerized scan tomography. Second year undergraduate medical students were invited to participate, where subjects were randomly assigned to the traditional 2D method or the 3D plaster bone model. A third group decided not to join any workshop. Following, all three groups were evaluated on bone landmarks and view, laterality, muscle insertions and functions. 2D and 3D workshop students were asked their opinion in a focus group and answered a survey regarding the overall perception and learning experience. Evaluation grades are presented as mean ± standard deviation, and answers from the survey are presented as percentages. RESULTS: The survey demonstrated the students in the 3D model graded the experience as outstanding, and in five out of the six questions, answers were very good or excellent. In contrast, for students participating in the 2D workshop the most common answers were fair or good. The exception was the answer regarding the quiz, where both groups considered it good, despite the average among all groups not being a passing grade. CONCLUSIONS: To learn the anatomy of the shoulder, the conventional methodology was compared with a haptic experience, where plaster bone models were used, enabling students to touch and paint on them. Based on the focus group and survey this study revealed the 3D workshop was an interactive experience where, the sense of touch and painting greatly contributed to their learning process. Even though this activity was useful in terms of learning bone landmarks, view muscle insertions, and establish relations, further activities must be developed to increase their understanding regarding their function, and its relevance in a clinical setting.

Delphi Analysis: Optimizing Anatomy Teaching and Ultrasound Training for Botulinum Neurotoxin Type A Injection in Spasticity and Dystonia.

Our objective was to provide expert consensus on best practices for anatomy teaching and training on ultrasound-guided botulinum neurotoxin type A (BoNT-A) injection for specialists involved in treating spasticity and dystonia. Nine experts (three neurologists; six physical medicine and rehabilitation physicians) participated in a three-round modified Delphi process. Over three rounds, experts reached consensus on 15 of 16 statements describing best practices for anatomy and BoNT-A injection training. They unanimously agreed that knowledge of the target audience, including their needs and current competency, is crucial when designing training programs. Experts also agreed that alignment between instructors is essential to ensure consistency of approach over time and between regions, and that training programs should be simple, adaptable, and "hands-on" to enhance engagement and learning. Consensus was also reached for several other key areas of training program development. The best-practice principles identified by expert consensus could aid in the development of effective, standardized programs for anatomy teaching and BoNT-A injection training for the purposes of treating spasticity and dystonia. This will enhance the exchange of knowledge, skills, and educational approaches between global experts, allowing more specialists to treat important movement disorders and ultimately improving patient outcomes.

Exploring the ambiguity in the anatomical terminology among Dental professionals.

BACKGROUND: Anatomical terms in medical literature have been used with varying meanings, leading to confusion in clinical practice. This study aims to investigate the ambiguity of anatomical terms in clinical dentistry. METHODS: Dentists who have undergone specialised training with at least one year of clinical experience were recruited to participate in the study. They were requested to localize specific terms on a skull and provide explanations based on their experience or opinion. All data were recorded, and then descriptive statistics were used for analysis. RESULTS: Seventy-eight participating dentists gave their consent and were eligible to study. For each anatomical term presented to dentists at least two meanings were provided, with some terms having up to eight interpretations. While most meanings were consistent with medical or dental literature, some responses revealed new interpretations not documented in textbooks. CONCLUSIONS: Dentists expressed anatomical terms with diverse meanings, possibly influenced by their various subspecialties. It is crucial to acknowledge this variability to prevent confusion. Emphasizing the consistent use of anatomical terms among dental professionals in the future is essential.

Creating new embryological models for teaching cardiac development in embryology.

Embryology is an essential component to understanding human anatomy. It requires an in-depth understanding of 3D knowledge but is primarily taught with 2-dimensional resources. In particular, the development of the human heart is a complex process and difficult to understand using traditional teaching methods. We present here a series of heart embryology models created to supplement embryology education and aid students in understanding this complex process. Using Polydoh moldable plastic, models representing six different critical steps in heart formation are described, including: the fusing of the heart tubes (days 21-23), beginning of the cardiac loop (early day 23), fully formed cardiac loop (late day 23), four-week heart, formation of the endocardial cushions and septi (late fourth week), and heart with fully formed septi with functioning foramen ovale (sixth week). These models not only improve embryology education but also the understanding of heart pathologies. This method provides an affordable option for embryology education and provides students with learning tools that assist with the comprehension of the development of a complex organ.

Does dissection influence weight bias among doctor of physical therapy students?

Anatomy with human dissection may help to develop respect for the human body and professionalism; however, dissection may worsen students' attitudes about body weight and adiposity. The purpose of this study was to measure weight bias among Doctor of Physical Therapy (DPT) students enrolled in gross anatomy and determine if, and how the experience of dissection impacts weight bias. Ninety-seven DPT students (70 University of Colorado [CU], 27 Moravian University [MU]) were invited to complete a survey during the first and final weeks of their anatomy course. The survey included demographic items, two measures of weight bias-the Modified Weight Bias Internalized Scale (M-WBIS) and the Attitudes Towards Obese Persons (ATOP) Scale-and open-ended questions for the students who participated in dissection (CU students) that explored attitudes about body weight and adiposity. At baseline, there were no significant differences (p > 0.202) in ATOP, M-WBIS, or BMI between the two universities. The mean scores on both the ATOP and M-WBIS indicated a moderate degree of both internalized and externalized weight bias. There were no significant changes in ATOP (p = 0.566) or M-WBIS scores (p = 0.428). BMI had a low correlation with initial M-WBIS scores (⍴ = 0.294, p = 0.038) and a high correlation with change scores in CU students (⍴ = 0.530, p = 0.011). Future studies should utilize the same measures of weight bias in other healthcare trainees to facilitate comparison and incorporate larger populations of DPT students.

ChatGPT versus a customized AI chatbot (Anatbuddy) for anatomy education: A comparative pilot study.

Large Language Models (LLMs) have the potential to improve education by personalizing learning. However, ChatGPT-generated content has been criticized for sometimes producing false, biased, and/or hallucinatory information. To evaluate AI's ability to return clear and accurate anatomy information, this study generated a custom interactive and intelligent chatbot (Anatbuddy) through an Open AI Application Programming Interface (API) that enables seamless AI-driven interactions within a secured cloud infrastructure. Anatbuddy was programmed through a Retrieval Augmented Generation (RAG) method to provide context-aware responses to user queries based on a predetermined knowledge base. To compare their outputs, various queries (i.e., prompts) on thoracic anatomy (n = 18) were fed into Anatbuddy and ChatGPT 3.5. A panel comprising three experienced anatomists evaluated both tools' responses for factual accuracy, relevance, completeness, coherence, and fluency on a 5-point Likert scale. These ratings were reviewed by a third party blinded to the study, who revised and finalized scores as needed. Anatbuddy's factual accuracy (mean ± SD = 4.78/5.00 ± 0.43; median = 5.00) was rated significantly higher (U = 84, p = 0.01) than ChatGPT's accuracy (4.11 ± 0.83; median = 4.00). No statistically significant differences were detected between the chatbots for the other variables. Given ChatGPT's current content knowledge limitations, we strongly recommend the anatomy profession develop a custom AI chatbot for anatomy education utilizing a carefully curated knowledge base to ensure accuracy. Further research is needed to determine students' acceptance of custom chatbots for anatomy education and their influence on learning experiences and outcomes.

Journal recommended guidelines for survey-based research.

Survey-based research is vital in education and social sciences, offering insights into human behaviors and perceptions. The prevalence of such studies in medical education has risen by 33% over the past decade. Despite this growth, the utility of survey findings depends on the study design quality and measure validity. Many manuscripts are rejected due to poor planning and lack of validity evidence. These guidelines aim to improve the rigor and reporting of survey-based research, ensuring credibility and reproducibility. They apply to various survey tools and evaluations, setting a standard for manuscript quality and informing the review process for Anatomical Science Education.

Journal recommended guidelines for systematic review and meta-analyses.

Systematic reviews and meta-analyses aggregate research findings across studies and populations, making them a valuable form of research evidence. Over the past decade, studies in medical education using these methods have increased by 630%. However, many manuscripts are not publication-ready due to inadequate planning and insufficient analyses. These guidelines aim to improve the clarity and comprehensiveness of reporting methodologies and outcomes, ensuring high quality and comparability. They align with existing standards like PRISMA, providing examples and best practices. Adhering to these guidelines is crucial for publication consideration in Anatomical Sciences Education.

El Trabajo Colaborativo como una Competencia Deseable en el Contexto del Aprendizaje de Anatomía Humana: Su Desarrollo Mediante Aula Invertida / Collaborative Work as a Desirable Competence in the Context of Learning Human Anatomy: Development Through a Flipped Classroom

El estudio de la anatomía humana como asignatura básica tiene el desafío de promover el desarrollo de competencias genéricas en los estudiantes. Tal es el caso del trabajo colaborativo, trascendental en el trabajo en salud. Así, aparece aula invertida cuyo esquema desarrolla actividades de trabajo en equipo. Por ello, el objetivo de este trabajo es analizar el impacto de aula invertida sobre el trabajo colaborativo en la enseñanza de la anatomía. Estudio cuantitativo, transversal, no experimental que involucró la implementación de aula invertida en un curso de Terapia Ocupacional de 2023. A partir de 5 sesiones planificadas se desarrollaron trabajos en 6 grupos; incluyeron síntesis de contenido y casos clínicos. Al cerrar el semestre se determinó un promedio de calificaciones (PC), junto a una autoevaluación (AE) y coevaluación (CE) que midió trabajo colaborativo mediante 3 subcompetencias (SC1-SC3) (escala 1,0 a 7,0). Se aplicaron pruebas estadísticas para determinar diferencias entre de SC1-SC3 según AE y CE, por grupos y si existe relación con PC. La prueba de U de Mann Whitney no arrojó diferencias entre AE y CE. La prueba de Friedman no evidenció diferencias entre SC1-SC3. La prueba H de Kruskal-Wallis halló diferencias de las subcompetencias según grupos; SC1 podrían influir en el PC, SC2 registra diferencias en el grupo G1 y G5, y "gestión de conflictos" (SC3) no difiere de forma destacada entre los grupos. La correlación de Spearman presenta una asociación positiva débil entre las subcompetencias y PC, aunque el valor-p no fue significativo. Es sumamente necesario potenciar el trabajo colaborativo en el inicio del pregrado. Anatomía humana, en este contexto, tiene la oportunidad de promover su desarrollo. Ello puede generarse en el marco de aula invertida, cuyo esquema promueve actividades de trabajo colaborativo, y como es sabido, en el rendimiento académico.

SUMMARY: As a basic subject, the study of human anatomy challenges the development of generic skills in students. Such is the case of collaborative work which is transcendental in the areas of healthcare work. Consequently, an inverted classroom is developed wherein teamwork activities are developed. The objective of this work is to analyze the impact of the flipped classroom on collaborative work in teaching anatomy. A quantitative, cross-sectional, non-experimental study that involved the implementation of a flipped classroom in an Occupational Therapy course in 2023 was applied. From 5 planned sessions, work was developed in 6 groups; they included content synthesis and clinical cases. At the end of the semester, a grade average (GA) was determined, along with a self-assessment (SA) and co-assessment (CA) measuring collaborative work through 3 sub competences (SC1-SC3) (scale 1.0 to 7.0). Statistical tests were applied to determine differences between SC1-SC3 according to SA and CA, by groups and if there is a relationship with GA. The Mann Whitney U test did not show differences between SA and CA. The Friedman test did not show differences between SC1-SC3. The Kruskal-Wallis H test found differences in sub competences according to groups; SC1 could influence GA, SC2 records differences in group G1 and G5, and "conflict management" (SC3) does not differ significantly between the groups. The Spearman correlation presented a weak positive association between the sub competences and GA, although the p-value was not significant. It is extremely necessary to promote collaborative work at the beginning of the undergraduate degree. In this context, human anatomy is an opportunity to promote its development. This can be generated within the framework of the inverted classroom promoting collaborative work activities, and academic performance as well.