Lessons learned while creating an effective emergency remote learning environment for students during the COVID-19 pandemic.

The COVID-19 pandemic is forcing many institutions to consider remote, virtual instruction for the safety of employees and students. Based upon the authors' experiences in transforming preclerkship medical science courses to virtual platforms, this paper shares tips for faculty rapidly establishing remote medical science instruction. With planning and support, faculty can create engaging, high-quality educational experiences for learners.

A comparison of the effectiveness of dissection and prosection on short-term anatomic knowledge retention in a reciprocal peer-teaching program.

Few discussions regarding instructional methods incite as much passion as the debate over dissection versus prosection. Despite numerous analyses, few studies have isolated the impact of dissection versus prosection from the numerous variables that are involved in anatomy education. This study used a retrospective design to assess the effect of peer teaching with dissection or prosection on anatomical knowledge retention of the peer teachers. Exam scores were analyzed from three cohorts of students (N = 184) who were enrolled in a Musculoskeletal System course in an allopathic medical school between academic years 2014-2017. Students in the first 2 yr learned anatomy of an assigned region through traditional dissection, whereas students in the third year learned anatomy of the same regions on prosected specimens. The effect of these instructional methods on anatomical knowledge retention was measured by student performance on a teaching-readiness quiz, written exam, and practical examination. One advantage of this study is the stability of variables between cohorts. Student groups peer taught the same objectives; course sequencing and content remained consistent between years; students spent the same amount of time learning their material, regardless of learning modality (dissection or prosection); and students were tested in the same manner. Comparisons of student performance data suggest that anatomy knowledge was equivalent, regardless of the instructional method (dissection or prosected cadavers) but is strongly associated with prior anatomy experience. Findings from this study support previous studies that conclude that there are no disparities in the effectiveness of learning anatomy via dissection or prosection.

Structure and function: how to design integrated anatomy and physiology modules for the gross anatomy laboratory.

Physicians must be able to integrate knowledge across disciplines. Therefore, educators need to provide opportunities for students to cognitively integrate information across the medical school curriculum. Literature has shown that specifically pointing out these connections helps students create cause and effect models and ultimately improve their performance. The gross anatomy laboratory provides an excellent environment for students to integrate information by establishing structure and function relationships. This article presents simple steps to create modules which help students cognitively integrate physiology and anatomy at the session level in the gross anatomy laboratory. Driven by backward design, these steps include establishing objectives, creating assessments, and developing activities that can be implemented in a specific learning environment. An example of a flexible module which could be implemented in a number of gross anatomy lab settings (e.g., prosection, dissection, models, virtual) is presented along with a template for the design of future modules. This is followed by a discussion of challenges encountered by educators attempting to integrate structure and function in the gross anatomy lab. Each of these considerations will be addressed with potential solutions for educators seeking to implement these types of integrated activities.

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.

Factors impacting the rapid transition of anatomy curricula to an online environment in response to Covid-19.

Due to the Covid-19 pandemic, many academic institutions had to rapidly transition education to a remote online environment. While a hurdle for most educators, this transition posed an even greater challenge for anatomy educators, many of whom were forced to depart from the traditional cadaver-based laboratory to a virtual format. Recent publications have discussed the rapid transition to online formats necessitated by Covid-19 and the accompanying difficulties, but none have identified specific factors that influenced the difficulty of this transition. Anatomy educators were surveyed to examine how this transition was accomplished and perceived. Of the 165 educators who responded, the majority utilized cadaver-based laboratory instruction. Educators felt that transitioning the laboratory portion of their courses was significantly more difficult and required more time than converting lecture materials. Factors that impacted the difficulty of the transition included a number of pedagogical aspects of the pre-Covid-19 curricula, including the delivery format of prior content, availability of pre-existing electronic materials, and the laboratory technique previously used. Additionally, the length of time an educator had been teaching prior to Covid-19 impacted their perception of difficulty, with newer and more senior educators finding this much more challenging than mid-tenure educators. Ease of transition may be related to previous exposure to curricular reform, experience with multiple anatomy pedagogies, and educator adaptability. While not surprising that converting a cadaver-based laboratory to an online format was challenging, knowledge of the alignment of this difficulty with prior educator pedagogy can help guide future innovations to anatomy education.

A comparison of three decalcification agents for assessments of cranial fracture histomorphology.

The extraction of mineral calcium from bone by decalcification is a critical step in the preparation of histological samples for light microscopy. This study assessed the time required for complete decalcification and the resultant histomorphological preservation of bone histomorphology by three decalcification agents: 7% hydrochloric acid (HCl), 5% nitric acid, and 10% ethylenediaminetetraacetic acid (EDTA). The goal of this study was to identify which decalcification agent provides the optimal combination of expedient processing and quality histological outcomes of cranial fracture samples. HCl provided the most rapid decalcification ( X ¯  = 3.57 days), nitric acid followed closely ( X ¯  = 10.35 days), while EDTA took significantly longer on average ( X ¯  = 78.97 days) but encompassed a broader range of times. Decalcification agent, sample thickness, sample width, and decedent age are significant predictors of decalcification time. Sample visualization quality, measured for tissues, cells, and nuclei on a five-point Likert scale, was highest for samples decalcified in 10% EDTA, second highest using 5% nitric acid, and lowest for 7% HCl. The quality difference between EDTA and nitric acid was not highly significant for any of the three features. For basic assessments of bone histomorphology, the study results indicate 5% nitric acid is suitable for the decalcification of adult specimens and samples thicker than 3 mm. EDTA is a suitable agent for thin samples of the cranial vault (<3 mm) from infants and young children less than three years old, decalcifying samples in a timeframe comparable to nitric acid while providing the best quality and clarity of samples.

The Value of Longitudinal Integrated TBLs and How to Create Them.

To mimic the experiences clinicians have with patients, longitudinally integrated team-based learning application exercises involving a group of patients who reappear across multiple courses in an integrated organ system-based curriculum were created to illustrate the multisystem nature of pathology. The aim of these cases was to provide student-centered learning opportunities that demonstrate how organ systems are interconnected in injury and disease and illustrate how a longitudinally integrated series of team-based learning activities can be woven throughout the preclinical curriculum.

Pedicle Screw Insertion: a Novel Approach to Enhance Anatomic Knowledge and Student Engagement.

A procedure experience was incorporated into the anatomy lab to advance knowledge of the spine and enhance student engagement (Nutt et al., Clin Teach 9(3):148-151, 2012). The spine lab was modified to include a scoliosis case with a pedicle screw placement simulation exercise. The experience has been a success for both undergraduate medical students and resident facilitators.