"" Improving Surgical Anatomy Teaching

Research Article

Austin J Anat. 2015; 2(3): 1042.

Improving Surgical Anatomy Teaching

Doomernik DE¹*, van Linge A¹, Donders R², Vorstenbosch MATM¹, van Goor H³ and Ruiter DJ¹

¹Department of Anatomy, Radboud University Medical Center, The Netherlands

²Department for Health Evidence, Radboud University Medical Center, The Netherlands

³Department of Surgery, Radboud University Medical Center, The Netherlands

*Corresponding author: Doomernik DE, Department of Anatomy, Radboud University Medical Center, Postbox 9101 6500 HB Nijmegen, The Netherlands

Received: October 05, 2015; Accepted: December 04, 2015; Published: December 07, 2015

Abstract

Background: Medical students in clinical settings may have difficulty to recall and apply anatomical knowledge in diagnostic reasoning and problemsolving. In this double blind prospective randomized trial we aimed to assess A) the learning effect of anatomy teaching in the Surgery Clerkship Preparation Course (SCPC) and B) whether offering an anatomical pretest has an additional learning effect.

Methods: In a 10 months period, 10 SCPC groups were randomly assigned in 2 study arms. The intervention arm (5 groups, n=128) received an anatomical pretest at day 1. The control arm (5 groups, n=135) received a sham pretest. All students participated in anatomy classes at day 2-4 and underwent an anatomical posttest at day 15. Pre- and posttest scores were corrected for item difficulty (Modified-Angoff method). Pre- and posttest scores of the intervention group were compared to assess the learning effect of anatomy teaching in the SCPC (Random Effects Model) and posttest scores of both groups were compared to assess the effect of pretesting.

Results: A significant improvement on posttest performance was seen in the intervention arm (p=<0.0005). No significant differences in posttest scores were seen (p=0.857) between the intervention and control group.

Discussion: This study demonstrates a significant learning effect of anatomy teaching in SCPC. However, no adjuvant effect of pretesting on directing students to subsequent learning was seen. These findings underscore the positive value of anatomy teaching in a SCPC and suggest that the pretest offered does not add to the learning effect in the current study design.

Keywords: Anatomy; Medical education; Subsequent learning; Pretesting

Abbreviations

SCPC: Surgery Clerkship Preparation Course; Radboudumc: Radboud University Medical Center; MCQ’s: Multiple-Choice Questions; TM: Trimmed Averages; CF: Correction Factor

Introduction

In most educational settings, tests have traditionally been used as assessment tools to evaluate students learning. Testing has been shown to increase long-term retention, i.e. ‘test-enhanced learning’. Test-enhanced learning refers to the fact that taking an initial test on previously studied material produces better retention over time than when not tested on that material. Frequent testing results indirectly in better retention due to increased efficiency of subsequent study time and improvement of study strategies. This phenomenon is called the testing-effect. Research suggests that the testing effect is driven by retrieval practice and not by repeated study [1,2].

Testing before study (i.e. pretesting) has shown to improve subsequent learning of pretested and non-pretested information and may lead to better recall [3,4]. The pre-testing effect is based on the finding that students score better in a pretest condition than in an extended learning condition on posttest performance. Pre-testing may be beneficial because it encourages a more active participation in learning, directs attention to important information and makes it easier to distinguish what is important to learn and what not even when test results are below average. However, a poor result on a pretest may also negatively affect the learning process [4].

The Radboud University Medical Center (Radboudumc) provides a problem-oriented, horizontally and vertically integrated medical curriculum. In the first 3 years of the undergraduate curriculum (Bachelor) the courses are organized by interdisciplinary themes, i.e. basic science and subsequent organ specific themes. During the last 3 years, the clinical phase (Master of Science), students follow a tailor made preparatory course each time they enter a clerkship of the clinical rotation in one of the major clinical disciplines, according to “the just in time” learning principle [5,6]. This “just in time” learning principle is based on the knowledge that spaced and vertical education, integration of basic sciences in an undergraduate and continuation of basic sciences in the later years of a medical curriculum, using problem based learning principles, improves knowledge retention and clinical reasoning [5,6].

We have observed that medical students in preparatory courses and in clinical settings have difficulty to recall, understand and apply their anatomical knowledge in diagnostic reasoning and problemsolving, especially regarding the surgery clerkship. We assume that anatomy teaching in a 3 weekly Surgery Clerkship Preparation Course (SCPC) prepare students’ well for their surgery clerkship. However, the learning effect of anatomy teaching in the SCPC has never been studied before. In the present study we aimed to assess in a double blinded prospective randomized trial A) the learning effect of teaching anatomy in the SCPC and B) whether offering an anatomical pretest has an additional learning effect.

Methods

Design and setting

During a period of 10 months, 10 SCPC groups (n=263) were randomly assigned into two arms of equal numbers. Students in the intervention arm (5 groups, n=128) were given an anatomical pretest at day 1, anatomy classes at day 2-4 and an anatomical posttest at day 15. Students in the control arm (5 groups, n=135) were given a sham pretest at day 1, anatomy classes at day 2-4 and a posttest at day 15 (Figure 1). Anatomy teaching was provided each month by the same two independent tutors. Both control and intervention group attended the same anatomy classes on applied anatomy of thorax, abdomen, upper and lower extremities. Basic anatomical knowledge is retrieved and students are trained in applying knowledge in diagnostic reasoning and problem solving through lectures, taskdriven non-directed self-study, tutorials and guided station-based cadaver practicals. The pretest consisted of 10 Multiple-Choice Questions (MCQ’s) with a maximum of four alternative answers at the level of the Bachelor Medical curriculum. The posttest consisted of 10 MCQ’s with a maximum of four alternative answers at the knowledge level that is expected after completing the anatomy classes in SCPC. The sham pretest included 11 statements about surgeons and the upcoming surgical clerkship on a five-point Likert scale (agree versus disagree). The multiple-choice questions and statements were formulated by one of the authors (AvL), and validated on content by an independent expert panel consisting of an anatomist, surgeon and three medical educationalists. The students were given 15 minutes to finish the assessment and encouraged to answer each question. An independent observer prevented peeking. No feedback was given. Both tutors and researcher were blinded for the randomization arm and the content of the questions of the pre- and posttest.