Lesson 62 Review Answers on Anatomy & Phys
Croat Med J. 2021 April; 62(2): 173–186.
The anatomy lesson of the SARS-CoV-2 pandemic: irreplaceable tradition (cadaver piece of work) and new teaching of digital technology
Ivan Banovac
1Department of Anatomy and Clinical Anatomy, University of Zagreb School of Medicine, Zagreb, Croatia
2Croatian Institute for Encephalon Enquiry and Center of Excellence for Basic, Clinical and Translational Neuroscience, Academy of Zagreb School of Medicine, Zagreb, Croatia
Vedran Katavić
1Department of Anatomy and Clinical Anatomy, Academy of Zagreb School of Medicine, Zagreb, Croatia
Andrea Blažević
aneDepartment of Beefcake and Clinical Anatomy, University of Zagreb Schoolhouse of Medicine, Zagreb, Republic of croatia
twoCroatian Constitute for Brain Research and Middle of Excellence for Basic, Clinical and Translational Neuroscience, University of Zagreb School of Medicine, Zagreb, Croatia
Ivana Bičanić
1Section of Anatomy and Clinical Beefcake, Academy of Zagreb Schoolhouse of Medicine, Zagreb, Croatia
2Croation Institute for Encephalon Enquiry and Eye of Excellence for Basic, Clinical and Translational Neuroscience, Academy of Zagreb School of Medicine, Zagreb, Croatia
Ana Hladnik
1Department of Beefcake and Clinical Anatomy, University of Zagreb Schoolhouse of Medicine, Zagreb, Croatia
2Croation Institute for Encephalon Inquiry and Heart of Excellence for Basic, Clinical and Translational Neuroscience, University of Zagreb School of Medicine, Zagreb, Republic of croatia
Nataša Kovačić
aneSection of Beefcake and Clinical Anatomy, University of Zagreb School of Medicine, Zagreb, Croatia
3Laboratory for Molecular Immunology, Croatian Found for Brain Research, University of Zagreb School of Medicine, Zagreb, Croatia
Zdravko Petanjek
1Department of Anatomy and Clinical Beefcake, University of Zagreb School of Medicine, Zagreb, Croatia
2Croation Establish for Encephalon Research and Center of Excellence for Basic, Clinical and Translational Neuroscience, Academy of Zagreb Schoolhouse of Medicine, Zagreb, Croatia
Received 2021 Jan xxx; Accustomed 2021 Mar 23.
- Supplementary Materials
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Supplementary material i
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Supplementary tabular array 1
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Supplementary table 2
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Supplementary figure 1
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Supplementary figure ii
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Supplementary figure 3
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Abstract
Aim
To compare the efficacy of different components of online and contact anatomy classes equally perceived past medical students.
Methods
An anonymous class evaluation survey was conducted at the end of the academic year 2019/2020. The organization of classes due to the SARS-CoV-2 pandemic provided our students with a unique opportunity to compare online and contact classes. Students' responses were analyzed co-ordinate to the type of obtained data (ratio, ordinal, and categorical).
Results
The response charge per unit was 95.58%. Approximately xc% of students establish anatomical dissection and practical work in full general to be the most important aspect of teaching, which could non exist replaced by online learning. During online classes, students missed the almost the interaction with other students, followed by the interaction with educatee teaching administration and educational activity staff. Very few students found contact lectures useful, with most students reporting that they could exist replaced with recorded video lectures. In dissimilarity, recorded video lectures were perceived as extremely helpful for studying. Regular weekly quizzes were essential during online classes as they gave students adequate feedback and guided their learning process. Students greatly benefitted from boosted form materials and interactive lessons, which were made hands bachelor via east-learning platform.
Conclusions
Anatomical dissection and interaction during contact classes remain the about important aspects of teaching anatomy. However, online didactics increases learning efficiency past allowing alternative learning strategies and by substituting sure components of contact classes, thus freeing upwardly more time for practical work.
From the middle of the final century, lecturers in anatomy courses for medical students have faced two major challenges. The commencement has been how to incorporate the speedily expanding new medical knowledge into the curricula. This required a reorganization of the existing curricula, and anatomy in detail was under pressure to reduce teaching hours and the pupil load (1-3). The second challenge has been how to modernize the teaching arroyo and didactically redesign the anatomy form. There has been pressure to supplant cadaver work due to high expenses and high organizational demands. In many medical schools, authorities have advocated the idea that cadaver piece of work can be replaced by other learning approaches with identical final outcomes (four). This pressure has become particularly notable in recent years and has been advocated by advancements in new digital technologies such as augmented and virtual reality (5).
Anatomy is 1 of the fundamental and most demanding courses in any medical school curriculum. A frequent bespeak of discussion is how to arroyo instruction anatomy and facilitate students' comprehension of difficult concepts and memorization of vast amounts of new information. Universities worldwide adopt different instruction approaches. Modern teaching ordinarily includes a combination of teaching methods within integrated and multimodal approaches to beefcake teaching (half dozen,vii). Six techniques for anatomy education have been proposed: in-person lectures, cadaveric autopsy, inspection of prosected specimens, models, radiological and living anatomy didactics, and computer-assisted learning (viii). Some universities have implemented curricular changes, especially since the time allotted to anatomy didactics in Europe, the U.s.a. of America, and Australia has considerably declined (9). The bulk of schools have switched from a completely traditional cadaver-based curriculum toward more than interactive custom-fabricated approaches that better fit the learning strategies of new generations and that appreciate technologies such as augmented and virtual reality, social networks, and imaging for a better understanding (7,10,eleven). Cadaver autopsy, considered a aureate standard for teaching anatomy (12), still remains widely used. While occasionally contested, its importance in different aspects of beefcake education has been proven by schools that returned to cadaver dissection after having temporarily abandoned it (3,xiii). Nonetheless, meta-analyses suggest that educators should appreciate and reevaluate each instructional method in order to meet all the students' needs, since none has and so far been proven superior to whatsoever other (14).
At the Academy of Zagreb School of Medicine (UZSM), nosotros teach a cadaver autopsy-oriented teaching curriculum, with the use of additional teaching methods/tools, such as prosection and instructions/demonstrations on cadavers and artificial anatomical models. In recent years, we have enhanced the provided e-learning by vastly expanding the materials and activities available on our online platform for communication and education. We have also implemented a new, functionally oriented textbook (15,16). These changes aimed to enhance the awareness of the subject's clinical relevance and to raise the students' active involvement in the course.
Our Department has been systematically assessing students' satisfaction with the Beefcake course through anonymous surveys (pupil evaluation of teaching) after the grade completion. The Anatomy course is taught during ii semesters in the first year of medical school. In the beginning semester of the academic year 2019/2020, we finished the planned curricular activities equally scheduled using our usual multimethod approach. In the second semester, the SARS-CoV-ii (COVID-19) pandemic forced us to switch to exclusively online instruction for an extended period of time (17,18). Online teaching was prolonged because of the heavy damage sustained by the UZSM buildings in an convulsion that hit Zagreb on March 22, 2020 (xix), immediately after the introduction of the outset lock-downwardly. We organized only a very brusque practical revision on cadavers and models in June, at the terminate of the academic year.
Such an organization of classes in the academic yr 2019/2020 allowed our students to provide unique feedback near the perceived advantages and disadvantages of different components of contact and online classes. Information technology also allowed them to evaluate the significance of these classes for meeting the beefcake course's aims and give feedback on the overall teaching arroyo of the faculty. Thus, we conducted a survey with the aim of analyzing information on the efficacy of contact and online classes in covering the anatomy course textile. We also analyzed how students' success on continuous assessment during the academic twelvemonth related to the way they responded to different survey questions and whether there were pregnant differences in those responses.
Fabric AND METHODS
This study was conducted at the stop of the Anatomy course (Integrated Undergraduate and Graduate Program of Studies In Medicine) at the University of Zagreb School of Medicine, as a part of the regular bearding grade evaluation survey conducted yearly.
Curriculum
Our beefcake grade is divided into three thematic blocks: A1 (Full general Anatomy, Anatomy of the Dorsum and Limbs), A2 (Anatomy of the Thorax, Abdomen, and Pelvis), and A3 (Anatomy of the Head and Neck). The gross and functional beefcake of the fundamental nervous organization is covered by the Fundamentals of Neuroscience course in the second year. Each course cake is divided into two parts. In part A, students learn the relevant general and systemic beefcake through lectures (mostly ex cathedra presentations of the course material); seminars, which include discussions in eye-sized groups; and practical work, which includes learning using prosections (previously dissected specimens) and anatomical models. In part B, students learn topographic anatomy by performing cadaver dissection themselves. After each course cake, students take a fractional written test, which consists of multiple-choice and matching questions assessing their theoretical noesis, and a partial practical test, in which students accept to name anatomical structures marked on anatomical specimens. The students who laissez passer the fractional exams are exempt from the corresponding portions of the terminal exam. The last examination consists of a written role, practical role, and oral part, with the final form determined by the noesis displayed in the oral exam.
In recent years, the Department has been gradually increasing the use of online teaching as an aid to traditional classes by adding diverse materials to our e-learning platform. These included engaging online activities, such as quizzes and interactive lessons covering clinically related anatomical problems (clinical cases). The Department has changed the obligatory literature to a didactically modernized textbook, which covers gross anatomy in a broader context and is functionally oriented with the aim of being more relevant to future clinical practitioners. In parallel, the Department preserved traditional classes involving applied piece of work (on cadavers, models, and prosections) and anatomical dissection as the core of the educational activity process.
In the bookish yr 2019/2020, due to the global SARS-CoV-2 pandemic and the extensive damage to Department of Anatomy building acquired by the Zagreb earthquake, a big portion of the Beefcake form (the second half of the A2 office and the entire A3 role) was held entirely online. Online classes included pre-recorded video lectures, selected links to animations, and other freely available online material, self-evaluation quizzes, clinical cases in the class of interactive lessons, additional explanations of challenging topics, textbook elaborations, and presentation slides. During online classes, students were frequently evaluated (at least once a week) via online quizzes, through which they received bonus or malus points that were added to the results of the written fractional examination. Later on online classes were finished, the Section organized mandatory practical (contact) classes (without dissection) as a short revision of the A2 and A3 parts, which were previously covered via online classes.
Study blueprint
The study was conducted via a questionnaire in the form of a course evaluation survey. The questionnaire (Supplementary cloth one(Supplementary material one)) was designed by the didactics staff of the Section of Anatomy and Clinical Anatomy and tailored to be relevant to our curriculum. This is the start time that this detail questionnaire was used at the Department of Anatomy, making this a benchmarking survey. A unlike, less-extensive questionnaire was used in previous years. Yet, due to significant changes in the curriculum construction and organization of classes (including the addition of online classes), the previous questionnaire was no longer suitable to address the relevant research questions. We plan to conduct follow-upwards surveys and further validate this questionnaire at the end of each subsequent bookish yr.
The questionnaire was made bachelor to students online via the School's Learning Management System (LMS) immediately later classes ended, merely before the final (oral) exam was completed. Students had one week to answer the questionnaire. The answers were anonymized in the software settings, which fabricated information technology impossible to connect the answers to a particular educatee'south identity. Before the survey was made available, we divided the students who attended our class into four groups based on the score they accomplished on the partial written exams conducted throughout the academic year as a office of continuous assessment. Students with a score amend than or equal to the first quartile of the generation were designated as grouping Q1, students with a score better than or equal to the 2nd quartile equally group Q2, students with a score better than or equal to the third quartile equally group Q3, and students with a score beneath the tertiary quartile every bit group Q4. The questionnaire results were then also filtered based on the defined groups. The results remained anonymous even when forming groups equally the software prohibits connecting the survey responses to a detail student'south identity.
The questionnaire consisted of lxx questions, 27 of which were relevant to the research presented in this study (assessment of the efficacy of dissimilar types of classes in roofing the anatomy form material) (Supplementary Table 1(Supplementary tabular array i)).
In most questions, students had to choose a number betwixt 1 and 5 that best represented their agreement with a given statement (Supplementary Table 2(Supplementary table ii)), with 1 representing complete disagreement and 5 representing complete understanding. In some questions, students either had to write a curt answer (the number of hours spent studying anatomy) or choose multiple answers from a predefined list of options. To be able to submit the survey, students had to answer every question.
Quantitative data analysis
Responses to the questions in which students chose a number (grade) representing their agreement with a argument were analyzed equally ordinal data, and the median and mean were calculated from the grades given by students.
Responses to the questions in which students chose one or more answers from a predetermined listing of possible answers were analyzed as categorical data, and frequencies for each reply were presented as the percentage of students who chose a detail answer.
Responses to the questions in which students wrote the number of hours spent studying anatomy were analyzed as ratio data (ie, continuous variables), and the mean and standard departure were calculated for each answer. The normality of the distribution was evaluated with GraphPad Prism'due south in-built software, which runs four normality tests.
For comparisons between the student groups with dissimilar partial examination scores (Q1, Q2, Q3, and Q4) we used 1-way ANOVA with Tukey's post hoc test for ratio data and the Kruskal-Wallis test (ane-manner ANOVA on ranks) with the Dunn mail service hoc exam for ordinal information. In the postal service hoc tests, a P-value of <0.05 was considered significant. For parametric tests, 95% conviction intervals were likewise calculated. Cantankerous-tabulation was used to analyze the differences between groups for categorical data.
To compare the responses given by the same students to unlike questions, the paired Wilcoxon rank test was used for ordinal data and the paired t-test for ratio data. For both tests, a P-value of <0.05 was considered significant. Simply the questions involving the comparison of online and directly classes were analyzed in this mode (responses to Question five were compared to Question 6, and responses to Question viii were compared to Question 9). Quantitative information analysis was performed with GraphPad Prism, version viii.three.0 (GraphPad Software, La Jolla, CA, USA).
RESULTS
Survey target population size, statistical relevance, and response rate
The target population for this survey were the first-yr medical students at the UZSM who actively participated in the Anatomy course (both in direct classes and online activities) throughout the entire course duration. 5 enrolled students discontinued their studies earlier the course ended and were not included in the survey, nor were they considered to be the survey target population. The full number of active medical students in the academic twelvemonth 2019/2020 was 340. With a target population size of 340 students, the required number of responses for this type of survey would be 181 for a confidence level of 95% and a margin of error of 5% (xx). The survey was available to all active first-year medical students, and 325 filled out the questionnaire, resulting in a response rate of 95.58%. Due to the high response rate and a sufficient number of responses, the study results tin can be considered an authentic representation of the entire start-year medical pupil population and are statistically relevant.
The about relevant questions of the survey are shown in Table 1 and are numbered from 1 to 9, while a complete overview of all the questions analyzed in this study is shown in Supplementary Table 1(Supplementary table one), where the questions are labeled from S1 to S27.
Tabular array i
The most relevant questions in the survey and responses given by students
| | Frequency distribution (%) for grades chosen as responses to statement | | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Questions | 1 | 2 | three | 4 | 5 | i and 2 | 4 and 5 | Mean grade | Median grade | |||||
| 1 | I regularly used the available online material in learning. | 0.00 | three.37 | 15.34 | 33.44 | 47.85 | iii.37 | 81.29 | four.26 | 4 | ||||
| 2 | I have put a swell deal of attempt into learning the required examination material. | 0.00 | 1.23 | 7.98 | 24.54 | 66.26 | 1.23 | ninety.80 | 4.56 | five | ||||
| 3 | Frequent quizzes (both during regular and online classes) contributed to my successfully mastering the required test material. | three.68 | 6.44 | eleven.66 | 24.23 | 53.99 | ten.12 | 78.22 | 4.xviii | v | ||||
| 4 | Online classes are a significant and useful addition to contact classes, only cannot replace it. | one.84 | four.91 | 13.fifty | 28.83 | 50.92 | 6.75 | 79.75 | iv.22 | v | ||||
| v | During contact classes, I could easily assess my cognition and progress at any given time. | 1.23 | iv.91 | 20.25 | 36.20 | 37.42 | 6.14 | 73.62 | 4.04 | iv | ||||
| 6 | During online classes, I could hands assess my knowledge and progress at any given time. | vi.75 | 21.17 | 32.52 | 26.99 | 12.58 | 27.92 | 39.57 | 3.17 | 3 | ||||
| 7 | This form was too challenging. | 9.twenty | 25.46 | 40.18 | 21.78 | three.37 | 34.66 | 25.15 | 2.85 | 3 | ||||
| | Mean response ± standard departure (h/d) | |||||||||||||
| All groups | Group Q1 | Grouping Q2 | Group Q3 | Group Q4 | ||||||||||
| viii | During contact classes I spent, on average, the post-obit amount of hours per day studying Anatomy: | 4.09 ± ane.52 | 4.40 ± one.57 | 4.29 ± i.55 | three.91 ± ane.xl | 3.87 ± ane.40 | ||||||||
| 9 | During online classes I spent, on average, the following corporeality of hours per day studying Anatomy: | 5.56 ± 2.46 | 6.13 ± 2.36 | 5.75 ± 2.59 | 5.42 ± two.36 | 5.xvi ± ii.39 | ||||||||
Evaluation of students' personal appointment and involvement in the course
Overall, students assessed their personal appointment in the form equally high – 95.71% of students stated that they attended contact classes regularly (grades 4 and 5 on Question S1) and 81.29% of students stated that they accessed the School'south LMS regularly (grades 4 and five on Question ane). Both values were also confirmed by the Department's official records. Students' preparation for contact classes was as well evaluated – students prepared most for practical work (89.26% gave grades iv and 5 on Question S5) and least for lectures (only 49.08% gave grades 4 and 5 on Question S3), while they prepared moderately for seminars (73.32% gave grades iv and 5 on Question S4). A total of 90.49% of students (grades four and 5 on Question 2) claimed to accept put a high level of attempt into learning the required material – this is in line with the fact that 93.50% of students successfully passed the final exam.
Evaluation of the form fabric, form organisation, and course construction
The most relevant findings from the student's evaluation of the course cloth, organization, and structure were as follows: 78.22% of students agreed (grades 4 and v) that regular online quizzes helped them larn the required course material, 63.fifty% agreed (grades 4 and 5) that learning outcomes helped them larn the required course material, 87.12% agreed (grades 4 and 5) that the required course material was of import for the medical profession, and only 25.15% (grades 4 and 5) considered the class to be too difficult (Tabular array 1 and Supplementary Table one(Supplementary table 1)). Furthermore, 73.62% of students agreed (grades 4 and 5) that classes (both contact and online) helped them cover the required form material, with simply 8.59% (grades i and ii) disagreeing with this statement (Question S12).
Students estimated that they spent on average 4.09 ± one.52 h/day studying anatomy during contact classes and 5.59 ± 2.46 h/day during online classes (Questions 8 and 9). The difference in the responses to these questions was meaning (P < 0.001) (Effigy 1A).
Comparing of students' responses to questions nearly contact and online classes. (A) Comparison of responses to questions in which students had to write the boilerplate number of hours per twenty-four hours that they spent studying anatomy during contact classes (Question 8) and during online classes (Question 9). Markers (black circumvolve and square) represent the mean, fault bars represent the standard difference, and the P-value is shown on the plot (paired t exam). (B) Violin plots showing a smoothed distribution of students' responses to the question in which students evaluated how easily they could appraise their knowledge and progress during contact classes (Question five) and during online classes (Question 6). The dotted line in the violin plots represents the median of the responses to each question. The size of the bulge in a violin plot is proportional to the frequency of students who chose the course displayed on the y-axis. The P-value is shown on the plot (paired Wilcoxon rank test).
A total of 73.44% of students agreed or by and large agreed (grades 4 and 5) that they could hands appraise their knowledge and progress during contact classes, while only vi.xiv% disagreed or mostly disagreed (grades 1 and 2) with this argument (Question 5). Only 39.57% agreed or mostly agreed that they could easily appraise their noesis and progress during online classes (Question 6), while 27.92% disagreed or generally disagreed. The difference in the responses betwixt these ii questions was as well meaning (P < 0.001) (Figure 1B).
Evaluation of student education assistants
Students well-nigh favorably assessed student educational activity assistants (STAs), with but 0.31% disagreeing (grade ii on Question S19, no pupil gave a grade ane on this question) with the statement that the STAs performed well. More than two thirds (69.33%) of students regarded practical work with STAs (practicing on cadavers and prosection with STAs outside regular classes defined by the curriculum) every bit one of the iii segments of contact classes from which they benefited the most in preparing the course material and 65.64% of students rated it as one of the three segments of contact classes that they missed the most during online classes. Furthermore, 72.09% of students expressed that the interaction with STAs was one of the three aspects of contact classes they missed the most. There were no significant differences between the student groups regarding STA evaluation.
Evaluation of contact classes
A total of 91.41% of students singled out contact lectures to be suitable for replacement with pre-recorded online video lectures (Question S23, students could cull any number of answers out of five options). Furthermore, 47.55% of students found seminars to exist suitable for replacement with either webinars or recorded video lectures. Only six.75% of students thought that regular applied work (demonstrations on models, cadavers, and prosections) could be replaced with online materials and as few as 0.92% thought the same for anatomical dissection. Only vii.06% of students felt that nix could be replaced by online classes (Figure 2A).
Bar graphs showing the response frequencies for the following questions: (A) Which types of contact classes could exist adequately replaced with online classes? (Question S23); (B) Which types of contact classes did you benefit from the well-nigh in preparing the course material? (Question S24).
Students singled out anatomical dissection as a segment of contact classes that aided them the near in covering the course material, with 81.xc% of responses (Question S24, students could cull up to three answers out of seven options). Practical work with STAs was the 2nd well-nigh important segment (69.33%), followed by regular practical work (demonstrations on models, cadavers and prosections) with the teaching staff (46.93%). Only vii.36% of students found traditional lectures to be of import for learning the course fabric, while only 1.23% found none of the contact classes to be helpful in this regard (Effigy 2B).
Evaluation of online classes
When asked which segments of online classes aided them the most in covering the class fabric (Question S25, students could choose up to three answers out of 12 options), 60.74% of students chose pre-recorded video lectures and 54.29% chose regular mandatory online quizzes. Students also recognized the importance of various additional text materials, such as mitt-outs (48.47%), boosted explanations of challenging topics (37.42%), and textbook elaborations (explanations of inconsistencies in the textbook and further elaborations of topics the students assessed equally unclear in the text) (27.91%). A substantial portion of students also appreciated the possibility to evaluate online quizzes (30.37%) by analyzing the questions and correct answers. Presentation slides and the use of the forum were viewed as less essential (chosen by but 6.44% and iii.37% of students, respectively). As with contact classes, but 1.23% constitute none of the online materials helpful in learning the course material (Supplementary Figure 1A(Supplementary figure ane)).
The 3 segments of contact classes that students missed the most during online classes (Questions S26, students could cull upwards to three answers out of vii options) were anatomical autopsy (81.90%), practical work with STAs (65.64%), and practical work with teachers without autopsy (49.08%) (Supplementary Figure 1B(Supplementary figure 1)).
The aspects of contact teaching that students missed the near during online classes to fairly prepare the grade textile (Question S27, students could choose upwards to three answers), were practical work (81.60%), the interaction with STAs (72.09%), and the interaction with fellow students (60.74%). Fewer students missed face-to-face interaction with the teaching staff (51.11%) (Supplementary Figure 1C(Supplementary figure 1)).
Out of a series of statements comparing online and contact classes (Questions S8-S11), students agreed most with the following: "On-line classes are a significant and useful addition to contact classes but cannot replace them," with 79.75% of students agreeing or generally agreeing.
Response comparison betwixt different student groups
For well-nigh questions in which students had to choose a grade representing their agreement with a given argument, there were no pregnant differences between student groups (based on their successfulness on partial written exams: Q1, Q2, Q3, and Q4). The exception were questions 1, 2, iii, 7, S3, S4, and S5, the responses to which were significantly different between certain groups (Figure 3 and Supplementary Figure 2(Supplementary effigy two)).
Violin plots showing a smoothed distribution of responses by students from unlike groups (divided into quartiles based on their written partial exam score during continuous cess: Q1, Q2, Q3 and Q4) to the questions in which pregnant differences between groups were found. The dotted line in the violin plots represents the median of the responses to each question. The size of the bulge in a violin plot is proportional to the frequency of students who chose the grade displayed on the y-axis. Significant differences are marked on the plots (Kruskal-Wallis examination with the Dunn post hoc test). The dissimilar panels bear witness responses to the questions pertaining to (A) the utilise of online material in learning (Question one), (B) the corporeality of effort students put into learning the grade material (Question 2), (C) the usefulness of frequent quizzes for mastering the course fabric (Question 3), and (D) the difficulty of the class (Question 7).
Students from the Q1 group spent on boilerplate the most time studying, while students from the Q4 group spent on average the to the lowest degree time studying. This was slightly more pronounced during online classes (Tabular array 1). Nevertheless, due to the large variability inside the groups, none of the differences betwixt groups was pregnant (Supplementary Figure 3(Supplementary figure 3)).
For questions in which students had to choose the answers from a predefined list, the crosstabulation analysis revealed that nearly groups responded similarly, but there were some noticeable differences in certain responses (Effigy 4) – primarily in the way different groups responded to the questions pertaining to online classes.
Bar graphs showing the results of the crosstabulation analysis. Students' responses are shown by groups (divided into quartiles based on their written partial exam score during continuous assessment: Q1, Q2, Q3 and Q4) to the questions on: (A) which types of contact classes could exist adequately replaced with online classes (Question S23), (B) which segments of online classes helped students the most in preparing the class textile (Question S25), and (C) which types of contact classes students missed the most during online classes (Question S26).
When asked which segments of online classes helped them the most in preparing the course textile (Figure 4A), students from the Q1 group noticeably more ofttimes chose pre-recorded video lectures (71.26%) than all other groups (57.50%, 51.28%, and 62.32% for Q2, Q3, and Q4, respectively). Students from the Q4 grouping considered mandatory online quizzes as less beneficial (42.03%) than other groups did (60.92%, 63.75%, and 52.56% for Q2, Q3, and Q4 respectively), however, they also considered the evaluations of the online quizzes more benign (xl.58% vs 24.xiv%, 30.00% and 28.1% for Q2, Q3, and Q4, respectively). Furthermore, students from the Q4 group considered cocky-assessment tests, online clinical cases, and links to animations more beneficial than whatever other group, while they also considered additional explanations of challenging topics less beneficial than any other grouping (Figure 4B).
When asked which aspects of contact teaching they missed the nigh during online classes (Effigy 4C), students from the Q1 group mostly chose contiguous interaction with the didactics staff (57.47% vs 43.75%, 47.44%, and 49.28% for Q2, Q3, and Q4, respectively), while the same group missed interaction with other students the least (51.72% vs 70.00%, 62.82%, and 62.32% for Q2, Q3, and Q4, respectively).
Give-and-take
The analysis of the survey results revealed several important findings. First, despite a large amount of digital content, students overwhelmingly stated that the practical parts of the course (anatomical dissection, practical work on cadavers, prosections and models) were essential for learning the course textile and could non be adequately transferred to an online environment. Second, students recognized online classes every bit a useful improver to contact classes, too as stated that some segments of contact classes, such every bit traditional ex cathedra lectures and some seminars, could be completely or substantially replaced past online classes. Finally, the data acquired in this survey suggest that some differences in students' responses could be related to how successful they were in learning the course material.
Applied work remains a key component of a modern anatomical curriculum
To teach and assess such a difficult form as beefcake in medical didactics is both challenging and demanding. Dissimilar universities worldwide offer instruction approaches that suit their visions and didactics philosophies, spanning from extremely item-oriented curricula to curricula devoted to problem solving and a general overview of the underlying structures. The best way of reaching these goals is nonetheless to be determined, though many agree that a combination of teaching methods should exist used, since none of the methods individually cover all the learning aims (21,22).
As the international contend on whether cadaver dissection is necessary in medical education continues, many educators all the same favor dissection over other tools (23) and it is still a preferred education method regardless of whether the anatomist is a "traditionalist" or a "modernist" (21). In our everyday work, we are challenged with cutting-border visualization technologies, and debates have arisen whether dissection, as the gold standard in anatomy education, can and should exist replaced (12). Our decision to go along with this traditional method is further supported past our students' opinion that dissection is a cardinal tool for meeting the learning outcomes.
The data obtained in this survey clearly show that students consider anatomical autopsy to be the most useful part of contact teaching. Support for anatomical autopsy was expressed in some studies (24-26), while other studies called into question its overall impact on learning outcomes (fourteen). During dissection, students directly study the three-dimensional topographic anatomy of the homo body and discuss it in small groups with the aid of STAs and guidance of the teaching staff. Other types of applied work, such as demonstrations on cadavers, prosections and models, were also regarded as very useful.
Later practical piece of work, during online classes students mostly missed the interaction with STAs, followed by the interaction with other students. The fact that students evaluated their knowledge more than hands during contact classes than during online classes supports the notion that through proper interaction, especially with peers and most-peers (27), students receive adequate feedback, which then meliorate guides them while learning the form material. Such an interaction is vital for the absorption of the school'southward hidden curriculum (28,29). In addition, over half of the students stated that they missed interaction with the teaching staff – this sentiment was more pronounced in the Q1 group than in the other groups. This discrepancy could exist explained past the fact that the most successful students (Q1 grouping) had less difficulty learning the basic course material on their ain; however, they needed additional explanations and feedback for more complex concepts, which falls exterior the competence of STAs. Even though the teaching staff regularly posted answers and detailed explanations to students' questions on Q&A forums on the Department's e-learning platform, this did not recoup for the level of interaction achieved during contact classes.
Notably, students perceived as most useful the types of contact classes that are organized in pocket-size groups (up to 10 students per group), ie, practical classes involving dissection, demonstration, or self-guided practical work. The level of interaction between students, STAs, and education staff in such classes in our curriculum is typically very loftier. In dissimilarity, students found traditional contact lectures to be the least useful blazon of contact classes – such lectures are held mostly ex cathedra in front of a large group of students (up to 150 students) and the level of interaction is typically very depression. Finally, seminars, which are held in medium-sized groups (usually up to 25 students), were rated as more useful than lectures, but less useful than applied classes. This strongly suggests that, at least from the students' perspective, the level of interaction greatly determines the usefulness of contact classes.
Online pedagogy can greatly enhance traditional anatomical classes
Despite recognizing the importance of contact classes, especially those involving practical piece of work, students likewise conspicuously identified the advantages of online learning and considered online classes a pregnant and useful addition to contact classes.
Our data show that contact lectures could almost entirely be transferred to an online environment since over 90% of students stated this and just 7% establish classical lectures useful for learning the course textile.
Students' opinions diverged most when it came to seminars, with approximately half of the students considering seminars to be replaceable by online classes, while the other one-half considered seminars to exist useful as contact classes. This tin exist explained by the level of interaction students experienced during contact seminars – students who achieved a higher interaction level with their teachers during seminars probable establish them more than useful than those who achieved a lower interaction level .
Students clearly stated that practical classes could in no way be replaced by online classes, which is in line with their sentiment that practical classes are the most useful role of contact classes.
Interestingly, students found pre-recorded video lectures to be the well-nigh useful segment of online learning, which is in dissimilarity with their sentiment that lectures were the least useful type of contact classes. This can be explained by the following advantages of pre-recorded video lectures over contact lectures: they are constantly available through the e-learning platform and tin can be viewed at students' leisure; students can re-view them multiple times, pause them, fast forward or rewind and re-spotter parts they find more difficult to embrace; this type of lectures also facilitates annotation taking or sketching of anatomical structures (30-33). The second nearly useful aspect of online classes for students were obligatory online quizzes, which were administered weekly and evaluated predominantly students' comprehension and integration of the course material. Other studies support the positive effect of frequent quizzes on the final cess in the anatomy course (34,35).
In general, information technology appears that students adopt classes with high interaction to be carried out as contact classes, while they find classes with low interaction better transferable to an online environment.
Nevertheless, certain segments of teaching deviated from this observation. Surprisingly, more students considered clinical cases more useful in the form of interactive online lessons (17%) than in the grade of contact classes (thirteen.5%), where clinical beefcake was discussed in small groups of five or half-dozen students. The fact that twice as many options were offered for the question on online classes as for the question on contact classes (12 options vs 7 options – on both question students could cull only three of the bachelor options) clearly indicates that students consider clinical cases in an online format to be superior to those carried out through contact classes. This could be explained by the format of interactive lessons, which enables students to extensively interact with the class material via the user interface – thus allowing for a deeper agreement of the topic – even though there is no physical interaction with another person. The fact that students plant active types of online content to be more useful (video lectures, quizzes, and quiz evaluations) than completely passive types of content (eg, presentation slides) shows that interaction is also important in online classes, albeit the way interaction is achieved in a virtual environment differs from the way it is achieved in a concrete classroom.
Therefore, the goal of creating online didactics content should non be to simply replace contact classes that entail a low level of interaction. To the contrary, the online content that replaces contact classes should be organized in a fashion that information technology allows for greater interaction with the course material than it would be possible to accomplish in equivalent contact classes. This is the reason why lectures and presentation segments of seminars are ideal for transfer into an online environment – these elements of contact classes are non merely suitable for an online environment, but they offer significant benefits when presented in an online class, if done correctly. Online classes used in this way get a valuable asset in enhancing and enriching the curriculum and supporting contact classes.
Organizing online teaching as described has an additional benefit for contact classes – transferring suitable segments of contact classes to an online environment, where students spotter them before contact classes, frees up time for other types of classes that students find more useful. Furthermore, conducting weekly quizzes in an online format, rather than during applied classes every bit was previously washed in our course, gives the education staff more than time to establish meaningful interactions with students. Similarly, transferring clinical cases to interactive online lessons allows devoting more contact classes to anatomical dissection, while transferring lectures and presentation portions of seminars into pre-recorded video lectures (that students can view before arriving to contact classes) allows devoting more time in class to relevant discussions with students. Authoritative requirements, such as keeping records of educatee test scores and attendance, are also more easily completed in an online environs. All of this enables the teaching staff and STAs to better focus on students' needs, didactics, and applied work during contact classes.
What affects students' success in the course?
Among the more than surprising findings of this survey is that only a quarter of first-year medical students considered the anatomy course likewise demanding, even though our Department maintained its traditional high demand when it came to anatomical detail-recognition and correct naming of anatomical structures, while simultaneously increasing the demands when it came to conceptual understanding of functional and clinical anatomy. Effectually xl% of the students considered the form to be adequately difficult, while a tertiary of the students did non consider the course besides demanding at all – this was even more than pronounced in the Q1 group, where almost half of the students did non consider the course too enervating. This indicates that students recognize the importance of learning anatomy in detail, which is supported by the fact that 87% of students agreed or mostly agreed with the statement that the required course textile is important for the medical profession (Question S16).
The large corporeality of detailed data that has to be memorized in our form demands that students possess good organisation skills, as well as the ability of long-term planning of complex and time-consuming tasks. Enquiry shows that the structural maturation of the prefrontal cortex extends well into the third decade of a human lifespan, which is connected to the functions of long-term planning, motivation, and directing emotions (36-40). This is in line with research showing that young adults nowadays accomplish psychosocial maturity at a later historic period than before (41,42). These facts should too exist considered when discussing students' success and perceptions of the course.
The data from our survey show that students from the Q4 group (the least successful on partial exams) reported having prepared significantly less for seminars and practical classes and that they as well used the bachelor online materials significantly less frequently. Furthermore, even though the differences betwixt the time that students from different groups spent studying anatomy were non pregnant, students from the Q4 group spent the least time studying both during contact (11.3% less time than students from Q1 group) and online classes (14.5% less time than students from Q1 group). In general, the more than successful a student group was on the exam, the more than time these students spent studying beefcake, and vice versa.
Finally, student groups differed in the segments of educational activity they constitute useful for learning the course material. The differences between the groups' responses to the questions pertaining to contact classes were rather small. However, for some aspects of online classes these differences were substantial. Merely half as many (around twenty%) students from the Q4 group as students from other groups plant additional explanations of challenging topics useful, while twice as many (around 40%) students from the Q4 group found links to animations and video materials useful. Furthermore, students from the Q4 group institute online quizzes less useful than did students from other groups, while they found the evaluation of the online quizzes more useful than did other groups. The Q4 group was also the simply group where a larger portion of students considered presentation slides as useful. All of this indicates that a larger proportion of students from the Q4 group had problems with learning the basic concepts, which is why they found the content that aids in this (presentation slides, links to animations, etc) more useful than the content that aids in acquiring a deeper understanding of the course material (quizzes, additional explanations). It is too possible that students from the Q4 groups had, on average, more problems determining priorities while studying and typically focused less on the topics being assessed in the exam. This is supported by the fact that the Q4 group was less successful on the partial exams, just also on the obligatory online quizzes, which they institute less useful than other groups.
It should be noted that the results of our report are most applicable to anatomy courses with like curricula, while certain aspects might not transfer likewise to differently structured beefcake courses.
Conclusions
In conclusion, the results of this survey suggest that: one) applied classes, particularly anatomical autopsy, should stay a key component of a mod anatomical curriculum; 2) online pedagogy is a valuable asset to a modern anatomical curriculum and can greatly enhance traditional anatomical classes; 3) interaction (between students, with STAs, with education staff and with the class material itself) is vital for determining how students perceive classes and how effective classes are in aiding students in learning; iv) education staff should strive to encourage less successful students to enhance their perception of the course and the attending to the overall importance of endeavor, too every bit to empower them for adaptive modify.
Acknowledgments
Funding This piece of work was supported by the Center of Excellence for Basic, Clinical and Translational Neuroscience, Academy of Zagreb School of Medicine, Zagreb, Croatia.
Ethical blessing given past the Ethics Committee of Zagreb University School of Medicine (380-59-10106-21-111/100).
Declaration of authorship IBa, VK, and ZP conceived and designed the study; IBa, AB, and VK acquired the data; all authors analyzed or interpreted the data; IBa, VK, IBi, and ZP drafted the manuscript and AB, AH, and NK critically revised the manuscript for important intellectual content; all authors gave approval of the version to be submitted; all authors agree to be accountable for all aspects of the piece of work.
Competing interests ZP is a member of the Managerial Board of the Croatian Medical Journal and NK is an executive editor in the periodical. To ensure that whatsoever possible conflict of interest relevant to the journal has been addressed, this article was reviewed according to best exercise guidelines of international editorial organizations. All authors have completed the Unified Competing Involvement form at www.icmje.org/coi_disclosure.pdf (bachelor on request from the corresponding author) and declare: no back up from whatsoever organization for the submitted piece of work; no financial relationships with whatsoever organizations that might accept an interest in the submitted work in the previous 3 years; no other relationships or activities that could appear to have influenced the submitted work.
Additional Material
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Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8107989/
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