Pawlina, Wojciech

Professionalism is a core competency of gross anatomy and general medical school curricula requiring students to develop the skills of giving and receiving peer feedback. Our study evaluated the effectiveness of delivering feedback in a group setting compared to delivering it individually. The first year class of Mayo medical students (n=50) enrolled in gross anatomy (in dissection teams of 3 or 4) completed weekly anonymous peer‐evaluations of their team regarding multiple aspects of professionalism (integrity, responsibility, compassion, and peer respect). Professionalism scores were calculated using the quantitative values from these surveys. Students were also asked to comment on strengths and areas for improvement for each student. At the mid‐point of the course, peer comments and professionalism scores were shared with students in debriefing sessions, either individually or as a team. Preliminary analysis of pre‐ and post‐intervention professionalism scores indicates that students receiving feedback in a group setting are more likely to demonstrate higher scores on subsequent evaluations. Our findings suggest that providing feedback to first‐year medical students in a group setting is more beneficial for group dynamics and may improve professional attitudes and behaviors. This work was supported by the Mayo Clinic Department of Anatomy. Grant Funding Source None

Gross anatomy courses often utilize teaching assistants (TAs) to serve a multifaceted purpose. Qualitative analysis of interviews with gross anatomy TAs reveals seven distinct roles: formal teaching during course lectures, informal teaching during dissection, prosecting a demonstration cadaver, orchestrating regular review sessions, coordinating formative feedback about academic progress and professionalism, tutoring struggling students outside of class time, and supporting students in crisis should the need arise. Analysis also finds that TAs did not anticipate the full scope of their duties prior to undertaking them, and felt particularly unprepared to address issues of student mental health. We report our findings and propose a model for proactively training TAs for their inherently complex role. This work was supported by the Mayo Clinic Department of Anatomy. Grant Funding Source Student/Postdoctoral Travel Award Student Award

Developmental anatomy can be used to organize the teaching of histology. Since certain tissues are derived from predictable embryonic layers or structures, the embryological organization can be used to organize tissues in a meaningful and useful manner. We offer several examples of this relationship to help students organize tissues by their developmental origins. First, all functional neurons originate from ectoderm, but the fate of cells coming from the neural tube differs from those that come from the neural crests. All neurons that have their final location within the central nervous system (CNS) are derived from the neural tube, whereas neurons whose nerve cell bodies are outside the CNS come from the neural crests. Second, almost all muscle tissue, which comprises about 40% of the human body mass, comes from the mesoderm. The exceptions are the smooth muscle cells within the eye, which are derived from the neural crest. Almost all connective tissues, with the exception of the notochord, are derived from the mesoderm, or more specifically from mesenchymal cells. Melanocytes (also satellite cells and Schwann cells) are derived from neural crest. Epithelial cells that contribute to the epidermis are derived from ectoderm, and almost all other epithelial tissues are derived from endoderm. Exceptions are endothelial cells (including endocardium) that come from mesoderm. This outlines the close relationship between developmental anatomy and histology that helps to categorize tissues by their embryologic origin.

Early medical education courses provide opportunities for promoting leadership in future physicians. Our research sought to integrate explicit activities of teamwork and leadership into the first‐year gross anatomy course and assess student leaders through self reflection and team evaluation. Fifty first‐year medical students were assigned to three‐ or four‐member dissection teams with group leaders designated on a rotating basis. Teamwork was emphasized through daily group quizzes, oral patient presentations relating clinical diagnoses to anatomy, and extensive embryology presentations. Group leaders were responsible for leading the dissections after attending daily orientation sessions on the teaching cadaver. Team and self evaluations of group leaders were gathered with weekly electronic surveys. Preliminary results suggest that team leaders rate themselves lower than their teammates do with respect to altruism, accountability and responsibility. One explanation for this discrepancy is decreased self‐awareness of student leaders regarding their own performance. Further research may demonstrate whether increased communication between leaders and team members can improve leaders' awareness of their capabilities. Research support came from the Mayo Clinic Department of Anatomy. Grant Funding Source N/A

Recent curricular redesign at Mayo Medical School integrated radiology into first‐year gross and developmental anatomy. The resulting six‐week (120 contact hours) Human Structure block teaches gross anatomy through dissection, radiologic imaging, and correlation with embryology. To further promote holistic physician‐development, refinement of the Human Structure course has been driven by the six core competencies of the Accreditation Council for Graduate Medical Education (ACGME): patient care, medical knowledge, practice‐based learning, interpersonal skills, professionalism, and systems‐based practice. We report here more than 20 educational interventions built into the Human Structure block that may serve as a model for incorporating the ACGME core competencies into early medical education. The block emphasizes clinically oriented anatomy, invites self‐ and peer‐evaluation, provides daily formative feedback through an audience response system, and employs team‐based learning. The course curriculum includes didactic briefing sessions and roles for students as teachers, leaders, and collaborators. Third‐year medical students serve as teaching assistants, enhancing their own knowledge of anatomy, bettering their skills as medical educators, and facilitating group communication and critiques. This work was supported by the Mayo Clinic Department of Anatomy. Grant Funding Source None

The goal of our study was to evaluate the effectiveness of the audience response system (ARS) as a tool for providing formative feedback to first year medical students. Over a three year period, we collected data from anatomy and histology courses in which students answered clinically oriented multiple choice questions using the ARS. We compared each student's cumulative ARS and final exam scores and we calculated a correlation coefficient between these two values. In addition, we conducted a questionnaire to evaluate the students' perception on ARS. According to our results, students saw ARS as useful for providing feedback on performance with a mean of 3.61 (1‐5 scale). There was a strong positive correlation between ARS and final exam scores. R values for the ARS and NBME Anatomy subject exam was R=.9556; and for the Anatomy/Radiology written exams, R=.9882. Students believed that ARS improved their performance with a mean of 3.94 (1‐5 scale). Students also preferred more frequent ARS quizzes with fewer questions to less frequent sessions with more questions (mean=3.74). In conclusion, students use ARS as a feedback tool and can rely on it as a good predictor of final course performance. We have found that ARS feedback motivates students to seek help from faculty when appropriate. It is user friendly, interacts well with PowerPoint, and is not time consuming for faculty. Grant Funding Source AAA

Objective The objective of this study was to introduce musculoskeletal physical examination skills in the gross anatomy course as a teaching tool and to evaluate medical students’ perceptions of this experience. Methods A list of 27 clinical examinations of the upper and lower limbs was generated from published core recommendations for undergraduate medical education. During gross anatomy laboratory sessions, teaching assistants (third year medical students) presented one or two of the clinical skills related to that day’s dissection to groups of 3–4 students at a time. The anatomic relationships tested by the clinical examinations were highlighted. One question on the laboratory examination at the end of the unit was an Objective Structured Clinical Examination (OSCE) station where students were given a clinical scenario and asked to demonstrate a physical examination that they would use in evaluating the patient. Following the upper and lower limb units, the students were given a Likert‐scale survey to evaluate their perceptions of the experience. Results Survey responses indicated that most students felt the physical examination demonstrations improved their understanding of the clinical significance of the related anatomy, increased their interest in and motivation to learn the material, and made the laboratory experience more enjoyable. Conclusions Introducing musculoskeletal physical examination skills in the gross anatomy course can be an effective way to emphasize the clinical significance of the anatomy, thereby enhancing students’ motivation to learn the material.

The quality of healthcare delivery is dependent on collaboration between various professional disciplines. Integrating opportunities for interprofessional learning in medical education programs will prepare future clinicians to be effective members of a multi‐disciplinary care team. We incorporated an ultrasound demonstration of the upper limb into the gross anatomy courses for first year medical (n=53) and physical therapy (n=28) students. Prior to participating in the learning experience, all students took a short individual pre‐test based on clinical concepts regarding the assigned study material. A physical medicine and rehabilitation physician demonstrated the use of ultrasound as a diagnostic and procedural tool for the shoulder and elbow. Following the demonstration, students worked within interprofessional teams (n=14 teams) to review the related anatomy on dissected specimens. At the end of the session, students worked within interprofessional teams to complete a collaborative post‐test. Team scores were compared to the mean individual score within each team using a paired t‐test. Students scored higher on the collaborative post‐test (5.7/6) than on the individual pre‐test (4.2/6), p <0.0001. Results suggest that working in interprofessional teams may enhance understanding and clinical application of anatomy, thereby reinforcing the benefit of an interdisciplinary team approach to patient care.

Recently many medical schools have introduced ultrasound education, with several institutions adopting formal teaching of ultrasound into their anatomy curricula. Additionally, medical schools nationwide have begun to incorporate various forms of interprofessional education (IPE) into their programs to prepare medical students for the teamwork necessary to serve as physicians. The Anatomy course at Mayo Medical School incorporated several IPE sessions with physical therapy students. Since the course is integrated with radiology, ultrasound imaging was recently added to complement static images and visualize living anatomy. Due to the success of prior IPE endeavors in anatomy, a new elective experience for hands‐on ultrasound practice sessions was offered to both medical and physical therapy students. The aim of this study was to assess student perception of elective ultrasound practice sessions as an opportunity for interprofessional peer‐learning. Practice sessions were scheduled once a week for 4 hours and a trained teaching assistant was available during the sessions. Students were encouraged to discuss different techniques and anatomical knowledge based on their respective experiences. A sign‐in sheet was kept to monitor how many students from both groups attended. Students were asked to fill out a survey at the end of 4 weeks to assess perceptions of the interprofessional experience. Preliminary results indicate that students appreciated the diversity of an interprofessional approach to learning ultrasound skills and enjoyed teaching each other anatomy through ultrasound.

Collaborative learning is recognized for its positive impact on student performance. Influence of social networking on evolution of student learning is rooted in construct of collaborative learning theory. Studies have alluded to benefits of informal learning (outside class) with little information evidenced in academic performance. Gross anatomy course at Mayo Clinic uses team based learning approach over 7 weeks. Teams are diversified (eg. cultural background, college attended, gender) while normalized (similar total average pre‐admission scores) to give each team equal footing from which to work. Teams are assigned at start of histology block 8 weeks prior and maintained through anatomy block. Based on premise of collaborative learning, we predicted students who spent more time interacting with classmates outside class contributed to collective knowledge of team and positively influenced team performance. Study aimed to determine if interaction of team members with classmates outside of assigned team impacted academic performance. Students voluntarily completed weekly surveys identifying classmates they had studied with after hours. Group size and duration of academic interaction were analyzed. Data were compared with final team performance for practical and written exams. Data were statistically analyzed and measured in terms of where teams ranked in overall class performance. Preliminarily, teams with 2 or more members who studied with non‐team members outside class showed improvement, with more overall members outside the bottom tertile. Students in bottom tertile studying with students in top tertile in a small group (< 5) > 1 hour outside class showed 5% improvement. Students in the top tertile are more likely to study alone or with students in the same tertile. Students who study with those in lowest tertile tend to have a positive effect on their performance. When students are allowed to choose their own networks, they tend to form mixed networks, in addition to formal teams.