Pawlina, Wojciech

Ultrasound education continues to be integrated into gross anatomy courses in the United States. The team based design of the anatomy course at Mayo Clinic School of Medicine incorporates team‐based ultrasound oriented activities that are formalized through defined course objectives and assessed in the final examination. Providing personal handheld ultrasound devices to first‐year medical students during the gross anatomy course has been the mainstay of ultrasound education for the past three years. Handheld ultrasound devices have been provided to students for limited periods in some medical schools within the United States, but unique to this curriculum, students are assigned devices that can be utilized outside formal class time. This provides unlimited opportunity to apply their understanding of three‐dimensional, living anatomy, while simultaneously promoting student comfort and engagement with advancing ultrasound technology. Student perception related to the use of ultrasound outside of formal curricular time was evaluated on a five point Likert scale. Both quantitative and qualitative analyses were used to interpret the data obtained from this study. A total of three surveys were sent to medical students over a period of twelve months with an average response rate of 58.9%. Students indicated that (1) ultrasound devices at personal disposal during the anatomy course improved understanding of anatomical structures imaged ( mean 3.9, SD=+/− 1.01 ), (2) the handheld ultrasound device was easy to use ( mean 3.9, SD = +/− 0.8), and (3) it would be beneficial if ultrasound was implemented as part of the longitudinal learning experience in medical school ( mean 4.1, SD = +/ − 0.7 ). Students were not convinced that (1) having a personal ultrasound device influenced future choice of medical specialty ( mean 2.8, SD = +/− 1.0 ) and (2) the opportunity augmented coursework in the past three months of medical school at time of taking the survey ( mean 2.7, SD =+/ − 1.25 ). Results of the study indicated that access to personal handheld devices motivated students to use ultrasound devices and that they did so with increasing frequency outside of class time. In addition, students were able to apply and reinforce anatomical concepts by using landmarks to first locate and orientate the anatomic field and then interpret images of underlying structures. The fact that students did not see the value of ultrasound in determining future career choices or relate their learning of ultrasound to subsequent courses should not deter prospective opportunity for use of ultrasound in clinical practice. Basic ultrasound proficiency and an ability to effectively interpret scans are skills that in the long term will significantly decrease the learning curve in the use of technology as a diagnostic tool in future clinical settings. This abstract is from the Experimental Biology 2018 Meeting. There is no full text article associated with this abstract published in The FASEB Journal .

While fundamental principles of anatomy are well‐established in early medical training, continued retention of anatomical knowledge is dependent on value, importability and relevance to surgical practice. As novel reconstructive strategies emerge, surgeons must account for individual patient factors and comorbidities in predicting patient outcome. Mastery of planning requires precise knowledge of local anatomy and reconstructive techniques, warranting reconnection with prior anatomic knowledge. Finding dedicated time to learn anatomy through self‐guided approach, is often challenging in a busy practice and CPD opportunities become a highly valued resource. In recent years, two mainstream professional dermatology societies have provided a platform for delivery of anatomy based clinical sessions. This study aims to assess value of point of care delivery of relevant anatomy and its role in improving perception of surgical confidence amongst procedural dermatologists in a CPD course. Assessment of core knowledge and knowledge gaps was conducted through the American College of Mohs Surgery (ACMS). Objectives were designed by a team of anatomists and clinicians based on a series of challenging cases. Anatomy sessions were offered at a large general session (>300 participants) and a small group hands‐on flap based session (n=20) Key anatomic teaching points relating to danger zones, safe zones and functional impairment were highlighted. Videos of real‐time dissection using a layered approach of targeted anatomy were created and supplemented with 3D‐printed models. For challenging anatomy encountered during Mohs reconstruction, patient defects were re‐created on the cadaver highlighting pertinent anatomy. Qualitative and quantitative analyses were conducting using course review for general session and confidence rating using Likert scale of anatomy based objectives for small group session. While 60–90 minute general session was sufficient for anatomist‐clinician team to facilitate discussion, participants indicated strong desire for increased session time. Videos and high quality photography were seen as outstanding tools for demonstrating anatomy within surgical field. Participants strongly valued anatomist/clinician partnership and relevance of material to everyday practice. Session review data (n=78) indicated session objectives “improved their ability to provide excellent patient care by helping close practice gaps”( 89.74%), helped “identify practice gaps in knowledge, performance and outcomes” (83.33%) and material presented was relevant to their Mohs and dermatologic practice (100%). Within small group session (n=11), only 18% had access to anatomy facility and material, with 100% agreeing/strongly agreeing that anatomy education was critical to their current practice. Analysis of perceived confidence in anatomic knowledge post course showed significant improvement in confidence in identifying, isolating and visualizing relevant anatomical (p<0.05). Positive impact of collaborative teaching of anatomy outside a mainstream academic setting using targeted point of care delivery through the use of technology (video), products of technology (photography and 3D‐printed material) and patient based clinical discussion to improve physician confidence was demonstrated. In era of authentic learning, anatomists share a responsibility for bringing point‐of‐care content for improved patient care. This abstract is from the Experimental Biology 2018 Meeting. There is no full text article associated with this abstract published in The FASEB Journal .

Near‐peer teachers continue to be a significant driving force behind curricular changes that provide anatomy instruction to meet the needs of students in the current learning environment. Near‐peer teaching assistants (TAs) are important contributors in the facilitation of Mayo Clinic School of Medicine, anatomy course. The team‐based design of this course incorporates various approaches to team oriented activities, including introduction to radiology and ultrasound education and whole body dissections. TAs are equally involved in delivery of briefing sessions, prosections, guidance of student dissections, and review sessions. While students acknowledge educational benefits of learning anatomy through dissection, many still experience challenges in effectively using combined classical resources such as dissection manuals, textbooks, atlases, and various computer‐assisted tools. To enhance student competency in dissection as well as to maintain curricular alignment between clinically oriented course content and dissection goals often different than what is presented in dissection manuals or commercially available videos, TAs dissected a cadaver and created short videos. Videos outlined necessary steps for the assigned dissection, identified challenging aspects of dissection procedure, and provided review of clinically relevant anatomic structures. Videos were filmed daily by TAs using commercially available iPads or iPhones and edited using iMovie software. All videos were uploaded to Blackboard curriculum management system the day before dissection and remained accessible to students throughout the course. The objective of this study was to determine medical student satisfaction and utilization of near‐peer created teaching videos for preparation and guidance of laboratory dissection. A total of 28 videos were created that ran from approximately 2 to 13 min in duration. Viewing data for the videos was tracked on the server and a survey was distributed to the students after the final examination (IRB protocol #17‐009090). Response rate was 91% (48 of 53 students responded to the survey). The survey used a five‐point Likert scale in which 1 = strongly disagree and 5 = strongly agree. In general, students found the videos useful in their preparation for laboratory dissection. They agreed that they frequently used the videos to prepare for the assigned dissection (4.74) and they felt that videos improved their efficiency (4.73) and confidence (4.45) in the laboratory. Additionally, 47% of students ranked the videos as their primary resource for dissection preparation. Near‐peer created videos provide an inexpensive and effective alternative to commercially available products. In addition, these videos allow facilitators to relate course specific material with dissection goals, advance self‐directed learning, and help students overcome the challenge of potential cognitive overload from the need to consult too many references within a short timeframe of the dissection laboratory. This abstract is from the Experimental Biology 2018 Meeting. There is no full text article associated with this abstract published in The FASEB Journal .

Significant increase in literature regarding “residents as teachers” highlights the importance of providing opportunities and implementing guidelines for continuing medical education and professional growth. Structured teaching assistant (TA) experiences are not uncommon. Programs, both nationally and internationally, have implemented and continue to provide established opportunities for under‐ and post‐ graduate students to develop teaching skills. However, due to the nature of undergraduate medical curricula, there is neither sufficient time nor an abundance of opportunity for medical students to develop teaching skills. The TA program at Mayo Clinic incorporates learning through apprenticeship and mentoring during a 7‐week anatomy block. This study explores the impact of the TA experience and the effectiveness of its facilitation by faculty mentors. Structured questionnaires obtained feedback regarding improvement in teaching and communication skills, as well as, experiences in curriculum development and educational research. Preliminary data revealed that teaching opportunities, mentoring from course faculty, and exposure to educational research and curriculum development improved the TA's ability to teach and fostered an increased interest in teaching. Medical student TA's perceive learning through apprenticeship and mentoring as an effective way to learn how to teach. Grant Funding Source : Department of Anatomy

Dramatic changes in the anatomical sciences education challenged the anatomy faculty and their education philosophy. As medical curriculum evolves, conventional courses need to adopt a new system of instruction. The overarching objective of an anatomy course is to provide anatomy‐specific knowledge and concepts for clinical application. However in the new environment, anatomy courses must incorporate other longitudinal objectives that will be revisited in clinical courses. These include discipline‐independent subjects such as leadership, teamwork, professionalism, and effective communication. Leadership can be fostered through classroom team‐based learning activities under the direction of a designated student team leader. Students are actively immersed in collaborative learning and as a team are responsible for obtaining, sharing, and presenting knowledge to other classmates. Professionalism in the classroom entails acts of dutifulness and respect for others. Emphasis on peer‐teaching results in development of communication skills that ensure effective transfer of knowledge and information between the members of the learning team. Also, an early introduction of peer and self evaluations result in enhancing assessment skills. The design of the contemporary anatomy curriculum must implement student‐centered approaches.

Anatomy programs that incorporate dissection of donated human tissue often hold ceremonies of gratitude and reflection for body donors. The content of these ceremonies often include learners’ reflections on mortality, respect, altruism, and personal growth told through various humanities modalities. The task of planning is usually faculty‐ and student‐led with participation from other health care students. Objective information on current memorial ceremonies for body donors in anatomy programs in the United States appears to be lacking. The number of programs in the United States that currently plan these ceremonies and information on trends in programs undertaking such remain unknown. Anatomy program directors throughout the United States were issued a brief, voluntary, thirteen‐item questionnaire on memorial ceremonies held at each institution. Qualitative data regarding the number of anatomy programs which hold their own memorial ceremonies, the content of such ceremonies, how they are planned, level of confidentiality maintained, and the types of participants who attend these events will be presented. This information may serve as a guide to institutions considering initiating a ceremony of their own. Grant Funding Source : Department of Anatomy

Use of reflection in medical education has been shown to enhance health care practitioner competency and enable a transformation from passive learning of theoretical constructs to a more active acquisition of core competences. Implementation of reflection in medical curriculum is a challenge, and a deficiency of reflective practice has been noted by residency directors. This highlights a need to develop reflective skills within the medical curriculum. In the anatomy course, reflection facilitates deeper learning and gives meaning to a student's dissection experience. During the 7 week gross anatomy course, we implemented four reflection sessions (“Safe Harbor”) aimed at fostering reflective capacity through encouraging student reflection on elements of professionalism including teamwork, ethics, and work‐life balance. Approximately two‐thirds of the class voluntarily participated in sessions lead by near‐peer facilitators. Reflection in professionalism index scores were analyzed at the beginning and end of the course. Preliminary results suggest first year students appreciate the “Safe Harbor” forum to reflect on anatomy course experience, professionalism, and personal challenges. Facilitators report positively on students personally adopting and integrating the reflection framework during Safe Harbor sessions, thereby suggesting an increased capacity to reflect on professionalism. Grant Funding Source : Dept of Anatomy, Mayo Clinic, Rochester, MN

Use of reflection in medical education has been shown to enhance health care practitioner competency and enable a transformation from passive learning of theoretical constructs to a more active acquisition of core competences. Implementation of reflection in medical curriculum is a challenge, and a deficiency of reflective practice has been noted by residency directors. This highlights a need to develop reflective skills within the medical curriculum. In the anatomy course, reflection facilitates deeper learning and gives meaning to a student's dissection experience. During the 7 week gross anatomy course, we implemented four reflection sessions (“Safe Harbor”) aimed at fostering reflective capacity through encouraging student reflection on elements of professionalism including teamwork, ethics, and work‐life balance. Approximately two‐thirds of the class voluntarily participated in sessions lead by near‐peer facilitators. Reflection in professionalism index scores were analyzed at the beginning and end of the course. Preliminary results suggest first year students appreciate the “Safe Harbor” forum to reflect on anatomy course experience, professionalism, and personal challenges. Facilitators report positively on students personally adopting and integrating the reflection framework during Safe Harbor sessions, thereby suggesting an increased capacity to reflect on professionalism. Grant Funding Source : Dept of Anatomy, Mayo Clinic, Rochester, MN

During the past two decades, anatomy instruction has changed due to curricular reforms in medical schools. Reduction in total hours of anatomy course and cadaver dissection, as well as shifts towards an integrated curricula has raised questions whether changes have had a negative impact on the students’ knowledge of anatomy. Our purpose was to investigate the effect of changes in course hours, curriculum type, and laboratory experience on USMLE Step 1 and Step 2 CK scores. Results of 2009 AAA online survey of anatomy course directors from 54 LCME‐accredited schools were matched with USMLE scores for 6,411 examinees taking Step 1 for the first time in 2009. The USMLE scores included Step 1 total test scores, Step 1 gross anatomy sub‐scores, and Step 2 CK total test scores. Analyses of data indicate that for all three USMLE scores, examinees from schools with stand‐alone gross anatomy courses slightly outperformed examinees from schools with integrated curricula. Conversely, the number of course hours had no effect on how students performed on Step 1 or Step 2 CK. Examinees that were exposed to both dissection and prosection slightly outperformed on Step 2 examinees that had dissection only. While these relationships are statistically significant, they may not be practically meaningful and more research is needed to fully explore different aspects of anatomy curricula and retention of anatomy knowledge.

Anatomy learned by active exploration in the dissection laboratory has been shown to be beneficial in improving anatomic knowledge, promoting self‐reflection, teamwork, and professionalism. Decreased dissection time may affect the quality of dissection and ultimately retention of gross anatomy knowledge. This could translate to lower student performance in the anatomy course. The purpose of this study was to determine whether evaluating the quality of students’ dissection has an effect on practical examinations performance, mid and end‐course evaluations. Quality of dissections for each team enrolled in a gross anatomy course at Mayo Medical School was evaluated bi‐weekly. Each member of the dissection team received the same score which was calculated towards 5% of their final grade. Dissections were evaluated using a five‐point rubric that incorporates measures for determining whether students had met laboratory learning objectives. Assessment of anatomic knowledge was based on laboratory practical exam scores recorded at intervals throughout the course and achievements on daily audience response system quizzes. Increase in quality of dissection was associated with improvement in practical exams. Teams that received lower dissection scores had lower scores on practical exams. Our results imply that students who achieve daily dissection goals, perform better on the practical examinations. Grant Funding Source : Department of Anatomy