SHORT COMMUNICATION
An Update on the Status of Anatomical Sciences Education in United States Medical Schools Richard L. Drake,1* Jennifer M. McBride,1 Wojciech Pawlina2 Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland Clinic, Cleveland, Ohio 2 Department of Anatomy, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, Minnesota 1
Curricular changes continue at United States medical schools and directors of gross anatomy, microscopic anatomy, neuroscience/neuroanatomy, and embryology courses continue to adjust and modify their offerings. Developing and supplying data related to current trends in anatomical sciences education is important if informed decisions are going to be made in a time of curricular and course revision. Thus, a survey was sent to course directors during the 2012–2013 academic years to gather information on total course hours, lecture and laboratory hours, the type of laboratory experiences, testing and competency evaluation, and the type of curricular approach used at their institution. The data gathered were compared to information obtained from previous surveys and conclusions reached were that only small or no change was observed in total course, lecture and laboratory hours in all four courses; more gross anatomy courses were part of an integrated curriculum since the previous survey; virtual microscopy with and without microscopes was the primary laboratory activity in microscopic anatomy courses; and neuroscience/neuroanatomy and embryology courses were unchanged. Anat Sci Educ 7: C 2014 American Association of Anatomists. 321–325. V
Key words: gross anatomy education; neuroanatomy education; histology education; microscopic anatomy education; embryology education; medical education; anatomical sciences; course hours; laboratory hours; assessments
INTRODUCTION Change is inevitable and curricular change has been a continuing theme in United States medical schools for the past 12–15 years. This has occurred as educators have realized that individuals acquire knowledge in different ways (Fleming, 1995) and educational programs must reflect not only this diversity in learning styles, but also principles of adult learning theories. In addition, basic sciences educators realized that they can make a valuable contribution to progressive formation of a physician’s professional identity (Irby et al., 2010) by incorporating nondiscipline-related competencies such as professionalism, teamwork, and leadership *Correspondence to: Dr. Richard L. Drake; Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland Clinic/NA24, 9500 Euclid Avenue, Cleveland, OH 44195, USA. E-mail: [email protected] Received 26 March 2014; Revised 6 May 2014; Accepted 22 May 2014. Published online 3 June 2014 in Wiley (wileyonlinelibrary.com). DOI 10.1002/ase.1468 C 2014 American Association of Anatomists V
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(Macpherson and Kenny, 2008; Gregory et al., 2009; Youdas et al., 2013) in their courses. Thus, a multimodal approach to education involving active learning, contextual learning of applied anatomical sciences, and longitudinal and vertical integration of anatomical curricula with assessments of competencies is the current pedagogical goal (Johnson et al., 2012; Drake, 2014). A philosophical change in the educational approach at a medical school will most likely have a major impact on how material is presented to students. In fact, if the curriculum changes, courses will need to modify their approach to be “in step” with the new educational paradigm of the institution. Due to the variety of vision and mission statements (Grbic et al., 2013), anticipated graduation outcomes, and approaches to curricular reform in different medical schools, there is no single prescription on how to revise anatomical sciences teaching across institutions. In addition to basic training, advanced elective student-choice courses have the potential to have a very positive impact on anatomy learning outcomes and knowledge retention. Therefore, design of advanced anatomy training that prepares students for the demands of their residency programs should consider the practical needs of each specialty rather than follow a generalized format for all clinical-year students (Orsbon et al., 2014).
Anat Sci Educ 7:321–325 (2014)
The reason for the current survey was to continue to provide a periodical update and collect relevant data relating to how education in the anatomical sciences is being presented in United States medical schools. This type of information helps curriculum committees, course directors, and teaching faculty make requested changes and improvements to their educational programs.
Table 1. Number of Courses Responding Number of responses
Response rate (%)a
Gross anatomy
55
32
METHODS
Microscopic anatomy
33
19
An online survey, similar to previous surveys (Drake et al., 2002, 2009), was developed and used to gather information about gross anatomy, microscopic anatomy, neuroscience/ neuroanatomy, and embryology courses during the 2012– 2013 academic year. Questions were asked about total course hours, number of lecture and laboratory hours, type of curriculum, number of examinations, any assessment of competencies, and other course specific information. Additionally, a variety of questions assessing demographic information related to students and faculty were also included. Notification to course directors and others that the survey was available was accomplished using a variety of methods. Initially, notices were sent to all members of the American Association of Anatomists (AAA), American Association of Clinical Anatomists, and the Association of Anatomy, Cell Biology, and Neurobiology Chairpersons asking that information about the availability of the survey be directed to the appropriate individuals. Additionally, the AAA had a list of course directors and these individuals were also contacted. Finally, after several weeks, institutions that had not responded were contacted and asked if they would get in touch with the individuals responsible for organizing the gross anatomy, microscopic anatomy, neuroscience/neuroanatomy, and embryology courses at their institutions. Finally, the data published in this survey were restricted to allopathic and osteopathic (one osteopathic school responded) medical schools in the United States. This allowed the focus of the survey to remain on schools with similar purposes and removed any bias related to specifically-directed or government-mandated programs. It also allowed a direct comparison to previously published survey data (Drake et al., 2002, 2009).
Neuroscience/Neuroanatomy
20
12
Embryology
31
18
Courses
a Response rate is calculated based on 170 schools (allopathic and osteopathic) which received the questionnaire.
courses in integrated curriculums (137, SD 6 45) to stand alone courses (154, SD 6 39). The average number of lecture hours was 41 (SD 6 24) with a range of 0–110, and the average number of laboratory hours was 91 (SD 6 27) with a range of 34–150 (Fig. 1). Responses relating to the type of laboratory experience indicated 36 used student dissection only, 18 a combination of student dissection and prosection (or previously dissected), and one used a prosection (or previously dissected) only approach. Information was also obtained in this survey related to the number of written and practical examinations in a course and whether competencies, such as professionalism and communication skills were assessed. Course examination information indicated that the average number of written examinations was 5 (SD 6 3) with a range of 0–12 and the average number of practical examinations was 4 (SD 6 2) with a range of 0–12. Regarding competencies, 31 out of 55 (56%) programs indicated they did assess competencies and the competencies usually assessed were professionalism, communication skills, and teamwork building.
RESULTS Survey Responses The number of responses received in this survey for each of the courses is indicated in Table 1.
Gross Anatomy All 55 responses in this category indicated that they still use cadavers in some type of laboratory experience, with 25 indicating their course was part of an integrated curriculum, 26 labeled their course as a stand-alone course, and four were in the mixed curriculum category. Additionally, 45 respondents indicated their course was organized regionally, eight systemically, and there were two programs that provided no response to this question. Total course hours reported by survey participants, excluding examination hours, averaged 147 (SD 6 41) with a range of 65–249 (Fig. 1). Additionally, there was no statistically significant difference in total course hours comparing 322
Figure 1. Survey results indicating the average total course hours, lecture hours, and laboratory hours for Gross Anatomy courses. Vertical bars indicate 6 SD.
Drake et al.
Figure 2.
Figure 3.
Survey results indicating the average total course hours, lecture hours, and laboratory hours for Microscopic Anatomy courses. Vertical bars indicate 6 SD.
Microscopic Anatomy In this survey, 17 respondents indicated their microscopic anatomy course was part of an integrated curriculum, 12 indicated their course was part of a stand-alone curriculum, and four programs responded they participated in a mixed curriculum. Total course hours, excluding examinations, averaged 72 (SD 6 30) with a range of 4–142 (Fig. 2). Additionally, there was no statistically significant difference in total course hours comparing courses in integrated curriculums to stand alone courses. The average number of lecture hours was 31 (SD 6 20) with a range of 0–97, and the average number of laboratory hours was 33 (SD 6 17) with a range of 0–69 (Fig. 2). Regarding the type of laboratory experience, of the 33 respondents 14 used only virtual microscopy, six used only microscopes, and 13 used both virtual systems and microscopes. Course examination information indicated that the average number of written examinations was 4 (SD 6 3) with a range of 0–14 and that there was also an average of 4 (SD 6 4) practical examinations with a range of 0–23. Regarding competencies, there seemed to be less competency evaluation in microscopic anatomy courses when compared to gross anatomy courses as only 13 of 33 (39%) respondents indicated they assessed competencies such as professionalism and communication skills.
Survey results indicating the average total course hours, lecture hours, and laboratory hours for Neuroscience/Neuroanatomy courses. Vertical bars indicate 6 SD.
2 (SD 6 2) with a range of 0–5. Regarding competency evaluation, just over half of the respondents, 11 (55%), indicated they assessed competencies such as professionalism and communication skills in their courses.
Embryology In this survey, 20 respondents indicated their embryology course was part of an integrated curriculum, while seven courses were in the stand-alone category and four were in the mixed curriculum group. Total course hours, excluding examination hours, averaged 16 (SD 6 8) with a range of 0–30 and lecture hours averaged 14 (SD 6 8) with a range of 0–30 (Fig. 4). Only two of 31 respondents indicated they had a
Neuroscience/Neuroanatomy Of the 20 respondents describing their neuroscience/neuroanatomy courses 15 indicated their course was a stand-alone course, with four indicating they participated in an integrated curriculum and one in the mixed curriculum group. Total course hours, minus examination hours, averaged 83 (SD 6 24) with a range of 32–118 (Fig. 3). The average number of lecture hours was 51 (SD 6 19) with a range of 12–75, and the average number of laboratory hours was 21 (SD 6 15) with a range of 4–72 (Fig. 3). Course examination data indicated that the average number of written examinations was 3 (SD 6 1) with a range of 1–5 and the average number of practical examinations was Anatomical Sciences Education
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Figure 4. Survey results indicating the average total course hours and lecture hours for Embryology courses. Vertical bars indicate 6 SD.
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Thus, response rates cannot be the only factor considered when evaluating the representative nature of a survey. Other factors must be considered. In the case of the current survey, it was important to demonstrate that information was gathered from all regions of the United States which occurred, that responses were received from both private and public schools which occurred, and that programs with a wide range of class size (gross anatomy 24–300; microscopic anatomy 24–211; neuroscience/neuroanatomy 72–204; and embryology 32–250 students) were represented.
Gross Anatomy
Figure 5. Comparison of current survey results with those from the 2009 and 2002 surveys for Gross Anatomy, Microscopic Anatomy, Neuroscience/Neuroanatomy, and Embryology courses. Vertical bars indicate 6 SD. aP-value > 0.05.
laboratory component in their embryology course. The average number of written examinations was 4 (SD 6 3) with a range of 0–10 and less than half of the programs reporting indicated any assessment of competencies, 13 out of 31 (42%).
Comparison with Previous Studies A comparison of the total course hours for gross anatomy, microscopic anatomy, neuroscience/neuroanatomy, and embryology courses from this survey with the results of the 2009 (Drake et al., 2009) and the 2002 (Drake et al., 2002) surveys is shown in Figure 5. As seen in this figure, statistically significant differences occur when the gross anatomy total course hours from the 2002 survey are compared with results from the 2009 survey and the current survey. Additionally, there is a statistically significant difference when the neuroscience/neuroanatomy total course hours from the 2002 survey are compared with the results from the 2009 survey.
DISCUSSION Survey Response In this type of survey, the information gathered must be comprehensive and representative. One way to assure this is to have a high response rate. However, that may not always be possible and depends on the correct individual receiving the survey and the willingness of that individual to fill out the survey. As mentioned in the Methods section, every effort was made to contact the course directors/responsible individuals at each of the 141 allopathic and 29 osteopathic medical schools in the United States. Additionally, previous studies evaluating response rates to surveys demonstrate that a typical response rate for individuals is 50% (SD 6 20%) and for individuals representing an organization or top management, like a course director, is 36% (SD 6 19%; Baruch, 1999; Baruch and Holtom 2008). Therefore, while the response rates in the current survey are low, they do fall within one standard deviation of the figure for top management, except for those related to neuroscience/neuroanatomy courses. 324
While there is a statistically significant decrease in total course hours when the results of the 2002 survey (Drake, et al., 2002) are compared to the 2009 survey (Drake, et al., 2009) and the current survey (Fig. 5), this downward trend seems to have stopped. The information supplied by respondents in the current survey indicates that there has only been a small change in total course hours, lecture hours, and laboratory hours when these results are compared to the results of the 2009 survey (Drake et al., 2009), total course–147 versus 149 (Fig. 5), lecture–41 versus 43, and laboratory–91 versus 94. This may signal that some stability regarding course hours has been reached. Additionally, all respondents still use cadavers, their courses are primarily laboratory based, and two-thirds indicate student dissection was their current laboratory experience. Some aspects of gross anatomy courses that have changed since the previous survey were that 45% of the courses reported that they are part of an integrated curriculum, up from about 30% in the 2009 survey (Drake et al., 2009), and 56% of survey respondents indicated that they do assess competencies. In the 2009 survey, competency assessment was very small. Both of these changes are typical of modifications that have occurred in curricular design and student assessment in the past several years (Gregory et al., 2009, Youdas et al., 2013).
Microscopic Anatomy The common theme in the current survey with regards to the organization of microscopic anatomy courses in United States medical schools was one of little change from the 2009 survey (Drake et al., 2009). In fact, the reported numbers were virtually identical: total course hours–72 versus 73 (Fig. 5), lecture hours–31 versus 35, and laboratory hours–33 versus 35. The one shift that has continued from the previous to the current survey is the increased use of virtual microscopy either by itself or in combination with microscopes. The reported number in the 2009 survey combining these two categories was 71% (Drake et al., 2009) and this number has increased to 82% in the current study. Regarding competency assessment, this still is not a particularly popular aspect of evaluation in Microscopic Anatomy courses as only 39% of respondents indicated documentation in this area.
Neuroscience/Neuroanatomy Survey results for neuroscience/neuroanatomy courses in United States medical schools showed small increases that were not significant when compared to the 2009 survey Drake et al.
(Drake et al., 2009). Total course hours increased from 79 to 83 hours (Fig. 5) and the range narrowed, current survey 32– 118 versus 11–136. Lecture hours remained nearly the same at 51 versus 52 in the previous survey, and laboratory hours increased from 15 in the previous survey to 21. However, there was a significant decrease in total course hours when the results from the 2002 survey (Drake et al., 2002) were compared to the results from the 2009 survey (Fig. 5).
Embryology As was the case with microscopic anatomy, embryology courses in United States Medical Schools showed little change in total hours when results from the current survey were compared to those of 2009 (Drake et al., 2009). Total courses hours were virtually the same (Fig. 5), 16 versus 17, and so were lecture hours, 14 versus 15. However, there was a change in the range of course hours, 0–30 versus 0–68, and lecture hours, 0–30 versus 0–54, reported when compared to data from the 2009 survey. While the meaning of this change is unclear, it may be nothing more than some of the longer courses being shortened as curriculum reform and reorganization continues.
CONCLUSIONS When the information obtained in the current survey was evaluated and compared to previous surveys, several conclusions were reached: Only small, nonsignificant changes in gross anatomy, microscopic anatomy, neuroscience/neuroanatomy, and embryology total course, lecture, and laboratory hours were observed, when the results from the current study were compared to the results of the 2009 study. The vast range of total course hours remains consistent across the current and previous surveys (Fig. 5), further emphasizing that course structure is dependent on a variety of factors such as curricular approach, class size, as well as other parameters. Gross anatomy: more courses were part of an integrated curriculum when the current study was compared to the 2009 study–45% versus 30%. Additionally, 56% of respondents indicated they do assess professionalism and other competencies while this number was extremely small in the 2009. Microscopic anatomy: The use of virtual microscopy with or without microscopes continues to increase, current survey–82% versus 2009 survey–71%. Neuroscience/Neuroanatomy and Embryology–these two courses remained unchanged. Finally, even though the sample size in this survey was small, we feel it is representative and the survey results may show that the pattern of decreasing hours for teaching the anatomical sciences in United States medical schools may be stabilizing. However, collection of future survey data is needed to fully establish this conclusion.
ACKNOWLEDGMENTS The authors thank all of the respondents to the survey for their willingness to supply information on their courses with the
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anatomical sciences community. They also thank Ms. Andrea Pendleton, former Executive Director of the American Association of Anatomists, for her assistance in preparing and facilitating the use of the online survey.
NOTES ON CONTRIBUTORS RICHARD L. DRAKE, Ph.D., is a professor in the Department of Surgery and Director of Anatomy at the Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio. He teaches gross anatomy, embryology, and neuroanatomy to first-year and second-year medical students. JENNIFER M. MCBRIDE, Ph.D., is an assistant professor in the Department of Surgery and Director of Histology at the Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio. She teaches gross anatomy, neuroanatomy, and histology to first-year and second-year medical students. WOJCIECH PAWLINA, M.D., is a professor and chair of the Department of Anatomy and Director of Procedural Skills Laboratory at the Mayo Clinic College of Medicine, Mayo Clinic, Rochester, MN. He teaches gross anatomy and histology, and serves as the director of the Human Structure didactic block for the first-year medical students. LITERATURE CITED Baruch Y. 1999. Response rate in academic studies–A comparative analysis. Hum Relat 52:421–438. Baruch Y, Holtom BC. 2008. Survey response rate levels and trends in organizational research. Hum Relat 61:1139–1160. Drake RL. 2014. A retrospective and prospective look at medical education in the United States: Trends shaping anatomical sciences education. J Anat 224: 256–260. Drake RL, Lowrie DJ, Prewitt CM. 2002. Survey of gross anatomy, microscopic anatomy, neuroscience, and embryology courses in medical school curricula in the United States. Anat Rec 269:118–122. Drake RL, McBride JM, Lachman, N, Pawlina, W. 2009. Medical education in the anatomical sciences: The winds of change continue to blow. Anat Sci Educ 2:253–259. Fleming ND. 1995. I’m different; not dumb. Modes of presentation (VARK) in the tertiary classroom. In: Zemler A, Zemler L (Editors). Research and Development in Higher Education: Blending Tradition and Technology. Proceedings of the 1995 Annual Conference of the Higher Education and Research Development Society of Australasia (HERDSA 1995); Rockhampton, Queensland, Australia; 1995 Jul 4–8. HERDSA 18:308–313. The Higher Education Research and Development Society of Australasia: Milperra, NSW, Australia. Grbic D, Hafferty FW, Hafferty PK. 2013. Medical school mission statements as reflections of institutional identity and educational purpose: A network text analysis. Acad Med 88:852–860. Gregory JK, Lachman N, Camp CL, Chen LP, Pawlina W. 2009. Restructuring a basic science course for core competencies: An example from anatomy teaching. Med Teach 31:855–861. Irby DM, Cooke M, O’Brien BC. 2010. Calls for reform of medical education by the Carnegie Foundation for the Advancement of Teaching: 1910 and 2010. Acad Med 85:220–227. Johnson EO, Charchanti AV, Troupis TG. 2012. Modernization of an anatomy class: From conceptualization to implementation. A case for integrated multimodal-multidisciplinary teaching. Anat Sci Educ 5:354–366. Macpherson C, Kenny N. 2008. Professionalism and the basic sciences: An untapped resource. Med Educ 42:183–188. Orsbon CP, Kaiser RS, Ross CF. 2014. Physician opinions about an anatomy core curriculum: A case for medical imaging and vertical integration. Anat Sci Educ 7:251–261. Youdas JW, Krause DA, Hellyer NJ, Rindflesch AB, Hollman JH. 2013. Use of individual feedback during human gross anatomy course for enhancing professional behaviors in doctor of physical therapy students. Anat Sci Educ 6: 324–331.
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An Update on the Status of Anatomical Sciences Education in United States Medical Schools Richard L. Drake,1* Jennifer M. McBride,1 Wojciech Pawlina2 Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland Clinic, Cleveland, Ohio 2 Department of Anatomy, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, Minnesota 1
Curricular changes continue at United States medical schools and directors of gross anatomy, microscopic anatomy, neuroscience/neuroanatomy, and embryology courses continue to adjust and modify their offerings. Developing and supplying data related to current trends in anatomical sciences education is important if informed decisions are going to be made in a time of curricular and course revision. Thus, a survey was sent to course directors during the 2012–2013 academic years to gather information on total course hours, lecture and laboratory hours, the type of laboratory experiences, testing and competency evaluation, and the type of curricular approach used at their institution. The data gathered were compared to information obtained from previous surveys and conclusions reached were that only small or no change was observed in total course, lecture and laboratory hours in all four courses; more gross anatomy courses were part of an integrated curriculum since the previous survey; virtual microscopy with and without microscopes was the primary laboratory activity in microscopic anatomy courses; and neuroscience/neuroanatomy and embryology courses were unchanged. Anat Sci Educ 7: C 2014 American Association of Anatomists. 321–325. V
Key words: gross anatomy education; neuroanatomy education; histology education; microscopic anatomy education; embryology education; medical education; anatomical sciences; course hours; laboratory hours; assessments
INTRODUCTION Change is inevitable and curricular change has been a continuing theme in United States medical schools for the past 12–15 years. This has occurred as educators have realized that individuals acquire knowledge in different ways (Fleming, 1995) and educational programs must reflect not only this diversity in learning styles, but also principles of adult learning theories. In addition, basic sciences educators realized that they can make a valuable contribution to progressive formation of a physician’s professional identity (Irby et al., 2010) by incorporating nondiscipline-related competencies such as professionalism, teamwork, and leadership *Correspondence to: Dr. Richard L. Drake; Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland Clinic/NA24, 9500 Euclid Avenue, Cleveland, OH 44195, USA. E-mail: [email protected] Received 26 March 2014; Revised 6 May 2014; Accepted 22 May 2014. Published online 3 June 2014 in Wiley (wileyonlinelibrary.com). DOI 10.1002/ase.1468 C 2014 American Association of Anatomists V
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(Macpherson and Kenny, 2008; Gregory et al., 2009; Youdas et al., 2013) in their courses. Thus, a multimodal approach to education involving active learning, contextual learning of applied anatomical sciences, and longitudinal and vertical integration of anatomical curricula with assessments of competencies is the current pedagogical goal (Johnson et al., 2012; Drake, 2014). A philosophical change in the educational approach at a medical school will most likely have a major impact on how material is presented to students. In fact, if the curriculum changes, courses will need to modify their approach to be “in step” with the new educational paradigm of the institution. Due to the variety of vision and mission statements (Grbic et al., 2013), anticipated graduation outcomes, and approaches to curricular reform in different medical schools, there is no single prescription on how to revise anatomical sciences teaching across institutions. In addition to basic training, advanced elective student-choice courses have the potential to have a very positive impact on anatomy learning outcomes and knowledge retention. Therefore, design of advanced anatomy training that prepares students for the demands of their residency programs should consider the practical needs of each specialty rather than follow a generalized format for all clinical-year students (Orsbon et al., 2014).
Anat Sci Educ 7:321–325 (2014)
The reason for the current survey was to continue to provide a periodical update and collect relevant data relating to how education in the anatomical sciences is being presented in United States medical schools. This type of information helps curriculum committees, course directors, and teaching faculty make requested changes and improvements to their educational programs.
Table 1. Number of Courses Responding Number of responses
Response rate (%)a
Gross anatomy
55
32
METHODS
Microscopic anatomy
33
19
An online survey, similar to previous surveys (Drake et al., 2002, 2009), was developed and used to gather information about gross anatomy, microscopic anatomy, neuroscience/ neuroanatomy, and embryology courses during the 2012– 2013 academic year. Questions were asked about total course hours, number of lecture and laboratory hours, type of curriculum, number of examinations, any assessment of competencies, and other course specific information. Additionally, a variety of questions assessing demographic information related to students and faculty were also included. Notification to course directors and others that the survey was available was accomplished using a variety of methods. Initially, notices were sent to all members of the American Association of Anatomists (AAA), American Association of Clinical Anatomists, and the Association of Anatomy, Cell Biology, and Neurobiology Chairpersons asking that information about the availability of the survey be directed to the appropriate individuals. Additionally, the AAA had a list of course directors and these individuals were also contacted. Finally, after several weeks, institutions that had not responded were contacted and asked if they would get in touch with the individuals responsible for organizing the gross anatomy, microscopic anatomy, neuroscience/neuroanatomy, and embryology courses at their institutions. Finally, the data published in this survey were restricted to allopathic and osteopathic (one osteopathic school responded) medical schools in the United States. This allowed the focus of the survey to remain on schools with similar purposes and removed any bias related to specifically-directed or government-mandated programs. It also allowed a direct comparison to previously published survey data (Drake et al., 2002, 2009).
Neuroscience/Neuroanatomy
20
12
Embryology
31
18
Courses
a Response rate is calculated based on 170 schools (allopathic and osteopathic) which received the questionnaire.
courses in integrated curriculums (137, SD 6 45) to stand alone courses (154, SD 6 39). The average number of lecture hours was 41 (SD 6 24) with a range of 0–110, and the average number of laboratory hours was 91 (SD 6 27) with a range of 34–150 (Fig. 1). Responses relating to the type of laboratory experience indicated 36 used student dissection only, 18 a combination of student dissection and prosection (or previously dissected), and one used a prosection (or previously dissected) only approach. Information was also obtained in this survey related to the number of written and practical examinations in a course and whether competencies, such as professionalism and communication skills were assessed. Course examination information indicated that the average number of written examinations was 5 (SD 6 3) with a range of 0–12 and the average number of practical examinations was 4 (SD 6 2) with a range of 0–12. Regarding competencies, 31 out of 55 (56%) programs indicated they did assess competencies and the competencies usually assessed were professionalism, communication skills, and teamwork building.
RESULTS Survey Responses The number of responses received in this survey for each of the courses is indicated in Table 1.
Gross Anatomy All 55 responses in this category indicated that they still use cadavers in some type of laboratory experience, with 25 indicating their course was part of an integrated curriculum, 26 labeled their course as a stand-alone course, and four were in the mixed curriculum category. Additionally, 45 respondents indicated their course was organized regionally, eight systemically, and there were two programs that provided no response to this question. Total course hours reported by survey participants, excluding examination hours, averaged 147 (SD 6 41) with a range of 65–249 (Fig. 1). Additionally, there was no statistically significant difference in total course hours comparing 322
Figure 1. Survey results indicating the average total course hours, lecture hours, and laboratory hours for Gross Anatomy courses. Vertical bars indicate 6 SD.
Drake et al.
Figure 2.
Figure 3.
Survey results indicating the average total course hours, lecture hours, and laboratory hours for Microscopic Anatomy courses. Vertical bars indicate 6 SD.
Microscopic Anatomy In this survey, 17 respondents indicated their microscopic anatomy course was part of an integrated curriculum, 12 indicated their course was part of a stand-alone curriculum, and four programs responded they participated in a mixed curriculum. Total course hours, excluding examinations, averaged 72 (SD 6 30) with a range of 4–142 (Fig. 2). Additionally, there was no statistically significant difference in total course hours comparing courses in integrated curriculums to stand alone courses. The average number of lecture hours was 31 (SD 6 20) with a range of 0–97, and the average number of laboratory hours was 33 (SD 6 17) with a range of 0–69 (Fig. 2). Regarding the type of laboratory experience, of the 33 respondents 14 used only virtual microscopy, six used only microscopes, and 13 used both virtual systems and microscopes. Course examination information indicated that the average number of written examinations was 4 (SD 6 3) with a range of 0–14 and that there was also an average of 4 (SD 6 4) practical examinations with a range of 0–23. Regarding competencies, there seemed to be less competency evaluation in microscopic anatomy courses when compared to gross anatomy courses as only 13 of 33 (39%) respondents indicated they assessed competencies such as professionalism and communication skills.
Survey results indicating the average total course hours, lecture hours, and laboratory hours for Neuroscience/Neuroanatomy courses. Vertical bars indicate 6 SD.
2 (SD 6 2) with a range of 0–5. Regarding competency evaluation, just over half of the respondents, 11 (55%), indicated they assessed competencies such as professionalism and communication skills in their courses.
Embryology In this survey, 20 respondents indicated their embryology course was part of an integrated curriculum, while seven courses were in the stand-alone category and four were in the mixed curriculum group. Total course hours, excluding examination hours, averaged 16 (SD 6 8) with a range of 0–30 and lecture hours averaged 14 (SD 6 8) with a range of 0–30 (Fig. 4). Only two of 31 respondents indicated they had a
Neuroscience/Neuroanatomy Of the 20 respondents describing their neuroscience/neuroanatomy courses 15 indicated their course was a stand-alone course, with four indicating they participated in an integrated curriculum and one in the mixed curriculum group. Total course hours, minus examination hours, averaged 83 (SD 6 24) with a range of 32–118 (Fig. 3). The average number of lecture hours was 51 (SD 6 19) with a range of 12–75, and the average number of laboratory hours was 21 (SD 6 15) with a range of 4–72 (Fig. 3). Course examination data indicated that the average number of written examinations was 3 (SD 6 1) with a range of 1–5 and the average number of practical examinations was Anatomical Sciences Education
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Figure 4. Survey results indicating the average total course hours and lecture hours for Embryology courses. Vertical bars indicate 6 SD.
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Thus, response rates cannot be the only factor considered when evaluating the representative nature of a survey. Other factors must be considered. In the case of the current survey, it was important to demonstrate that information was gathered from all regions of the United States which occurred, that responses were received from both private and public schools which occurred, and that programs with a wide range of class size (gross anatomy 24–300; microscopic anatomy 24–211; neuroscience/neuroanatomy 72–204; and embryology 32–250 students) were represented.
Gross Anatomy
Figure 5. Comparison of current survey results with those from the 2009 and 2002 surveys for Gross Anatomy, Microscopic Anatomy, Neuroscience/Neuroanatomy, and Embryology courses. Vertical bars indicate 6 SD. aP-value > 0.05.
laboratory component in their embryology course. The average number of written examinations was 4 (SD 6 3) with a range of 0–10 and less than half of the programs reporting indicated any assessment of competencies, 13 out of 31 (42%).
Comparison with Previous Studies A comparison of the total course hours for gross anatomy, microscopic anatomy, neuroscience/neuroanatomy, and embryology courses from this survey with the results of the 2009 (Drake et al., 2009) and the 2002 (Drake et al., 2002) surveys is shown in Figure 5. As seen in this figure, statistically significant differences occur when the gross anatomy total course hours from the 2002 survey are compared with results from the 2009 survey and the current survey. Additionally, there is a statistically significant difference when the neuroscience/neuroanatomy total course hours from the 2002 survey are compared with the results from the 2009 survey.
DISCUSSION Survey Response In this type of survey, the information gathered must be comprehensive and representative. One way to assure this is to have a high response rate. However, that may not always be possible and depends on the correct individual receiving the survey and the willingness of that individual to fill out the survey. As mentioned in the Methods section, every effort was made to contact the course directors/responsible individuals at each of the 141 allopathic and 29 osteopathic medical schools in the United States. Additionally, previous studies evaluating response rates to surveys demonstrate that a typical response rate for individuals is 50% (SD 6 20%) and for individuals representing an organization or top management, like a course director, is 36% (SD 6 19%; Baruch, 1999; Baruch and Holtom 2008). Therefore, while the response rates in the current survey are low, they do fall within one standard deviation of the figure for top management, except for those related to neuroscience/neuroanatomy courses. 324
While there is a statistically significant decrease in total course hours when the results of the 2002 survey (Drake, et al., 2002) are compared to the 2009 survey (Drake, et al., 2009) and the current survey (Fig. 5), this downward trend seems to have stopped. The information supplied by respondents in the current survey indicates that there has only been a small change in total course hours, lecture hours, and laboratory hours when these results are compared to the results of the 2009 survey (Drake et al., 2009), total course–147 versus 149 (Fig. 5), lecture–41 versus 43, and laboratory–91 versus 94. This may signal that some stability regarding course hours has been reached. Additionally, all respondents still use cadavers, their courses are primarily laboratory based, and two-thirds indicate student dissection was their current laboratory experience. Some aspects of gross anatomy courses that have changed since the previous survey were that 45% of the courses reported that they are part of an integrated curriculum, up from about 30% in the 2009 survey (Drake et al., 2009), and 56% of survey respondents indicated that they do assess competencies. In the 2009 survey, competency assessment was very small. Both of these changes are typical of modifications that have occurred in curricular design and student assessment in the past several years (Gregory et al., 2009, Youdas et al., 2013).
Microscopic Anatomy The common theme in the current survey with regards to the organization of microscopic anatomy courses in United States medical schools was one of little change from the 2009 survey (Drake et al., 2009). In fact, the reported numbers were virtually identical: total course hours–72 versus 73 (Fig. 5), lecture hours–31 versus 35, and laboratory hours–33 versus 35. The one shift that has continued from the previous to the current survey is the increased use of virtual microscopy either by itself or in combination with microscopes. The reported number in the 2009 survey combining these two categories was 71% (Drake et al., 2009) and this number has increased to 82% in the current study. Regarding competency assessment, this still is not a particularly popular aspect of evaluation in Microscopic Anatomy courses as only 39% of respondents indicated documentation in this area.
Neuroscience/Neuroanatomy Survey results for neuroscience/neuroanatomy courses in United States medical schools showed small increases that were not significant when compared to the 2009 survey Drake et al.
(Drake et al., 2009). Total course hours increased from 79 to 83 hours (Fig. 5) and the range narrowed, current survey 32– 118 versus 11–136. Lecture hours remained nearly the same at 51 versus 52 in the previous survey, and laboratory hours increased from 15 in the previous survey to 21. However, there was a significant decrease in total course hours when the results from the 2002 survey (Drake et al., 2002) were compared to the results from the 2009 survey (Fig. 5).
Embryology As was the case with microscopic anatomy, embryology courses in United States Medical Schools showed little change in total hours when results from the current survey were compared to those of 2009 (Drake et al., 2009). Total courses hours were virtually the same (Fig. 5), 16 versus 17, and so were lecture hours, 14 versus 15. However, there was a change in the range of course hours, 0–30 versus 0–68, and lecture hours, 0–30 versus 0–54, reported when compared to data from the 2009 survey. While the meaning of this change is unclear, it may be nothing more than some of the longer courses being shortened as curriculum reform and reorganization continues.
CONCLUSIONS When the information obtained in the current survey was evaluated and compared to previous surveys, several conclusions were reached: Only small, nonsignificant changes in gross anatomy, microscopic anatomy, neuroscience/neuroanatomy, and embryology total course, lecture, and laboratory hours were observed, when the results from the current study were compared to the results of the 2009 study. The vast range of total course hours remains consistent across the current and previous surveys (Fig. 5), further emphasizing that course structure is dependent on a variety of factors such as curricular approach, class size, as well as other parameters. Gross anatomy: more courses were part of an integrated curriculum when the current study was compared to the 2009 study–45% versus 30%. Additionally, 56% of respondents indicated they do assess professionalism and other competencies while this number was extremely small in the 2009. Microscopic anatomy: The use of virtual microscopy with or without microscopes continues to increase, current survey–82% versus 2009 survey–71%. Neuroscience/Neuroanatomy and Embryology–these two courses remained unchanged. Finally, even though the sample size in this survey was small, we feel it is representative and the survey results may show that the pattern of decreasing hours for teaching the anatomical sciences in United States medical schools may be stabilizing. However, collection of future survey data is needed to fully establish this conclusion.
ACKNOWLEDGMENTS The authors thank all of the respondents to the survey for their willingness to supply information on their courses with the
Anatomical Sciences Education
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anatomical sciences community. They also thank Ms. Andrea Pendleton, former Executive Director of the American Association of Anatomists, for her assistance in preparing and facilitating the use of the online survey.
NOTES ON CONTRIBUTORS RICHARD L. DRAKE, Ph.D., is a professor in the Department of Surgery and Director of Anatomy at the Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio. He teaches gross anatomy, embryology, and neuroanatomy to first-year and second-year medical students. JENNIFER M. MCBRIDE, Ph.D., is an assistant professor in the Department of Surgery and Director of Histology at the Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio. She teaches gross anatomy, neuroanatomy, and histology to first-year and second-year medical students. WOJCIECH PAWLINA, M.D., is a professor and chair of the Department of Anatomy and Director of Procedural Skills Laboratory at the Mayo Clinic College of Medicine, Mayo Clinic, Rochester, MN. He teaches gross anatomy and histology, and serves as the director of the Human Structure didactic block for the first-year medical students. LITERATURE CITED Baruch Y. 1999. Response rate in academic studies–A comparative analysis. Hum Relat 52:421–438. Baruch Y, Holtom BC. 2008. Survey response rate levels and trends in organizational research. Hum Relat 61:1139–1160. Drake RL. 2014. A retrospective and prospective look at medical education in the United States: Trends shaping anatomical sciences education. J Anat 224: 256–260. Drake RL, Lowrie DJ, Prewitt CM. 2002. Survey of gross anatomy, microscopic anatomy, neuroscience, and embryology courses in medical school curricula in the United States. Anat Rec 269:118–122. Drake RL, McBride JM, Lachman, N, Pawlina, W. 2009. Medical education in the anatomical sciences: The winds of change continue to blow. Anat Sci Educ 2:253–259. Fleming ND. 1995. I’m different; not dumb. Modes of presentation (VARK) in the tertiary classroom. In: Zemler A, Zemler L (Editors). Research and Development in Higher Education: Blending Tradition and Technology. Proceedings of the 1995 Annual Conference of the Higher Education and Research Development Society of Australasia (HERDSA 1995); Rockhampton, Queensland, Australia; 1995 Jul 4–8. HERDSA 18:308–313. The Higher Education Research and Development Society of Australasia: Milperra, NSW, Australia. Grbic D, Hafferty FW, Hafferty PK. 2013. Medical school mission statements as reflections of institutional identity and educational purpose: A network text analysis. Acad Med 88:852–860. Gregory JK, Lachman N, Camp CL, Chen LP, Pawlina W. 2009. Restructuring a basic science course for core competencies: An example from anatomy teaching. Med Teach 31:855–861. Irby DM, Cooke M, O’Brien BC. 2010. Calls for reform of medical education by the Carnegie Foundation for the Advancement of Teaching: 1910 and 2010. Acad Med 85:220–227. Johnson EO, Charchanti AV, Troupis TG. 2012. Modernization of an anatomy class: From conceptualization to implementation. A case for integrated multimodal-multidisciplinary teaching. Anat Sci Educ 5:354–366. Macpherson C, Kenny N. 2008. Professionalism and the basic sciences: An untapped resource. Med Educ 42:183–188. Orsbon CP, Kaiser RS, Ross CF. 2014. Physician opinions about an anatomy core curriculum: A case for medical imaging and vertical integration. Anat Sci Educ 7:251–261. Youdas JW, Krause DA, Hellyer NJ, Rindflesch AB, Hollman JH. 2013. Use of individual feedback during human gross anatomy course for enhancing professional behaviors in doctor of physical therapy students. Anat Sci Educ 6: 324–331.
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