From Conceptualization

to Implementation

Modernization of an Anatomy Class

Elizabeth Johnson Dept of Anatomy Lab Education & Research in Neurosciences (LERNs) University of Athens, School of Medicine

A Case for Integrated

Multimodal-

Multidisciplinary

Teaching

Johnson et al, Anat Sci Education, 2012 American Association of Anatomists (AAA)

• How we Learn: Old World vs New World

• Current Thinking in Medical Education

• Curricular Models

• Multimodal Tools for Teaching Anatomy

Modernization of an Anatomy Class

Medical Doctors

Old World New World

Practice As individuals In teams

Source of knowledge Expert opinion Review of the evidence

New skills & knowledge not required

Continuous education a must

Education

Vs

Today

The three most important words in medical education are . . .

I

“Εν οίδα ότι ουδέν οίδα”

Socrates 470 BC - 399 BC

Know Don’t

The one thing that I know is that I know nothing

Medical Knowledge doubles every ~ 2.5 years

Medicine will change more in the next 20 yrs

than it has in the past 2000 !

Learning Medical Science

Old World New World

Knowing what

you should know

BMJ, 2003

Knowing what you don’t know,

But knowing how to find out

Vs

The Challenge

How to reform

medical curriculum

with innovative ways that

accommodate increasing burden of

medical information.

Curricular Models

Traditional

Systems Based

Problem Based

Current Trends

3 types

Let’s take a closer look . . .

? What do we know about these curricular models

• Content Driven - Focus on details

• Rote Memorization of lots of facts

• Little integration across disciplines

• Little clinical relevance

• Poor staff-to-student ratio

• Passive learning

Patel & Moxham, Clin Anat, 2006 Aziz et al, Anat Record, 2002

Traditional format Current Trends

• Integration of several disciplines for each system

• Material presented in traditional manner

• Passive learning of details

•Low basic knowledge scores

McKeown et al, Med Ed, 2003

Systems Based Curriculum Current Trends

• Active learning • Critical thinking • Significant individual effort • Direct clinical relevance • Results in basic knowledge gaps

Problem Based Model Current Trends

Drake, New Anatomist 1998

Curricular Models

Traditional

Systems Based

Problem Based

Teaching Others 95%

Doing

Discussion

Demonstration

Audiovisual

Reading

Lectures

75%

50%

30%

20%

10%

0.9%

Millers Prism

Retention

Active learning significantly promotes knowledge retention

No single method of teaching anatomy

is able to provide supremacy over another.

Johnson et al, Anat Sci Ed, 2013

Apparent that . . . Current Trends

Traditional Model Outline

Basic Concepts

Systems Based Organization plan for presenting

material & integrating function, clinical relevance, imaging, etc

Problem Based Discuss

Clinical Cases for each system

Integrated Approach

Current Trends Anatomy

• Embraced different approaches – multi-disciplinary (traditional, problem solving, systems, surface, radiographic, & clinical association)

• Use all available tools - multi-modality (traditional teaching tools & modern innovative educational programs)

Program devised to take advantage of & maximize benefits from different teaching methods.

• Multi-modal lectures • Clinical problems • Peer groups / Team-based learning • Peer teaching • Models, bone boxes, skeletons • Cadaveric Anatomy - Dissection • Surface Anatomy – Living Anatomy • Radiologic Anatomy • Cross-sectional Anatomy • Computer-assisted Learning (CAL)

Anatomy Curriculum Anatomy

The “Whys” &

“Hows”

• Integrated approach

• Clinical Association

• Radiologic Anatomy

• Problem Based Learning -

Clinical Problems

Lectures

Clinical Association Lectures

• Illustrate clinical application & importance of anatomy • Introduce importance of anatomical knowledge in performing physical exams

• Increase student interest

EUC Anatomy

Radiologic Anatomy Lectures

• Aim : enhance knowledge of human structure through modern imaging techniques • Apply knowledge of human body to interpretation of 2-diminsional images

“See the human body with the visual tools of a doctor”

Problem Based Learning (PBL) Clinical Problems

• A clinical problem/case = starting point • Team effort • Literature search • Talk with faculty & clinicians • Formal oral presentation • Brief synopsis

• Increased interest • Active learning • Integrative process • Cooperative learning • Promotes critical thinking

Strong Points Weak Points

• Increased teaching time (40%) • Increased need for instructors • Insufficient basic knowledge

Problem Based Learning (PBL) when used alone

Peer Groups Team-Based Learning (TBL) • Promotes cooperation

• Promotes communication skills • Introduces professionalism

• Introduces Accountability & responsibility

• Improves learning

Peer Groups

• Team 4-6 students

• Choose own team

• Share responsibilities

• Teamwork required for

Laboratory

Surface anatomy

Clinical problems

Peer Teachers (near-peer teachers) • Medical students who have passed class with excellence

• Willing to devote time to help their younger colleagues

Responsibilities

• Facilitators in laboratory sessions

• Lead laboratory teams

• Tutoring

Purpose

• Enhance quality of education

• Promote accountability & professionalism

• Mentorship

Peer Teachers – Advantages for Tutees • Students perform significantly better

• Learn study methods

• Decrease student-teacher ratio

• PTs - serve as young mentors

• Students approach PTs more easily

• Fuel student interest in becoming future PT

Peer Teachers – Advantages for PTs

• Reinforce communication skills

• Acquire teaching skills

• Solidify knowledge continuous contact

“See One – Do One – Teach One”

Models

• Demonstrate internal organ relationships

• Teach 3-D comprehension

• Show spatial relationship of structures

• Don’t show anatomic variation

• Show limited number of structures

• Often lacks accurate shape & surface details

Important Adjunct

Surface Anatomy • Understand how surface features can reveal details of underlying structures

• Provides anatomical basis of clinical exam

Aggarwal et al, Clin Anat 2006

Computer Assisted Learning (CAL) Perceiving 3D from 2D Images

Trelease, Anat Rec 2002

Computer-Assisted Learning (CAL) • Important instructional (lecture & lab) adjunct

• Independent / interactive learning tool

• Allows schedule flexibility

• Enhances learning • Allows effective use of time in laboratory

Computer-Assisted Learning (CAL)

Disadvantages / Weak Points • Not fully integrated into curriculum

• Students are not always tested on what they have learned in CAL

• Often poorly designed implementation

Erkonen et al, Invest Rad, 1992

Cross-Sectional Anatomy Importance

• Shows anatomic relations

• Significantly improves - interpretation of CT & MRI

Computer Assisted Learning (CAL)

Computer Assisted Learning (CAL) Cross-sectional anatomy Interactive Human

Visualization of 3D Structures

Let the Students Use Their Imagination

Modernization of an Anatomy Class

• Multi-modal lectures • Clinical problems • Peer groups / Team-based learning • Peer teaching • Models, bone boxes, skeletons • Cadaveric Anatomy - Dissection • Surface Anatomy – Living Anatomy • Radiologic Anatomy • Cross-sectional Anatomy • Computer-assisted Learning (CAL)

Modern Medical Education is a

Team Effort

Learn as a Team

Teach as a Team

Peer Teachers

Student Teams

Staff

Adminis- tration

Faculty

Thank You

University of Athens School of Medicine