Master students’ perception and attitude on methods of anatomy teaching and assessment, Khartoum, Sudan 2014–2020

Abstract

Background

Medical education relies heavily on anatomy as a fundamental component. Irrespective of their specific field of expertise, it is undeniably essential for doctors to possess a comprehensive grasp of anatomical principles. Teaching and obtaining knowledge of anatomy are highly important and challenging disciplines for both educators and learners. The aim of this study was to assess the perception and attitude towards the methods used for teaching and assessing anatomy among postgraduate students.

Methods

A descriptive cross-sectional study was conducted on three consecutive cohorts of anatomy master students. The data collection process employed a semi-structured questionnaire, and the data analysis was carried out using the IBM Statistical Programme for Social Sciences version 24 (SPSS 24).

Results

There was a total of 44 participants who filled out the questionnaire. Among them, 90.9% chose dissection room sessions as the most effective approach for attaining the necessary learning outcomes. Practical dissection was found to be the most successful educational method in terms of stimulating attention (81.1%), offering enjoyment (70.5%), boosting information retention (65.9%), and ensuring satisfaction (59.1%). Of the study participants, 72.7% of the participants hold the belief that the practical dissection test is the most efficient method for evaluating the designated learning goals. The utilisation of multiple-choice questions proved to be highly beneficial in facilitating good comprehension of anatomy and served as the optimal means for evaluating one’s knowledge among 63.6% of the students.

Conclusions

Overall, the majority of students held positive views regarding the efficacy of cadaveric dissections in all their forms for transferring knowledge about anatomy. The most effective evaluation procedures were the utilisation of multiple-choice questions and the implementation of the spotter test.

Background

The current millennium has witnessed an increase in research related to the teaching and learning of human anatomy. These studies discussed the struggle between classic methodologies and innovative ones in the teaching and learning of anatomy [1]. Cadaver-based teaching of anatomy is getting less popular, with more interest in using innovative teaching methodologies [2, 3]. The instruction and acquisition of anatomical knowledge is a very significant and demanding discipline for both educators and learners [4, 5]. Without a doubt, a comprehensive understanding of anatomy is essential for clinicians in every medical field, establishing anatomy as the fundamental basis of medical education [6]. Nevertheless, anatomical instruction has recently become a very contentious field in medical education [7].

At a postgraduate level, there is worldwide uncertainty regarding the methodology for delivering optimal anatomical knowledge [8]. Even within the anatomist community, there are differing viewpoints as to whether the new methods of teaching anatomy are better than the traditional use of cadaveric dissection [9].

The practice of dissecting cadavers has long been considered an essential need for anatomy school and for the professional careers of graduates [10, 11]. However, researchers have tested and reviewed other methods of anatomy teaching that have shown comparable results to cadaveric dissection. These may include plastic models, body painting, virtual reality, simulation, imaging, and computer-assisted learning [12,13,14,15]. Others reported that an optimal approach to instructing modern anatomy involves integrating many educational resources that mutually enhance each other; this method has been observed to result in enhanced student learning, motivation, satisfaction, and academic achievement [16].

In addition to the best teaching methodology dilemma, the best assessment techniques are of paramount importance to ensure that students have truly gained the required anatomical knowledge [17]. A review study linked surgical errors to knowledge of anatomical variations. Anatomical knowledge, especially of the surgical background, may decrease surgical errors [18].

There has been variability in testing higher- and lower-order thinking using different assessment tools in anatomy examinations. Research has reported that open-ended or short-answer questions are a more effective tool for testing higher-order thinking compared to multiple-choice questions (MCQs) [17, 19].

Medical and healthcare practices constantly evolve and are expected to undergo significant transformations in the future. These developments will necessitate a revised strategy for educating, training, and evaluating the upcoming cohort of healthcare professionals [20]. The opinions of students serve as a helpful foundation for enhancing and changing medical education. We can determine the teaching methodology’s strong and weak points by analysing feedback. World-wide, student-centred, integrative, problem-based, and clinically relevant teaching and learning are becoming more and more important [21, 22]. In Sudan, despite the abundance of anatomy master’s programs, there is a scarcity of research that emphasises the most effective teaching and assessment methods for anatomy at the postgraduate level. Furthermore, the curriculum design varies amongst universities. With this background, the current study aimed to assess the students’ perceptions and attitudes towards anatomy teaching and learning methodologies.

Materials and methods

A descriptive cross-sectional study was conducted at the Faculty of Medicine, University of Khartoum. The University of Khartoum (U of K) is a multi-campus, co-educational, public university located in Khartoum. It is the largest and oldest university in Sudan. The Faculty of Medicine is located on Al-Qasr Street and hosts various master’s degree programmes, among which is the Master of Anatomy (Human Morphology), the focus of the study. The Graduate College runs these master programmes.

The curriculum of the anatomy master programme is a two-year programme; the first year includes the four divisions of anatomy (gross anatomy, embryology, histology, and neuroanatomy). While the second year includes advanced subjects including radiological anatomy, research methodology, an introduction to medical education, and the submission of a thesis. A final exam takes place at the end of each year. Submission of the thesis is a requirement for entry into the second-year exam.

Methods of instruction for the anatomy master programme include didactic lectures, histology laboratory (identification and preparation of general and systemic slides), and dissection room sessions (where master students act as instructors for the first- and second-year medical students who are usually grouped into four subgroups and each subgroup gets allocated to a certain station, each subgroup will shift to the next station after a certain period so that all students will eventually go through the four stations), students` seminars, practical dissection (where each master student is provided with half a cadaver to dissect over a month, at the end of which there will be a practical dissection exam), assignments, and supervision of the undergraduate dissection room and histology laboratory sessions.

Assessment methods include a written exam (MCQs, modified clinically oriented short notes, modified long assays), a histology spotter exam using microscopes and images, a gross anatomy spotter exam, an oral exam, and a dissection exam at the end of the second year. During the practical dissection exam, students are required to dissect half a cadaver and present their dissection to a panel of two examiners after a specified time.

All the graduates from the anatomy master programme between 2014 and 2020 participated in this study. The batches included were three: 2014–2016, 2016–2018, and 2018–2020. The number of graduates in each batch was 14, 15, and 16, respectively.

The sampling technique used was total coverage of all graduates of the master programme of anatomy in the period between 2014 and 2020. As the admission to the master program is every two years, there were three batches in this period. The total number of graduates in the three batches over that period was 45. We chose those three batches as the study population because they were the most recent ones, and the teaching and assessment methods were consistent across them.

A semi-structured and pre-tested questionnaire - that was developed for this study - was used as a tool for data collection and was sent to all students via Google Forms (44 out of 45 students responded to the online form). Two experts in anatomy and medical education prepared and validated the questionnaire in English. The questionnaire consisted of three parts; the first part included the personal characteristics of the respondents, like age, gender, place of residence, and the batch year. While the second part included close-ended questions regarding the methods of teaching and assessment used in gross anatomy, embryology, histology, neuroanatomy, radiological anatomy, and research methodology using a drop list where multiple options could be chosen for the same question. Lastly, the third part consisted of open-ended questions regarding the teaching method that was mostly liked by the students and the one that was mostly disliked by them.

The questionnaire included lectures, seminars, small group discussions, histology labs, dissection room (DR) sessions (where the master’s students instruct and supervise the undergraduate students in the dissection room), practical dissection (where each student dissects half a cadaver), and the museum as teaching methods. Self-assessment of acquiring knowledge and skills in the above fields was also explored among them.

IBM’s Statistical Package for Social Sciences version 24 (SPSS 24) was used for the data analysis. Descriptive statistics such as frequencies were used in the study.

Ethical consideration and consent

The Research Ethical Committee, Faculty of Medicine, University of Khartoum, granted permission to conduct this research before study initiation (Reference Number: FM/DO/EC). The researchers obtained informed consent from the respondents before their participation in the study, providing an explanation of the nature of the study as part of the Google form provided. The researchers also sought permission from the Head Department of Anatomy, Faculty of Medicine, University of Khartoum. To ensure the confidentiality of the participants, questionnaires were collected anonymously.

Results

Demographic characteristics

In this study, the total number of respondents was 44 out of 45 master students (response rate is 97.8%). 26 (59.1%) of them were aged between 31 and 40 years, and the remaining 18 (40.9%) were aged between 20 and 30 years. The majority of the respondents, 24 (54.5%), were males, whereas 20 (45.5%) were females.

Anatomy teaching methods

90.9% of students thought that dissection room sessions (where master students instruct undergraduate students) enabled them to achieve the intended learning outcomes. (81.8%) of them were interested in, (70.5%) of them enjoyed and (59.1%) were mostly satisfied with practical dissection (dissecting half a cadaver) (Table 1).

Anatomy assessment methods

(72.7%) of the respondents selected the practical dissection exam as the assessment method that facilitated the fulfilment of the intended learning objectives. (63.6%) of the respondents chose multiple-choice questions as the best assessment tool for measuring theoretical knowledge, followed by essay questions (short and long) (61.4%). The majority of the respondents (86.4%) were comfortable with the spotter test as the best practical assessment tool, followed by the practical dissection test (70.5%) (Table 2).

Open-ended questions

(43.2%) of the students liked dissection room sessions as a tool for anatomy teaching. This is followed by small group discussion (23.3%), practical dissection (18.2%), and seminars (11.4%). On the other hand, most of them (70.5%) did not like lectures as a method of anatomy teaching (Table 3).

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Discussion

A comprehensive understanding of anatomy is essential for the practice of medicine; therefore, it should not be solely dependent on current teaching methods. The objective of this study is to examine student perspectives on various teaching and assessment approaches in the field of anatomy education. Overall, the majority of students held favourable opinions regarding the effectiveness of cadaveric dissections in teaching and acquiring anatomical knowledge.

In this study, master students chose dissection room sessions to be the most helpful in achieving the desired learning outcomes. Cadaveric dissection has long been a fundamental method of teaching anatomy in medical schools worldwide since ancient times [23]. This finding aligns with a separate study in which students expressed a robust belief that engaging in cadaveric dissection strengthens their comprehension of anatomy and increases their reverence for the human body [24]. Other anatomists stated that cadaveric dissection cannot be replaced while it can be augmented for better learning of anatomy [23, 25–26]. Despite being positive about dissection room sessions regarding obtaining the intended learning objectives (90.9%), only (47%) of the students were satisfied with them. This might indicate that seminars and practical dissection were more satisfying than dissection room sessions because they provided an opportunity for innovation and adding their own touches to existing medical knowledge, unlike dissection room sessions where students are kept within a certain frame.

In line with the above opinions on cadaveric dissection, most of the participants in the present investigation recognised that dissecting half a cadaver (practical dissection) was the most interesting, enjoyable, and satisfying tool for learning anatomy. Undergraduate students have also reported similar findings, with the majority of students perceiving cadaveric dissection as interesting and this is similar to a study conducted by Asante EA et al. in Ethiopia [24]. Engaging in the practical dissection of a human body offers a more thorough and in-depth comprehension of human anatomy in a three-dimensional manner. Such favourable aspects of dissection have been highlighted previously [27]. The master students are the future anatomists or surgeons, which is why their interest in and understanding of cadaveric sessions should be greater than that of undergraduate students. A similar study has reported that cadaveric dissection is associated with a better learning experience [28].

The majority of the anatomy students pursuing advanced degrees in this study also reported that engaging in practical dissection of cadavers was beneficial for recalling and retaining the knowledge they have acquired. This is in line with other studies which agreed that cadaveric dissection is a supportive tool for the retention of anatomical knowledge [29]. A scarcity of cadavers and a lack of regulations permitting students to learn anatomy through dissection practice have hindered the routine use of anatomy instruction [30]. Whole body-dissection has also been demonstrated to be associated with short- and long-term retention of anatomical knowledge [31]. However, a move towards cadaver-less anatomical education has been a matter of controversy. Some researchers identified cadaver-less anatomy education as undesirable and affected skill and professional attitude acquisition [32]. While others reported promising results of students` satisfaction and retention of knowledge following virtual anatomy teaching, especially in the era of the Corona virus pandemic [26, 33].

On the other hand, anatomical models were the least useful teaching tool in obtaining the intended learning objectives among the students. This is in contradiction to the literature; 3D digital anatomical models and texture maps can effectively depict the morphological attributes of human tissues and structures. Additionally, they can highlight complex structures that are challenging to examine in human anatomical models, thereby enhancing the effectiveness of anatomy instruction. Anatomical models were introduced due to the lack of cadaveric specimens [34]. This was not the case among our students, where they had full access to cadavers throughout their study curriculum. Maybe that’s why they were more positive about the cadaveric methods as opposed to the anatomical models.

The majority of the postgraduate students in this study felt that the best assessment method that fulfilled the intended learning outcomes was the practical dissection test. The students found practical dissection to be a valuable opportunity for applying their anatomical knowledge. Moreover, it’s a chance for innovation and promotes deep learning [35].

With regard to their theoretical knowledge of anatomy, the master students chose Multiple-choice-questions (MCQs) and Extended-match-questions (EMQs) as the best assessment methods. MCQs are known to have high content validity, enabling efficient sampling of anatomical knowledge [36].

In line with the present study results, EMQs were described as being as effective as MCQs and oral examinations in monitoring student progress in gross anatomy [37]. While others reported that MCQs were better in monitoring poorly performing students [38], or they were halfway between free-response questions and MCQs [39].

With regards to the best practical assessment tool in anatomy, most of the respondents were mostly satisfied with the spotter test, followed by the practical dissection test. The spotter test was known for its validity, reliability, and educational impact [40]. The use of spotter examination in the assessment of anatomy has received some criticism as it tests low levels of recall and remembering [41]. While other anatomists suggested improvements on spotter to modify the questioning verbs and techniques to test higher levels of Bloom`s taxonomy [35, 42].

When given a chance to choose a teaching method that they dislike the most, majority of the students chose lectures. Comments regarding this choice indicate that several students perceived the lectures as tedious, lengthy, and overly teacher-centred, asserting that most of the information presented could be readily located in textbooks. This is in line with another study by Michael Lüscher and others, which stated that lectures yield low information retention rates of 5–20%. They concluded that the conventional lecture method must transform into more interactive and engaging formats to enhance participants’ long-term learning [43].

Conclusion

Overall, the vast majority of students held positive judgements regarding the efficacy of cadaveric dissections in all of their forms in terms of teaching and learning knowledge about anatomy. The most successful methods of assessment were the multiple-choice questions and the spotter test. The results of this study were communicated to the department of anatomy to aid in designing the master’s curriculum. A comparative study between the teaching and assessment methods examined in this study and other approaches will be considered in the future.

Study limitations

The sample size is relatively small, and it was a total coverage of three consecutive batches with a response rate of 97.8% (44 out of 45 students). The Faculty of Medicine, University of Khartoum is the top-ranking medical school in Sudan and is highly selective; hence the total numbers of the students per each batch were relatively small (14 (2014–2016), 15 (2016–2018), and 16 (2018–2020)) which might impact the broader applicability of the study results. Also, the study did not differentiate between the different batches perceptions but rather it assessed the overall perceptions of all participants regardless of their year. Differentiation may have provided insights into the generational disparities in beliefs.

Data availability

The dataset generated during this study are available from the corresponding author on reasonable request.

Abbreviations

MCQs:

Multiple choice questions

SAQs:

Short answer questions

EMQs:

Extended-match-questions

OSPE:

Objective structured practical examination

OSCE:

Objective structures clinical examination

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