Rationale and Objective
To quantifiably measure the impact of self-instructed radiological anatomy modules on anatomy comprehension, demonstrated by radiology, gross, and written exams.
Materials and Methods
Study guides for independent use that emphasized structural relationships were created for use with two online radiology atlases. A guide was created for each module of the first year medical anatomy course and incorporated as an optional course component. A total of 93 of 96 eligible students participated. All exams were normalized to control for variances in exam difficulty and body region tested. An independent t -test was used to compare overall exam scores with respect to guide completion or incompletion. To account for aptitude differences between students, a paired t -test of each student’s exam scores with and without completion of the associated guide was performed, thus allowing students to serve as their own controls.
Results
Twenty-one students completed no study guides; 22 completed all six guides; and 50 students completed between one and five guides. Aggregate comparisons of all students’ exam scores showed significantly improved mean performance when guides were used (radiology, 57.8% [percentile] vs. 45.1%, P < .001; gross, 56.9% vs. 46.5%, P = .001; written, 57.8% vs. 50.2%, P = .011). Paired comparisons among students who completed between one and five guides demonstrated significantly higher mean practical exam scores when guides were used (radiology, 49.3% [percentile] vs. 36.0%, P = .001; gross, 51.5% vs. 40.4%, P = .005), but not higher written scores.
Conclusions
Radiological anatomy study guides significantly improved anatomy comprehension on radiology, gross, and written exams.
Concern over the inadequacy of preclinical medical education for residency preparation has led to reevaluation of teaching methods in many content areas. Undergraduate anatomy education has been specifically identified as problematic because students and residents currently have difficulty applying their anatomical knowledge to clinical situations . These concerns, along with new, more readily available technologies, have led to a movement to use radiologic imaging technologies in anatomy instruction. For example, reports of ultrasound images of visceral organs in live models, computerized image databases, plain film images in the cadaver rooms, and small- and large-group lectures that use digital radiographic images projected on monitors are typical of the technological advances disseminated in preclinical medical anatomy classes .
“Blended learning” refers to the incorporation of various teaching modalities for the same endpoint—such as modern medical imaging combined with traditional gross dissection to comprehend anatomy. Previous research has found support for the use of blended learning in anatomy. For instance, when used as an adjunct to cadaver dissection, Shaffer reported that two-dimensional imaging resulted in positive student feedback, and Pereira found that annotated nonradiologic graphics resulted in improved performance on anatomy exams . Multiple representations of anatomical structures thus appear to help students understand anatomy.
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Materials and methods
Study Setting and Participants
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Study Design
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Table 1
Characteristic Examples of Study Guide Instructions
From Abdomen, X-ray Imaging From Thorax, Serial Computer Tomography Image #10: Barium contrast, anteroposterior view
Note the characteristics of the large intestine:
Omental appendices, taenia coli, haustra .
Which parts of the colon are intraperitoneal and secondarily retroperitoneal?
Intraperitoneal : cecum, appendix, transverse colon, sigmoid colon
Secondarily retroperitoneal : ascending colon, descending colon_Click on the “Anatomical Structures” button and click on “Bones._ ”
View the ascending aorta until it reaches T4/T5. Look to the left of the image and appreciate the level where the slice was taken with respect to lung and heart positions. In a single section, you should be able to see the following characteristic landmarks:
-beginning and end of the aortic arch
-bifurcation of the trachea
- pulmonary trunk at its most superior point
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Data Analysis
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Results
Descriptive Data
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Table 2
Demographic Characteristics of Aggregate Participants
Characteristic Value ∗ Age, years ± SD 23.5 ± 2.9 Male sex, number/total (%) 41/88 (46.6) Bachelor’s degree completed within 3 months of beginning medical degree, number/total (%) 42/89 (47.2) Bachelor’s degree in a basic science, number/total (%) 58/89 (65.2) Previously attained advanced science degree, number/total (%) 9/89 (10.1) Parent(s) trained as physician, number/total (%) 17/88 (19.3) Ethnicity, number/total (%) African American 10/85 (11.8) Asian American 23/85 (27.1) Caucasian 43/85 (50.6) Native American 3/85 (3.5) Other 6/85 (7.1)
SD, standard deviation.
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Aggregate Analysis
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Table 3
Distribution of Study Guide Completion and Corresponding Means of Normalized (Z) Scores
Number of Guides Used Number of Students n (%) Mean ± SD of Normalized Radiology Practical Exam Scores Mean ± SD of Normalized Gross Practical Exam Scores Mean ± SD of Normalized Written Exam Scores Without Guide With Guide Without Guide With Guide Without Guide With Guide 0 21 (22.6) 0.08 ± 0.76 - 0.01 ± 0.67 - −0.07 ± 0.66 - 1 8 (8.6) −0.06 ± 0.60 0.07 ± 0.56 −0.004 ± 0.57 0.34 ± 0.71 0.29 ± 0.53 0.46 ± 0.52 2 7 (7.5) −0.26 ± 0.95 −0.37 ± 0.90 −0.10 ± 0.69 0.12 ± 0.72 0.04 ± 0.64 0.10 ± 0.52 3 18 (19.4) −0.42 ± 0.45 −0.11 ± 0.56 −0.33 ± 0.90 −0.17 ± 1.14 −0.006 ± 0.54 −0.14 ± 0.71 4 9 (9.7) −0.36 ± 0.68 0.24 ± 0.52 0.03 ± 0.62 0.22 ± 0.46 −0.07 ± 1.08 0.20 ± 0.62 5 8 (8.6) −0.61 ± 1.17 0.11 ± 0.55 −0.71 ± 1.29 −0.07 ± 0.73 −0.25 ± 1.16 −0.17 ± 0.82 6 22 (23.7) - 0.40 ± 0.68 - 0.37 ± 0.76 - 0.44 ± 0.59 Total 93 −0.12 ± 0.99 0.20 ± 0.95 † −0.09 ± 0.92 0.17 ± 0.97 † 0.004 ± 0.94 0.20 ± 0.84 ∗
SD, standard deviation.
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Paired Analysis
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Discussion
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Acknowledgments
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