Innovation Among the Deceased - Anatomy Education Revisited
Purpose: Anatomy education is a hallmark of any physical therapy program and yet there is a wide variance of what is ‘acceptable’ with regards to the teaching of this foundational subject. From a scant view across programs there appear to be two camps of anatomy teachers – anatomists and clinicians. What has been clear in the literature is the debate between these two groups as to the most appropriate approach to anatomy education for physical therapy. The human body is a complex organism and a solid knowledge of the essential building blocks is critical for appropriate care. However, is the medical model of anatomy education more superior than a more functional anatomy education model? This was the question we faced a few years ago and will discuss through this session. The purpose of this session therefore is to describe how medical model biased anatomy education can be transformed into a more functional model biased anatomy education curriculum within one academic year.Methods and/or Description of Project: From the inception of our physical therapy program, anatomy was taught by an anatomist with traditional medical styled lectures and dissection labs. These labs afforded the students the opportunity to perform hands on dissection as part of their learning experience. The entire anatomy of the human was taught including the internal organs, and of course, the muscular, skeletal and peripheral neural systems. Groups of 3- 4 students would dissect one side (left or right) of a cadaver as part of their weekly anatomy dissection lab sessions. Students had 24/7 access to the dissection facility to be able to complete tasks that were not accomplished in allocated class sessions. In discussion with the students and evaluating our teaching methods, it became clear that students were spending a considerable amount of time ‘scraping fat off a foot’ (as one colleague put it one day) as opposed to learning the important anatomical structures being hidden by that aforementioned fat. We were training physical therapists, not anatomists or skilled dissection technicians and yet that was not what the students were feeling. Our process, as good as it was, had shifted our focus and we had lost sight of what was important in the anatomy education of physical therapy students. A transition in faculty provided us with a perfect opportunity to review what we were doing and whether it was really providing the outcomes we required. Our next anatomy and neuroanatomy instructors were clinicians by background and approached anatomy education from that vantage point. Through discussion with other faculty it was decided that the anatomy of the brain and spinal cord should remain our neuroanatomy course, but it should be taught with a functional context (whereas previously it was also taught with the medical model). There was further discussion on the importance of students dissecting the internal organs. Again this was an area where the time and energy spent dissecting did not match the follow up in later courses in the program. This content was reduced to a single demonstration of a prosected specimen. The study of Anatomy can be a complete degree all by itself, however in the physical therapy profession we truly need to have a solid knowledge of functional anatomy and be willing to accept that there are some finer aspects of anatomy knowledge that may not be that useful in our profession. To this end we reviewed our Foundations in Physical Therapy course, that runs concurrently with our anatomy course to identify areas where each course can support the other. This led to a complete transformation and rewrite of our anatomy program to coincide with instruction on manual muscle testing, joint range of motion and functional activities such as gait. Rather than simply teaching muscular attachments and nerve root innervations, we began to apply the anatomy to the activities that were being reviewed in our Foundations course. For many of our students, the connections between the anatomical design of the body and the way that we were teaching them to assess the body started to make more sense. We became less concerned with students being able to identify an obscure anatomical location marked by a pin and more focused on them understanding the potential functional impacts of damage to the anatomical location beneath the pin.Results/Outcomes: The process took a number of years and considerable support from our faculty. When the initial change of anatomy instructor was made, we were fortunate to have the same adjunct faculty member who worked with both the previous and current instructors. We also had the adjunct faculty member who worked with the Foundations of Physical Therapy course attend the anatomy lectures and lab sessions to better understand the pacing of anatomy and the information being covered week to week. This assisted us in matching pace (where possible) between the anatomy instruction and the Foundations instruction. This was not always a smooth synchronized pairing, but the improvements were vastly superior to the previous offerings. We were breaking down silos and building connections across the information our students were being asked to consume. So what did the students say about this transition? Unfortunately students only take anatomy and Foundations once in the program so they really do not have the ability to make a direct comparison. Given those limitations though, our anecdotal evidence through discussion groups and end of semester feedback has positively supported the transition and encouraged us to continue with it. One suggestion that arose from the students was that we should attempt to integrate anatomy education through our tutorial series that runs as part of the Foundations course. Our modified problem-based curriculum is designed with small group case based tutorial discussions among a small group of students and one faculty member. The students suggested that there be a substantial anatomy component introduced to these cases to solidify their learning.Conclusions/Relevance to the conference theme: Our Leadership Landscape: Perspectives from the Ground Level to 30,000 Feet: At the beginning of this proposal we discussed the ongoing debate in how anatomy should be taught. We are not trying to draw a comparative conclusion between the medical model and the function model, but we are providing evidence of how one program can take the steps to transition their program from one model to another and still maintain a high quality of education for the students. As we have made this transition, we have not seen any negative change in clinical performance from our students as they have progressed through the program. As we graduate our first class following this transition, we see no issues with continuing to pursue the functional anatomy focused style of anatomy education and are confident that our students are well prepared for the workforce.References: 1. Estai M1, Bunt S2. Best teaching practices in anatomy education: A critical review. Ann Anat. 2016 Nov;208:151-157. doi: 10.1016/j.aanat.2016.02.010. Epub 2016 Mar 17, 2. Ghosh SK. Cadaveric dissection as an educational tool for anatomical sciences in the 21st century. Anat Sci Educ. 2017 Jun;10(3):286-299. doi: 10.1002/ase.1649. Epub 2016 Aug 30. 3. Papa V, Vaccarezza M. Teaching anatomy in the XXI century: new aspects and pitfalls. ScientificWorldJournal. 2013 Nov 7;2013:310348. doi: 10.1155/2013/310348 4. Davis CR, Bates AS, Ellis H, Roberts AM. Human anatomy: let the students tell us how to teach. 2014 Jul- Aug;7(4):262-72. doi: 10.1002/ase.1424. Epub 2013 Nov 18. 5. Huitt TW,Killins A, Brooks WS. Team-based learning in the gross anatomy laboratory improves academic performance and students' attitudes toward teamwork. Anat Sci Educ. 2015 Mar-Apr;8(2):95-103. doi: 10.1002/ase.1460. Epub 2014 May 2. 6. Fabrizio PA Oral anatomy laboratory examinations in a physical therapy program. Anat Sci Educ. 2013 Jul- Aug;6(4):271-6. doi: 10.1002/ase.1339. Epub 2012 Dec 6. 7. Day LJ. A gross anatomy flipped classroom effects performance, retention, and higher-level thinking in lower performing students. Anat Sci Educ. 2018 Jan 22. doi: 10.1002/ase.1772. [Epub ahead of print] 8. Green RA, Whitburn LY, Zacharias A, Byrne G, Hughes DL. The relationship between student engagement with online content and achievement in a blended learning anatomy course. Anat Sci Educ. 2017 Dec 13. doi: 10.1002/ase.1761. [Epub ahead of print]Course Objectives: During this session, we will discuss the transformation that has taken place in our anatomy education across our curriculum as we switched from an anatomist to a clinician as our lead instructors and thereby switched from a more medical model to a more functional model. We are not promoting one approach over another, but we do believe that we have some interesting insights into how simple transitions can be made in anatomy instruction that meets the demands of a rigorous physical therapy program. Objectives Through this session we will demonstrate how programs can: 1. Transform anatomy instruction to be more connected to additional curricular content. 2. Focus anatomy education towards functional understanding of how the body works relevant to PT practice 3. Connect Anatomy with foundations in PT and tutorial sessions (60 minutes of anatomy objectives) in a modified problem based learning curriculum. 4. Create case studies to enhance anatomy education focused on the function and the clinical relevance of anatomy as opposed to the origin/insertion rote learning 5. Create anatomy education that prepares their students to practice. Glean the clinically relevant from the total available content. Does this mean that anatomy is no longer one course, but separated out over relevant clinical courses? Only individual programs can determine that.Instructional Methods: Platform style presentation will be interspersed with group discussion of participants. We hope that each person leaves with a set of clear steps as to how they can review their programs anatomy education to ensure that they model they are using best meets their student needs.Tentative Outline/Schedule: Welcome and introductions (5 mins) Defining the models - Medical versus Functional (20 minutes) Include the first break-out discussion to allow participants to identify their own model and their own bias/preference Discussion of our transition (15 minutes) What did the students have to say about the transition? (10 minutes) What did it take to change models? (20 minutes) Break out discussion as to what it might take to transition each participant's program to an alternate model Discussion of altrenate models that may be followed by participants (15 minutes) Questions and Answers