|Year : 2020 | Volume
| Issue : 3 | Page : 90-94
Teaching anatomy and dissection in an era of social distancing and remote learning
Keerti Singh, Uma Gaur, Kiana Hall, Keisha Mascoll, Damian Cohall, Md Anwarul Azim Majumder
Faculty of Medical Sciences, The University of the West Indies, Cave Hill Campus, Bridgetown, Barbados
|Date of Submission||13-Aug-2020|
|Date of Acceptance||24-Aug-2020|
|Date of Web Publication||22-Sep-2020|
Md Anwarul Azim Majumder
Faculty of Medical Sciences, The University of the West Indies, Cave Hill Campus, Bridgetown
Source of Support: None, Conflict of Interest: None
Anatomy is one of the fundamental and core basic medical sciences in medical education. It forms the basis for physiology and subsequently pathophysiology to understand the aetiology of diseases, followed by the treatment in medical curricula. The traditional mechanism and gold standard for teaching anatomy in the medical curricula is cadaveric dissection in a small-group teaching environment. This type of teaching also develops compassion and empathy in training medical professionals. The onset of COVID-19 pandemic has limited the ability of faculty and students to function in this educational space as social/physical distancing guidelines, and the halting of cadaveric donation programmes has been implemented as safeguard measures against the transmission of the virus. Anatomists and other teaching staff within the discipline have been limited significantly to the use of technology-enhanced learning (TEL). TEL has been used in teaching environments prior and subsequent to the onset of COVID-19 to supplement cadaveric dissection, especially in medical programmes with limited cadaveric resources. While TEL is not interchangeable with cadaveric dissection, it appears to be a near and potentially medium–long-term solution to remote anatomy teaching during the COVID-19 pandemic. A blended hands-on approach with virtual reality three-dimensional experience can also be adopted in anatomy teaching during the neo-normal period.
Keywords: Anatomy teaching, challenges, COVID-19, dissection, face-to-face, online teaching, opportunities, remote teaching
|How to cite this article:|
Singh K, Gaur U, Hall K, Mascoll K, Cohall D, Majumder MA. Teaching anatomy and dissection in an era of social distancing and remote learning. Adv Hum Biol 2020;10:90-4
|How to cite this URL:|
Singh K, Gaur U, Hall K, Mascoll K, Cohall D, Majumder MA. Teaching anatomy and dissection in an era of social distancing and remote learning. Adv Hum Biol [serial online] 2020 [cited 2021 May 13];10:90-4. Available from: https://www.aihbonline.com/text.asp?2020/10/3/90/295846
| Introduction|| |
Anatomy is the fundament of Medical Education. Anatomical education provides the solid foundation for practice of medicine and for the clear understanding of the structure and function of the human body.,, It is strongly recommended that students learn anatomy using dissection, which provides hands-on experience with three-dimentional (3D) view of complex anatomical structures and relationships, which would provide the basis for understanding pathologic and clinical problems. Importantly, dissection helps to develop compassion and empathy amongst students. It is unfortunate that many medical schools reduced investment in effective anatomy education by shortening teaching hours, limiting faculty and demonstrator recruitment and eliminating cadaveric dissection from the curriculum., Although cadavers constitute the gold standard for teaching anatomy, now, face-to-face cadaveric dissection is becoming a real challenge due to the demands of social distancing in the time of COVID-19. It is also of real concern that many medical schools are planning to exclude cadaveric teaching in the time of COVID-19 pandemic.
Before COVID-19, anatomists were increasingly using innovative, engaging and creative approaches to teach anatomy. Anatomy education is by nature multi-modal, and technology has an important role to play in anatomy education. However, despite the increased use of technology-enhanced learning (TEL) options, during the current pandemic, face-to-face teaching is still considered as the “safest and most effective method to guarantee student success” in teaching anatomy. The pertinent question is: can we adopt innovative teaching strategies to teach anatomy face to face or remotely during this unprecedented time and change the perception of anatomy, as mentioned, 'from a mnemonic and boring subject to an engaging and fascinating one'? We endeavour to answer this question in this commentary by exploring the opportunities and challenges of teaching anatomy and dissection in an era of social distancing and remote learning.
| Impacts of Covid-19 on Anatomy Teaching Including Practicals|| |
'COVID-19 has changed the world…Academia and the roles of faculty, administrators and students will also change'.
The COVID-19 pandemic was declared in the mid-March 2020; most universities decided to suspend teaching to protect staff and student health by quarantine measures and social distancing strategies. During the teaching pause, academic staff actively remodelled and re-established resources, updated digital competencies and developed new materials to shift from face to face and blended to remote online delivery mode, and anatomy teaching was transformed to an abrupt 'virtual mode'., It has been arduous for faculty as extra effort is needed to explain the subject without dissections or face-to-face interactions with teacher and peers, thus impacting every student's education. Faculty worked with difficult timelines and a challenging workload, adjusting to work from home culture with concurrent tasks of child-care and home schooling.,, Although pedagogy remained the same, execution of pedagogy has changed considerably. Role of demonstrators reversed from small face-to-face group teaching to electronic resource development and streaming small-group teaching sessions via streaming platforms. IT staff are also learning new skills and upgrading their roles in creating educational videos. While lectures were the least complicated of all activities, it was difficult re-designing anatomy practical sessions and assessments. Moreover, practical teaching tools such as bones, specimens, embryology models and microscopic slides used for long-term memory and better understating of the human body in 3Ds cannot be used currently; therefore, every anatomist feels persuaded to unlock technology in the delivery of quality education. A cadaver-less/virtual anatomy teaching makes it difficult for the students to perceive and visualise the spatial orientation and neurovascular relationships. Dissection-less training deprives future surgeons of practicing novel surgical techniques, precise finger movements and hand and eye coordination, thus impacting their clinical skills development.
Both distance and blended learning approaches have been used successfully as a part of anatomy education previously but will need strategic planning, inter-academic collaboration with careful consideration of pedagogical evidence in this current space., After the crisis is over, the biggest challenge would be availability of the corpses, and several medical schools are refusing body donation programmes globally to avoid an infection at carrier stage of the virus. Undoubtedly, anatomy education has stepped into a yet more unknown future. Therefore, it is prognosticated that after the pandemic is over, real cadavers will be replaced by virtual dissections for quite a few years. Interestingly, there has been an increased workload in the absence of cadavers. The major challenge was time invested to support the curricular change during the pandemic, which has engulfed faculty's personal time; this has been followed by job security stresses, budget deficits and concerns of a fragile future for the professional staff.
Faculty also had difficulty responding to messages from students regarding their expectations or 'getting what they paid for' versus what was achieved by staff during the limited time frame to get ready for the new instruction mode, lack of dissection experience and lack of motivation without teacher and peer interaction. Lack of physical presence of peers can lead to negative learning experiences for some students; this was compounded by increased student anxiety with constant news updates and the dynamic circumstances of pandemic. Students' efficacy on online teaching and assessment may be undetermined, so their transition to the complete online programming may be learning experience for both students and faculty. This creates an additional layer of complexity for learning. Thus, student mental wellness and preparedness are concerns; there should be effective support for managing student preparedness for online learning, stress and anxiety. Faculty had concerns for the repatriated students having to teach across multiple time zones, completely relying on internet accessibility, especially in remote and rural areas.
| Opportunities and Challenges of Face-to-Face Anatomy Teaching|| |
Current COVID-19 pandemic uncertainties and challenges have caused a significant anxiety in both students and faculty, while exposing them to a sharp learning curve of anatomy along with curricular time constraints. Pandemic emergency-placed demands have encouraged the anatomists to join the clinical workforce, which added more responsibilities on the rest of the anatomy team; moreover, non-clinical academic staff may get sick or have care-giving responsibilities. On the other hand, forced student absenteeism due to pandemic lockdown has caused procrastination and postponement of study plans, impeding academic progress and student satisfaction, thus posing a challenge for academics. The COVID-19 face-to-face teaching environment with social distancing lacks exposure to broader educational teaching techniques that are conventionally adopted by faculty and student teachers under normal circumstances. Previously, educators easily identified and responded to student learning needs, especially those at risk of underperforming during small face-to-face group teaching sessions, which could easily go amiss during online sessions., A study conducted on anatomy teaching of the UK and Irish Universities during COVID-19 reported that 14% of universities did not have a practical assessment, 36% cancelled their assessment and 21% had online digital spotter examinations. The most common faculty concern was time invested in the development of new resources to replace lectures and practicals (57%), 36% of universities identified reduction in student engagement, while 21% showed concerns regarding teacher–student relationship, 14% on assessments and 7% on suspension of body donation programs and lack of technical support. Cadavers are medical students' first patients; absence of cadaveric experience deprives them from the emotional experience of working with cadavers, lack of haptic experience, inexperience encountering death and empathy, communication and teamwork skills, clinical skill building in surgery residents and also lack of appreciation of anatomical variations.,,, Indefinite suspension of body donation programmes in universities and hospitals has caused severe shortage of donor bodies, thereby changing the teaching modality, impeding anatomy research and affecting medical device research community. Relevant measurements of cadavers and anatomic structures are needed for the development of new medical devices and execution of novel clinical procedures. Storage, maintenance and embalming of cadaveric specimens are currently a challenge with limited onsite access.
Despite chronic disruption of anatomy teaching, COVID-19 pandemic has thrown many opportunities for educators and universities. Attributes of adaptability and determination are now essential for both faculty and students to prove themselves with enthusiasm as they make a 'paradigm shift' to alternative modes of teaching using prosections, medical imaging, living anatomy and other multimedia resources, during their teaching and learning sessions. The emergency has given students and faculty opportunities of academic collaboration, exposure and experimentation with a variety of pedagogical techniques, thereby impacting their methods and style of teaching and helping them become better teachers. Faculty can involve students actively in learning and research to experiment with active and engaging learning techniques by transforming virtual dissector workbooks to interactive Portable Document format, group WIKIs, individual presentations within modules and artistic techniques such as body painting, anatomy drawings, clay work and using pipe cleaners.,, With the confidence of anatomical understanding and pedagogical experience, student teachers of anatomy (e.g. postgraduate students, teaching assistants and peer teachers) will be better prepared and confident to enter the employment market. Currently, available cadavers can be utilised to maximise educational benefits by the dissection by laboratory staff in preparing prosected specimens and creating image libraries for short education courses as well as spotter assessments. Moreover, faculty can allow interested students to complete their dissections in the new academic year in a safe environment. Once face-to-face classes commence, the biggest challenge to the faculty will be following strict safety guidelines and social distancing in preventing the risk of exposure and infection amongst staff and students. It is encouraging to note that a few US medical institutions recently welcomed students for the new session, amidst masks, small-group sessions not exceeding ten and social distancing. Students will largely get a virtual experience of gross anatomy with two planned in-person small-group sessions of cadaver teaching. The American Council of Academic Physical Therapy addresses the complexities involved in classroom teaching with social distancing, laboratory considerations and resources to be considered for returning to in-person educational practices.
| Opportunities and Challenges of Remote Anatomy Teaching|| |
COVID-19 has tested the online teaching delivery preparedness of educational institutions, all over the world. Many are now focused on how to deliver course content online, engage learners and perform assessments effectively. Web-based software such as whiteboards, chat rooms, polls quizzes, discussion forums and surveys allow both instructors and students to communicate and share content online. Numerous videoconferencing tools, learning management solutions and collaborative platforms such as Edmodo and Moodle, Microsoft Teams, Google Meet, BigBlueButton, Zoom, Skype, WebEx and Adobe connect have been reported good for medical education continuum.,
Remote anatomy teaching has enhanced over the last few years due to increased implementation of TEL. Numerous variants of TEL are evolving and are currently available: virtual reality (VR), online resources, virtual dissection tables, virtual 3D model software and social media., These technologies although well received by students also have disadvantages, which faculty must be aware of. Social media, for instance, has the potential for misinformation and lacks content and organisation and the content must be validated. TEL therefore can be used as a supplemental or preparatory work to bridge the gap between laboratory and lecture, providing beneficial opportunities to both student and faculty.
There are unique opportunities for anatomists in up-skilling new technologies and resources, for instance, license-free software are offered by many companies during this time such as 'Visible Body' (Argosy Publishing, Inc., Newton, MA, USA) and 'Human Biodigital' (Biodigital Inc., Seoul, South Korea). Although there is no replacement to cadaveric dissection, recent technological advances such as virtual interactive human anatomy (VIHA) and virtual interactive simulation environment (VISE) create a 3D virtual environment of life such as hospital emergency scenarios and can give a near hands-on dissection experience to medical students and surgical residents for pre-operative surgery planning and rehearsal of procedures. The pandemic has made all universities adopt an online mode of examination; new skills are being explored to maximally utilise the virtual learning environment capabilities, especially building question banks and designing assessments that can be automatically or manually marked. Some software, for example, 'Brightspace' (D2L Corp., Kitchener, Canada) amongst others, have feature of precise keystroke recording to prevent cheating.
Technological advancements have created the ability to view dissection or prosection virtually; most students with 'smart' devices would find the accessibility of these online alternatives very easy. Recordings are permanent and can be easily and readily retrieved any time via the asynchronous online learning mode. It is advised however that faculty actively participate in the making of these videos to facilitate association between theory and practical implications; Gupta and Pandey recommended that 'videos improve learning, enable formation of mental image close to the real dynamic structures'.,
There are some challenges with the incorporation of TEL into any anatomy curriculum. Use of TEL in resource-poor countries that lack the economic and financial resources could be a crippling hindrance.,, Virtual software that cannot align seamlessly with the content of the curriculum is a major limitation. The transition from face-to-face to online teaching can be difficult for some, presenting a significant challenge: time 'lag' between participants, poor transmission of body language, time zone differences, financial challenges of universities, data protection and confidentiality issues, increased anxiety/stress, time management issue, poor connectivity, software compatibility, communication are some issues the students face; some faculty may have limited knowledge/application of the technology. Hence, training and support for both staff and students are important for this transition to be successful. Institutions must invest in hardware that are not restricted to specific campus sites – large cohorts cannot learn in the same way at the same time. Institutions must be cognizant that the absence of devices by some students would create an uneven playing field.
A blended learning approach with the use of TEL and face-to-face learning would be beneficial to the students but adoption of fully (100%) TEL would deny the students of haptic experience acquired from dissection and hands-on training. Dissection creates motivation, self-confidence and self-esteem; the benefits of dissection cannot be replaced with TEL.,
| Implications Future of Anatomy Teaching|| |
The quantum changes in course of anatomy education due to COVID-19 may give rise to new threats and opportunities. The crisis can be a catalyst for technological innovation and integration of novel technological resources in teaching, thus fostering stronger academic ties of inter-faculty and inter-anatomy departmental collaborations. The sustainability of these technological modalities and adaptations utilised by universities should be checked in the future through reviews and follow-up surveys; comparison of examination and assessment outcomes of traditional versus newer strategies can be done in short-term and long-term assessments., In the future, professionally created video tracks will be accessible and evidence-based medicine video journals citable. The single daunting thought that every anatomist is now concerned with is 'cadaver-less anatomy teaching', which will put current and future students, surgery residents and faculty at a disadvantage, also handicapping future anatomy research., However, the prospect remains obscure in the absence of established evidence. Hopefully, more optimal donor screening approaches in the future can change the situation of cadaver-less anatomy teaching. On the other hand, some countries body donation programme will suffer to a lager extent due to high rates of mortality in elderly male. Restarting of body donation programmes will be a future dilemma. Future students going through a cadaver-less anatomy programme will be lacking in non-traditional discipline independent skills. More so, suboptimal anatomy knowledge can be a threat to patient safety and lack of dissection skills in surgery residents and can result in increased number of surgical errors and litigations in the future. Looking forward, the combination of hands-on training and VR experience with VIHA and VISE has elevated anatomy teaching to a whole new level creating life-like hospital emergency scenarios. Thus, this is a seminal moment for faculty to contribute towards transformation and advancement of anatomy education by developing active curricular innovations using technology for future.
| Conclusion|| |
COVID-19 pandemic has disrupted face-to-face lectures and anatomy laboratory teaching with cadavers, hence seeded opportunities for technological innovations in teaching anatomy. These changes support a transition towards distance and blended learning approaches and a learner-oriented anatomy curriculum using TEL. At present, effects of COVID-19 on anatomy and medical education are yet to be fully explored. In addition, the pandemic induced abrupt changes over the course of a few months which elicited the non-traditional responses by academics, giving rise to new challenges and opportunities. The challenges of time constraint, removal of cadaveric dissection, changes in assessments with implications in students' engagement and analogy are stabilised by opportunities of new curricular development, adopting innovative approaches with the integration of novel technologies and the development of inter-faculty and inter-departmental collaborations. Replacement of cadaveric dissections and their unavailability may result in shortage of fully trained anatomists and decline in anatomy research. Undoubtedly, the anatomy education in its current situation has stepped into an undefined future, which required medical educationists need to guide its evolution and adopt innovative blended teaching/learning strategies. Ultimately, students should be able to attain the core anatomical competencies required for other preclinical and clinical courses of medical curriculum.
- Anatomists should adopt forward thinking scholarly approaches with flexibility and adaptability in finding solutions for teaching knowledge and practical skills
- A blended hands-on approach with VR 3D experience can be adopted in anatomy teaching during in the neo-normal period
- Effective inter-faculty and inter-departmental academic collaborations are needed with integrating of human and technical resources for online and remote teaching
- Support from technical and laboratory staff is crucial for meeting laboratory teaching commitments
- Health and safety measurement should be put in place utilising strict safety guidelines and social distancing in preventing the risk of exposure and infection amongst staff and students.
Financial support and sponsorship
Conflicts of interest
Dr. Md. Anwarul Azim Majumder is in the Editorial Board of Advances in Human Biology. The other authors report no conflicts of interest in this work.
| References|| |
Saverino D. Teaching anatomy at the time of COVID-19. Clin Anat.2020;10.1002/ca.23616. doi:10.1002/ca.23616.
Papa V, Vaccarezza M. Teaching anatomy in the XXI century: New aspects and pitfalls. ScientificWorldJournal 2013;2013:310348.
Singh K, Bharatha A, Sa B, Adams OP, Majumder MA. Teaching anatomy using an active and engaging learning strategy. BMC Med Educ 2019;19:149.
Brassett C, Cosker T, Davies DC, Dockey P, Gillingwater TH, Lee TC, et al.
COVID-19 and anatomy: Stimulus and initial response. J Anat. 2020;10.1111/joa.13274. doi:10.1111/joa.13274.
Pacheco LF, Noll M, Mendonça CR. Challenges in Teaching Human Anatomy to Students with Intellectual Disabilities During the Covid-19 Pandemic. Anat Sci Educ. 2020;13:556-57. doi:10.1002/ase.1991.
Woolliscroft JO. Innovation in response to the COVID-19 pandemic Crisis. Acad Med 2020;95:1140-2.
Ross CF, Pescitelli MJ, Smith HF, Williams JM. Teaching anatomy with dissection in the time of COVID-19 is essential and possible. Clin Anat. 2020;10.1002/ca.23640. doi:10.1002/ca.23640.
Evans DJ, Bay BH, Wilson TD, Smith CF, Lachman N, Pawlina W. Going virtual to support anatomy education: A STOPGAP in the midst of the COVID-19 Pandemic. Anat Sci Educ 2020;13:279-83.
Singal A, Bansal A, Chaudhary P. Cadaverless anatomy: Darkness in the times of pandemic Covid-19. Morphologie. 2020;S1286-0115(20)30045-X. doi:10.1016/j.morpho.2020.05.003
Longhurst GJ, Stone DM, Dulohery K, Scully D, Campbell T, Smith CF. Strength, Weakness, Opportunity, Threat (SWOT) analysis of the adaptations to anatomical education in the United Kingdom and Republic of Ireland in response to the COVID-19 pandemic. Anat Sci Educ 2020;13:301-11.
Pather N, Blyth P, Chapman JA, Dayal MR, Flack NA, Fogg QA, et al
. Forced disruption of anatomy education in Australia and New Zealand: An acute response to the COVID-19 pandemic. Anat Sci Educ 2020;13:284-300.
Kelsey AH, McCulloch V, Gillingwater TH, Findlater GS, Paxton JZ. Anatomical sciences at the University of Edinburgh: Initial experiences of teaching anatomy online. Trans Res Anat 2020;1:100065.
Franchi T. The impact of the COVID-19 pandemic on current anatomy education and future careers: A student's perspective. Anat Sci Educ 2020;13:312-5.
Gupta N, Pandey S. Disruption of anatomy dissection practical in COVID-19 pandemic: Challenges, problems and solutions. J Lumbini Med Coll 2020;8:3.
Byrnes KG, Kiely PA, Dunne CP, McDermott KW, Coffey JC. Communication, collaboration and contagion: “Virtualisation” of anatomy during COVID-19. Clin Anat. 2020;10.1002/ca.23649. doi:10.1002/ca.23649.
Iwanaga J, Loukas M, Dumont AS, Tubbs RS. A review of anatomy education during and after the COVID-19 pandemic: Revisiting traditional and modern methods to achieve future innovation. Clin Anat. 2020;10.1002/ca.23655. doi:10.1002/ca.23655.
Ravi KS. Dead body management in times of COVID-19 and its potential impact on the availability of cadavers for medical education in India. Anat Sci Educ 2020;13:316-7.
Mukhtar K, Javed K, Arooj M, Sethi A. Advantages, limitations and recommendations for online learning during COVID-19 pandemic era. Pak J Med Sci 2020;36:S27-31.
Erolin C. Interactive 3D digital models for anatomy and medical education. Adv Exp Med Biol 2019;1138:1-6.
Lu W, Pillai S, Rajendran K, Kitamura Y, Yen CC, Do EY. Virtual Interactive Human Anatomy: Dissecting the Domain, Navigating the Politics, Creating the Impossible. Association for Computing Machinery, New York, USA: Proceedings of the 2017 CHI Conference Extended Abstracts on Human Factors in Computing Systems; 2017. p. 429-32.
Barteit S, Guzek D, Jahn A, Bärnighausen T, Jorge MM, Neuhann F. Evaluation of e-learning for medical education in low- and middle-income countries: A systematic review. Comput Educ 2020;145:103726.
Cecilio-Fernandes D, Parisi M, Santos T, Sandars J. The COVID-19 pandemic and the challenge of using technology for medical education in low and middle income countries. MedEdPublish 2020;9:74. [doi: https://doi.org/10.15694/mep.2020.000074.1
Allsop S, Hollifield M, Huppler L, Baumgardt D, Ryan D, van Eker M, et al
. Using videoconferencing to deliver anatomy teaching to medical students on clinical placements. Transl Res Anat 2020;19:100059.
Evans DJ, Pawlina W, Lachman N. Human skills for human[istic] anatomy: An emphasis on nontraditional discipline-independent skills. Anat Sci Educ 2018;11:221-4.
Yammine K. The current status of anatomy knowledge: Where are we now? Where do we need to go and how do we get there? Teach Learn Med 2014;26:184-8.