Perceptions Among Occupational and Physical Therapy Students of a Nontraditional Methodology for Teaching Laboratory Gross Anatomy

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1 RESEARCH REPORT Perceptions Among Occupational and Physical Therapy Students of a Nontraditional Methodology for Teaching Laboratory Gross Anatomy K. Jackson Thomas, 1 * Bryan E. Denham, 2 John D. Dinolfo 3 1 Division of Physical Therapy, College of Health Professions, Medical University of South Carolina, Charleston, South Carolina 2 Department of Communication Studies, Clemson University, Clemson, South Carolina 3 Department of English, Clemson University, Clemson, South Carolina This pilot study was designed to assess the perceptions of physical therapy (PT) and occupational therapy (OT) students regarding the use of computer-assisted pedagogy and prosection-oriented communications in the laboratory component of a human anatomy course at a comprehensive health sciences university in the southeastern United States. The goal was to determine whether student perceptions changed over the course of a summer session regarding verbal, visual, tactile, and web-based teaching methodologies. Pretest and posttest surveys were distributed online to students who volunteered to participate in the pilot study. Despite the relatively small sample size, statistically significant results indicated that PT and OT students who participated in this study perceived an improved ability to name major anatomical structures from memory, to draw major anatomical structures from memory, and to explain major anatomical relationships from memory. Students differed in their preferred learning styles. This study demonstrates that the combination of small group learning and digital web-based learning seems to increase PT and OT students confidence in their anatomical knowledge. Further research is needed to determine which forms of integrated instruction lead to improved student performance in the human gross anatomy laboratory. Anat Sci Educ 4: American Association of Anatomists. Key words: gross anatomy; teaching methodologies; student perceptions; occupational therapy; physical therapy; prosections; e-learning; computer assisted learning INTRODUCTION *Correspondence to: Dr. K. Jackson Thomas, Division of Physical Therapy, College of Health Professions, Medical University of South Carolina, 151 Rutledge Avenue, Charleston, SC 29425, USA. thomaskj@musc.edu Received 22 November 2010; Revised 12 January 2011; Accepted 13 January Published online 8 March 2011 in Wiley Online Library (wileyonlinelibrary.com). DOI /ase American Association of Anatomists The study of human anatomy remains a keystone in postgraduate health sciences education in the United States and abroad (Mukhtar et al., 2009, Sugand et al., 2010). Current debates about ways to finance the teaching of human anatomy courses have assumed greater urgency, given the significant challenges that many medical, dental, and allied health schools are facing, such as curricular and time constraints, availability of suitable cadavers, and availability of sufficiently trained instructional personnel (Mattingly and Barnes, 1994; McLachlan and Patten, 2006; Drake et al., 2009; Hildebrandt, 2010). Such challenges are occurring even as enrollments are increasing in many academic health sciences programs in order to offset existing or anticipated practitioner shortages in primary care medicine, certain surgical specialties, nursing, physical therapy (PT), occupational therapy (OT), and other clinical disciplines. Against that backdrop, various significant developments are distinguishable in undergraduate and postgraduate human anatomy courses in the United States and abroad. When implemented, each development has the potential to support and enhance student learning in the anatomical sciences. These developments include an increased reliance on: Anatomical Sciences Education MARCH/APRIL 2011 Anat Sci Educ 4:71 77 (2011)

2 1. Small group and team-based instruction (Chan and Ganguly, 2007; Vasan et al., 2008, 2009). 2. Peer and near-peer teaching (Youdas et al., 2008; Bentley and Hill, 2009; Evans and Cuffe, 2009; Wait et al., 2009). 3. Computer-assisted and web-based instruction that typically uses digitalized anatomical images to supplement traditional teaching and learning through cadaver dissections and prosections (Berube et al., 1999; Plack, 2000; Bukowski, 2002; Foreman et al., 2005; Hisley et al., 2008; Yip and Rajendran, 2008; Drake et al., 2009, Petersson et al., 2009). 4. Principles and strategies from visual communications theory to address pedagogical issues in anatomy education (John and Lim, 2007; Thakore and McMahon, 2008). CONTEXT FOR THIS STUDY Clinical anatomists and anatomy instructors have long argued that dissections should remain a primary form of human anatomy instruction to prepare health sciences students for future clinical work (McLachlan and Patten, 2006). Students echo the consensus among anatomy educators that hands-on learning in anatomy laboratories is central to professional training in the clinical sciences (Moxham and Plaisant, 2007). Other researchers have assessed the relative advantages of dissections versus prosections in medical school anatomy courses, typically concluding that cadaver dissections are a preferable way to teach future clinicians about the clinical relevance of anatomical facts and relationships (Hisley et al, 2008). Yet other studies have documented the value of innovation and reform in medical school anatomical education in the United States (Gregory et al., 2009; Hildebrandt, 2010; Sugand et al., 2010); the benefits of digital, and in some cases three-dimensional anatomy simulations to support undergraduate and postgraduate anatomy instruction (Hisley et al., 2008; Thakore and Mahon, 2008; Yip and Rajendran, 2008; Daruwalla et al., 2010), and the role of anatomy education in transmitting professional values to clinical students (Pawlina, 2006; Pearson and Hoagland, 2010). Researchers also have investigated the benefits of exploratory learning to teach clinical reasoning and to prepare anatomy students for future clinical work (Philip et al., 2008), the benefits of developing writing skills regarding anatomical knowledge as a preparation for communicating effectively with patients (Evans, 2008), the learning benefits of verbal discussions and oral presentations by students in anatomy education (Lake, 2001; Philip et al, 2008), and the need to identify and consider different learning styles of clinical students (Lujan and DiCarlo, 2006). Other scholars have discussed the recommendations of allied health clinicians regarding instructional content of anatomy courses for students in the allied health professions (Latman and Lanier, 2001), the role of evidence-based learning in PT education (McKenzie and Gutierrez, 2007), the merits of interprofessional education among medical students and PT students (Hamilton et al., 2008), among other salient issues in anatomical sciences education. Goals of this Study To the authors knowledge, no studies have identified and assessed the perceptions and preferences of PT and OT students regarding teaching, learning, and modes of instruction and communication in a human gross anatomy course and related laboratories. Given this paucity of information, our study was designed to help fill the gap in existing knowledge. We asked if a measurable change could be detected in PT and OT student perceptions and preferences for learning laboratory gross anatomy with verbal, visual, tactile, and web-based pedagogies. During summer 2009, we surveyed PT and OT students who were enrolled in a required human gross anatomy course at a comprehensive health sciences university in the southeastern United States. First, we wanted to receive specific feedback from our students regarding their perceptions as to how effective our teaching methodologies were for learning human gross anatomy in the laboratory setting. Second, we anticipated that the findings of the study would supplement existing knowledge regarding PT and OT anatomy education during a time of nationwide debate about how to support the cost of postgraduate instruction in human anatomy. METHODS Participants At the university in which the study occurred, PT and OT students are required to have a baccalaureate degree from accredited colleges or universities. All PT and OT students also are required to have passed a specific list of undergraduate prerequisite courses, including an undergraduate anatomy course. However, the opportunity to participate in a sufficiently rigorous undergraduate anatomy course can vary widely among students. Thus, some are highly prepared to perform well in an intensive summer course in human gross anatomy, whereas for other students, this is their first immersion in a rigorous course in human gross anatomy that is designed to build a foundation for the application of anatomy-learning to clinical situations. Study participants consisted of volunteers enrolled as firstyear entry level master s degree students in OT or first year entry level doctoral degree students in PT. All participants were enrolled in human gross anatomy, which was taught during the ten week summer session of This particular offering in human gross anatomy is a general survey course that covers the entire body (head and neck, extremities, back, thorax, abdomen, and perineum). Although physician assistant (PA) students also were enrolled in the course, the PA students were not surveyed for the study because their laboratory learning method involved dissections, virtually all of which they performed themselves, rather than prosections and prosection-demonstrations, which occurred for OT and PT students. PA students laboratory sessions followed a dissection format due to the request of their core faculty. A total of 175 students were enrolled in the human gross anatomy course in summer 2009, with a distribution of 42 OT students, 64 PT students, and 69 PA students. Eight cadavers were used for the prosections. OT and PT students were assigned to one of three laboratory sections, with each student being required to attend a two-hour prosection session once per week. Integrated Instructional Procedure In addition to attending regular didactic lectures, OT and PT students learned anatomy in the laboratory by attending teaching assistant (TA)-narrated prosections. Students were assigned in small groups of four to five to a TA, each of whom was a rising second year medical student who had successfully taken and completed gross anatomy the previous year. No specific 72 Thomas et al.

3 grade earned in the medical school gross anatomy course was required for being a TA. There were eight TA s altogether, each of whom taught an anatomical region that had been previously assigned. TA s were selected on the basis of recommendations from the medical school faculty and from impressions gained through individual interviews. TA s discussed the regions that they were assigned to teach with each other to help assure content validity. All teaching by TA s was overseen and supervised by a trained and experienced anatomist, who is the first author of this research report. All PT and OT students were required to attend a twohour laboratory prosection session each week for ten weeks. TA s received a list of anatomical terms before every laboratory session, all of which were to be demonstrated to students in a TA s group over a time period of minutes. Students each had an identical copy of the list of structures to be demonstrated, which comprised a section of the course syllabus. At the end of the min time period, each small group of PT and OT students moved to another table where another TA demonstrated a different group of anatomical structures. Small groups of students moved to successive tables approximately every min until all students had attended each of the TA prosection-demonstrations. To keep the prosection-demonstrations from becoming merely passive exercises for the PT and OT students, TAs were instructed to make each demonstration an interactive experience. TAs asked students about various anatomical structures pertinent to the respective prosection demonstrations, and students responded orally. No grades were recorded for the verbal responses. TAs were directed to keep that portion of the learning experience relevant and nonthreatening. In addition to scheduled lectures and laboratory sessions, students participated in didactic supplementary meetings where TAs reviewed key teaching points regarding anatomical facts and relationships. At key stages of the summer session, during regularly scheduled classes, multiple choice exams were administered to test students on their knowledge of human gross anatomy of the head and neck, extremities, back, thorax, abdomen, and perineum. Cost Management The budgetary costs to teach the human anatomy course are managed by utilizing rising second year medical students as TA s to instruct PT and OT students using laboratory prosections. In addition, PT and OT students are required to view and learn anatomy through sequential assignments taken from Human Anatomy online version 2.2 (Rarey et al., 1997), to which all students enrolled in the human gross anatomy course have access. Human Anatomy online version 2.2 is a web-based anatomy tutorial that includes digitized photographs of dissections and allows viewers to study anatomical structures on a regional basis. Computer Assisted Instruction Students were assigned appropriate portions of Human Anatomy online version 2.2 and directed to use those modules as independent study. In addition, students used the same lists of anatomical structures for identification that were in the course syllabus and were used by the TA s during the laboratory prosection sessions. Students were directed to locate each structure in the computer program, using the list of anatomical structures as a guide. To increase learner efficiency, Table 1. Statements Included on Pre- and Post-test Questionnaires 1. I can name major anatomical structures from memory. 2. I can draw major anatomical structures from memory. 3. I can explain major anatomical relationships from memory. 4. I learn about anatomy primarily by reading about anatomical facts and relationships. 5. I learn about anatomy primarily by looking at anatomical art and anatomical drawings. 6. I learn about anatomy primarily through hands-on, tactile experience in laboratory activities. 7. I learn about anatomy primarily by listening to lectures, podcasts, and other informed talks. 8. I learn about anatomy primarily by discussing anatomy with instructors or classmates. 9. I learn about anatomy primarily by participating in laboratory dissections, which means that I cut apart the structures myself. 10. I learn about anatomy primarily by viewing online dissections on the Internet. 11. I learn about anatomy primarily by participating in laboratory prosections, which are dissections that have been prepared by someone else in advance. 12. To learn anatomy, I rely upon supplemental instruction and tutoring. Response were evaluated on the five-point Likert scale: Strongly Disagree 5 1, Disagree 5 2, Unsure 5 3, Agree 5 4, and Strongly Agree 5 5. the computer program has a subject index and photographic enlargement features for students to locate, visualize, and learn anatomical features. Students were informed that their practical examinations would be drawn from the lists of anatomical structures mentioned above, and that the practical examinations would be based on their knowledge of the dissections shown in Human Anatomy online version 2.2. Survey Tool and Quantitative Measurements for the Study PT and OT student perceptions regarding laboratory instruction were obtained with pre- and post-test questionnaires administered online. During the second week of the summer semester, PT and OT students were invited to complete a pretest questionnaire that contained 12 five-point Likert scale statements (Table 1). The questionnaire was designed to measure student perceptions regarding the teaching of human anatomical structures and their relationships, along with student attitudes regarding three communication activities: listening, viewing, and conversing. Data were collected through the online program SurveyMonkey TM (SurveyMonkey, 2010). Anatomical Sciences Education MARCH/APRIL

4 Table 2. Display of Mean Scores and Standard Deviations (SD) for Anatomy Survey Questions Items OT Pre-test OT Post-test PT Pre-test PT Post-test n 5 12 n 5 15 n 5 25 n 5 30 Can name major structures 4.00 (0.603) 4.73 (0.458) a 4.16 (0.624) 4.77 (0.430) b Can draw major structures 3.08 (0.996) 4.40 (0.632) b 3.33 (0.702) 4.53 (0.507) b Can explain major structures 3.25 (0.866) 4.47 (0.516) b 3.40 (0.764) 4.45 (0.572) b Learn by reading facts 3.00 (1.128) 3.00 (1.069) 2.84 (1.179) 3.31 (0.891) Learn from art and drawings 4.00 (0.953) 4.33 (0.900) 4.20 (0.816) 4.17 (0.699) Learn from tactile and labs 3.25 (1.055) 4.07 (0.799) 3.44 (1.121) 4.20 (0.761) c Learn from lectures 4.17 (0.577) 3.07 (0.961) c 3.92 (0.909) 3.41 (0.946) c Learn from discussion 2.67 (1.155) 4.20 (0.676) b 3.40 (1.080) 3.77 (0.898) Learn from dissections 2.83 (1.193) 2.93 (0.961) 2.84 (1.028) 3.60 (1.037) c,d Learn from Web dissections 2.92 (1.165) 3.20 (1.207) 2.96 (1.020) 2.93 (0.907) Learn from prosections 3.75 (0.965) 3.73 (0.884) 3.68 (0.802) 3.74 (0.783) Learn from supplements 3.83 (0.718) 3.60 (1.298) 3.20 (1.041) 3.23 (1.040) Five-point Likert Scale: Strongly Disagree 5 1, Disagree 5 2, Unsure 5 3, Agree 5 4, and Strongly Agree 5 5. a P < b P < c P < d PT students pre-test/post-test responses to this questionnaire item were somewhat enigmatic. Assuming that PT students did not participate in dissections on their own or in an unsupervised fashion, the authors speculate that these students equated active exploration, tissue separation, and other manual and tactile investigation done during the regularly scheduled laboratory prosections as dissections. During the final week of the summer session, OT and PT students completed a post-test questionnaire. Again, survey items measured student perceptions of how well they learned anatomy during the laboratory prosection sessions in relation to the three communication activities of listening, viewing, and conversing. Students also were asked to rate their perceptions regarding how well they were able to learn anatomy from lectures and from using the web-based program Human Anatomy online version 2.2 (Rarey et al., 1997). The IRB of the university approved the study. Before students answered any survey questions, PT and OT students were advised in writing that participation in the survey was voluntary, and responses would remain confidential, for use only in the aggregation of data. STATISTICAL ANALYSIS While survey respondents were identified by group, their individual identities were not known to the authors, thus precluding the use of repeated measures. Consequently, in making group comparisons, the authors used one-way nonparametric analysis of variance (ANOVA) procedures (i.e., Kruskall- Wallis tests) to examine differences between groups. Like parametric ANOVA models, Kruskall-Wallis tests provide an overall indication of statistical significance. In this study, when Kruskall-Wallis tests indicated significant differences, the authors used nonparametric Mann Whitney U tests to examine within-group differences on a post hoc basis. The authors recognize the importance of considering family P-values for multiple comparisons and interpret results with those in mind. All statistical analyses were performed with the Statistical Package for the Social Sciences (IBM SPSS software) version 18 (SPSS Inc., Chicago, IL). RESULTS Of the 42 OT students and 64 PT students who were enrolled in the human gross anatomy course and laboratories, the following number volunteered for the pilot study: OT pre-test n 5 12 and OT post-test n PT pre-test n 5 25 and PT post-test n Table 2 reports pre- and post-test mean scores for OT and PT respondents. As the table indicates, the most significant (nonparametric) differences occurred across three statements: I can name major anatomical structures from memory. I can draw major anatomical structures from memory. I can explain major anatomical relationships from memory. 74 Thomas et al.

5 In both the PT and OT groups, students indicated greater learning over time in the ability to name, draw, and explain major structures. Additionally, PT students indicated greater learning over time from participating in tactile lessons and laboratories, as well as from dissections, and OT students indicated greater learning over time from participating in discussions with instructors and classmates. Most of the differences were highly significant, with the PT tactile difference being significant at P < Among both PT and OT students, learning from lectures showed a significant decrease in scores. These findings are included in our Discussion. Notable Trends in the Data In addition to statistically significant differences, some notable trends emerged that, in the future, should be examined in further detail. For OT students, mean post-test questionnaire scores increased on items addressing art and drawings, tactile learning and laboratories, and web dissections but declined with regard to learning from lectures. For PT students, mean post-test questionnaire scores increased for reading and understanding anatomical facts as well as learning from discussions with instructors and classmates. While not significant in statistical procedures conducted for the present research, these differences merit additional thought and study. DISCUSSION Although education in human gross anatomy can contribute significantly to the foundational knowledge of future healthcare professionals, a number of issues cloud the ability of colleges and universities to offer suitable courses in this academic discipline, notably, curricular and time constraints, the availability of suitably trained anatomy instructors, and the availability of cadavers (Mattingly and Barnes, 1994; McLachlan and Patten, 2006; Drake et al., 2009; Hildebrandt, 2010). Data from this study suggest that (a) alternative methods to teach laboratory human gross anatomy to OT and PT students may be deployed and (b) for the students surveyed in this study, satisfaction with integrated multimodal instructional methods was high. Statistical Implications Although the sample size was relatively small, and students from only two disciplines in the health sciences participated, the pilot study produced some meaningful findings regarding OT and PT preferences and attitudes. OT responses varied in some areas from PT responses. Yet both groups indicated perceived improvement in the ability to name major anatomical structures from memory, to draw major anatomical structures from memory, and to explain major anatomical relationships from memory (Table 2). The PT group indicated greater learning over time from tactile lessons and laboratories, as well as dissections, and the OT group indicated greater learning over time from discussions with instructors and classmates. Nonparametric ANOVA tests showed PT students to perceive a benefit from participating in dissections (question # 9 in the survey). At first glance, this finding may seem paradoxical. PT and OT students who attended prosection-demonstrations in the human gross anatomy laboratory did not participate in prior dissections conducted by the medical student- TAs. However, during laboratory prosections, PT and OT students manually traced nerves and muscles and manually inspected other anatomical structures with the guidance of their respective medical student-tas, while their classmates watched. Likewise, throughout the summer session, all PT and OT students observed how TAs manually inspected and presented dissected anatomical structures at each of the eight prosection-tables. The authors speculate that the PT and OT students observation of, and in some cases, participation in hands-on anatomical inspection could explain why some PT and OT students perceived a benefit from dissections. Possibly, those students, immersed in laboratory learning, were conflating the concepts of prosection and dissection, which is an assumption that needs to be confirmed or refuted in future research. Analyses also revealed that, for PT students, scores for learning from lectures decreased over time. Why some PT students assigned a diminished value to lectures and an increased value to learning from laboratory lessons merits further investigation, perhaps from the perspective of learning styles (Fleming and Mills, 1992). These findings could be investigated in a future study, perhaps with the previously mentioned trend that PT students indicated that they learned from discussions with instructors and classmates. Also noteworthy is the finding from ANOVA analysis that OT students learned over time from discussions with instructors and classmates, but showed a trend toward diminished learning from lectures. Why scores for both PT and OT students declined with regard to learning from lectures and increased with regard to learning from discussions is not understood at the present time and offers potential substance for future investigation. Pedagogical Implications That PT and OT student groups both indicated greater learning over the summer session in the ability to name, draw, and explain major anatomical structures is not surprising. The new knowledge that resulted from this pilot study involves student perceptions regarding modes of teaching and communication that were perceived to enhance students ability to learn anatomical facts and relationships. Our findings suggest that PT and OT students may approach learning in a different manner and thus may have different learning styles. For example, OT students appeared to learn best through art and drawings, tactile input (actually touching the cadaver during a prosection-demonstration), lab discussions, and web-based instruction involving images of dissections. PT students indicated that their best learning occurred by reading about anatomical facts, learning from laboratory discussions, and learning from dissections. These findings suggest that students benefited from multiple modes of learning. Furthermore, the observation that each student group showed a preference for different pedagogical methods suggests a preference among individual students for alternative learning styles. However, the best way to actualize each mode of learning through integrated multimodal instruction remains undetermined for this population of students. Interestingly, the data do not indicate a statistically significant change in student perceptions regarding learning from participating in prosections (question # 11 in the survey). This raises the possibility of further research to confirm or refute these preliminary findings. Such research might focus more intensively on various aspects of prosection-related pedagogy and communications to determine which, if any, can enhance student learning. Paradoxically, student responses to survey questions 1 3 suggest that they perceived a significant Anatomical Sciences Education MARCH/APRIL

6 benefit from the integrated teaching methods used in the study. As discussed above, a key part of that teaching methodology is the active involvement of medical students as prosection-instructors (TAs). This raises the possibility of further research in the human gross anatomy laboratory to determine how pedagogical exchanges among future physicians, future physical therapists, and future occupational therapists can contribute to interprofessional education in orthopedic and rehabilitative patient care. In any such future research, a larger sample size and a controlled study designed to compare perceived student confidence with student learning outcomes would enhance the authors ability to interpret and apply results. The authors recognize that a selection bias may have occurred in this study, given the small sample size for both OT and PT students. We cannot rule out the possibility that students who typically do well in basic science courses volunteered to participate in this pilot study. Thus, any follow up study of OT and PT student learning in the human gross anatomy laboratory should control for potential selection bias. CONCLUSIONS Despite the pilot study s limitations, our findings lend support to the argument that the combination of small group learning in laboratory human gross anatomy, complemented by digital web based learning, is a pragmatic, cost effective way to enhance anatomy learning at the postgraduate level. PT and OT students generally reported positive outcomes to learning criteria, as set forth in the pretest and post-questionnaires. The findings suggest the need for more research on integrated multimodal methods to teach human gross anatomy to OT and PT students as a preparation for future clinical work. The findings also may have implications for human gross anatomy teaching and learning in other disciplines, e.g., in nursing, physician assisting, medicine, and dentistry. Studies of this kind represent a promising new line of interdisciplinary research in the anatomical sciences and in health communications. NOTES ON CONTRIBUTORS K. JACKSON THOMAS, P.T., Ed.D., is a professor in the Division of Physical Therapy, in the College of Health Professions at the Medical University of South Carolina in Charleston, South Carolina. He teaches courses in human gross anatomy, imaging and electrodiagnosis, clinical anatomy of the upper limb, anatomy for nurse anesthetists, clinical reasoning and practice, clinical pathophysiology, and an interprofessional course entitled Transforming Health Care for the Future. His research interests include interactive computer applications for anatomy and pathology, exercise and aging, efficacy of cardiac rehabilitation, and home exercise programs for individuals with a mobility disorder, such as spinal cord injury. BRYAN E. DENHAM, Ph.D., is Charles Campbell Professor of Sports Communication in the Department of Communication Studies at Clemson University in Clemson, South Carolina. He teaches courses in communication theory, research methods, sports communication, and public relations. His research interests are in health communications, empirical research methods, political and sports communication, media ethics, and public policy formation. JOHN D. DINOLFO, M.A., is a lecturer in the English Department and a Ph.D. student in Rhetorics, Communication, and Information Design at Clemson University in Clemson, South Carolina. He teaches courses in science writing and communication. His research interests are in health communications, healthcare rhetorics, interprofessional communications, and writing and visual communication across the curriculum in the life sciences and the humanities. ACKNOWLEDGMENTS The authors thank the physical and occupational therapy students for their willingness to complete the pre- and post-test questionnaire and for their participation in the study. LITERATURE CITED Bentley BS, Hill RV Objective and subjective assessment of reciprocal peer teaching in medical gross anatomy laboratory. Anat Sci Educ 2: Berube D, Murray C, Schultze K Cadaver and computer use in the teaching of gross anatomy in physical therapy education. J Phys Ther Educ 13: Bukowski EL Assessment outcomes: Computerized instruction in a human gross anatomy course. J Allied Health 31: Chan LK, Ganguly PK Evaluation of small-group teaching in human gross anatomy in a Caribbean medical school. Anat Sci Educ 1: Daruwalla ZJ, Courtis P, Fitzpatrick C, Fitzpatrick D, Mullett H Anatomic variation of the clavicle: A novel three dimensional study. Clin Anat 23: Drake RL, McBride JM, Lachman N, Pawlina W Medical education in the anatomical sciences: The winds of change continue to blow. Anat Sci Educ 2: Evans DJ Designing patient-focused information: An opportunity for communicating anatomically related information. Anat Sci Educ 1: Evans DJ, Cuffe T Near-peer teaching in anatomy: An approach for deeper learning. Anat Sci Educ 2: Fleming ND, Mills C Not another inventory: Rather a catalyst for reflection. To Improve Academy 11: Foreman KB, Morton DA, Musolino GM, Albertine KH Design and utility of a web-based computer-assisted instructional tool for neuroanatomy self-study and review for physical and occupational therapy graduate students. Anat Rec 285B: Gregory JK, Lachman N, Camp CL, Chen LP, Pawlina W Restructuring a basic science course for core competencies: An example from anatomy teaching. Med Teach 31: Hamilton SS, Yuan BJ, Lachman N, Hellyer NJ, Krause DA, Hollman JH, Youdas JW, Pawlina W Interprofessional education in gross anatomy: Experience with first-year medical and physical therapy students at Mayo Clinic. Anat Sci Educ 1: Hildebrandt S Lessons to be learned from the history of anatomical teaching in the United States: The example of the University of Michigan. Anat Sci Educ 3: Hisley KC, Anderson LD, Smith SE, Kavic SM, Tracy JK Coupled physical and digital cadaver dissection followed by a visual test protocol provides insights into the nature of anatomical knowledge and its evaluation. Anat Sci Educ 1: John NW, Lim IS Cybermedicine tools for communication and learning. J Vis Commun Med 30:4 9. Lake DA Student performance and perceptions of a lecture-based course compared with the same course utilizing group discussion. Phys Ther 81: Latman NS, Lanier R Gross anatomy course content and teaching methodology in allied health: clinicians experiences and recommendations. Clin Anat 14: Lujan HL, DiCarlo SE First-year medical students prefer multiple learning styles. Adv Physiol Educ 30: Mattingly GE, Barnes CE Teaching human anatomy in physical therapy education in the United States: A survey. Phys Ther 74: McKenzie AL, Gutierrez B The varied-integrative-progressive (VIP) model for anatomy instruction in physical therapist education. J Phys Ther Educ 21: McLachlan JC, Patten D Anatomy teaching: Ghosts of the past, present and future. Med Educ 40: Moxham BJ, Plaisant O Perception of medical students towards the clinical relevance of anatomy. Clin Anat 20: Mukhtar Y, Mukhtar S, Chadwick SJ Lost at sea: Anatomy teaching at undergraduate and postgraduate levels. Med Educ 43: Pawlina W Professionalism and anatomy: How do these two terms define our role? Clin Anat 19: Thomas et al.

7 Pearson WG Jr, Hoagland TM Measuring change in professionalism attitude during the gross anatomy course. Anat Sci Educ 3: Petersson H, Sinkvist D, Wang C, Smedby O Web-based interactive 3D visualization as a tool for improved anatomy learning. Anat Sci Educ 2: Philip CT, Unruh KP, Lachman N, Pawlina W An explorative learning approach to teaching clinical anatomy using student generated content. Anat Sci Educ 1: Plack MM Computer-assisted instruction versus traditional instruction in teaching human gross anatomy. J Physic Ther Educ 14: Rarey KE, Romrell LJ, Pawlina W, Rathe R, Rosenberg JJ Human Anatomy. CD-ROM. Intranet version 2.2. Tampa, FL: Gold Standard Multimedia, Inc. Sugand K, Abrahams P, Khurana A The anatomy of anatomy. A review for its modernization. Anat Sci Educ 3: SurveyMonkey SurveyMonkey.com online based survey software. Portland, OR. URL: [accessed 20 November 2010]. Thakore H, McMahon T Designing an interactive multimedia rich tutorial for medical students: beyond a book on a screen. J Vis Commun Med 31:4 10. Vasan NS, DeFouw DO, Compton S A survey of student perceptions of team-based learning in anatomy curriculum: Favorable views unrelated to grades. Anat Sci Educ 2: Vasan NS, DeFouw DO, Holland BK Modified use of team-based learning for effective delivery of medical gross anatomy and embryology. Anat Sci Educ 1:3 9. Wait KR, Cloud BA, Forster LA, Jones TM, Nokleby JJ, Wolfe CR, Youdas JW Use of an audience response system during peer teaching among physical therapy students in human gross anatomy: Perceptions of peer teachers and students. Anat Sci Educ 2: Yip GW, Rajendran K SnapAnatomy, a computer-based interactive tool for independent learning of human anatomy. J Vis Commun Med 31: Youdas JW, Hoffarth BL, Kohlwey SR, Kramer CM, Petro JL Peer teaching among physical therapy students during human gross anatomy: Perceptions of peer teachers and students. Anat Sci Educ 1: Anatomical Sciences Education MARCH/APRIL