FACULTY EXPERIENCES ABOUT TEACHING AND LEARNING HUMAN ANATOMY AT UNIVERSITY OF CHILE NURSING SCHOOL

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1 11th Iberoamerican Conference on Nursing Education 3rd Latin American-European Meeting. FACULTY EXPERIENCES ABOUT TEACHING AND LEARNING HUMAN ANATOMY AT UNIVERSITY OF CHILE NURSING SCHOOL Brunstein, Juan*; Joglar, Carol; Malvaez, Olga; Quintanilla, Mario *Universidad de Chile. Facultad de Medicina Background. The expansion of information production in sciences has generated unprecedented complexity in Nursing practice and education, both in nature and in their relationships. These multidimensional and dynamic relationships have produced, at least in part, what Waterston (2005) explored in medical education, as under the minimum necessary for safe and responsible medical practice. This challenge both, health professions practice and the knowledge that is at stake, in a level of complexity for which there is no return (Tonelli, 1998). Another challenge facing Nursing education is related to the quality of university teaching. The reports of the Organization for Economic Cooperation and Development on Higher Education (OECD) show university undergraduate teaching as the weakest component of the education system. University education is seen strongly centered in a positivistic paradigm of education, where the focus is on academics and memorizing information. The Nursing education is not an exception to these general findings, actually, in most of the medical and health professions curriculum the vision of cumulative content and instrumental skills as the main goal of student development is hegemonic (Waterston 2005; Kassirer, 2010). These characteristics are consistent with the trend to regard students as passive receptors of static scientific facts with no space to doubt or uncertainty (often out of specific context), as if those contents and the implicit conceptual development had not interdependent relations with the methods of teaching (e.g. use a two-dimensional strategy for teaching relations between 3D structures, as human organs). At the same time, an increase in the number of trainees, the depth and breadth of scientific knowledge teachable also increase exponentially. Therefore, in order to react in harmony with this multiple and nested aspects, there is a necessity to comprehend the epistemological and ontological complexity that this issues involve (Tonelli, 1998; Heng, 2008). Human anatomy teaching has multiple factors for its progressive weakness in the medical and health professions curricula and this reduction process might be necessary and even positive, but the responsible and deep analysis of this factors are necessary to evaluate the status of this discipline and how is fading into the dense matrix of courses that are organized to transform a high school student into a professional nurse. On the same hand, no shared criterion about the philosophy behind the programs appears to be established as The Didactic of Human Anatomy for Nursing students (Drake, 2007, Darrell and Watt, 2005; Evans, 2005). In fact, in some health professions schools human anatomy is studied using cadavers, in others it is taught without the use of this material, considered by many essential for proper training. Research in human anatomy teaching has been geared primarily to instrumental analysis, specially oriented to the study of teaching techniques. Most of this research

2 presents methods developed from trial and error and without taking in consideration theories of learning and teaching and research in the sciences; which are fundamental steps to understand the inter-subjectivity and the relationships that interact in the process of deep and meaningful learning (Seyfer, 2007; Smallwood, 2004, Terrell, 2006). As an example, we can observe that despite functional and surface anatomy could be considered more relevant for the expected competences acquisition; they usually are the least considered as part of the object of study. Rationale. Considering that learning anatomy is one of the most important subjects of preclinical curriculum (Weeks, Harris and Kinzey, 1995; Kassirer, 2010; DiLullo, 2009), this requires a specific and strategic planning, oriented toward the achievement of defined levels of competence. The research fields that promote deep learning in adults suggest that teachers' conceptions about teaching, learning and assessment, rely primarily on the experiences they have had in life. In this study, the experiences are elicited by the conceptions of the scholars, these conceptions are engaged in a historical context, and socio-cultural patterns, thus they give meaning to the distinct aspects that influence their practice (Knowles, Holton and Swanson, 2005). After doing insight about the experiences, practices would not be performed automatically and uncritically, and some changes will occur in the interactions within the classroom, not only on a strictly academic manner, but also from a psychological and symbolic perspective. For that reason an educational intervention based on its context and dimensioned in its complexity provide unique opportunities to student growth, giving coherence to thought, speech and action, as freelancer and ethical people (Quintanilla, 2005). The main objective of this study is to draw a map of the academics conceptions, from a distinctive schools of Nursing, about teaching and learning human anatomy. To achieve this goal, certain specific objectives have had to be considered 1) analyzing the referential and structural aspects of the participants experiences about teaching 2) constructing the spectrum of variation that is set around the experiences of these academics. Methods. The chosen phenomenographic methodology aloud an approach to the object of study oriented to the description, analysis and understanding of the experiences with a specific purpose: to elicit the spectrum of variation that represent a group of individuals. This is possible by a depth analysis of multidimensionality and nested categories of description, which are elicited by in-depth interviews geared to comprehend the experience of the participants about the studied phenomena. Conceptions of individual academics are attached to a certain level of sophistication of the way the participants are able to understand the phenomena of teaching human anatomy for Nursing school s students. The human anatomy course is usually programmed in the first year of the curricula and fit in the Basis Sciences Department; though the fact of structuring a deeper comprehension of the teaching of anatomy is vital, not only since is an early stage of the formation process and the student are specially receptive, but also because this course is the first instance to introduce the medical (Nursing) language, as well as a deep and complex way to approach to the human body comprehension (Weeks, Harris and Kinzey, 1995; Kassirer, 2010; DiLullo, 2009). Consequently the human anatomy course acts as a body of knowledge that articulates the rest of the knowledge and skills that will be developed during the program. The subjects that are part of the sample are scholars of the human anatomy department which have taught this subject for at least five years in the Nursing school. Results. The structure of the "outcome space" is a qualitative characterization of the different dimensions and aspects of teaching that professors are aware of. The results

3 are presented as categories of description. These categories represent the relationships between the different modes of experiencing a phenomenon; this is called dimensions of awareness. Each category reveals something distinctive in the way of understanding the phenomenon. This study elicits a group of nested categories showing a wide spectrum of variation between academics (Table Nº1). This occurs both, in an inter-contextual perspective, where experiences vary according to different contexts studied, as well as in an intra-context standpoint, in which the dimensions of awareness are expressed as internal variation. Some scholars experience teaching their subject matter in atomistic and less integrated ways, where the transmission-reception model and the teacher-focused approach, generally as a form of directly transferable knowledge, possible to be objectively measured. Those with a more integrated and holistic experience of understanding their subject experience their teaching in more conceptual change and student-focused ways, considering the process of teaching and learning in a multi-factorial and relational viewpoint where, for example, assessment is seen as an integrated and fundamental part of the teaching and learning process. This was registered primarily in between academics from the medium stage of development (5-10 years). The elicited dimensions of senior professors are located within an intermediate stance in the spectrum constructed. In this case different aspect of the phenomenon are elicited, however the interest towards the thinking process development does not appear in any of the discourses, as well as the development of students creative abilities (Table Nº2). The why and what for of the teaching of anatomy does not appear to be part of the approaches of any scholars, for the contrary experiences appear constantly and with a special focus on: how the teaching of contents should be done. Conclusions and Implications. In summary, various categories overlap, especially in high levels of complexity (multi-structural, relational and extended-abstract), which tend to occur in the same individuals as well. The spectrum of variation manifested by analyzing different age, gender, professional stage and profession participants is wider than the elicited spectrum within a similar group. The expansion of the spectrum of variation of the professors awareness will allow a more sophisticated understanding of the phenomena. Understanding how the participants are experiencing the phenomenon in the classroom, and the epistemological foundations that underlie their conceptions enable new ways to understand and address the teaching-learning-evaluation construction and implementation, as well as the creation and modeling of professional development programs, promoting critical and systematic reflection about the different perspectives of a phenomena. Table Nº3. This table illustrates the distribution of the categories of description that has initially emerged from this study. Referential Structural Aspects Aspects Atomistic structure Multi-structural Relational Extended abstract Facts and techniques 10 professors 8 professors 4 professors 1 professor Concepts and skills 7 professors 5 professors 2 professors 1 professor Underlying Theories 4 professors 3 professors 0 professors 0 professors Conceptual Development 4 professors 3 professors 1 professors 1 professor Personal Development 3 professors 2 professors 1 professor 0 professor Community or Social Dimensions 2 professors 1 professor 0 professor 0 professor

4 We recognized three fundamental limitations. In the first place the established conclusions are specific for human anatomy academics in determined Nursing schools and therefore the results could be useful to understand certain aspects of the phenomenon, or to outline new hypothesis in similar contexts. The participants belong to a determined university and for that reason, although comparisons could settle down with other universities, the selected university have multiple conditions that are characteristic of the social system of which they play a part. In second place, the results of this investigation are subject to the look of the researcher and hence they cannot be reproduced in an identical way when it is carried out by another investigator. In third place, the results do not show the wealth of each individual's experience, but a map that illustrate the distribution of the participants experiences as a whole. Nevertheless, the storing of qualitative studies around teaching and learning human anatomy in Nursing will allow to articulate conclusions that, in a summative way, could approximate to a generalization or to build theories around the studied phenomena (Åkerlind, 2005). The object of this study, that is: the relationship among the studied phenomenon, the participants and the investigator, is specific in these three senses (illustration Nº1) and, therefore, the use of the results and conclusions for external contexts will be subjected to the approaches that correspond to each implementation type or analysis Researcher Relation reseacherparticipants Object of study Relation reseacherphenomena Participants Phenomena Relation participants-phenomena Illustration Nº1. Phenomenographic rationality (Bowden y Green, 2005, pp.18). Bibliography Åkerlind, G. (2005). Variation and commonality in phenomenographic research methods. Higher Education Research and Development 24(4), Bowden, J., Green, P. (2005). Doing developmental phenomenography. Qualitative Research Methods series. Series Editor: Professor John Bowden, RMIT University Press Melbourne. Darrell J.R. y Watt D. (2005). Provision of Anatomical Teaching in a New British Medical School: Getting the Right Mix. The Anatomical Record (PART B: New Anat) 284B, DiLullo, C., Morris H., Kriebel, R. (2009). Clinical Competencies and the Basic Sciences: An Online Case Tutorial Paradigm for Delivery of Integrated Clinical and Basic Science Content. Anat Sci Educ, 2, Drake, R. (2007). A Unique, Innovative, and clinically oriented approach to anatomy education. Educational Strategies. Academic Medicine, Vol. 82, 5: Evans, D. (2005), Provision of anatomical Teaching in a British Medical School: Getting the right mix. The Anatomical Record (PART B: New Anat) 264b, Kassirer, J.P. (2010). Teaching clinical reasoning: Case-based and coached. Acad. Med, 85:7,

5 Knowles, M.S., Holton, E.F., Swanson, R.A. (2005). The Adult Learner. 6th ed. Amsterdam, Netherlands: Elsevier. Quintanilla, M. (2005). Historia de la ciencia y formación docente: una necesidad irreducible. Revista TED de la Universidad Pedagógica Nacional de Bogotá (número extra), Seyfer, A. (2007.). The Value of surgeons teaching anatomy to first year medical students. Bulletin of the American College of surgeons, 92(10), Smallwood, J. (2004). An anatomist s comments on learning and teaching. JVME 31(1). Terrell, M. (2006) Anatomy of Learning: Instructional Design Principles for the Anatomical Sciences. The Anatomical Record, Part B: New Anat. 289B, Tonelli M. R. (1998). The philosophical limits of evidence-based medicine. Academic Medicine, 73, Waterston, S.W., & Stewart, I.J. (2005). Survey of Clinicians Attitudes to the Anatomical Teaching and Knowledge of Medical Students. Clinical Anatomy, 18, Weeks, S.E., Harris, E.E., & Kinzey, W.G. (1995). Human gross anatomy: A crucial time to encourage respect and compassion in students. Clinical Anatomy, 8(1),