Evaluating the Teaching-Learning Methodology of the Gross Anatomy Course at San Juan Bautista School of Medicine

Assessment is an important and useful tool to examine and enhance the effectiveness of teaching and learning by medical students.^{1, 2} This tool has also been developed to assure quality in training programs in other Medical Schools. ³ In the United States, a unique examination, the United States Medical Licensing Examination (USMLE), is used to assess the ability of the medical student to apply knowledge and concepts to patient care. ⁴ The Anatomy Department of the San Juan Bautista School of Medicine, conscious of the importance of preparing the students in the core courses, to assure that their performance as physicians should be in concordance with their performance in the USMLE examinations, has added assessment, consisting of 40 multiple choice questions and case studies, in the Gross Anatomy course. The purpose of this assessment process is to determine how students are learning and then use this information to bring beneficial changes, if necessary, into the teaching and learning processes. ^{4, 5} The Gross Anatomy course is offered during the first semester to the first year medical students. The learning objectives are stated in the corresponding syllabus, and include: 1) gross anatomy of the upper/lower extremities, back, head/neck, thorax/ abdomen, pelvis/perineum ; 2) developmental anatomy ; 3) clinical case presentations ; 4) radiological anatomy throughout the course ; 5) and dissection of human cadavers. Teaching strategies include; lectures, conferences, clinical correlations, quizzes, written and practical exams, portfolios, discussion of radiological images, and laboratory dissection of the cadavers (for which students are grouped 8-9 students/group). After the lecture periods, the students work in the laboratory dissecting cadavers. The dissection groups are heterogeneous with many of the students possessing professional degrees while others are direct graduates from undergraduate college. This diversity presents challenges to working harmoniously in the anatomy laboratory. The faculty participates with the students in the dissection, an activity which permits the professor to observe and analyze student work and which also helps the students to overcome challenges presented by the group diversity. It is the faculty responsibility to assure that the students receive the correct instruction and to evaluate if the department was using the correct teaching methodology to help them acquire the requisite knowledge.

To enhance evaluation, the assessment tests were administered to 39 first year medical students at three intervals: formative pre-test, on the first day of class; formative mid-term after the topics on upper extremity/ thorax, and abdomen/pelvis were covered; and a summative test towards the end of the semester in which head/neck, lower extremity and perineum were completed. The data obtained from the pre-test was used as the basis for comparison with the other assessment tests. The data was analyzed using one analysis of variance (Sigma Stat 3.1).

After the topics of upper extremity/thorax were covered and tested in class, based on the results , two important strategies were added: 1) Tutorial Program (a formal peer-driven program established at the institution); and 2) providing laboratory time for dissection after class hours. Following the initiation of these new strategies, the students were tested on the mid-term exam and the results showed significant improvement in all areas, when compared to the pre-test.

The material covered in the Gross Anatomy course especially in the upper extremity area is extensive and difficult for a new student to acquire. The abdomen and pelvis areas were evaluated separately comparing the pre-test and mid-term assessment; and showed an increase of 40% in correct answers. This confirms that the introduced changes to the teaching methodology, i.e. the tutorial program and extension of laboratory hours, as well as the program of assessment optimized the subsequent performance of the students.

Based on the final grades of the course, grades of the assessment tests, and Shelf Examination grades, reported as percentage correct, with a letter grade, and percentile rank (which compares our students to others nationwide), it can be concluded that the teaching/learning methodologies used in the Gross Anatomy course have been effective in the learning process of the students. It also shows that specific classroom assessment is valuable in analyzing the outcomes of the students at the individual course level. Adding the new strategies after the first exam enhanced the performance of the students, and suggested that the course sequence could be successfully modified. There is a limitation in comparing the regional anatomical areas of our assessment test with those seen on the Anatomy shelf examination, because the shelf does not include specific anatomy areas covered.

Based on the results of the present study, the Anatomy Department will modify the course sequence and incorporate the new instructional changes for all classes in the future.

REFERENCES

1.Framework for Outcomes Assessment. Middle State Commission on Higher Education, Philadelphia. 2000; 1-18.
2.Case, S., Swanson, D., Constructing Written Test Questions For the Basic and Clinical Sciences. National Board of Medical Examiners, Philadelphia, 3rd Edition, 2002; 9-12.
3.Shumway, J., Harden, R. The Assessment of Learning Outcomes. Education Guide, Association for Medical Education in Europe. 2003; 7-19.
4.Karle, H., Nystrup, J. Evaluation of Medical Specialist Training: Assessment of Individuals and Accreditation of Institutions. Occasional Paper. Association for Medical Education in Europe. 2003; 3-7
5.Boston, C. The concept of formative assessment. Practical Assessment, Research and Evaluation. 2002; PAREonline.net/getvn.