Effects of four supplemental instruction programs on students' learning of gross anatomy

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    Effects of Four Supplemental Instruction Programs onStudents Learning of Gross Anatomy


    University of Health Sciences College of Osteopathic Medicine, Kansas City, Missouri

    Many researchers have reported that supplemental instruction programs improve medicalstudents performance in various basic sciences. This study was conducted to evaluate thesummative effects of four supplemental instruction programs (i.e., second-year medicalstudent teaching assistant program; directed study program; weekly instructor laboratoryreviews; and a web-based anatomy program) on medical students gross anatomy laboratorypractical performance. First-year medical students from the graduating class of 2006 (n 223) received the four supplemental instruction programs (Experimental Group). The ControlGroup consisted of rst-year medical students from the graduating class of 2005 (n 254)who did not receive the four supplemental learning methods. Mann-Whitney rank sum testswere used to compare the two groups median percentages for the back-upper limb (B-UL)and the lower limb (LL) parts of a gross anatomy laboratory practical. The ExperimentalGroups median percentages for both the B-UL (77.78%) and LL (83.33%) were signicantlygreater than that of the Control Group (B-UL 69.00%; LL 81.00%; P 0.05). Resultsfrom a post-hoc student survey showed that more students both rated and ranked the weeklyinstructor laboratory reviews as extremely useful and most benecial, respectively. A greaternumber of students rated and ranked the web-based anatomy program as not useful and leastbenecial, respectively. The results from this study suggest that the four supplementalinstruction programs improved students learning of gross anatomy as measured by labora-tory practical performance. In addition, students most valued the additional time in the grossanatomy laboratory with the instructors. Clin. Anat. 17:322327, 2004. 2004 Wiley-Liss, Inc.

    Key words: education; medical curriculum; alternative teaching methods


    The curricular transition of some medical schoolsfrom using a traditional discipline-based curriculum toan integrated basic and clinical science program hascreated a challenge for teaching gross anatomy(Mandin et al., 1995; Drake, 1998; Blue et al., 2000;Woloschuk, 2000; Vidic and Weitlauf, 2002). The in-tegration of basic and clinical science in medicalschool curricula has resulted in less time for grossanatomy lectures and laboratories (Cottam, 1999; Azizet al., 2002). Consequently, many anatomists are usingalternative/supplemental methods for teaching grossanatomy, particularly in the laboratory.

    To enhance students learning of gross anatomy,Op den Akker et al. (2002) implemented the use ofbody paint in the gross and living anatomy courses atUtrecht Medical Center. The entire class of rst-yearmedical students (n 240) painted abdominal and

    thoracic organs on each others skin surface during two3-hr laboratory sessions. Results from students eval-uations (97.5% response rate) indicated increased en-thusiasm towards learning anatomy, and that the sup-plemental method of body painting provided insightinto the spatial relations of internal organs.

    The effects of supplemental instruction in bio-chemistry, gross anatomy, microbiology, and physiol-ogy on mean test scores were studied by Sawyer et al.(1996). In this study, second-year medical studentsdirected an optional, supplemental instruction pro-

    *Correspondence to: David L. McWhorter, PhD, Department ofAnatomy, UHS-COM, 1750 Independence Avenue, Kansas City,MO 64106. E-mail: dmcwhorter@uhs.edu

    Received 11 February 2003; Revised 15 May 2003

    Published online in Wiley InterScience (www.interscience.wiley.com). DOI 10.1002/ca.10219

    Clinical Anatomy 17:322327 (2004)

    2004 Wiley-Liss, Inc.

  • gram to all 150 rst-year medical students at the Uni-versity of Southern California School of Medicine.The results of this study demonstrated signicantincreases in mean test scores for the students (n 127) who received the supplemental instruction. Ad-ditionally, failure rates for at-risk students (i.e.,composite Medical College Admission Test score of26 and a science grade-point average below 3.0) inthe supplemental instruction group decreased by 46%when compared to previous classes.

    Hallgren et al. (2002) evaluated gross anatomy lab-oratory examination performance after supplementinganatomy instruction with a web-based anatomy pro-gram. Sixty-three of the 124 rst-year medical stu-dents at Michigan State University College of Osteo-pathic Medicine used the web-based anatomyprogram. The results of this study showed that the 63students who used the web-based program performedsignicantly better on both mid-term and nal grossanatomy laboratory exams than the students who didnot use the web-based program.

    Peer teaching is yet another supplemental methodused by some anatomists to instruct their students.Yeager and Young (1992) implemented a system ofpeer teaching due to decreased course hours and fac-ulty time, and to increased class size. Eight studentswere assigned to each cadaver and teams of two stu-dents performed every fourth dissection. Studentevaluations from this study indicated that peer teach-ing was an effective learning tool. Additionally, theauthors reported no change in national board exami-nation performance following the implementation ofthe peer-teaching program.

    In another peer-teaching study, Nnodim (1997)compared students in a traditional dissecting pro-gram with students in an experimental peer-teachingprogram. A total of 160 second-year medical studentswere divided into two equal groups. One group, serv-ing as the Control dissected in every anatomy labora-tory. The other group (Experimental) was further di-vided into two subgroups that participated in a peer-teaching program. In the peer-teaching program, eachhalf of the Experimental Group participated in 50% ofthe dissections and teaching. Results from this studyshowed that the students in the peer teaching pro-gram performed signicantly better than their full-time dissecting counterparts on both a two-choicetheory paper and a 50-station practical exam.

    In the fall of 2002, we implemented four newsupplemental instruction programs in the gross anat-omy course at the University of Health Sciences Col-lege of Osteopathic Medicine (UHS-COM). The foursupplemental instruction programs consisted of thefollowing: 1) second-year medical student teaching

    assistant program, 2) directed study program, 3)weekly instructor laboratory reviews, and 4) web-based anatomy program. These pilot programs were inresponse to an internal S.W.O.T. (i.e., strengths,weaknesses, opportunities, and threats) analysis per-formed by the Continuous Quality Improvement(CQI) teams at UHS-COM. The CQI teams werecomprised of rst- and second-year students, UHS-COM faculty, and Curriculum Department staff.Thus, the purpose of this study was to assess thesummative effect of four supplemental instructionprograms on students gross anatomy laboratory prac-tical performance.


    During the 20012002 academic year, rst-year stu-dents in the graduating class of 2005 (n 254) dis-sected in every other 3-hr gross anatomy laboratory(Control Group). After completing the back, upperlimb, and lower limb dissections, students were givena 50-question identication-based (e.g., Identify thetagged structure?) or tag-related (e.g., Which muscle issupplied by the tagged structure?) laboratory practical.The number of back, upper limb, and lower limbquestions related to the number of corresponding lab-oratories. Two anatomy department instructors gradedall laboratory exams using a standardized key.

    The same teaching and testing protocol was fol-lowed during the 20022003 academic year for therst-year students in the graduating class of 2006 (n 223). This group of students (Experimental Group),however, received the following supplemental in-struction programs (SIPs; Table 1): 1) second-yearmedical student teaching assistant program (TA), 2)directed study program (DS), 3) weekly instructorlaboratory reviews (IR), and 4) a web-based anatomyprogram (WP).

    A total of 24 second-year medical students from ofthe graduating class of 2005 were selected to assistUHS-COM anatomy faculty in the laboratory teachingof gross anatomy. Criteria that anatomy faculty usedfor selecting second-year teaching assistants were astrong interest in teaching anatomy, an aptitude ingross anatomy (i.e., 80% average in gross anatomy),and an upper 30% class rank. Teaching assistants metwith anatomy faculty prior to each laboratory sessionto discuss the objectives for each dissection and toreview structures on a prosected specimen. Moreover,teaching assistants were required to attend at least onegross anatomy laboratory per week. Second-year stu-dents earned college credit for their participation inthe anatomy teaching assistant program.

    Supplemental Instruction and Lab Performance 323

  • Because of the alternating dissection program atUHS-COM, students perform 50% of the gross anat-omy dissections. Students in the Control Group reliedmainly on independent study to learn the anatomythat they did not dissect. For the ExperimentalGroup, a directed study program was implemented.The required directed study program consisted of aweekly 1-hr laboratory session in which students inthe Experimental group reviewed the dissection per-

    formed by their peers with the anatomy instructorsand teaching assistants.

    Weekly 2-hr instructor laboratory reviews wereanother supplemental instruction program offeredto the Experimental Group. This optional programgave interested students an instructor-directed re-view of dissected material and an additional oppor-tunity