Peer teaching in gross anatomy at St. Louis University

Clinical Anatomy 5:304-310 (1992)

MEDICAL EDUCATION

Peer Teaching in Gross Anatomy at St. Louis University

VERNON L. YEAGER AND PAUL A. YOUNG Department of Anatomy and Neurobiology, St. Louis Univemity School of Medicine,

St. Louis, Missouri

The gross anatomy course at St. Louis University was designed to utilize peer teaching. Eight students are assigned to each cadaver and they work in teams of two, so that every student does one out of every four dissections. During one class period, the lecture for a unit is given to all class members, followed by a prosection demonstration to only the dissectors of that unit (one-fourth of the class). At the beginning of the following class period, the dissectors give a prosection demonstration of their dissection to the other six students assigned to their cadaver. The lecture and prosection demonstrations for the next unit are given to the next team of dissectors as above. The students anonymously evaluate the course each year. Passing Part I of the National Board Examina- tions is required. For 12 years, the National Board Unit examination of gross anatomy was given as the final examination for the course.

The course is liked by the students, can be taught with a minimal number of faculty, utilizes only half the cadavers of a traditional course, has less contact hours than the national average, yet students do better than the national average on the anatomy part of the National Board Examination. o 1992

Key words: dissection, prosection, demonstration

Wiley-Liss, Inc.

INTRODUCTION The gross anatomy course at St. Louis University was a traditional course in

1967- 1968 and consisted of 268 scheduled class hours. Thirty-two cadavers were used for the 129 students enrolled. A number of modifications have been tried here since that time. In 1969-1970, a course which integrated gross anatomy, embryology, and histology was offered. A “core” course of only 75 hours of assigned class time was offered in 1971-1972, in which students did no dissections, but were Received for publication June 7, 1991; revised September 16, 1991.

Address reprint requests to Vernon L. Yeager, Ph.D., Department of Anatomy and Neurobiology, St. Louis University School of Medicine, 1402 South Grand Boulevard, St. Louis, MO 63104.

0 1992 Wiley-Liss, Inc.

Peer Teaching in Anatomy 305

shown prosection demonstrations by teaching assistants. Neither the students nor the faculty were pleased with these courses. Additional reasons for changing to the present course were a decrease in course hours, decrease in space after the old laboratory was modernized, pressure on faculty to devote more time for research and less for teaching, and an increase in class size.

T h e present course was conceived by one of the authors (P.A.Y.) and to our knowledge, no comparable course using peer teaching was being given. T h e University of Buffalo has adopted our type of course and communications indicate that it is working well. Others have inquired about our course.

MATERIALS AND METHODS Beginning in 1972 the laboratory portion of the course has involved peer teach-

ing, with teams of two or three medical students doing a dissection and presenting that material to the other students assigned to their cadaver. At first, ten students were assigned to each cadaver, but since 1974 eight students have been assigned to each cadaver and each of the two-member teams does every fourth dissection. T h e National Board of Medical Examiners Unit Examination in Gross Anatomy was used as the final examination for the course for 12 years, including the classes of 1976-1988 except 1987. This exam contains gross anatomy and a small amount of embryology, which is a separate course at St. Louis University.

At first, the gross anatomy course consisted of 45 4-hour periods for unit assignments and four periods for examinations, giving a total of 196 hours. Currently there are 41 4-hour periods to cover 40 units and four 4-hour periods for examinations giving 180 hours of assigned class time. A syllabus containing the 40 units is purchased by each student. Each unit in the syllabus has three parts: 1) Objectives; 2) Material to be covered; and 3 ) Dissection instructions. Examples of unit titles are Axilla, Face, Pancreas and Duodenum, and Plantar Surface of the Foot. There is one dissection for each unit. T h e 40 units cover all the material included in a typical gross anatomy course. Other courses taken during the same time period as gross anatomy are medical biochemistry, communication skills, embryology, psychiatry, ethics, community medicine, histology, physiology, and neurosciences.

A combination lock on the gross anatomy laboratory allows students to dissect or study at any time they wish. Two typical periods are shown in Figure 1.

Students reporting to class at 1:00 p.m. will go either to the peer demonstration or review. All will have heard the lecture on this material the previous period. Those demonstrating to their peers will also have seen a prosection demonstration of the dissection by staff and will have done the dissection they demonstrate. Adjacent to every cadaver in the laboratory is blackboard space and students are encouraged to put drawings or outlines on the board as an aid to their demonstrations. Because the class meets Tuesdays and Fridays, the dissectors will have had three or four evenings to complete the dissection and prepare for the presentation. T h e fact that the dissections need to be completed outside assigned class hours is accepted by the students because the non-dissectors (six out of every eight students) are excused from assigned class time from 3:30 to 5:OO p.m. Therefore each student is excused from 4*/z hours of assigned class time and is expected to make up that time when it is hidher turn to complete a dissection. Four and one-half hours is a reasonable amount of time to completed a dissection. Faculty and

306 Y e e e r and Young

CLASS PERIOD N+ 1 1:OO-1:45 p.m.-Half of class goes to lab for peer demonstration of Unit N by

team A at cach tablc. A faculty membcr circulatcs in the laboratory to answer questions. Other half of class goes to lecture room for a slide review of Unit N, conducted by the course director.

1:45-230 p.m.-Students switch groups above. 230-3:30 p.m.-Lecture in Unit N + 1 (all students). Lectures are given by

3:30-5:OO p.m.-Staff prosection demonstration of Unit N + 1 for team B from the course director or other faculty.

each table. Staff includes some students who completed the course the previous year. After demonstration, team B will begin dissection of Unit N + 1. Staff will be present. Teams A, C , and D are excused-they will make up this time when it is their turn to dissect.

CLASS PERIOD N + 2 1:OO-1:45 p.m.-Half of class goes to lab for peer demonstration of Unit N + 1

by team B at each table. Other half of class goes to lecture room for a slide review of Unit N + 1.

1:45-230 p.m.-Students switch groups above. 230-3:30 p.m.-Lecture on Unit N + 2 (all students). 3:30-5:00 p.m.-Staff prosection demonstration of Unit N + 2 for team C from

each table. After demonstration, Team C will begin dissection of Unit N + 2. Teams A, B, and D are excused-they will make up this time when it is their turn to dissect.

Fig. 1. Consecutive class periods.

teaching assistants are expected to be in the laboratory until 5:OO p.m. to assist the students while they are dissecting, and one staff member is required to be present from 6:OO to 9:OO p.m. on Tuesdays and Fridays. A student would use the following sequence of scheduled learning opportunities during scheduled class time when it is hidher unit to dissect:

Lecture Prosection demonstration by staff member Dissection Peer prosection demonstration Review

When it is not hidher unit to dissect, one of the two sequences below would be

Lecture (previous class day) Peer demonstration Review

followed:


or Lecture (previous class day) Review Peer demonstration

T h e unit lectures attempt to organize the material, explain the difficult concepts, and provide the clinical relevancy of the anatomy in the unit. From 160 to 192 students take gross anatomy and eight or nine students are assigned to each table (cadaver). Sophomore students are hired to prosect three cadavers for staff presentations, since virtually all of our graduate students are in the Neurobiology program which does not require them to take or assist in gross anatomy. We are currently preparing three- dimensional video tapes to replace the staff prosection demonstrations.

On examination days, the class is divided into thirds and each third is given three examinations. T h e practical examinations consist of 56 stops with 32 questions and 24 rest stops. T h e students are given 1’/4 minutes per stop. T h e questions typically ask the student to identify the structure tagged, but occasionally a question other than identification is asked. T h e written examinations consist of five questions per unit or 50-55 machine-graded multiple choice questions. All questions are of the “choose the one best answer” type. T h e third examination utilizes 2 x 2 slides projected on a screen and consists of eight questions each on surface, radiologic, and cross-sectional anatomy. They are also machine-graded multiple choice questions. For grading purposes, the practical examination counts 50%, the written examination counts 40%, and the slide examination only 10%.

RESULTS T h e average grades (Fig. 2) on the National Board Unit Examination have

ranged from 570.4 to 630.8 with a mean of 604.0 for the 12 years it was given as the

Unit Test

NB Paf! 1 -Anatomy

NB Part 1 Total

National Average

-15 ’ , I I I I I I 1976 1978 1980 1982 1984 1986 1988

Class x Unit lest not given 10 class of 1987

Fig. 2. Mean scores on National Board Examinations (St. Louis University School of Medicine).

308 Yeqjer and Young

final written examination. Students are also required to pass National Board Examina- tion Part I. T h e mean scores of our students on National Board Examinations are shown in Figure 2. You will notice that the average scores on the total Part 1 score is lower than that for Part 1 Anatomy only, and the highest averages were on the Unit examination taken as the final written examination at the end of the course. T h e anatomy part of the National Board Examination Part I includes gross, histology, embryology, and neuroanatomy. For 2 years, the questions on the anatomy part of the test were recorded according to course (gross, histology, etc.) and the percent correct for the gross part was equal or slightly better than the whole score for anatomy.

Each year the courses in the basic sciences are anonymously evaluated by the students. Sample questions from different years and the responses are shown below.

INDICATE WHETHER OR NOT YOU AGREE OR DISAGREE WITH THE FOLLOWING STATEMENTS.

AGREE DISAGREE Gross anatomy is a well organized and taught course. I am happy with the arrangement of dissections in

107 88

0 20

which I do 1 out of every 4 dissections. MORE LESS

If you answered “disagree” to the previous 20 0 statement, then would you like to do more or less dissections?

PLACE THE NUMBERGRADE, ONA SCALE OF 1 TO 5, THATYOU FEEL THE COURSEMERITS. “1”WLL SIGNIFY THEMOST FAVORABLE OR POSITIVE RESPONSE AND “5” WILL SIGNIFY A COMPLETE FAILURE BY THE DEPARTMENT.

1 2 3 4 5 How would you describe your feelings toward the 82 36 2 3 1

Overall, was the course well organized and 106 15 2 1 2

Do you favor retention of the 8 persons per group 50 41 15 11 7

Do you favor retention of the student doing every 59 38 10 8 7

---

course?

integrated?

setup?

fourth dissection idea?

INDICATE WHETHER OR NOT YOU AGREE, ARE NEUTRAL, OR DIS- AGREE WITH THE FOLLOWING STATEMENTS.

AGREE NEUTRAL DISAGREE I was able to learn the material 73.8% 17.8% 8.5%

T h e dissection schedule was 80.1% 15.6% 4.3% adequately as it was presented.

acceptable.


USING THE FOLLOWING SCALE, RATE THE FOLLOWING SWTE- MENTS (1 = Excellent; 3 = Average; 5 = Unacceptable).

Average Rating 2.075

1.588

2.044

I was able to learn the material adequately as it was

T h e lectures in this course were valuable as a learning tool, presented.

in addition to being just a source of facts. T h e dissection schedule was acceptable.

IN MY OPINION, THIS COURSE SHOULD BE KEPT THE SAME OR TO’lALLY RESTRUCTURED (1 = Kept the same; 5 = Totally restructured).

1 2 3 4 5 56 35 4 3 0

RANK THE FOLLOWING STATEMENT ACCORDING TO THE FOLLOW- ING SCALE: a = Strongly agree; b = Agree; c = Disagree; d = Strongly disagree; e = Does not apply.

a b c d e T h e laboratory was an effective teaching aid which 101 10 0 0 0

allowed the integration of “book learning” and practical experience.

PLEASE EVALUATE THE FOLLOWING SEGMENTS OF THE COURSE USING THE FOLLOWING CHOICES: a = Very helpful; b = Above average; c = Average; d = Below average; e = Not helpful.

a b C d e NR Lectures 63% 30% 2% 2% 2% 1%- Prosection demonstrations by teaching 21% 45% 27% 4% 1% 2%

Your own dissection assignments 50% 31% 13% 2% 3% 1% Prosection demonstrations by your 6% 34% 42% 14% 3% 1%

staff

peers

DURING THE YEAR, YOU WERE RESPONSIBLE FOR 10 DISSECTIONS. SHOULD THE NUMBER BE

Increased? 39% Left same? 54% Decreased? 7% No response 1%

DISCUSSION Hendelman and Boss (1986) indicate that peer teaching can be traced to the

1st century A.D., but studies of peer teaching by students of the same age, ability

310 Yeager and Young

and education are few. Their study of peer teaching in gross anatomy indicated that their students learned as much from their peers as from staff teaching and learned most from what they taught their peers. They also concluded that the activc involvement in teaching would prepare students to be continual and independent self-learners throughout their professional life.

Our course utilizes more than peer teaching. Students are first introduced to a new unit by lecture. Nnodim (1988) showed that significant learning can occur during a lecture.

After the lecture, the students assigned to dissect that unit will see a prosection demonstration. Nnodim (1990) reported on an experimental program in which one group studied the lower limb by dissection in the traditional way and another group studied the lower limb without dissecting, using prosected material only. Both groups had previous dissecting experience with the upper limb. They were tested with a 300 item two-choice examination and a practical examination. T h e experimental group scored significantly (0.05) better on both tests. This group also spent only 74% of the time the traditional group spent.

Our students also attend a slide review of each unit and they find them very worthwhile.

Our course has been repeatedly evaluated by two separate means: 1) student evaluations and 2) National Board examinations. T h e student evaluations show that the course is well organized, that the lectures are useful, and that peer teaching is effective. T h e National Board examination results show that our students compare well with students nationally. I t would be difficult to prove “cause and effect” between the methods used in this course and the good results. T h e majority of our students rank gross anatomy the hardest but best course in the 1st year and graduating seniors have selected the course director of gross anatomy for the basic science Golden Apple award seven out of the last 16years. What this report is trying to show is that these results can be obtained by this method which utilized less faculty time, one-half the cadavers, and fewer course hours.

ACKNOWLEDGMENTS T h e authors gratefully acknowledge the patience and secretarial assistance of

Susan L. McClain in the preparation of this manuscript.

REFERENCES Hendelman, W.J., and M. Boss 1986 Reciprocal peer teaching by medical students in the gross

Nnodim, J.O. 1988 Learning human anatomy: does learning occur during a lecture? J. Med.

Nnodim, J.O. 1990 Learning human anatomy: by dissection or from prosections? J . Med. Educ.,

anatomy laboratory. J. Med. Educ., 61:674-680.

Educ., 22338-93.

24:389-395.

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Peer teaching in gross anatomy at St. Louis University