Benefits from peer teaching in the dental gross
anatomy laboratory
Jennifer K. Brueckner and Brian R. MacPhersonUniversity of Kentucky Medical Center, Department of Anatomy and Neurobiology, Educational Technology Group, Lexington, KY 40536-0298, USA
This study examined the impact of implementing a rotatingdissection schedule on the attitudes and performance of first-
year dental students in the gross anatomy laboratory at theUniversity of Kentucky. In 2002–2003, half of the students
assigned to each cadaver dissected the assigned objectivesduring the first 90 min of the laboratory session. During the last
30 min, the non-dissecting group members came into the labor-atory and had the day’s dissection demonstrated and explained
to them via peer instruction. Dissection responsibilities rotatedwith each laboratory session. Eighty-eight percent of student
participants were satisfied with the rotating dissection approachaccording to a mid-term survey, and this satisfaction level
remained unchanged at the end of the semester for most
students. Students’ perceptions of the quality of peer laboratory
presentations varied, with only 44% rating them as good orbetter. Eighty percent of students perceived that rotating dissec-
tion did not impede their performance, and this was confirmed byanalysis of grade data. Student satisfaction and the ability to
devote additional weekly curriculum time to studying anatomy ina very compressed curriculum were the main student-described
benefits.
Key words: peer instruction; gross anatomy; laboratory; basic
science instruction.
ª Blackwell Munksgaard, 2004Accepted for publication 10 November 2003
‘I n teaching others, we teach ourselves’ (proverb).
For educators at all academic levels, the learning
pyramid has been a longstanding advocate for peer
training, demonstrating that the process of teaching
others results in a 90% retention rate of material, as
compared to the 5% for lecture, 10% for reading, and
50% for discussion (1). In addition to its intellectual
benefits, peer teaching also heightens students’ sense
of responsibility, increases self-confidence, and allows
for growth in interpersonal and collaborative relation-
ships while improving organizational and problem-
solving skills (2–5). Peer teachers are often better at
understanding students’ learning problems, more
interested in their lives and personalities, less autho-
ritarian and yet are still focused on assessment (6).
In the realm of health science education, peer
instruction is a cooperative learning technique used
widely during both basic science (7) and clinical
training (8, 9) in a variety of contexts, including
lecture (10, 11) and laboratory (5, 12). For more than
30 years, the medical education literature has docu-
mented different forms of peer instruction in gross
anatomy in order to save time and facilitate learning
(13–19). As curricular demands increase and qualified
anatomists become scarce (20), medical schools are
seeking more cost- and time-efficient ways to teach the
laboratory component of gross anatomy. A number of
medical schools have replaced the traditional dissec-
tion method (where all students attend laboratory and
participate in dissection) with alternative strategies,
such as the ‘rotating dissection’ approach. In this
instructional technique, only a fraction of the students
at each laboratory station dissect on any given day; at
the end of the laboratory, they teach the day’s
dissection to their peers. To date, the effectiveness of
this peer teaching method has been evaluated primar-
ily for medical students; the present study focuses on
the implementation of rotating dissection in a dental
anatomy curriculum.
In the 2002 academic year, the authors restructured
the laboratory component of the first-year dental gross
anatomy course at the University of Kentucky in order
to correct some serious instructional trends. While
dental gross anatomy had always been a dissection-
based course, the dedication to the dissection effort by
the students was highly variable. Some students
preferred to spend little time in the laboratory during
the scheduled course dissection, returning to the
laboratory in the evening to learn the material largely
by prosection. Other students preferred to monopolize
72
Eur J Dent Educ 2004; 8: 72–77All rights reserved
CopyrightªBlackwell Munksgaard 2004
euro pean journal of
Dental Education
the dissection, theoretically readying themselves for a
future in oral surgery. In addition, a concern for the
faculty was a reduction in the number of trained
laboratory instructors and their potential monopoliza-
tion by the full class of 52 students in the laboratory.
Laboratory instructors needed to be able to move
between dissection tables quickly to ensure that each
student group received appropriate assistance.
The purpose of this curricular shift in dental
anatomy was to ensure all students participated in
the dissection experience as well as to make more
effective use of their dissection time/experience. The
authors took the opportunity to assess the impact of
rotating dissection on student attitudes and laboratory
performance.
Methods
The rotating dissection approach was tested with the
first-year dental class during the spring semesters of
2002 and 2003 (52 students each semester). On the first
day of class, the rationale for and structure of the
rotating dissection approach was presented to the
class. Dissection teams of six to eight dental students
were assigned alphabetically and divided into two
groups. During each laboratory period, only one group
at each table attended the first 90 min of laboratory and
dissected the day’s objectives. The non-dissectors used
most of the laboratory time to study anatomy in groups
or independently. During the last 30 min of laboratory,
the non-dissecting members of each group came into
the laboratory and had the days’ dissection demon-
strated and explained to them by the dissectors. Each
student present for the dissection played a specific role
in the laboratory demonstration, as described below.
Faculty members were present throughout the labor-
atory period to answer questions and monitor the
quality of student presentations.
Each member of individual dissecting groups
assumed one of three team roles each day. The reader
was responsible for leading the dissection by reading
the dissection instructions to the others and locating
appropriate atlas images to assist in the dissection.
The reader was also responsible for narrating the
laboratory demonstration for the students who did not
participate in the day’s dissection. The head dissector
took a lead role in the dissection process and also
identified key structures during the laboratory demon-
stration. One or more assistant dissectors assisted the
head dissector by retracting structures or dissecting
the opposite side of the cadaver, when appropriate.
These roles rotated with each laboratory period so that
all students had the opportunity to act in each role on
six different occasions during the semester.
To evaluate student satisfaction with the rotating
dissection approach, surveys were conducted at mid-
term and end of semester time points. The surveys
were designed to collect quantitative data as well as
qualitative written comments on many aspects of the
new dissection experience from the first-year class. In
addition, the teaching faculty recorded their impres-
sions on the pros and cons of the rotating dissection
experience.
To ensure that the rotating dissection approach did
not impact on student laboratory performance negat-
ively, laboratory examination scores from 2002 to 2003
(rotating dissection implemented) were compared to
the performance in 2001, when a traditional laboratory
schedule was used (in which all students are expected
to dissect during each laboratory period). spss statis-
tical software was used to perform statistical analyses
on the grade data.
An exemption certification for this study (Protocol
03-0375-X2Q) was granted for this study from the
University of Kentucky’s Institutional Review Board.
Results
One hundred and four dental students from the first-
year classes of 2002 and 2003 participated in the study.
The overall response rate for the surveys (2002–2003)
was 87.5% (91 respondents out of a total of 104
students). Forty-six of the respondents were male
students (50.5%), and 45 were female (49.5%).
Eighty-eight percent of student participants indi-
cated some level of satisfaction with the rotating
dissection approach (Fig. 1), according to the mid-
term survey. This satisfaction level remained
unchanged at the end of the semester for most
students (79%), while 17.5% indicated a higher level
and 3% reported a reduced level of satisfaction.
With regard to student perceptions of the schedule’s
impact on learning, 45.6% felt it enhanced their
learning, while 34.4% perceived that it had no effect
and 20% thought that it impeded learning (Fig. 2). In
order to ensure that rotating dissection did not
impact on performance negatively, laboratory exam-
ination performance in 2001 (prior to rotating
dissection schedule implementation) was compared
to that in 2002 and 2003 (after rotating dissection
implementation) using anova analysis. Overall per-
formance on laboratory examinations was not com-
promised as a result of implementing the rotating
dissection method.
Peer instruction in anatomy
73
Students’ perceptions of the quality of laboratory
presentations was varied: 15.4% rated them as excel-
lent, 44% as good, 23.1% as satisfactory, and 17.6% as
needing improvement (Fig. 3). Most students’ views
of presentation quality did not change as measured by
the end of semester survey (69.1%); 15.5% felt that the
demonstrations improved over time, while 15.4%
perceived a reduction in presentation quality. Figure 4
demonstrates that most students enjoyed teaching
their peers (88.9%) while fewer reported that they
enjoyed learning from their peers (64%). 83.8% felt that
the division of labor among their group was equitable.
When queried about the schedule’s influence on
laboratory preparation, 43.2% indicated that the
schedule encouraged them to prepare more diligently,
while the rest indicated that the schedule had no
impact on their preparation (Fig. 5).
Each survey provided space for subjective student
comments. Student-derived benefits of the approach
were listed as: (i) more time-efficient laboratory
schedule, allowing extra study time on non-dissecting
days; (ii) less crowded laboratory environment; and
(iii) a lower student–faculty ratio. Students expressed
concerns about three aspects of the rotating dissection
approach: (i) 22% of the class wanted to dissect during
every laboratory and were displeased on days when
they failed to view the dissection in progress; (ii) 36%
Enhanced Impeded0
5
10
15
20
25
30
35
40
45
50
Per
cen
tag
e o
f st
ud
ents
No effect
Fig. 2. Students’ perceptions of rotating dissection on theirlearning at end of semester. An exit survey indicated that 80%of students felt that the rotating approach did not impede theirlearning. As with the mid-term survey, those students who feltthat rotating dissection compromised their learning cited theinability to participate in all dissections and distrust of the peerinstructors as the primary issues.
Excellent Good Satisfactory Needs improv.0
5
10
15
20
25
30
35
40
45
50
Per
cen
tag
e o
f stu
den
ts
Fig. 3. Students’ perceptions of the quality of peer laboratorydemonstrations, as evaluated by mid-term survey. Eighty-two percent of the class rated the student presentations as satisfactory orbetter at mid-term. Only a minority of the class (15.4%) consideredthe presentations to be excellent, however, because of manystudents’ distrust of the information conveyed by their peerinstructors.
Yes
No
0
10
20
30
40
50
60
70
80
90
100
Per
cen
tag
e o
f st
ud
ents
Enjoyed learning from peers
Enjoyed teaching peers
Fig. 4. Students’ attitudes about peer learning and teaching. Mid-semester evaluation revealed that students enjoyed both teachingtheir peers and learning from them. More students howeverindicated a preference for teaching their classmates (88.9%) overlearning from them (64%).
Very satisfied Satisfied Dissatisfied Very dissat.0
5
10
15
20
25
30
35
40
45
50P
erce
nta
ge
of
stu
den
ts
Fig. 1. Students’ satisfaction with rotating dissection at mid-term.A mid-term survey indicated that 88% of students were satisfiedwith the rotating dissection approach. Of those 12% of studentswho indicated some level of dissatisfaction, most cited the under-lying reasons as either a desire to participate in all dissections or aninherent distrust of their peers as teachers.
Brueckner & MacPherson
74
of the class cited structure misidentification during
student presentations as a problem; and (iii) 20% of
the class perceived that they had less effective labor-
atory learning on non-dissection days.
In addition, the faculty recorded their impressions
of the rotating dissection experience and noted the
following benefits: (i) laboratory attendance was 99%
or better; (ii) students more effectively divided the
responsibilities of the dissections at their tables so that
everyone participated; and (iii) a less crowded labor-
atory environment facilitated faculty circulation to all
tables more quickly (fewer faculty can be effective in
the laboratory); (iv) a better quality of dissection and
more accomplished per interval as students feel an
onus to be able to demonstrate the structures to those
arriving later; (v) faculty can better determine the level
of knowledge of individual students as they get to
interact one-on-one with the reduced number of
students in the laboratory; and (vi) students have the
opportunity to refine their presentation skills in an
informal setting through their demonstrations.
Discussion
In the literature to date, most of the innovative
approaches in teaching and learning gross anatomy
have focused on medical students (21–23). Given some
of the documented differences in the medical and
dental student populations (24–26), it is surprising
how few studies have addressed dental students’
attitudes toward and performance in the gross anatomy
laboratory (26, 27). The present study investigated the
impact of implementing a rotating dissection schedule
on students’ attitudes and performance in a first-year
dental anatomy course at the University of Kentucky
during the 2002–2003 academic years.
Overall, the new approach to laboratory instruc-
tion was well received by our students. They
reported the primary benefits of the approach to be
a low faculty to student ratio as well as extra study
time for lecture material on their non-dissecting
days. While most students enjoyed serving in the
role of teacher, a substantially lesser number of
students liked being in the role of student. Their
ratings of the quality of student presentations gen-
erally expressed uncertainty and mistrust regarding
the accuracy of information presented by their peers
during the student presentations. Interestingly, most
students’ trust in peer instruction did not change
over the course of the semester, and 15% of the class
became even more disenchanted with their col-
leagues’ teaching. The literature pinpoints the quality
of instruction delivered by students as a potential
disadvantage of peer teaching (28). Similar responses
have been reported in medical students (14, 29),
where students indicated a preference for either
dissecting and presenting the material themselves or
learning via presentations by faculty or teaching
assistants rather than by their peers. Hunt et al. (30)
suggested that students’ lack of enthusiasm for
instructional approaches focused on team-based
behaviours may stem from their comfort with tradi-
tional teaching approaches that do not foster indi-
vidual accountability. Based on student subjective
comments from the annual course evaluations, we
further postulate that some students’ dissatisfaction
may be because of the intentional randomized
assignment of students to dissection tables. In most
instances, students were not paired with their regu-
lar study partners, with whom they prefer to study
and whom they trust. Regardless of the underlying
reasons for students’ dissatisfaction with their peers’
laboratory presentations, the course’s faculty is
working to implement a more formal evaluation of
student presentations in the future. Instructors will
be responsible for evaluating the presentations at
two to three dissection tables each class meeting,
rating presentations on parameters such as complete-
ness of dissection, accuracy of anatomical identifica-
tion and ability to answer relevant questions on the
material of interest.
The educational benefits for the peer tutor/teacher
are well documented in the literature (28, 31). The
process of preparing for peer instruction enhances
cognitive processing in the student instructor by
Increased No Effect0
10
20
30
40
50
60
Per
cen
tag
e o
f st
ud
ents
Fig. 5. Impact of rotating dissection on student self-reported pre-laboratory preparation. The rotating dissection approach encour-aged 43.2% of students to preview the material to be covered inlaboratory on the days that they dissected and presented thedissection to their peers. The majority of students however reportedthat the implementation of rotating dissection did not alter theirstudy habits.
Peer instruction in anatomy
75
focusing attention to and motivation for the task,
necessitating review of existing knowledge and skills
and presenting the material in a simple and clear
fashion (28). For these reasons, we expected that
student pre-laboratory preparation would increase,
yet less than half of the class reported any change in
their pre-laboratory preparation. As our survey did
not evaluate the underlying reasons for this phenom-
enon, we can only surmise that this phenomenon may
arise either from a high basal level of preparation or
from a resistance to pre-class preparation. Follow-up
studies are being designed that will characterize and
track the performance of the students who reported
increased preparation as a result of the rotating
dissection approach.
Future directions for this area of research in
anatomical instruction include monitoring the influ-
ence of specific laboratory roles (head/assistant dis-
sector, reader) on examination performance in
different anatomical regions (for example, does being
head dissector impart an advantage on that material
when tested?) as well as comparing the efficacy of
cross-year versus same-year peer instruction. In addi-
tion, studies are currently underway to track students
from the present study through their clinical years of
training in order to evaluate if this peer teaching
programme improved their ability to interact with
their peers and patients, as compared to more senior
students who took gross anatomy prior to implemen-
tation of the peer teaching programme. Studies
designed to track the quality of students’ presentation
skills during their basic science and clinical training
are being designed currently in order to determine if
the anatomy peer instruction experience significantly
improves student oral presentation skills during their
clinical years. A more thorough understanding of the
mechanisms by which peer instruction influences
student learning will facilitate future changes in the
approach to teaching and learning not only in the
gross anatomy laboratory but in other basic science
and clinical courses as well.
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Address:
Dr Jennifer K. Brueckner
University of Kentucky Medical Center
Department of Anatomy and Neurobiology
Room MN 225, 800 Rose Street
Lexington, KY 40536-0298
USA
Tel: +1 859 323 3780Fax: +1 859 323 5946e-mail: [email protected]
Peer instruction in anatomy
77
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