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Study pace as a factor that influences achievement in a human anatomy course.

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THE ANATOMICAL RECORD (PART B: NEW ANAT.) 289B:134 –138, 2006
EDUCATION NOTE
Study Pace as a Factor That Influences
Achievement in a Human Anatomy Course
RODRIGO ENRIQUE ELIZONDO-OMAÑA,* MARÍA DE LOS ANGELES GARCÍA-RODRÍGUEZ,
JESÚS ALBERTO MORALES-GÓMEZ, AND SANTOS GUZMÁN-LÓPEZ
Determining the optimal conditions for learning anatomy will help medical students to do better in a gross anatomy
course. We examined the two types of anatomy courses offered in our institution: slow-paced (SP) and fast-paced
(FP) courses, in which the same content is taught in approximately the same number of hours (SP ⴝ 91 hr; FP ⴝ 90
hr), but the duration of each course differed (SP ⴝ 91 1-hr sessions lasting 20 weeks; FP ⴝ 45 2-hr sessions lasting
9 weeks). The objective of this study was to find out whether a relationship exists between anatomy course pace and
achievement. Two groups of students were tested on their anatomy knowledge both before beginning and after
completing either the SP or the FP course. The average difference in scores obtained on the pre- and postcourse tests
for each group was obtained and a t-test was used (P < 0.05) to compare the mean score for each group. A significant
difference was found between group SP and group FP, with the highest achievement obtained by group SP. The pace
of the course is thus a factor that influences achievement. Anat Rec (Part B: New Anat) 289B:134 –138, 2006.
© 2006 Wiley-Liss, Inc.
KEY WORDS: education; achievement; gross anatomy; anatomy teaching; learning
INTRODUCTION
During the first part of the last century, anatomy courses were considered by some to be too long and often
implied learning anatomical details
that were irrelevant in clinical practice. During the 1960s and 1970s, the
duration of gross anatomy courses
Dr. Elizondo-Omaña is coordinator of
scholarship recipients for the Department of Human Anatomy, School of
Medicine, Universidad Autónoma de
Nuevo León. His research interests include morphological characteristics of
vascular conduits used as a bypass.
Ms. Garcı́a-Rodrı́guez and Mr. MoralesGómez are scholarship recipients of the
department.
Dr. Guzmán-López is the head of the
Department of Human Anatomy at the
same institution. His research interests
include medical education.
*Correspondence to: Rodrigo Enrique Elizondo-Omaña, Departamento de Anatomı́a Humana, Facultad de Medicina Universidad Autónoma de Nuevo León,
Ave. Madero y Dr. Aguirre Pequeño
s/n. Col. Mitras Centro, Monterrey,
Nuevo León, C.P. 64460, Mexico. Fax:
01-52-8183477790; E-mail: rod_omana@
yahoo.com
DOI 10.1002/ar.b.20103
Published online in Wiley InterScience
(www.interscience.wiley.com).
© 2006 Wiley-Liss, Inc.
was drastically reduced as the result of
the introduction of new subjects into
the medical curriculum (Monkhouse,
1992).
During the last few years, medical
schools in various countries have
modified their curriculum and many
others have begun debates concerning
modification of the same (Pabst and
Rothkotter, 1997). One of the factors
contributing to these changes is the
growing body of knowledge in both
the clinical and basic sciences, particularly in the areas of cellular and molecular biology, which has resulted in
a considerable reduction in the time
dedicated to the study of traditional
basic science subjects, including anatomy (Marks and Cahill, 1988).
Due to these changes, studies have
been carried out to determine the optimum gross anatomy course duration, the content to be presented
(Drake, 1998; Bukowski, 2002), and to
adjust that content to student needs,
taking into consideration that which
is most relevant for future clinical
practice (Pabst, 1993; Dangerfield,
2000; Kagan, 2002).
In the School of Medicine at the
Universidad Autónoma de Nuevo
León, there is a low passing rate (under 50%) for gross anatomy (Elizondo-Omaña, 2004). At this time, the
school’s academic committee is planning to change the curriculum, including a reduction in the time dedicated to the gross anatomy course. In
order to show that relationship, we
examined the different types of anatomy courses offered at our institution:
slow-paced (SP) and fast-paced (FP)
courses, in which the same content is
taught in the same teaching system.
The SP course is for regular students
and has 91 class hours taught in 91
sessions (covered in 20 weeks), and
the FP course is for repeaters and has
90 class hours taught in 45 sessions
(covered in 9 weeks). The objective of
this study is to find out whether a relationship exists between anatomy
course pace and achievement.
MATERIALS AND METHODS
A longitudinal study was carried out
on 130 students divided into two
groups (SP and FP) according to the
pace of the anatomy course. Both
groups were exposed to the traditional
EDUCATION NOTE
form of anatomy teaching based on
lectures. The group SP was formed by
91 regular students who took a 20week-long anatomy course, and the
group FP was formed by 39 repeaters
(students who previously took and
failed the traditional course) exposed
to the abbreviated form of the gross
anatomy course with a duration of 9
weeks. The SP 20 week course consisted of 91 theoretical class sessions
lasting 1 hr/day (a total of 91 class
hours). The FP 9 week course was abbreviated to 45 theoretical class sessions lasting 2 hr/day (a total of 90
class hours). Both groups had access
to laboratory sessions (dissection), to
a bone room, and to a virtual room.
These three auxiliary resources were
optional. As a part of each course, students also took three examinations
and a final global examination and received passing or failing grades. Those
evaluations were not taken into account in this study. The textbook for
both groups was Anatomı́a Humana
(Human Anatomy) by Lockhart et al.
(1965). In our teaching format, the
teacher interacts with students during
the class, asking them to explain some
topic to the rest of their classmates
while the teacher guides and complements students’ exposition.
Both groups were given a survey
and two tests, one upon starting the
course (pretest) and another upon finishing the course (posttest). The survey consisted of 10 questions for
group SP and 13 questions for group
FP. One test was applied twice (preand posttest) in each group and it consisted of 30 multiple-choice questions
appropriate to the study plan in effect.
There were three questions, randomly
selected for each of the 10 areas of
study, e.g., head and neck, upper limb.
The separate pre- and posttests were
used rather than the actual course examinations so that the group teacher
would be blinded as to the questions
in the test, thereby avoiding biased
coaching toward the pre- and posttests used to compare SP and FP
groups. All subject areas were covered
with the same amount of questions
for both groups. The tests were scored
on a 30-point scale. The pretest was
used to establish a baseline for the
groups and also to determine the initial difference between them. The
posttest was used to determine the im-
THE ANATOMICAL RECORD (PART B: NEW ANAT.) 135
TABLE 1. Demographic characteristics of students in group SP
High School
Female
Male
Age
SD
Frequency
Technical
Private
Public
17.17
17.77
16-30
0.8
2.1
46
45
n ⫽ 91
4
6
10
10
13
23
32
26
58
provement of the students from baseline. Achievement was defined as the
difference between the average scores
obtained on the posttest and pretest.
The data obtained were placed in a
database and processed in Microsoft
Excel. Descriptive statistics were applied for the information derived from
the survey. The achievement (difference in mean scores obtained on the
pre- and posttests for each group) was
analyzed with a t-test (P ⬍ 0.05).
RESULTS
Demographic characteristics of the
survey are as follows.
registered in other semesters taking
subjects for the first time as regular
students.
Many FP students (35.89%) did not
use any available auxiliary resource.
The most used was the bone room,
which was used by 30.76% of the students. The virtual room and laboratory had very low attendance, with attendance percentages of 5.12% and
17.94%, respectively. The average
number of hours spent by an FP student in the bone room was 3.8 hr. Use
of the other resources (virtual room
and laboratory) averaged less than 1
hr per FP student.
Group SP
The demographic characteristics of
group SP are shown in Table 1. The
auxiliary resource most used was the
laboratory in which 100% of the SP
students did an average of four dissections. The average amount of time invested in dissection per student was 3
hr a week. The SP student had to dissect and identify required structures
as per directions in the dissection
manual. The bone room was used by
94.50% of the students and the virtual
room was used by 74.75% of the students. The average number of hours
of use per SP student of the bone
room was 16 hr and of the virtual
room was 5.9 hr.
Group FP
The demographic characteristics of
group FP are shown in Table 2. Students in group FP took gross anatomy
for a second time as repeating students (Fig. 1). Seventeen FP students
took only the anatomy course for 9
weeks, while the other 22 FP students
were simultaneously registered in
other courses, including courses for
repeating students in other subjects.
Of these students, only 11 were found
Pretest and Posttest
The average scores obtained from the
pretest and posttests for both groups
are shown in Table 3. There was a
significant difference (P ⬍ 0.05) between the SP and FP pretests, and students in group FP performed better
than those in group SP. There was no
significant difference (P ⬍ 0.05) between the SP and FP posttests, even
though students in group FP did better than group SP. There was a statistically significant difference (P ⬍ 0.05)
in achievement between both groups,
with SP students exhibiting higher
achievement than FP students.
DISCUSSION
Gross human anatomy is one of the
basic subjects within the medical curriculum. In a survey answered by
medical residents in which an attempt
was made to establish the importance
of anatomical knowledge in their
training as doctors, the gross anatomy
course was thought to be indispensable and highly relevant (Pabst and
Rothkotter, 1997).
136 THE ANATOMICAL RECORD (PART B: NEW ANAT.)
EDUCATION NOTE
TABLE 2. Demographic characteristics of the students in group FP
High School
Female
Male
Age
SD
Frequency
Technical
Private
Public
18.1
18.8
16-25
1.109
1.868
22
17
n⫽ 39
1
5
6
6
5
11
15
7
18
Student’s Demographic
Characteristics: The Survey
The characteristics of our student
population in the first year of their
medical training differ widely in comparison to those observed in other
countries. In medical schools in Canada, the age range of students starting
their medical studies is from 20 to 24
years and 51.1% of the population is
female (Dhalla et al., 2002). In medical schools in the United States, the
average age is 25.6 years (Dinsmore et
al., 2001) and 49% of the population is
female (Barzansky and Etzel, 2003).
In our study, the average age in group
SP was 17.5 years, and the gender
showed a slightly female predominance (50.54%). Group FP had an average age of 18.5 years and was predominantly female (56.40%). The
difference in ages between the groups
studied is due to the fact that group
SP includes only students in their first
semester and group FP consisted of
students in their second or third semester. The difference in the average
age observed in this study with respect to that observed in other medical schools is explained as follows: upper middle education (high school) in
Mexico lasts 3 years for private and
technical schools, while in public
schools it lasts 2 years. In addition, in
Mexico there are no medical school
requirements for premed college
courses such as those found in the
United States or Canada. For that reason, the majority of our students in
professional education enter medical
school after an abbreviated high
school education and without the benefit of a college education. Most Mexican medical students are thus only 17
years old, an age that is much lower
than that in other countries. The
above factors probably influence the
low achievement observed in the gross
anatomy course. We must remember
that anatomy is a basic science and, in
our present curriculum, it is studied
in its entirety in the first year of medical studies. As Miller (2000) says, it
represents a totally different way of
learning for young students, as it implies the learning of concepts that
they have never been exposed to previously.
The course format used for teaching
the subject of anatomy is quite varied
in different medical schools throughout the world and there are even multiple forms of teaching it within each
school. In our school, courses (slow
and fast) consist of daily theoretical
classes taught by physicians with
graduate degrees, as well as laboratory sessions during which human cadavers are dissected. In addition,
students have optional auxiliary resources provided by the department: a
virtual room and a bone room (Elizondo-Omaña et al., 2004). The way in
which class content is reviewed, the
hours dedicated to dissection, and the
auxiliary resources used for that purpose also have an influence on student
achievement.
The traditional teaching model of
anatomy was originally based on faculty instruction, usually in a lecture
setting, and student discovery in laboratory. This offers low integration of
areas of study (Drake, 1998) and
places the student in a receptive situation, in which he memorizes concepts that he does not necessarily understand. In our teaching model,
students of both groups were randomly asked to explain some topics
regarding the subject of anatomy in
each class session. We think that a
student’s class participation is important since it promotes active learning.
They need to understand and keep in
mind (in an organized fashion) the
topic in order to explain it to the rest
of their classmates and show mastery
of the topic to the teacher.
Pretest and Posttest
Group SP had an average score of 7.3
on the pretest in a 30-point scale. Students in this group had never taken a
human anatomy course, except those
who studied in technical medical high
schools (10/91). In group FP, the average score on the pretest was 10 in a
30-point scale. The higher FP pretest
scores were probably because they
have a higher level of knowledge since
they had already taken a previous slow
paced anatomy course in the School of
Medicine (which they failed), and/or
because prior exposure to this form of
testing may have given them greater
skill at answering these kinds of test
questions. The pretest intention was
to establish a precise baseline level of
knowledge from which to determine
the progress of students’ learning. Regardless of differences in average pretest scores, when subtracted from the
posttest score, it allowed an independent measure of each group’s progress
Figure 1. Academic situation of students in group FP.
EDUCATION NOTE
THE ANATOMICAL RECORD (PART B: NEW ANAT.) 137
TABLE 3. The scores obtained by the students in both groups.
Achievement was defined as the subtraction between post-test
and pre-test averages
Group SP
Group FP
Pre-test
Post-test
Achievement
7.3 (␴⫽3.47)
10 (␴⫽4.34)
13.49 (␴⫽3.74)
15.28 (␴⫽3.79)
6.18 (␴⫽4.83)
4.87 (␴⫽5.62)
(achievement) without bias from prior
medical school gross anatomy course
exposure. However, as some students in
both groups had already taken anatomy
courses as part of their academic training in high school, we believe that use
of pretest scores subtracted from posttest scores was a helpful tool for measuring only achievement. In the posttests, the average score obtained by
group SP was 13.49 in a 30-point scale,
which is lower than the 15.28 average
obtained by group FP on the same
scale. Based on the posttest alone, it can
be assumed that group FP had better
absolute knowledge of the subject than
group SP; however, this score does not
consider the degree in which the anatomical knowledge improved once the
courses were completed (i.e., achievement).
Achievement
The most important factor in our
study was to determine achievement
according to our operational definition (the difference obtained by the
subtraction of pretest average from
posttest average scores). This revealed
that the achievement for group SP
was 6.18 points, which is significantly
higher (P ⬍ 0.05) than achievement
for group FP, which was 4.87 points.
This significant difference in achievement indicates that the slow-paced
course likely provided a better learning environment for acquiring new
anatomical knowledge than the fastpaced course.
In both anatomy courses (slow and
fast), the content covered was the
same, the way of presenting this content was very similar among the
groups, and the tests applied for evaluating student achievement were
identical. The only difference between
groups was the number of sessions
during which the content was presented, 91 for group SP and 45 for
group FP. In spite of this, the number
of theoretical class hours was practi-
cally the same (group SP, 91 hr; group
FP, 90 hr), while the number of course
days was lower for group FP. We
therefore conclude that the pace of
the course was the most likely factor
accounting for the difference in
achievement. This is in agreement
with McKeown et al. (2003), who observed better achievement in courses
that last longer.
In 2002, Drake et al. did a survey to
learn about the composition of
courses in different medical schools in
the United States and found that of
the 83 schools answering the survey,
in most of them (72%) the duration of
gross anatomy courses was found in
the range of 126 to 200 total hours
(mean ⫽ 167 ⫾ 39 hr). It was also
found that the percentage of the
course hours dedicated to the laboratory was 34% to 89%. In 40% of
schools surveyed (33/83), laboratory
work represented 70% or more of the
total course hours. In five schools in
the United States, the anatomy course
had a duration of 101 to 125 hr, and
anatomy courses lasted less than 100
hr in only four schools. Reidenberg
and Laitman (2002) reported that the
anatomy course in their medical
school consists of 140 hr, including
dissections, lectures, and group discussion. In our medical school, the
time spent in anatomy laboratory is
only about 30 hr and students have
the option of spending additional time
outside of official class hours going to
the bone room or virtual room. At the
end of the long course, most of the
students spent approximately 120 –130
hr learning anatomy (90 hr in required
lectures, 30 hr in required anatomy laboratory, and some additional hours in
other optional resources).
Although Muller (1984) suggests that
the curriculum in medical schools
should reduce the number of hours
dedicated to lectures, our study shows
that it is not advisable to reduce any of
the time dedicated to anatomy learn-
ing. An alternative option would be to
increase the number of hours spent in
the laboratory doing dissections (bringing this number closer to the U.S. average of 70% of the total course hours)
and requiring use of the currently optional additional resources (bone and
virtual rooms). This would reduce the
proportion of the course devoted to
lectures while adding the benefit of
more hands-on learning. We must remember that changes in the curriculum must be based on the principle
that modifying educational programs
must improve the quality of subjects
taught in the medical profession
(Drake, 1998), not the opposite.
Study Limitations
There are other factors that were not
specifically tested in this study, which
could influence the student’s achievement, such as interest in anatomy and
motivation to learn. The FP groups is
likely to have a larger proportion of
students (compared with the SP
group) exhibiting a lack of interest
and low motivation, as evidenced by
their failing grades in the initial slowpaced course. Thus, we would expect
lower achievement scores in the FP
group. These two variables were not
measured with a specific test, but
there are two indications that low motivation and lack of interest occurred:
the FP group students had a negative
experience in the past course, and the
record of attendance to optional activities was lower in FP students. While
this study has shown that course pace
was a significant factor affecting
achievement, it is possible that these
additional two variables may have
also played a role in lowering achievement of the FP group. In order to
identify the specific contributions of
each variable, a future study should
be conducted in which naive students
(i.e., no prior anatomy training) take
the fast-paced course and are compared with naive students in the slowpaced course. Likewise, repeaters
(i.e., students who failed anatomy)
should also be tested in a second attempt at the slow-paced course and
compared with repeaters taking the
fast-paced course.
Course pace is a factor that influences achievement. When course pace
is accelerated, achievement gets worse.
138 THE ANATOMICAL RECORD (PART B: NEW ANAT.)
A fast-paced course is not the best option for repeaters. We suggest that repeaters should retake the slow-paced
course.
ACKNOWLEDGMENT
The authors thank an anonymous referee for carefully editing the manuscript.
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