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Traditional teaching supported by computer-assisted learning for macroscopic anatomy.

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Traditional Teaching Supported by ComputerAssisted Learning for Macroscopic Anatomy
Over the years we have observed that there is a very low passing rate for the Anatomy and Neuroanatomy courses in our
department, and for that reason we decided to implement the use of student-learning resources. The objective of this
study was to compare the results of traditional methodology with those obtained with the support of computer-assisted
learning (CAL). We performed a retrospective and joint study for Anatomy and Neuroanatomy groups during the period of
September 2001 to February 2003, to establish a comparison between traditional learning and traditional learning
supported by CAL. In the Anatomy group, students who used the traditional method (n1 ⴝ 365) received an average final
grade of 58 (SD ⴝ 14.94), while the average final grade for students who used the traditional method supported by CAL
(n2 ⴝ 283) was 68 (SD ⴝ 14.56). In the Neuroanatomy group, the students who used the traditional method (n3 ⴝ 217) had
an average final grade of 61 (SD ⴝ 14.51), while the students who used the traditional method supported by CAL (n4 ⴝ 134)
received an average final grade of 68 (SD ⴝ 13.52). A z-test was conducted to determine the difference in averages
between the two groups (␣ ⴝ 0.05), and the results showed that the averages were significantly different (P < .001). The
modified traditional method with CAL support was shown to be the best option in comparison with the traditional method.
Anat Rec (Part B: New Anat) 278B:18 –22, 2004. © 2004 Wiley-Liss, Inc.
KEY WORDS: computer-assisted learning; education; medical education; anatomy
This study discusses how we have
taken our traditional teaching methDr. Rodrigo E. Elizondo-Omaña is the
coordinator of scholarship recipients
for the Department of Human Anatomy,
School of Medicine, Universidad Autónoma de Nuevo León, Monterrey,
México. Drs. Jesús Alberto Morales-Gómez and Ricardo Patiño Ibarra are
scholarship recipients from the Department of Human Anatomy, School of
Medicine, Universidad Autónoma de
Nuevo León, Monterrey, México. Dr.
Santos López Guzmán is the head of the
Department of Human Anatomy, School
of Medicine, Universidad Autónoma de
Nuevo León, Monterrey, México. Dr.
Iván León Hernández is a resident in
Gynecology and Obstetrics, School of
Medicine, Universidad Autónoma de
Nuevo León, Monterrey, México. Dr. Félix Cavazos Vilchez is a resident in Traumatology, School of Medicine, Universidad Autónoma de Nuevo León,
Monterrey, México.
*Correspondence to: Rodrigo E. Elizondo-Omaña, Department of Human
Anatomy, School of Medicine, Universidad Autónoma de Nuevo León, Ave.
Madero y Dr. Aguirre Pequeño. C.P.
3-4107, Monterrey, N.L., México. E-mail:
DOI 10.1002/ar.b.20019
Published online in Wiley InterScience
© 2004 Wiley-Liss, Inc.
odology and supported it with computer-assisted learning. Since the time
of Aristotle, the study of the relationship between form and function, such
as anatomy and physiology, has been
considered a basic part of education
in the health sciences (Paalman,
2000). For this reason, the subject of
anatomy is indispensable in medical
Over the years, methods of teaching
anatomy have gone through three
stages, from simple observation to
dissection of cadavers, and now to
computer-assisted learning (CAL)
(Trelease, 2002).
In 1910, Flexner introduced a medical education technique in which
both basic and clinical sciences used
the scientific method. In the 1980s
this method was criticized for being
too “horizontal” and “vertical” (that is
to say, divided into independent compartments with no integration). It was
also thought that students should not
have access to patients if the students
were not prepared in basic science
(Marks and Cahill, 1988). With this
method (termed the “traditional”
method), the student attends confer-
ences and the learning is passive. As a
consequence, the use of the traditional method declined with the introduction of reform in the 1980s, which
proposed that training in medical education must be integrated and patient-oriented (Marks and Cahill,
This reform introduced new techniques, such as problem-based learning (PBL) and small student groups to
study cases, which were aided by “facilitators” who helped to integrate basic and clinical knowledge (Aziz et al.,
2002). This modification considerably
reduced the amount of time that students could dedicate to the study of
certain subjects, including anatomy
(Marks and Cahill, 1988), and some
universities even abandoned the dissection of cadavers altogether (Aziz et
al, 2002).
Education protocols for the first 2
years of medical school are changing,
and over the past few years many
schools have revised their curriculums or have started to debate how to
modify them (Pabst and Rothkötter,
1997; Drake, 1998). New techniques
and resources for teaching anatomy
Figure 1. The classical traditional form of teaching during the theory class. The students only
listen to the professor’s presentation.
have been developed. For example,
CAL is now used in human anatomy
laboratories (Paalman, 2000). Additionally, different teaching techniques
have been introduced, such as “brainstorming” (Geuna and Giacobini-Robecchi, 2002), animated presentations
in Power Point (Carmichael and
Pawlina, 2000), and educational videos (Galván et al., 1999). These new
methods have yielded good results. In
addition, three-dimensional software
and multimedia computer programs
for anatomy (Schwartz, 1980) have
been developed for the same purpose
(Trelease, 2002; Van Sint Jan et al.,
In the past, our department has observed a very low passing rate for the
Anatomy and Neuroanatomy courses,
and for that reason we decided to implement the use of other resources for
student learning. In this work we discuss how we have taken our traditional teaching methodology and supported it with CAL. We conducted a
detailed study of the results obtained
with the use of traditional methods
only versus CAL-supported traditional
teaching, which showed that learning
improved with the latter method.
omy groups, from September 2001
through February 2003. The grades
obtained by the students in these
courses were considered as a dependent variable, and the method used
(traditional or modified traditional)
was an independent variable. We did
not take into consideration demographic variables such as age, sex, or
socioeconomic level, or psychological
All of the students used an official
textbook (Lockhart et al., 1965), and
they were encouraged to consult a
complementary atlas (Netter, 1997).
In addition, for the past 4 years the
department has updated a macroscopic anatomy compendium every
semester, which includes clinical
notes related to the content of the
course. In the school’s bookstore,
there is also a list of additional books
for consultation (textbooks as well as
anatomical atlases). The students
have the option of purchasing these
resources, and they rarely take advantage of this option because they would
incur an additional expense, and the
exams are based on the content of the
official textbook. In addition to these
supplementary materials, the department includes an area with a bone
collection and an amphitheater,
where students have access to materials such as bones, anatomical models,
and cadavers.
When the students followed the traditional method (Fig. 1), the Anatomy
group spend 91 h on theory and 60 h
on dissection of cadavers. The Neuroanatomy groups spent 55 h on theory
and 30 h on dissection of cadavers.
For groups that used the modified traditional method, the theory and dissection classes were of the same duration, and a virtual classroom was used
(Fig. 2). With this method, each student’s class attendance was registered
on a credential that was given to the
student at the beginning of the course.
When the students finished their rotation, the frequency with which they
had attended the classroom was
counted and they were accordingly
awarded points toward their final
grade (Table 1). It must be mentioned
that the students were only able to
attend the classroom a maximum of
A retrospective and joint study was
carried out in which traditional (classical) learning was compared with traditional learning supported by CAL
(hereafter referred to as “modified traditional”) in Anatomy and Neuroanat-
Figure 2. The virtual classroom setup used in the modified traditional teaching method.
TABLE 1. Points awarded for attendance in the virtual classroom
Points Awarded
Percentage of Attendance
Minimum Number of
Less than 49%
Only 40
two times a week (2 h per week), due
to student demand and physical space
The virtual classroom is a physical
space located in the area of the Department of Human Anatomy. It has
24 personal computers that can be
used by students to consult different
programs, such as Power Point slides,
a multimedia program (Fig. 3) created
by the professors in the same department (Elizondo-Omaña et al., 2003),
and various commercial interactive
Registered students in the Anatomy
and Neuroanatomy courses were divided into two groups. One group was
taught with the traditional method,
and the other group was taught with
the modified traditional method. The
students’ average grades were obtained and then compared by means
of a z-test at the end of the course for
each subject.
For the sample (n1 ⫽ 365) of the Anatomy groups using the traditional
method, an average final grade of 58
(SD ⫽ 14.94) (Table 2) was obtained,
with 24.93% (n ⫽ 91) passing. The
average grade for students who
passed the course was 77.96 (SD ⫽
6.53). For the sample (n2 ⫽ 283) of the
Anatomy groups that used the traditional method supported by CAL, an
average final grade of 68 (SD ⫽ 14.56)
(Table 2) was obtained, with 53.71%
(n ⫽ 152) passing. The average grade
for students who passed the course
was 79.20 (SD ⫽ 6.40).
For the sample (n3 ⫽ 217) of the
Neuroanatomy groups using the traditional method, an average final
grade of 61 (SD ⫽ 14.51) (Table 3) was
obtained, with 34.10% (n ⫽ 74) passing. The average grade for students
who passed the course was 78.19
(SD ⫽ 5.65). For the sample (n4 ⫽
134) of the Neuroanatomy groups using the traditional method supported
by CAL, an average final grade of
(SD ⫽ 13.52) (Table 3) was obtained,
with 58.2 % (n ⫽ 78) passing. The
average grade of students who passed
the course was 77.98 (SD ⫽ 6.61). A
z-test was conducted to determine the
difference between the average of the
two groups (␣ ⫽ 0.05), which revealed
that the averages of the groups were
different (P ⬍ .001).
Changing the macroscopic anatomy
curriculum is a challenging task, and
it is necessary to evaluate educational
methods to determine which are the
most effective and efficient. In our
study we observed a significant difference between the methods used in
terms of average student grades. In
agreement with our observation, Trelease (2002) concluded that the study
of anatomy benefits from the incorporation of new methodologies based on
computer and information sciences.
However, since we did not compare
the traditional and CAL-only methods
in an isolated fashion, the current results must be interpreted with caution, as we believe that it is the combination of both techniques that
produced the improvement.
Previous studies also obtained good
results with the use of CAL in anatomy courses. For example, Carmichael and Pawlina (2000) noted
that interactive resources, such as animated Power Point presentations, are
excellent tools for teaching anatomy.
(2002) concluded that brainstorming
in anatomy courses can be a very efficient means of stimulating learning.
According to Galván et al. (1999), the
use of educational videos increases retention and long-term learning.
On the other hand, in a study in
which each learning method was isolated, Bukowski (2002) found no statistically significant difference between groups of students who
attended a theory class with cadaver
dissection (completed traditional cadaver human gross anatomy course)
and those who took a computerized
self-directed course with no cadaver.
Therefore, Bukowski (2002) suggested
that technological resources do not
provide a clear advantage. This is in
contrast to the current study, in which
CAL was used in combination with
the traditional method. Previous studies by Plack (2000) and Peck and Benton (1970) indicated that CAL alone
can be just as effective as the traditional method.
The results we obtained show, at
least for our department, that a clear
Figure 3. A multimedia program created by the professors in the department.
TABLE 2. Grades in anatomy: average, SD, and population size studied
using both teaching methods
Traditional Method
Modified Traditional
TABLE 3. Grades in anatomy: average, SD, and population size studied
using both teaching methods
Traditional Method
Modified Traditional
advantage can be obtained with the
modified traditional method. The
change in the grade average observed
with the use of the modified traditional method was directly influenced
by the points awarded based on student attendance in the virtual classroom, but this increase was not sufficient to explain the difference
observed in the group average. The
results of our study suggest that an
increase in the time dedicated to
studying the subject, and the study
method employed positively affected
the achievement of students using
CAL. The high rate of failure may be
due to the absence of both; the combination (traditional method plus
CAL) of both systems produced the
difference in our study.
We do not know the exact cause of
the high rate of failure by our students
in Anatomy, but we believe that two
factors may be the way the course is
taught and the high difficulty of the
exams (which have a morphological
focus). Among other problems, we
found that our students had not taken
premedical courses, and we noted
some demographical characteristics
of the population (e.g., median age ⫽
17 years) that may also be involved
(Caplan et al., 1996; Forester et al.,
2002). In addition, we believe that the
number of hours a student spends
studying a subject have a direct influence on achievement. We do not believe that a lack of trained teaching
personnel is a factor, because the traditional class was taught by full-time
professors, who were each assisted by
two scholarship students.
According to other authors, multimedia resources are more widely accepted than the above-mentioned resources (such as bone collections and
amphitheaters). The advantages of
CAL include a more attractive presentation for students, the possibility of
“surfing” the program according to
one’s needs, and interaction with the
user. Given these advantages, we
chose CAL as a resource to aid students in increasing their achievement
scores in our department.
The students who used multimedia
resources received the same information as those who did not use them.
The difference in the results reflects
the manner in which the information
was presented, and, in our opinion,
the CAL presentation was more attractive. The difference in achievement between groups is probably due
to the fact that students who used
multimedia resources were exposed to
the study material for at least 20 additional hours during the semester.
We must mention that in our research, variables that could have in
some manner affected the results
(such as age, sex, and socioeconomic
condition) were not taken into consideration. It is known that certain student educational and psychological
factors (such as emotional, intellectual, and personality aspects) can affect study results, as well as the educational level reached by the students.
Therefore, further research must be
conducted in which these demographic and psychological variables
are taken into account to obtain more
exact results.
Finally, we believe that if students
would invest more time in areas such
as the bone collection and amphitheater, they would probably achieve
more, as was the case with the use of
CAL. However, we cannot affirm that
greater exposure to traditional materials (e.g., bone collections and anatomical models) would result in equal
numbers of students passing the subject. For that reason, we recommend
that a study be carried out comparing
traditional learning enhanced by CAL
vs. traditional learning enhanced by
traditional resources (bone collections and anatomical models), using
the same number of additional hours
for both groups.
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