Scott Border

Perceptions of junior doctors and undergraduate medical students as anatomy teachers: Investigating distance along the near-peer teaching spectrum

Near‐peer teaching involves more experienced students acting as tutors and has been widely used in anatomy education. This approach has many advantages for the learner due to the social and cognitive congruence they share with the teacher, however, the influence of distance between the teacher and learner on these congruences has yet to be explored. The aim of this study was to compare the attitudes and perceptions of the student learner towards neuroanatomy review sessions taught by either a senior medical student or a junior doctor. The students were randomly assigned to an allocated tutor. All tutors used standardized material and had access to identical resources. The type of allocated tutor was swapped between the two teaching sessions and 99 student feedback forms were collected in total. The rating for the overall quality of the teaching session was not significantly different between the junior doctors and senior medical students (P = 0.11). However, criteria closely relating to social and cognitive congruence such as “enjoyment of the session,” “delivery of the teaching,” and “was it a good use of time” were all rated significantly higher for the senior medical students (P < 0.05). The results of this study suggest that small increases in distance along the near‐peer teaching spectrum have an impact upon the students perception of their learning experience. While all teachers were suitable role models it appears that junior doctors are too far removed from their own undergraduate experiences to share congruences with pre‐clinical medical students. Anat Sci Educ 7: 242–247.

Near-peer teaching in clinical neuroanatomy

Background:  Near‐peer teaching involves students being taught by more senior students and draws on their similar knowledge base and shared experiences. It has been used previously for teaching gross anatomy, but has not yet been reported specifically for neuroanatomy. At the University of Southampton there is no formal neuroanatomy teaching during the clinical years, and so a near‐peer teaching programme was developed to support students, learning in between attending their clinical attachments.

Near peer teaching in medical curricula: integrating student teachers in pathology tutorials.

Introduction Due to increased cognitive and social congruence with their tutees, near peer teachers (NPTs) may be capable of more effectively delivering course material. This study examines NPTs as pathology tutors alongside more traditional teachers (e.g., consultants and registrars) to explore their acceptability, effectiveness, and years of ‘distance’ between tutors and tutees. Method In total, 240 first- and second-year undergraduate medical students were taught set material in a pathology tutorial setting by NPTs (fourth-year medical students), registrars, or consultants. Learners were then asked to provide feedback using a 15-item, Likert-type scale. Results On 11 of the 15 items, there were no significant differences in students’ median ratings. However, NPTs were perceived to be significantly more approachable than consultants, more aware of learning outcomes, more receptive to student input, and more invested in exam success. Compared with second-year students, first-year students showed a preference towards registrar tutors in terms of perceived gain of knowledge and use of time. In contrast, second-year students showed a preference towards NPTs, who provided more perceived knowledge gain and investment in exam success. No significant differences were found regarding consultant tutors. Discussion Perhaps due to increased congruence with tutees, NPTs show promise as tutors within medical curricula. This provides advantages not only to tutees, but also to tutors – who may gain vital teaching experience and offer an effective supplement to ‘traditional’ faculty educators.

Can medical students accurately predict their learning? A study comparing perceived and actual performance in neuroanatomy.

It is important that clinicians are able to adequately assess their level of knowledge and competence in order to be safe practitioners of medicine. The medical literature contains numerous examples of poor self‐assessment accuracy amongst medical students over a range of subjects however this ability in neuroanatomy has yet to be observed. Second year medical students attending neuroanatomy revision sessions at the University of Southampton and the competitors of the National Undergraduate Neuroanatomy Competition were asked to rate their level of knowledge in neuroanatomy. The responses from the former group were compared to performance on a ten item multiple choice question examination and the latter group were compared to their performance within the competition. In both cohorts, self‐assessments of perceived level of knowledge correlated weakly to their performance in their respective objective knowledge assessments (r = 0.30 and r = 0.44). Within the NUNC, this correlation improved when students were instead asked to rate their performance on a specific examination within the competition (spotter, rS = 0.68; MCQ, rS = 0.58). Despite its inherent difficulty, medical student self‐assessment accuracy in neuroanatomy is comparable to other subjects within the medical curriculum. Anat Sci Educ 9: 488–495.

Working with Students as Partners in Anatomy Education

Anatomy is a subject that has a long standing relationship with using students or trainees as teachers (Ocel et al., 2003; Gill et al., 2006; Bulte et al., 2007; Sugand et al., 2010). The application of near-peer teaching (NPT) is prevalent in our discipline and much research has been undertaken in the field to inform the anatomical community about the value of implementing it within curriculums; both in terms of objective outcome measures of performance and with regards to the student learning experience (Ten Cate and Durning, 2007; Lockspeiser et al., 2008; Jackson and Evans, 2012; Hall et al., 2013, 2014). Arguably, the student teachers who gain the most from the experience feel trusted, empowered and valued by faculty anatomists (Stephens et al., 2016). The benefits of working with students in this way are also well recognized, particularly if the NPT programs are sustainable and provide opportunities for scholarship and the development of professional and transferable skills (Evans and Cuffe, 2009). In fact, many of the attributes fit nicely with the Higher Education Academy’s (HEA) criteria for good practice when engaging with students as partners on educational projects (Healey et al., 2014). The document, entitled engagement through partnership: students as partners in learning and teaching in higher education is a toolkit which makes an excellent case for why we should work with students as partners in education in some key areas, such as learning, teaching and assessment, subject based inquiry, scholarship of teaching and learning, and curriculum design and pedagogic consultancy. Due to the nature of their delivery, medical curriculums are particularly conducive to providing these opportunities when compared to other undergraduate programs. So, what exactly is the issue here (?), well, the crux of the problem is that staff and students do not really share the same definition of what constitutes a partnership. Although they are mostly underpinned by similar values there appears to be some differences. Staff tends to focus more on the joint working aspect or the agreed shared goals which exist, while students understand it to be more about an equal relationship and shared responsibility (Healey et al., 2014). The key point of interest here comes with exploring and unpacking the differences between the rather generic term “student engagement” and what constitutes a true and meaningful partnership. It is possible to take a partnership approach, such as when listening to and asking the opinion of students, but this does not constitute true partnership. With specific reference to the way we as anatomists work with trainees and students I would argue that we achieve the best results for all parties when partnership does imply an equal relationship and where decisions are taken jointly. To use the established NPT program in neuroanatomy at the University of Southampton as an example, the longevity of the project is a product of an authentic relationship which is irrespective of institutional hierarchy; it is built on trust whereby all members get to know each other and are confident to share ideas. The scholarship embedded within the delivery of our NPT fosters critical and analytical thinking resulting in academic rewards such as authorship on publications (twice in ASE) (Hall et al., 2014, 2016). As the HEA document (Healey et al., 2014) clearly states, partnership is an ethos rather than an activity and the total sum of engagement within any given faculty does not equal partnership. However, my concern is that most universities are risk averse to this kind of working relationship because of the potential tensions and challenges that exist; the traditional barriers between staff and students needs to be rethought if institutions are likely to embrace the full meaning of partnerships as outlined by Healey et al. (2014). While it is not unreasonable for academics to be concerned over conflicting priorities, it should be understood that the partnership model does challenge existing assumptions about how staff and students should work together and this will involve thinking and acting differently to what we are used to. This might mean sharing working space with students or giving them privileged access to resources and facilities (such as the dissecting room)—essentially adopting a more collaborative and informal approach to working. However, anatomy is a traditional subject steeped in a rich history associated with the birth of universities. Anatomy as a discipline could be considered partly responsible for the established chain of command in academia (professor, reader, dissector) that remains today in its various guises (Moxham and Plaisant, 2014). The original dissecting rooms and anatomy theatres such as those at Padua and Bologna were designed with this strict hierarchy in mind. We should not forget that the most famous anatomist of all time, Andreas Vesalius disliked hierarchy intensively and insisted on undertaking dissection himself even when he was elevated to the position of professor of surgery and anatomy at the University of Padua (Moxham and Plaisant, 2014). He expected students to contribute to medical knowledge as well as receive it making his legacy as much about changing the *Correspondence to: Dr. Scott Border, Centre for Learning Anatomical Sciences, Southampton General Hospital, Faculty of Medicine, University of Southampton, Southampton SO16 6YD, United Kingdom. E-mail: s.border@soton.ac.uk

Interprofessional anatomy education in the United Kingdom and Ireland: Perspectives from students and teachers

There is increasing recognition of multiprofessional learning in anatomy and its role in medical and healthcare professions. This study utilized two components to investigate anatomy interprofessional education (AIPE) in the United Kingdom and Ireland. First, a survey involving qualitative and quantitative components asked Heads of Anatomy to report on their institutions’ uptake of AIPE. Second, a series of case studies explored the experiences of students by using evaluation forms and an in‐depth analysis of thematic concepts to understand the learners’ perspectives on designing and delivering AIPE. Out of the 13 institutions that took part in the survey, eight did not offer an AIPE program. Between the remaining five institutions that deliver AIPE programs, 10 different modules are offered with the majority involving healthcare professions. The AIPE component is rated highly by students. The themes from the case studies highlight how valuable AIPE is from the student perspective both in terms of engaging them in anatomy as well as in the broader skills of teamwork and communication. The case studies also revealed how AIPE can be engaging for groups of students who might not have previously had access to cadaveric anatomy, for example, engineers and archeologists. The results of this study have implications for curriculum design in medicine and healthcare but also for further engagement of professional groups from non‐healthcare backgrounds. Anat Sci Educ 8:360–370.

How important is personalised and timely feedback in formative assessment

Rationale Since the illustrations of Leonardo da Vinci in the 15-16th Century, artistic portrayals of human anatomy have been used in education. Modern students of anatomy take a variety of approaches to learning including visualisation [1] and while there is limited evidence to support the idea of students as visual learners [2], creating artwork can fulfil components of experiential learning [3] and it is known that visual artistic techniques can improve learning [4].

Blending the virtual and physical teaching environment: the potential role of the anatomy e-booklet

Osteoarthritis is a painful and debilitating disease of the joints that is characterized by progressive degeneration of the articular cartilage that lines the joint surfaces. The etiology of osteoarthritis is poorly understood, although it is now well accepted that biomechanical factors play an important role in the onset and progression of this disease. The primary goal of our studies has been to determine the mechanisms by which mechanical loading affects the physiology of our joints. Using a hierarchical approach to span different systems ranging from clinical studies and in vivo animal models to studies of tissue, cellular, and subcellular anatomy (form) and biomechanics (function), we have identified specific mechanical signaling pathways that are critically involved in cartilage physiology as well as pathology. These pathways may provide novel pharmacologic targets for the modification of inflammation or cartilage degeneration in osteoarthritis. Additionally, our studies have focused on tissue engineering approaches for repairing cartilage damage with osteoarthritis. Using novel textile processes that allow weaving of biomaterial fibers in three dimensions, we have created functionalized bioactive scaffolds that can recreate many of the complex biomechanical properties and anatomic features of articular cartilage. In combination with a multipotent population of adult stem cells, we have developed a tissue-engineering approach for complete resurfacing of osteoarthritic joint surfaces. Taken together, these studies emphasize the important roles of form and function in the health, disease, and regeneration of the joint.

An evaluation of near-peer teaching in neuroanatomy

Skeletal material is commonly used for teaching anatomy. However, these collections are rarely used for primary research, despite their potential for student projects or more detailed anatomical investigations. Although the undocumented nature of the specimens can arguably limit study, archeologists characteristically deal with unknown skeletal material. Many methods exist to estimate age, sex, and ethnicity that could enable research. Accordingly, 94 skeletal individuals from Southampton University’s Anatomy department were assessed to determine the usability of methods routinely used in archeology. Age was estimated from degenerative joint changes and dental wear. Sexually dimorphic regions of the skull and pelvis were examined. Ethnicity was identified through craniometrics and CRANID software. As skeletons were complete, aging and sexing methods were easily applied: 95% of individuals were sexed confidently. Although all individuals were aged, often only wide estimates were produced (e.g., 21–45 years). Ethnicity however was problematic and produced less usable results. Ancestry was not determined for 19 skulls. CRANID therefore requires extremely accurate cranial measurements by a practiced researcher. This study demonstrates that archeological methods benefit anatomical research but should be selected with limitations considered. Additionally, anatomical collections are valuable teaching and research resources to osteoarcheologists who are normally limited to fragmented remains.

The National Undergraduate Neuroanatomy Competition: Lessons Learned from Partnering with Students to Innovate Undergraduate Neuroanatomy Education

Undergraduates often perceive neuroscience to be a challenging discipline. As the scope of neuroscience continues to expand, it is important to provide undergraduates with sufficient opportunities to develop their knowledge and skills with the aim of encouraging the future generation of basic and clinical neuroscientists. Through our experience of developing the National Undergraduate Neuroanatomy Competition (NUNC), we have accrued an extensive volume of performance data and subjective insight into the delivery of undergraduate neuroanatomy education, which has the potential to inform how to better engage students within this field. More broadly, our group has implemented a technology enhanced learning platform alongside a peer-assisted teaching program. These achieve the dual purpose of compensating for the reduction in dedicated neuroanatomy teaching hours and encouraging undergraduates to develop an interest in the neurosciences. Here, we consider how improving the learning experience at an undergraduate level encourages further engagement in the neurosciences and the importance of this within the wider neuroscience community.