Assessment of Anatomy Education Teaching Modalities before and during COVID-19 in US Medical Schools

Medical schools in the United States, as well as across the world, have undergone curriculum reform in the delivery of anatomy courses, which recently required social distancing during the COVID-19 pandemic. The aim of this study was to compare total teaching time across three major types of anatomy curricular formats in preclerkship and clerkship phases of US medical education, and quantitatively describe which tools/teaching modalities are used within different curricula structures across preclinical and clinical anatomy courses as well as evaluate the relative percent of the curricular time their use comprised prior to and during the pandemic. An optional survey instrument (with skip patterns), developed using Qualtrics Software and approved by the author's home Institutional Review Board, was sent to anatomy course directors at 152 allopathic medical schools, from all four geographic and size categories delineated by the Association of American Medical Colleges. Data were analyzed using Qualtrics XM Stats iQ software. Thirty allopathic US medical institutions were represented in this survey, among which there existed an even distribution across the three integration formats with the majority of instruction occurring in the first-year curriculum. Total anatomy teaching time varied widely, but cadaveric dissection and lectures were the predominant teaching modalities, even during the pandemic. Traditional dissection comprised the majority of contact time compared to alternative modalities, but less than half of respondents currently incorporate new modalities. Approximately half of the schools changed to an all-virtual format for 2020-2021. Among those that were fully virtual, time using 3D anatomy significantly increased. Our results demonstrate that traditional anatomic educational practices remain the mainstay of medical education. Surprisingly, total contact hours in anatomic education varied widely, but there were striking similarities in the use of traditional tools. © 2023 Gaia Cicerchia et al.

Optimizing Use of COVID-19 Personal Protective Equipment among Resident Physicians at a Veterans Affairs Hospital

Background. Correct personal protective equipment (PPE) use is key to prevent infection. Observations on a single unit at the Veterans Affairs (VA) Tennessee Valley Healthcare System (TVHS) prior to COVID-19 (October 2019-February 2020) showed low rates of correct PPE use among healthcare workers (HCWs) (Figure 1). In response to the COVID-19 epidemic, the VA implemented new PPE protocols. Based on our initial observations, we were concerned that incorrect use of PPE may increase the risk of COVID-19 exposure among HCWs. Resident physicians, who work at many sites, may be at high-risk for incorrect PPE use due to rapid turnover and limited site-specific PPE training. We aimed to assess and improve COVID-19 PPE use among internal medicine residents rotating at the VA TVHS. Figure 1: Pre-COVID-19 Observations of Adherence to Contact Precaution Protocols at the Veterans Affairs Tennessee Valley Healthcare System Methods. We used the plan, do, study, act (PDSA) model. Prior to starting VA rotations, residents were emailed PPE education to review. We implemented a 1-hour video conference PPE protocol review at rotation start followed by in-person PPE use evaluations for residents performed by infectious diseases fellows on day 2 and day 5-6 post-review to provide just-in-time educational intervention. Errors at each PPE don/ doff step were tracked. Correct PPE use data from both observations were compared using McNemar's test. Baseline and post-implementation resident surveys assessed PPE use knowledge and comfort. Results. Pre-implementation survey response rate was 72% (21/29);19/21(91%) reported knowing which PPE to use and 16/21(76%) reported knowing how to safely don/doff PPE. Twenty of 29 (69%) residents completed both observations. Errors decreased by 55% (p=0.0045) from 17/20 (85%) to 6/20 (30%) between initial and follow up observations. Errors in hand hygiene, inclusion of all donning/doffing steps, and PPE reuse decreased, but PPE don/doff order errors increased (Figure 2). Postproject survey response rate was 16/29 (55%). All 16 reported knowing which PPE to use and how to safely don/doff PPE, and 11/16 (69%) residents felt both online and in-person interventions were helpful. Figure 2: COVID-19 PPE Errors and Correction Types by Observation Conclusion. Correct COVID-19 PPE use is essential to protect HCWs and patients. Just-in-time education intervention for PPE training may yield higher correct use compared to pre-recorded or online training.