Integration of Scientific Competence into Gross Anatomy Teaching Using Poster Presentations: Feasibility and Perception among Medical Students.

Scientific competences as defined in the German competency framework describes the ability to think independently and act scientifically, and forms a central component of medical education. This report describes its integration into anatomical teaching. On the basis of the findings in dissection courses from two consecutive years, students worked on either a case report (n = 70) or an original work (n=6) in the format of a scientific poster while learning to use primary literature. Posters were evaluated by juror teams using standardized evaluation criteria. Student perception of the project was estimated by quantitative and qualitative data obtained from the faculty´s course evaluation and an online-survey. Overall, students worked collaboratively and invested extra-time (median [MD] 3.0 hours) in poster creation. Primary literature was integrated in 90.8% of the posters. Overall poster quality was satisfactory (46.3 ±8.5 [mean ±standard deviation] out of 72 points), but several insufficiencies were identified. Students integrated information gained from the donor´s death certificate, post-mortem full-body computer tomography (CT) scan (22.4%) and histopathological workup (31.6%) in their case reports. Students were positive about the experience of learning new scientific skills (MD 4 on a six-point Likert scale), but free text answers revealed that some students experienced the project as an extra burden in a demanding course. In summary, it was feasible to introduce students to science during the dissection course and to increase interest in science in approximately a third of the survey respondents. Further adjustments to ensure the posters´ scientific quality might be necessary in the future.

Recommendations of the working group of the Anatomische Gesellschaft on reduction of formaldehyde exposure in anatomical curricula and institutes.

The practice of human and veterinary medicine is based on the science of anatomy and dissection courses are still irreplaceable in the teaching of anatomy. Embalming is required to preserve body donors, for which process formaldehyde (FA) is the most frequently used and well characterized biocidal substance. Since January 2016, a new occupational exposure limit (OEL) for FA of 0.37mg/m3 issued by the European Committee on Hazardous Substances is obligatory since FA has been classified as a human 1B carcinogen. The anatomical institutes in the German-speaking region are called upon to consolidate efforts to reduce use of FA in anatomical curricula and body donations. As a result, the Anatomische Gesellschaft (AG) has formed a "Working Group for Reduction of Formaldehyde Exposure in Dissection Courses" tasked with discussion and recommendation of measures to reduce FA. Based on the assessment of the Working Group, the AG has issued an official opinion to the effect that, at this point in time, embalming of body donors without FA completely is not feasible. Therefore, a combination of approaches are to be used to reduce FA exposure, including technical and structural (architectural) adaptations, modification of protocols for fixation and preservation as well as organizational measures. One structural measure considered unavoidable is the integration of air supply and exhaust of individual dissecting tables into the ventilation system of the anatomy building. To embalm human body donors, intra-arterial perfusion fixation with up to 4% FA and a total fluid volume of 150mL/kg body weight will suffice. For animals where body weights and biology of bodies vary widely (i.e. special needs of fixation for ruminants, large animals as horses) perfusion fixation with up to 4% FA and a quantity of fixative solution of 10-15% of the body weight may be required. Preservation of body donors in storage (immersion) can be done with 40% ethanol or in a full bath preservation containing up to 2% FA. Corpse humidification in the dissecting room is possible with 2% phenoxyethanol, in each case without FA. In veterinary anatomy, microbiological burden is often higher and therefore might lead to a need of FA in long-time storage. Compliance with the current OEL in all institutes would appear to be feasible in combination with various organizational measures.

Reduction of mental distress in the dissection course by introducing the body donor experience through anatomical demonstrations of organ systems.

The practice of dissection teaches students not only the foundations of anatomical knowledge but also encourages the development of professional competencies. Yet, the dissection of cadavers in the gross anatomy course can be a stress factor for medical students. There are a minor proportion of students who demonstrate strong emotional reactions in anticipation of being confronted with a cadaver. Therefore, in 2008, the authors implemented a voluntary course entitled, "Anatomical demonstrations of organ systems" (AD-OS) in advance of the dissection course to ease this psychological burden. The question of whether attendees of AD-OS showed less mental distress at the start of the dissection course compared with those that had not or only infrequently visited AD-OS was addressed. AD-OS attendees assessed their expected mental distress using a five-point Likert scale before starting the dissection course and a second time at the end of their first day, after they had been confronted with a cadaver. AD-OS was evaluated as excellent and the majority of students participated actively during teaching sessions. Overall, female students showed higher levels of mental distress. AD-OS attendees assessed themselves as being less burdened by mental distress than members of the control group. Longitudinal analysis revealed that students who visited AD-OS showed a marked decrease of their mental distress level, comparing prospective and retrospective ratings. This was significantly (P < 0.001; Z = -6.061) different from nonattendees or those who visited AD-OS only infrequently. AD-OS satisfied its intended teaching goals and proved that a step-by-step introduction of dissection through anatomical demonstrations helped to reduce the mental distress of students. Future studies are planned to measure mental distress with objective instruments.

Ready for the OR? - Clinical anatomy and basic surgical skills for students in their preclinical education.

Medical students' first experience in the operating theatre often takes place during their electives and is therefore separated from the university's medical curriculum. In the winter term 2009/10, the Institute of Anatomy and Cell Biology at the University of Ulm implemented an elective called "Ready for the OR" for 2nd year medical students participating in the dissection course. We attempted to improve learning motivation and examination results by transferring anatomical knowledge into a surgical setting and teaching basic surgical skills in preparation of the students' first participation in the OR. Out of 69 online applicants, 50 students were randomly assigned to the Intervention Group (FOP) or the Control Group. In 5 teaching session students learned skills like scrubbing, stitching or the identification of frequently used surgical instruments. Furthermore, students visited five surgical interventions which were demonstrated by surgical colleagues on donated bodies that have been embalmed using the Thiel technique. The teaching sessions took place in the institute's newly built "Theatrum Anatomicum" for an ideal simulation of a surgical setting. The learning outcomes were verified by OSPE. In a pilot study, an intervention group and a control group were compared concerning their examination results in the dissection course and their learning motivation through standardized SELLMO-test for students. Participants gained OSPE results between 60.5 and 92% of the maximum score. "Ready for the OR" was successfully implemented and judged an excellent add-on to anatomy teaching by the participants. However, we could not prove a significant difference in learning motivation or examination results. Future studies should focus on the learning orientation, the course's long-term learning effects and the participants' behavior in a real surgery setting.

"Theatrum anatomicum" -- a revived teaching facility in gross anatomy.

Because of a new legislation concerning fees for study in Germany, novel financial opportunities for improvement of medical education have been provided. Some of these additional funds were invested at Ulm University in the Institute of Anatomy and Cell Biology to realize a teaching operating theatre similar to the ancient anatomical theatre in an amazingly short period of time. The anatomical theatre is a unique teaching facility in Germany, a direct implementation of joint preclinical and clinical education in the medical curriculum as required by the new Federal Medical Licensing Regulations (Approbationsordnung). It was set up in January of 2008. In this teaching operating theatre students and doctors will meet to study anatomical structures. In a simulated operating setting, surgeons will demonstrate invasive procedures and operative techniques on donated bodies. About 50 students can be positioned on a grandstand at a short distance to the operating table to follow the "operation" or anatomical demonstrations. Students can also learn how to behave in a sterile environment before they are actually confronted with this new situation during their first clinical clerkship. The anatomical theatre is supposed to be integrated in preclinical and clinical medical education as well as in advanced professional education for suitable sub-specialties. We are confident that the anatomical theatre will further improve students' motivation and their efforts in gaining knowledge in the field of gross anatomy because of its clinical relevance.