Analysis of testing with multiple choice versus open-ended questions: Outcome-based observations in an anatomy course.

The pedagogical approach for both didactic and laboratory teaching of anatomy has changed in the last 25 years and continues to evolve; however, assessment of student anatomical knowledge has not changed despite the awareness of Bloom's taxonomy. For economic reasons most schools rely on multiple choice questions (MCQ) that test knowledge mastered while competences such as critical thinking and skill development are not typically assessed. In contrast, open-ended question (OEQ) examinations demand knowledge construction and a higher order of thinking, but more time is required from the faculty to score the constructed responses. This study compares performances on MCQ and OEQ examinations administered to a small group of incoming first year medical students in a preparatory (enrichment) anatomy course that covered the thorax and abdomen. In the thorax module, the OEQ examination score was lower than the MCQ examination score; however, in the abdomen module, the OEQ examination score improved compared to the thorax OEQ score. Many students attributed their improved performance to a change from simple memorization (superficial learning) for cued responses to conceptual understanding (deeper learning) for constructed responses. The results support the view that assessment with OEQs, which requires in depth knowledge, would result in student better performance in the examination. Anat Sci Educ 11: 254-261. © 2017 American Association of Anatomists.

Team-based learning in anatomy: an efficient, effective, and economical strategy.

Team-based learning (TBL) strategy is being adopted in medical education to implement interactive small group learning. We have modified classical TBL to fit our curricular needs and approach. Anatomy lectures were replaced with TBL that required preparation of assigned content specific discussion topics (in the text referred as "discussion topics"), an individual self-assessment quiz (IRAT), analysis of the discussion topics, and then the team retaking the same quiz (GRAT) for discussion and deeper learning. Embryology and clinical correlations were given as lectures. Unit examinations consisted of graded IRAT and GRAT. The National Board of Medical Examiners (NBME) Subject Examination was the comprehensive final examination. To evaluate the effect of TBL on student performance we compared the departmental and NBME subject examination scores between the traditional and TBL curricula. We collected five years of data on student performance in TBL-based anatomy and lecture-based preclinical courses. Our results show that departmental and NBME subject examination scores for TBL-based anatomy were higher than those for lecture-based anatomy. We subsequently compared average NBME scores for anatomy with those in other preclinical courses that were lecture-based. Average NBME anatomy scores were significantly higher than those for all the lecture-based preclinical courses. Since the introduction of TBL in anatomy, student performance has progressively improved in the NBME subject examination. Students perceived TBL as a motivator to be a responsible team member and to contribute to collective learning by the team. Further, it reinforced self-directed learning and fostered an appreciation for peer respect. Interestingly, these perceptions were uniform irrespective of student course performance.

A survey of student perceptions of team-based learning in anatomy curriculum: favorable views unrelated to grades.

Team-based learning (TBL) combines independent out of class preparation with in class small group discussion. We adopted TBL in teaching first year medical gross anatomy. In this study, we evaluated student perceptions of TBL by using a survey that elicited perceptions of both pedagogy and mode of learning. Anatomy lectures were replaced with required preclass readings, self-assessment quizzes, small group discussions of assignments, and groups retaking the same quizzes for deeper learning. At the course conclusion, students were surveyed to assess their preference for TBL, their perceptions of TBL effectiveness, and their perceptions of successful interpersonal relationships within groups. Respondents (n = 317; 89% response) were asked to rate the extent that they agreed (-2 = strongly disagree; -1 = disagree; 0 = neutral; 1 = agree; and 2 = strongly agree). A principal components factor analysis with varimax rotation identified two 8-item factors: "perceptions of TBL" and "perceptions of teamwork." Internal consistency for each was high [Cronbach's alpha = 0.908 (preference for TBL); 0.884 (preference of teamwork)]. Results of one-way analysis of variance between Honors/High Pass/Pass/Fail students indicated that Honors (n = 73) tended to rate perceptions of TBL higher than Pass (n = 54) [mean difference = 2.92; 95% CI (0.05, 5.79)], and also higher than Fail (n = 11) [mean difference = 6.30; 95% CI (1.13, 11.47)]. However, each had overall positive ratings. No difference was noted between mean ratings of teamwork, which were also, overall, positive. We conclude that medical students view TBL favorably irrespective of their grades.

Modified use of team-based learning for effective delivery of medical gross anatomy and embryology.

Team-based learning (TBL) is an instructional strategy that combines independent out-of-class preparation for in-class discussion in small groups. This approach has been successfully adopted by a number of medical educators. This strategy allowed us to eliminate anatomy lectures and incorporate small-group active learning. Although our strategy is a modified use of classical TBL, in the text, we use the standard terminology of TBL for simplicity. We have modified classical TBL to fit our curricular needs and approach. Anatomy lectures were replaced with TBL activities that required pre-class reading of assigned materials, an individual self-assessment quiz, discussion of learning issues derived from the reading assignments, and then the group retaking the same quiz for discussion and deeper learning. Students' performances and their educational experiences in the TBL format were compared with the traditional lecture approach. We offer several in-house unit exams and a final comprehensive subject exam provided by the National Board of Medical Examiners. The students performed better in all exams following the TBL approach compared to traditional lecture-based teaching. Students acknowledged that TBL encouraged them to study regularly, allowed them to actively teach and learn from peers, and this served to improve their own exam performances. We found that a TBL approach in teaching anatomy allowed us to create an active learning environment that helped to improve students' performances. Based on our experience, other preclinical courses are now piloting TBL.

Increased clinical correlation in anatomy teaching enhances students' performance in the course and National Board subject examination.

The purpose of this study is to determine the effectiveness of increased clinical correlation teaching in a first year anatomy program and subsequent student performance on departmental and nationally standardized examinations. Basic science curricula in medical schools are increasingly being taught with clinical correlation in order to provide a >seamless transition' from preclinical-to-clinical years. The National Board examination for basic science is also increasingly clinically oriented and designed to test students problem solving and applied skills. Five-year period data of students course grades and standardized subject examination scores are compared statistically in this study. The results indicate that incorporation of clinical correlation teaching and more problem-focused assessment of student learning resulted in better performance on the standardized National Board anatomy examination. We suggest that such an approach can be easily adopted in other preclinical courses.

Nonuniformity within Embryonic Somites: Differental Response to Retinoic Acid in Vitro: (retinoic acid / selerotome/ dermamyotome/ chondrogenesis proteoglycan).

Recent studies have shown that in the developing chick embryo, at physiological level retinoic acid (RA) causes mirror-image duplication of limb skeletal elements. This has led to the suggestion that RA could be the endogenous morphogen or isgnal substance. In this study, in order to explore the effect of RA on somite chondrogenesis, we have standardized a serum-free chemically defined medium that supports the growth of somite explants in vitro. The results indicate that in somites RA at 10 ng/ml level induces cell proliferation, DNA and sulfated proteoglycan synthesis, and at higher concentrations is toxic. The results further show that RA induced stimulation of somite chondrogenesis is sclerotomal specific and the dermamyotemal portion of the somites does not exihibit a similar response. Retinoic acid also increases heparan sulfate synthesis and aggregation of isolated sclerotomal cells in culture. These results thus suggest that in amplifying chondrogenesis, RA acts at all phases such as cell proliferation (may increase cell viability) and aggregation, increased DNA synthesis and increased synthesis of matrix components. In otherwords, RA seems to initiate a chain of inter-related events.

Cardiac syncope secondary to glossopharyngeal neuralgia--effectively treated with carbamazepine.

A 64-year-old male with glossopharyngeal neuralgia, cardiac asystole and grand mal seizures has been relieved of his attacks by intake of 400 mg of Carbamazepine per day over a 4-year period. Simultaneous EEG-EKG recordings before and after drinking water document the diagnosis.

A case of limbic system dysfunction with hypersexualith and fugue state.

This paper describes a case of limbic dysfunction in a 28-year-old female veteran who presented with psychoses and sexual promiscuity. She had EEG abnormalities and showed dramaic improvement with anti-convulsant medication. Limbic system dysfunction in general may present as "functional psychoses." The literature is briefly reviewed.

Vanillyl mandelic acid excretion in unilateral electroconvulsive therapy (ECT).

The twenty-four hour urinary excretion of vanillyl mandelic acid was determined in a group of eleven psychiatric patients prior to and during the day of the fifth unilateral electroconvulsive treatment. The patients were all determined by their treating psychiatrists and by psychological testing to be psychotically depressed. In ten of the eleven patients a marked decrease in excreted vanillyl mandelic acid was apparent from the pretreatment level to the fifth treatment level. In one of the eleven patients there was a slight rise from the pretreatment level to the excreted level during the fifth day of treatment. The mean pretreatment determination of vanillyl mandelic acid was 4.2 mg per twenty-four hours; the mean determination made on the fifth treatment was 2.8 mg per twenty-four hours.

Treatment of phenothiazine induced bulbar persistent dyskinesia with deanol acetamidobenzoate.

The late manifestation of neuroleptic-induced dyskinesia (persistent dyskinesia) is an irreversible complication of long-term treatment that is poorly understood and difficult to treat. Recently, a theory of dopamine receptor hypersensitivity in the dopaminergic-cholinergic system has suggested an explanation of choreiform movements and, thus, an implication for the management of persistent dyskinesia. The case presented is that of bulbar persistent dyskinesia in a patient who had been prescribed a phenothiazine derivative for eleven years; his symptoms improved with the use of deanol, which probably converts to acetylcholine after crossing the blood brain barrier. This improvement suggests that deanol may shift the neuroleptic-induced dopaminergic-cholinergic system unbalance toward equilibrium by matching predominant dopaminergic effect or by enhancing deficient cholinergic action in the dopaminergic-cholinergic system. This isolated finding needs to be confirmed by more research in neuropharmacology.