Introduction
It is essential for
clinicians and physicians to command an excellent understanding of functional
anatomy. Surgeons and orthopedists are required to have a cavernous
understanding of functional human anatomy and their respective anatomical
structures [1]. Cadavers and plastic models are generally used to teach in
gross anatomy courses [2]. At Istanbul Gelisim University, human anatomy is
taught in preclinical courses to students during the first two semesters as
part of their fundamental medical education [3,4]. Orthopedic examination
courses are assigned at a later time as part of the clinical aspect of the
curriculum. While both topics are closely related educationally, they are
taught independently of one other [5,6].
Interestingly, several
studies have shown that the preservation of anatomical knowledge from the
commencement of the medical education to the later clinical phases is meager
[1,7]. These observations correlate well with the fact that many advanced
students and recent graduates feel insufficiently prepared in anatomy for
practical clinical tasks [8]. Furthermore, the extended duration between gross
anatomy courses, clinical applications and examinations; the lack of applied
and functional instruction of anatomical knowledge from the beginning of the
medical education is likely to be a relevant factor [9]. As the modern
healthcare system shifts towards interdisciplinary and collaborative approach
care, medical education including courses in anatomy should take these
developments into consideration by modifying the current curricula [10].
Moreover, a collaborative approach is of outstanding significance for clinical
healthcare (Figure 1).
Figure 1: Schematic overview of the collaborative learning aspect course design.
Material and Methods
Sample
Every course was
designed for 30 students (15 nursing and 15 physiotherapy students) per day.
The course enrollment list was made available at the beginning of the anatomic
preparation course. As the demand for participation increased, additional
students were accepted. From 2016 to 2017, 230 individuals participated in the
course of which 115 were physiotherapy students.
Anatomical preparations
of hip and knee joints
Body plastic models were
used for preparations of hip and knee joint and the respective hip and knee
ligaments including menisci. Images were taken using a Nikon D5300 DSLR camera
(Mitsubishi Group) and figure panels were designed, processed and labeled using
Adobe Illustrator CCgraphic software (Adobe Inc) (Figure 2).
Methodological instrument
The evaluation was
conducted at the commencement and culmination of every course. Standardized
questionnaires were designed using items of the Heidelberger Inventory
(HILVE-I/II) [11]. Briefly, multidimensional questionnaires were designed and
used for the assessment of teaching quality and teaching by students and
teachers and further considered aspects such as motivation and potential
benefits for participants.
Figure 2: Anatomical hip joint preparations. Examples of hip joint preparation used throughout the course to demonstrate ligaments of the hip under functional aspects. Ventral (A), dorsal (B) and with ligament are depicted (C).
The number of correct
answers concerning the “hip and knee” in the anatomical exam of participants
(n=108) was compared with those of non-participants (n=207). The anatomical
exam contained two questions specifically on the anatomy of the “hip and knee”.
Data analysis programs used were Microsoft Excel (Microsoft Corporation) and
SPSS version 24 (IBM Corporation).
Statistics
Standard Error of the
Mean (SEM) is used for data presentation. All diagrams and statistical analyses
were generated and performed using GraphPad Prism7 software (GraphPad Software
Inc.).
Results
Design and schedule for
course
The basic educational
concept of the course was on the idea of bringing lecturers of different
medical disciplines together with students to learn from each other. At this
stage we would like to emphasize that at the initiation of this course, the
evaluation and fundraising was performed by medical students. To discourage
students from over loading their curriculum, participation in the course was
made as an elective. The course has been designed as following: an
interdisciplinary team consisting of a lecturer for anatomy, an orthopedic
surgeon and a physical therapist presented different aspects of the hip and
knee joint from their contrastive professional perspectives.
The varying perspectives
were intended to help students develop a better understanding of the relevant
questions concerning hip and knee joint examination and pathogenic mechanisms
of traumatic and degenerative processes. Additionally, the supervisors gave the
participants different methods of approach to the same anatomical Structure.
For each course, 30 participants (15 nursing students and 15 physical therapy
students) were accepted.
Data Analysis
The motivation of
students was assessed for their participation in the elective course by a
pre-course questionnaire in a multiple choice format. Participants were able to
choose multiple answers. As shown in Figures 3 and 4 physiotherapy
students and nursing students specified that the clinical aspect (74.2% ± 4.8%)
and the topic itself (71.9% ± 5.3%) were the most attractive reasons to
participate in the hip and knee joint course. More than fifty percent of all
course participants were attracted by the interdisciplinary aspects (56.6% ±
9.3%). Preparation for the later anatomical exams was interestingly the least
motivating aspect (41.2% ± 12.9%). Other points in common mentioned were the
physical contact with anatomical preparations or special interest in sport
injuries.
In the post-course
questionnaire, participants were asked to rate different statements concerning
the quality and usefulness of the hip and knee joint course (Figure
5). The most relevant results from these post-course evaluations were that
participants had a better understanding of the hip and knee joint anatomy and
that the general motivation in anatomy had increased after the course. Moreover,
palpation and clinical testing enhanced learning in joint anatomy.
According to the evaluations, the interdisciplinary approach subjectively supported the understanding of hip and knee joint anatomy. Conjointly, these evaluations underline that nursing students and physiotherapy students appreciated this interdisciplinary teaching approach for hip and knee joint anatomy. They were also motivated to participate by both the interdisciplinary and the functional and clinical aspects of the course.
Analysis of Anatomy Exam
Results
Though Participants
thought that the course increased their understanding of hip and knee joint
anatomy, we analyzed if students of nursing were better in responding hip and
knee joint related questions in the written multiple-choice anatomy exam. To
achieve this, we compared the results of hip and knee joint questions of participants
and non-participants. As shown in Figure 4 and 5, 74% of the participants
gave corrects answers to the hip and knee joint related questions, whereas only
65.6% of the nonparticipants managed to answer correctly. There was no
significant difference between the two groups. That said, these preliminary
results indicate that participants are better prepared for the anatomy exams.
In order to draw a better conclusion, additional anatomy exams have to be
evaluated to ascertain whether participants are better in correctly answering
hip and knee joint specific questions.
Discussion
The presented data in
this study show that the interdisciplinary approach to teach hip and knee joint
anatomy was well received by both nursing and physiotherapy students. We were
able to demonstrate that anatomy of the musculoskeletal system, which is in
generally less appreciated and mastered, at least in the case of nursing
students becomes much more interesting to learn when connected to questions of
clinical relevance. We believe that this teaching approach contributes to a
long lasting sensitization for orthopedic questions and a more profound
understanding of functional anatomy. Exam results also suggested better
performance in answering questions relating to the hip and knee joint of
students in the participatory group vs. the non-participatory group. It does
appear that the evaluation is biased by the fact that it is more likely to have
been the more motivated students who would participate in an elective course.
However the overall results of participants versus non-participants in the
written anatomy exams did not show any significant differences (data not
shown), which appears to indicate that this is not the case Figure 6.
Given that participation
is optional, written anatomical tests to evaluate the benefit of participants
due to the course did not seem to be appropriate for evaluation. The effects on
anatomical knowledge are difficult to measure as physiotherapist students do
not have a written exam at the end of their anatomy studies. In the written
anatomy exams of the participatory nursing students, initial evaluations of hip
and knee specific questions suggested they were superior in correctly answering
hip and knee joint specific questions. However, the numbers of questions were
too few and more groups have to be analyzed in order to draw more definitive
conclusions on the benefit of this teaching approach for later exams. The
interdisciplinary approach has been shown to be advantageous for an anatomical
teaching concept in different ways. Evaluation results especially from medical
students, demonstrate that palpation and clinical tests helped provide a better
“feeling” for anatomical structures that are often neglected.
Having students and
supervisors of two professions together underlines the importance of healthcare
topics. Specifically, second semester nursing students are not aware of the
extent to which other health care professionals will cooperate with them at
later clinical stages. The World Health Organization WHO (2010, World Health
Organization - Framework for Action on Inter disciplinary Education &
Collaborative Practice)(WHO/HRH/HPN/10.3), the German Council of Science and
Humanities as well as the Advisory Council on the Assessment of Developments in
the Health Care System (Sachver ständigenratzur Begutachtung) Gesundheitsversorgung
have stated that interdisciplinary education and research should be extended in
order to provide a more integral medical approach in taking advantage of the
synergistic effects in bringing together different health care professions
[12].
This interdisciplinary
course fulfills these requirements and is part of the Longitudinal Strand
Interprofessionality (LongStI), which comprises 13 different interdisciplinary
projects offered during medical studies. This consortium was created in 2013 by
the Nursing Faculty of Istanbul Gelisim University and aims to integrate
different interdisciplinary workshops into the medical curriculum. From funds
raised in the last three years it has been made possible to acquire additional
materials and produce long lasting anatomical preparations. During the next
years, courses covering the topics of "shoulder" and the "lumbar
vertebral column" will be designed and offered according to the teaching
approach presented in this study. With the current resources, continuity is secured
for the following years, as additional investments will not be necessary.
Conclusions
This study presented an interdisciplinary teaching concept for nursing students and physiotherapy students that complement the existing medical curriculum at Istanbul Gelisim University. Evaluation of these courses showed high acceptance and appreciation among participants of both professions. Participation appeared to demonstrate improved anatomy exam results. We propose that this interdisciplinary teaching approach is a contemporary and appropriate method of teaching functional and clinical anatomy, while strengthening interdisciplinary cooperation as an essential aspect of modern healthcare and further fulfilling the requirements for future adaptation of medical teaching and preclinical curricula as requested by the Wissenschaftsrat [13-15]. Upcoming courses will be developed and implemented in the medical curriculum along with improved evaluations, in order to determine the benefit of interdisciplinary teaching in anatomy for anatomy exams and in the future clinical applications.
Acknowledgements
The authors thank Istanbul Gelisim University faculty and students.
References
- Huitt TW, Killins A and
Brooks WS. Team-based learning in the gross anatomy laboratory improves
academic performance and students’ attitudes toward teamwork (2015) Anat Sci
Educ 8: 95-103. https://doi.org/10.1002/ase.1460
- Older J. Anatomy: A must
for teaching the next generation (2004). Surgeon 2: 79-90.
https://doi.org/10.1016/S1479-666X(04)80050-7
- Feigin DS, Magid D,
Smirniotopoulos JG and Carbognin SJ. Learning and retaining normal radiographic
chest anatomy: does preclinical exposure improve studentperformance? (2007)
Acad Radiol 14: 1137-1142. https://doi.org/10.1016/j.acra.2007.06.023
- Prince KJAH, Scherpbier
AJAA, Van Mameren H, Drukker J and Van Der Vleuten CPM. Do students have
sufficient knowledge of clinical anatomy? (2005) Med Educ 39: 326-332.
http://dx.doi.org/10.1111/j.1365-2929.2005.02096.x
- Bohl MA and Gest TR.
Resident perceptions of anatomy education: a survey of medical school alumni
from two different anatomy curricula and multiple medical specialties (2011) Anat
Sci Educ 4: 126-131. https://doi.org/10.1002/ase.207
- Gogalniceanu P, Palman J,
Madani H, Sheena Y, Birch W, et al. Traditional undergraduate anatomy education
a contemporary taboo? (2010) ANZ J Surg 80: 6-7.
https://doi.org/10.1111/j.1445-2197.2009.05167.x
- Nieder GL, Parmelee DX,
Stolfi A and Hudes PD. Team-based learning in a medical gross anatomy and
embryology course (2005) Clin Anat 18: 56-63. https://doi.org/10.1002/ca.20040
- Wang J, Zhang W, Qin L,
Zhao J, Zhang S, et al. Problem-based learning in regional anatomy education at
Peking University (2010) Anat Sci Educ 3: 121-126. https://doi.org/10.1002/ase.151
- Shoji H, Solomonow M,
Yoshino S, D’Ambrosia R and Dabezies E. Factors affecting postoperative flexion
in total knee arthroplasty (1990) Orthopedics 13: 643-649.
- Kirch DG and Ast C.
Interprofessionalism: Educating to meet patient needs (2015)
- Anat Sci Educ 8: 296-298.https://doi.org/10.1002/ase.1504
- Rindermann H and Amelang
M. Development and testing of a questionnaire for student event evaluation
(1994) Empirical pedagogy 8: 131-151.
- Walkenhorst U and Schäfer
T. Acting together. Doctors and health professionals in training (2012) Med
Mabuse 197: 35-37.
- Leveritt S, McKnight G,
Edwards K, Pratten and Merrick D. What anatomy is clinically useful and when
should we be teaching it? (2016) Anat Sci Educ 9: 468-475.
https://doi.org/10.1002/ase.1596
- Wissenschaftsrat.
Recommendations of the Science Council on the qualification of healthcare
personnel (2014).
Corresponding author:
Nasir Mustafa, Department of Nursing, Istanbul Gelisim University, Turkey, E mail: nasirmustafaspan@gmail.com
Citation:
Mustafa N, Zahoorand H, Majoo MF and Azmatullah. Collaborative learning aspect for training hip and knee joint anatomy (2020) Rheumatic dis treatment J 1: 13-16.http://edelweisspublications.com/edelweiss/figures/rdtj-20-102_figure_1.jpg
Keywords
Hip and knee joint anatomy, Collaborative
learning, Anatomy teaching, Nursing students, Physiotherapy students