Competency Level Based Anatomy Teaching: An Evolving Approach

Introduction

Anatomy undoubtedly forms the basis of any medical curricula as well serves a strong component for good clinical practice. However, literature pertaining to anatomy education is increasingly reporting of a deterioration of anatomy knowledge not only among undergraduate students but also among clinical practitioners. Partly in response to these observations and due to changes in demands of medical professions, anatomy curricula have experienced a major paradigm shift from passive didactic and teacher centered approach to active, clinical based and student-centered approach. However comparative retrospective analysis of these different approaches has failed to identify a significant difference in terms of student performance. A possible explanation is that both approaches have failed to emphasize key competencies required to be known by the student. This has led to a deprivation of a strong anatomy foundation, a common observation made amongst most medical undergraduate students. The authors herewith propose a competency level based approach for teaching anatomy whereby the understanding of anatomy is allowed to evolve within the student based on pre defined competency levels. The proposed approach enables the student to develop a strong core knowledge via a teacher centered, didactic commencement and ends in a complete student centered, clinical based approach allowing for application and synthesis of new knowledge based on the already laid strong foundation.

The big picture vs details

Different approaches used in teaching anatomy, whether traditional or novel is observed to share one thing in common: the focus on detailed anatomy of a selected region. Regional anatomy taught in traditional curricula for example presents the upper limb under the main subdivisions of pectoral region, shoulder region, the arm, forearm and the hand. This approach is seen to allow the student to focus on detailed anatomy of each sub region discussed and leaves the student to amalgamate the knowledge gained so as to perceive the upper limb as a single functional unit. Careful analysis of “problem based learning” and other modern reforms to the traditional curricula is also observed to be lacking in this sense, thus leaving the challenge of amalgamation to the student.

The authors believe that the possession of a holistic understanding of anatomy is the key to successful anatomy learning. Good clinical practice requires the understanding of different anatomical entities as a single functional unit, reflecting the role in nature. Possessing detailed knowledge of regional anatomy will therefor only cater partly to the demands of the practice of anatomy in the clinical setting. The remining greater proportion thus relies on the student’s capability of self-amalgamating the acquired knowledge which woefully is not observed amongst the majority of the student population today. It is in this context that authors also argue on the threshold of such amalgamating capacities expected from undergraduate medical students.

The proposed approach for teaching anatomy is designed in such a way so as to substantially rid the student of the need of self-amalgamation. This is brought about through pre identified competency levels with each defined level designed to perceive this broader anatomical picture. Thus, at any given time it is expected that a selected student will possess a holistic understanding of a learnt functional unit appropriate of his/her competency level. The gradual course of a student through increasing competency levels will enable him/her to add required details to the broader picture whereby a deeper understanding is generated.

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The evolving nature

Two major criteria (center and discipline) will be used when defining each competency level. Commencing from a teacher centered mode of deliverance the teaching methodology is gradually shifted toward the student with increasing competency level. Thus, competency level I which is identified as a complete teacher centered approach makes a gradual transit towards a fully student-centered approach on reaching competency level IV. The teaching learning methodology will also undergo a similar transition reflecting the change of center. Lectures and prosected specimen observation employed as the main teaching learning methodology at competency level I will change to student presentations and dissections when reaching the competency level IV. A simultaneous shift will also be conducted with regard to the type of anatomy taught. Commencing with core structural anatomy at competency level I, the student will course through descriptive to functional and clinical anatomy at competency level IV. Sub disciplines of histology and embryology is also expected to be presented in a similar manner with core knowledge being presented at competency level II and III and with abnormal development, histopathology and molecular basis being introduced at competency level IV. The gradual transition of the aforementioned criteria exemplifies the dynamic nature of the proposed approach when compared to traditional as well as novel teaching methods such as PBL.

Vertical integration

In the setting of basic sciences, integrated learning has proven to be effective both in terms of factual comprehension and promoting life long learning. However, studies conducted in this regard has yet to answer questions pertaining to the extend as well as exact points of such integrations. Retrospective analysis of student performance in most problem-based learning curricula which accommodates a marked degree of vertical integration has failed to identify a significant improvement in terms of student performance. In contrary to the expectations such approaches have been observed to leave students with sporadic knowledge. The authors thus present the argument that a strong core anatomy knowledge is mandatory and forms the foundation for successful vertical integration. In bringing this ideology to light, the proposed approach herewith suggests to emphasize functional and clinical anatomy learning during latter stages of competency levels, a stage where the student has already mastered his core knowledge and is ready to apply.

Structuring formative and summative assessment

While summative assessment is considered to evaluate a student’s learning progress, formative assessment can be considered as an approach to reinforce learning. Formative assessment also plays a key role in motivating the students to learn thus allowing for continuous improvement. In this perspective formative assessment can be considered to be a crucial component of a curricula and conduction of a systematic formative assessment not only is beneficial directly to the student but also allows for identification of areas to be improved within a curriculum. However, conducting a successful formative assessment demands a sensible partition of the learnt subject matter in such a way the student himself can identify his/her weaknesses and apply the experience during the next level. The competency level-based teaching approach presented herewith facilitate this process of partition enabling a successful formative assessment to be carried out.

Summative assessments are usually applied at the end of a period of instruction to measure the outcome of student learning. Such assessments ideally require a structure covering all aspects of knowledge gained over the specified time period. However, a grey area exists in defining such a structure within a traditional or a novel approach such as PBL. The competency level based approach presented herewith also facilitates the structuring process of a summative assessment via the outcome based different weightages which can be allocated to each competency level.