|ORIGINAL RESEARCH ARTICLE
|Year : 2019 | Volume
| Issue : 2 | Page : 62-74
Approaches of anatomy teaching for seriously resource-deprived countries: A literature review
Ana Yoe-Cheng Chang Chan1, Olle ten Cate2, Eugène J. F. M. Custers2, Maarten S van Leeuwen3, Ronald L. A. W. Bleys4
1 Department of Morphological Sciences, National Autonomous University of Nicaragua, Leon, Nicaragua
2 Center for Research and Development of Education, University Medical Center Utrecht, Utrecht, The Netherlands
3 Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
4 Department of Anatomy, University Medical Center Utrecht, Utrecht, The Netherlands
|Date of Web Publication||18-Nov-2019|
Ana Yoe-Cheng Chang Chan
Department of Morphological Sciences, Faculty of Medical Sciences, National Autonomous University of Leon
Source of Support: None, Conflict of Interest: None
Background: Teaching anatomy is an important but expensive part of the medical curriculum, potentially more than many countries can afford. In the search for efficient methods, cost-effectiveness is of utmost importance for such countries. The aim of this contribution is to provide a review of the literature on anatomy teaching methods, evaluating these for feasibility in resource-deprived countries. Methods: A literature review was carried out to identify distinct approaches to anatomy teaching published in the period 2000–2014, using the databases of PubMed, Wiley Online Library, Elsevier, HINARI, Springer, and ERIC. The approaches found were compared against their conceptual, operational, technical, and economic feasibility and Mayer's principles of effective instruction. Results: Our search yielded 432 papers that met the inclusion criteria. We identified 14 methods of teaching anatomy. Based on their conceptual feasibility, dissection and technology enhanced learning approaches appeared to have more benefits than others. Dissection has, besides benefits, many specific drawbacks. Lectures and peer teaching showed better technical and economic feasibility. Educational platforms, radiological imaging, and lectures showed the highest operational feasibility. Dissection and surgery were found to be less feasible with regard to operational, technical, and economic characteristics. Discussion: Based on our findings, the most important recommendations for anatomy teaching in seriously resource-deprived countries include a combination of complementary strategies in 3 different moments, lecturing at the beginning, using virtual learning environment (for self-study), and at the end, using demonstration through prosected specimens and radiological imaging. This provides reasonable insights in anatomy through both dead and living human bodies and their virtual representations.
Keywords: Anatomy teaching approaches, anatomy teaching strategies, cost-effectiveness, resources-deprived countries
|How to cite this article:|
Chang Chan AY, Cate Ot, Custers EJ, Leeuwen MS, Bleys RL. Approaches of anatomy teaching for seriously resource-deprived countries: A literature review. Educ Health 2019;32:62-74
|How to cite this URL:|
Chang Chan AY, Cate Ot, Custers EJ, Leeuwen MS, Bleys RL. Approaches of anatomy teaching for seriously resource-deprived countries: A literature review. Educ Health [serial online] 2019 [cited 2020 Feb 27];32:62-74. Available from: http://www.educationforhealth.net/text.asp?2019/32/2/62/271196
| Background|| |
Anatomical science has long been regarded a cornerstone in medical education.,,, Knowledge of the anatomy of the human body is important to understand how both structure and function are modified by disease,, but also to perform a good physical examination. The teaching of anatomy has, for many ages, dominated the medical curriculum.,,,,,,,, In the second half of the 20th century, the curricula changed and more time became devoted to other disciplines, often at the cost of anatomy., To maintain the required level of anatomy knowledge of medical students, many schools have explored and developed new and more efficient teaching approach. However, a factor that has been considered less frequently is the cost-effectiveness and feasibility under difficult circumstances. Teaching anatomy a dissecting room is one of the most expensive components of the undergraduate medical curriculum. Many countries around the world are seriously deprived of financial means but are at the same time in high need of a well-trained medical workforce.
The medical education literature has abundant examples of new methods of teaching anatomy. Most publications claim that the new strategy has been successful.,,,,,,,,,, Failing education is rarely reported. Most reports do not compare approaches to anatomy teaching but describe a stand-alone educational method. Our aim was to identify educational strategies that fit the students' learning needs, specifically in low- and middle-income countries (LMIC), with the purpose to classify methods according to educational approach, resources, and feasibility.
The aim of this paper is to review the state of the art in anatomy teaching available in the scientific literature of the last 15 years, providing an overview or taxonomy of methods with their benefits and limitations with a focus on cost-effectiveness.
| Methods|| |
We performed a scoping review with a realist purpose, answering the question: What different approaches are used to teach gross anatomy? Which of them are feasible in LMIC?
A review of original articles was performed in scientific journals on medical education that addressed the subject of anatomy education during a period of 14 years (2000–2014) using the following electronic databases and virtual journal libraries: PubMed, ERIC, Wiley online library, HINARI, SPRINGER, Elsevier sciences direct, LWW, Taylor, and Francis. The starting year of 2000 was chosen as an estimated point in time when electronic media would be substantially introduced in anatomy teaching. All titles and abstracts were reviewed by the first author and were excluded if they did not meet the inclusion criteria.
Inclusion criteria were original articles, articles that addressed one or more approaches, strategies and/or methodologies in the undergraduate anatomy teaching in heath professional careers, and English language.
The articles were categorized as traditional (methods that commonly have been used in medical schools, these methods are mainly teacher-centered and nonintegrative) and innovative (strategies which emphasize an active, self-directed learning and integrative courses; those strategies have been implemented in medical schools for 50 years or less, due to anatomy teaching being very traditional)., Next, the approaches found were rated on conceptual feasibility (to supplement academic learning.), organizational feasibility (organizational infrastructure and time needed), technical feasibility (managerial knowledge and skills, human resources, and technological capacity needed) and economic feasibility (cost of the didactic materials and resources needed for both students and teachers) and instructional effectiveness [Figure 1].
Instructional effectiveness was operationalized by analyzing the teaching strategies and relating to the nine principles that Mayer has proposed:
- Coherence principle: eliminate extraneous material
- Signaling principle: highlight essential material
- Contiguity principle: place printed words near corresponding graphics
- Pretraining principle: provide pretraining in names and characteristics of key concepts
- Segmenting principle: break lessons into learner-controlled segments
- Modality principle: present words in spoken form
- Multimedia principle: present words and pictures rather than words alone
- Personalization principle: present words in conversational or polite style
- Voice principle: use a human voice rather than a machine voice.
All methods found in the literature were viewed from the perspective of instructional theory using these Mayer's principles of instructional design.
| Results|| |
From an initial yield of 607 articles about anatomy education, a total of 432 original articles met the inclusion criteria. We identified 14 methods of teaching anatomy that can be further categorized. Next, we compared the methods with on conceptual, operational, technical, and economic feasibility [Table 1]. All teaching methods are described with their benefits and limitations in [Table 2].
Didactic lecturing in anatomy education is as traditional as dissection and follows the learning objectives for students. It is characterized as a teacher presenting theoretical contents to a group. The event requires the presence of the participants in a specific time and location.
Dissection, one of the main anatomical learning tools in medical schools, has been used worldwide in teaching anatomy for >400 years. Dissection of human cadavers is the physical exploration of a dead human body through cutting and is essentially a regional-based approach to learning topographical anatomy.
Three anatomical demonstration modes can be distinguished: prosection of cadavers, using plastic models, and plastination.
Prosected cadavers provide learners with predissected material. Some universities have chosen to teach anatomy through prosected cadavers and specimens and have abolished dissection courses. Leung et al. (2006) found course hours in the prosection class to be 74% shorter than dissection class. One study found knowledge retention of anatomy 5 years after training to be similar in prosection group and dissection groups. Plastination is a relatively new advancement in cadaveric science; an effective technique of tissue preservation of entire organs or cross-sectional body slices introduced in 1987. Using polymers such as resin, silicone, and polyester give differing mechanical properties that ultimately result in robust, dry, odorless, and life-like specimens, which can be used well in an educational capacity in gross anatomy and radiology.
A problem-based learning (PBL) curriculum enables students to integrate basic and clinical science, evidence-based decision-making, clinical reasoning, and psychomotor skills., PBL's application to anatomy teaching requires a close follow-up of each student with regular feedback on his/her work. Students create and share learning objectives, including ones related to anatomy and obtain the required information through textbooks, the internet, assigned disciplinary resource staff, skill laboratories, anatomy museum, and audio–visual aids. Anatomy is incorporated in the majority of the problems and their accompanying learning activities; the proportions vary according to the problem or the system unit in question.,
Anatomy in the living body: Physical examination
Anatomy can be studied in the living body through physical examination (through simulated patients and peer examination), where the surface anatomy is vital. This method can be very useful in studying some systems and/or organs such as muscles, bones, joints, peripheral nervous system (through the study of tendon reflexes), abdominal organs, and cardiorespiratory organs.,
Anatomy in the living body: Radiological imaging
Radiology education, such as radiographic, ultrasound, computed tomography (CT), and magnetic resonance imaging (MRI), offersin vivo visualization of anatomy and physiology as well as insight into pathological processes.,,,,, Common methods to integrate radiology with anatomy instruction include concurrent radiology lectures, small group learning with and without formal instructors, and radiologic images of deidentified patients in the dissection laboratory.
Anatomy in the living body: Observation of surgeries
The sixteenth and seventeenth centuries operation theaters were created as the first amphitheaters of anatomy, initially intended for surgical demonstrations, dramatized rather than functional to teach anatomy. These procedures were also known as “theatre operations,” which subsequently, due to the need to train surgeons, the theatres acquired educational functions and therefore became surgical amphitheaters, Nowadays, the operating theater is no longer an educational setting but, in contrast, a challenging place in which to learn; and especially suitable for medical residents.
Anatomy in the living body: Body painting or drawing
Painting internal structures on the surface of the body can be effectively used in conjunction with palpation and auscultation.,, Students find it a highly memorable experience that leaves them with strong visual memories and a heightened appreciation of the links between visual, tactile, and auditory aspects of human anatomy.
Technology-enhanced, self-directed learning in anatomy
Among the basic sciences, gross anatomy represents a unique opportunity for the incorporation of technology and electronic dissemination of information because of the visual nature of the course material. There are teachers who have incorporated the technology into anatomy teaching in different forms or variants.,,,, Technology-enhanced learning through didactic resources like the anatomical commercial packages, and numerous free and commercial apps can be particularly successful when the teaching content and exemplars are predominantly visual.
Educational virtual platforms
In educational platforms, also called learning management system (LMS) or virtual learning environment (VLE), interactivity is an important element in instructional design, as it serves learner interest, cognitive processing, and curriculum integration., Allen et al. report on the implementation of a website called ARI (Anatomy Reports on the Internet), allowing students to document cadaveric findings online with photographs and text, providing an opportunity for medical students to research, describe, and publish their findings, albeit in a limited format.
Social virtual platforms
Facebook and YouTube invite users to actively participate in content creation and editing through open collaboration between members of communities of practice (collaborative learning).,, One study showed the use of Facebook to supplement traditional anatomy education as an appropriate instructional tool; they found that 94% of the students rated the page as very good or excellent; in addition, the page was perceived by 89% of students to be effective in contributing to their learning experience. Some authors believe YouTube's popularity should be considered an effective tool to enhance anatomy instruction if the videos are better scrutinized, diversified, and aimed toward course objectives,, but there is no consensus in the literature.
Some have explored unconventional methods such as Comics trips/Limmerick,, Yoga and Pilates, and Plasticine/clay modeling.,, In such cases, “fun” is one feature they have in common, but they can also be useful for those students with preference for a kinesthetic learning style. However, these methods are limited to the study of a single system (muscle), as in the case of yoga and Pilates and clay modeling.,
For each of these 12 anatomical teaching methods, benefits and limitations are described, as well as Mayer's educational principles, and summarized in [Table 3].
|Table 3: Comparison of anatomical teaching methods on aspects of feasibility and proven instructional design principles (Mayer's principles)|
Click here to view
| Discussion|| |
For the selection of strategies, we must consider the type of content and skills to be developed, as we have seen, not all strategies are suitable for the teaching and learning of all content (conceptual, procedural, and attitudinal) and skills (cognitive, psychomotor, psychoaffective, and communication). Anatomy for its theoretical–practical nature needs strategies that develop both conceptual and procedural content, as well as cognitive and psychomotor skills.
Our literature review revealed fourteen distinct approaches to the teaching and learning of anatomy. Of those 14 different approaches, we specifically evaluated their feasibility for LMIC and classified this feasibility (conceptual, economic, operational, and technical). Different approaches to teaching and learning experiences in anatomy are driven by many factors and perceptions, for example, the curriculum, assessment, previous educational experience, and the influence of staff and fellow students. Not all faculty teaching anatomy appear to have had appropriate training in dissection techniques, radiological images reading, teaching methodology, or computer skills.,, Anatomy teachers are usually medical doctors and senior medical students or recently graduated doctors, usually serve as teaching assistants. Some aim primarily at gaining work experience or securing a temporary income and do not feel much passion for teaching anatomy. This may affect education, as the quality may not to be optimal when teachers do not fully understand or do not enjoy what they teach. Motivation of faculty affects motivation of students.
Dissection and prosection remain useful for understanding the three-dimensionality of the human body and the haptic perception, distinguishing the texture of the different tissues of the body.,,,,, However, its expenses are clear limitations, given the high costs of transportation, maintenance, and the disposing of cadavers.,,,,,, These and other limitations, such as safety risks due to the exposure to formaldehyde,,, and the time-consuming nature, make prosection and dissection operationally, technically, and economically unfeasible methods in LMIC.
While PBL is known to stimulate retention and acquisition of basic science knowledge, inadequate resources are often a limitation; it requires faculty training on PBL facilitation and adequate infrastructure to assist small groups, making it operationally and technically a less feasible method in LMIC. PBL was not originally designed for the acquisition of basic science knowledge and is generally believed to be more suitable for clinical knowledge.
The use of radiological imaging helps to give a more practical and applicable sense to the knowledge of gross anatomy, as radiology is rapidly expanding as a domain in medicine to visually represent the body in numerous ways., However, it only meets 5 of 9 Mayer's principles, also its economic and technical feasible are not optimal. Many anatomy departments may not be large enough to purchase facilities for ultrasound, CT, or MRI and have trained staff to use these.
Online tools can be very attractive for current generations of students, and it helps to increase the interest of a difficult topic such as the gross anatomy., Online learning is reported to be as effective as traditional methods in the training of health professionals, yielding retention of skills and knowledge up to 25% more than traditional methods. However, computer skills vary among learners, and there may be technical difficulties using the programs or platforms., Despite these the risks, specifically for LMIC if adequate technical support staff lacks, its operational feasibility is one of the most appropriate, providing learners with content and interaction anytime and anywhere.
Mayer's principles that are most found are the signaling and segmenting. These principles go hand in hand and complement each other, since anatomy can be studied segmented, addressing only one anatomical system or region (segmenting). It keeps students focused on the task by highlighting the truly essential information (signaling) [Table 2].
The literature highlights successes of several approaches in the teaching of anatomy used so far. Therefore, an eclectic model, it means, a combination of complementary strategies could be the better way of teaching and the key to meet the curricular changes and the current needs of teaching and learning, for better understanding, retention, and application of anatomical knowledge.,, For example, at the beginning of anatomy course, traditional strategies such as lectures can be used to give a general orientation of the topic to study. Next, innovative strategies such as VLE for self-study session with the aid of a study guide, homework and academic chat to clarify doubts using. At the end, it can be practical classes on 2 phases, the first one, traditional with models and prosected specimens and the second one, innovative with use of radiological imaging and CAL (Computer Aided Learning), that way the anatomy is studied both in the dead (specimens/cadavers prosected) andin vivo(use of imaging) with an emphasis on self-directed learning. However, none of these methods are useful without a proper instructional design and without well-trained anatomy teachers.
Our review was set out to yield recommendations for anatomy teaching in resource-deprived countries. If viewed from the perspective of educational principles, combined with feasibility of execution, technology-enhanced learning and educational platform methods seem most promising. However, it is important to remember that, despite the many benefits of technology in the teaching of anatomy, “the most important thing in e-learning is not the technology, it's the teaching.” An aspect to consider is the pretraining principle in both students and teachers; these methods need training in how to use them (platform or software), how to design an online course and also professional staff who manage the educational platforms. In addition, it is important to have constant electrical power, a good and fast internet service, which fail in resources-deprived countries. Not all these methods are economically and technically optimal, but it is expected that the economic and technical cost will decrease as the initial investments may serve many generation of students. In addition, compared to the cost of the maintenance that entails dissection, technology-enhanced learning and LMS are cheaper in the long term.
The authors wish to thank Dr. Ligia Cruz, MD, PhD and Dr. Sonia Acevedo, MD, Family doctor specialist, for their collaboration reviewing and editing the paper.
Financial support and sponsorship
The authors received no financial support neither sponsorship.
Conflicts of interest
There are no conflicts of interest.
| References|| |
Brooks WS, Woodley KTCP, Jackson JR, Hoesley CJ. Integration of Gross Anatomy in an Organ System-Based Medical Curriculum: Strategies and Challenges. Anat Sci Ed 2015;8:266-74.
McLachlan JC, Patten D. Anatomy teaching: ghost of the past, present and future. Med Educ 2006;40:243-63.
Wessels Q, Vorster W, Jacobson C. Anatomy education in Namibia: Balancing facility design and curriculum development. Anat Sci Ed 2012;5:41-7.
Turney B. Anatomy in a modern medical curriculum. Ann Rec Coll Surg Engl 2007;89:104-7.
McCuskey RS, Carmichael SW, Kirch DG. The importance of Anatomy in Health professions education and the shortage of qualified educators. Acad Med 2005;80:349-51.
Holla S RK. Anatomy Education in a changing medical curriculum in India: Medical Student feedback on duration and emphasis of gross anatomy teaching. Anat Sci Educ 2009;2:179-83.
Vorstenbosch M, Bolhuis S, van Kuppeveld S, Kooloos J, Laan R. Properties of publications on anatomy in medical education literature. Anat Sci Ed 2011;4:105-14.
Alfonso AL, Indalecio S, María MR, Blanca M, Ramón SJ. Relevance of Human Anatomy in daily Clinical Practice. Ann Anat 2010;192:341-8.
Drake RL, McBride JM, Lachman N, Paulina W. Medical Education in Anatomical Sciences: The Winds of Change Continue to Blow. Anat Sci Educ 2009;2:253-9.
Lewis TL, Burnett B, Tunstall RG, Abrahams PH. Complementing Anatomy Education Using Three-Dimensional Anatomy Mobile Software Applications on Tablet Computers. Clin Anat 2014;27:313-20.
McKeown PP, Heylings DJ, Stevenson M, McKelvey KJ, Nixon JR, McCluskey DR. The impact of curricular change on medical student´s knowledge anatomy. Med Educ 2003;37:954-61.
Sugand K, Abrahams P, Khurana A. The anatomy of anatomy: A review for its modernization. Anat Sci Educ 2010;3:83-93.
Fitzgerald JE, White MJ, Tang SW, Maxwell-Armstrong CA, James DK. Are we teaching sufficient anatomy at Medical School? Clin Anat 2008;21:718-124.
Smith CF, Mathias HS. What impact does anatomy education have on clinical practice? Clin Anat 2011;24:113-9.
Jaffar AA. YouTube: An emerging tool in anatomy education. Anat Sci Ed 2012;5:158-64.
McCulloch C, Marango SP, Friedman ES, Laitman JT. Living AnatoME: Teaching and learning musculoskeletal anatomy through yoga and Pilates. Anat Sci Ed 2010;3:279-86.
David JH, Daniel JO, Heidi LL, Stephen ED. Constructivist learning of anatomy: Gaining knowledge by creating anatomical casts. Anat Sci Ed 2011;4:98-104.
Park JS, Kim DH, Chung MS. Anatomy comic strips. Anat Sci Ed 2011;4:275-9.
Geuna S, Giacobini-Robecchi MG, Note E. The use of brainstorming for teaching human anatomy. Anat Rec 2002;269:214-6.
Carnegie JA. The use of limericks to engage student interest and promote active learning in an undergraduate course in functional anatomy. Anat Sci Ed 2012;5:90-7.
Motoike H. Clay modeling as a method to learn human muscles a community college study. Anat Sci Educ 2009;2:19-23.
Gat I, Pessach-Gelblum L, Givati G, Haim N, Paluch-Shimon S, Unterman A, et al.
Body painting to promote self-active learning of hand anatomy for preclinical medical students. Med Educ Online. 2016;21:1-6.
Finn GM, White PM, Abdelbagi I. The impact of color and role on retention of knowledge: A body-painting study within undergraduate medicine. Anat Sci Ed 2011;4:311-7.
Yiou R, Goodenough D. Applying problem-based learning to the teaching of anatomy: The example of Harvard Medical School. Surg Radiol Anat 2006;28:189-94.
Griksaitis MJ, Sawdon MA, Finn GM. Ultrasound and cadaveric prosections as methods for teaching cardiac anatomy: A comparative study. Anat Sci Ed 2012;5:20-6.
Hirt B, Shiozawa T, Herlan S, Wagner H-J, Küppers E. Surgical prosection in a traditional anatomical curriculum-Tübingens' Sectio chirurgica. Ann Anat 2010;192:349-54.
Bergman EM, Prince Katinka JAH, Drukker J, van der Vleuten CPM, Scherpbier AJJA. How much anatomy is enough? Anat Sci Educ 2008;1:184-8.
Mayer RE. Applying the science of learning to medical education. Med Educ 2010;44:543-9.
Ketelsen D, Schrödl F, Knickenberg I, Heckemann RA, Hothorn T, Neuhuber WL, et al.
Modes of Information Delivery in Radiologic Anatomy Education: Impact on Student Performance. Acad Radiol 2007;14:93-9.
Azer SA, Eizenberg N. Do we need dissection in an integrated problem-based learning medical course ? Perceptions of W rst- and second-year students. Surg Radiol Anat 2007;29:173-80.
McMenamin P, Mcmenamin PG, McMenamin P. Body painting as a tool in clinical anatomy teaching. Anat Sci Educ 2008;1:139-44.
Leung KK, Lu KS, Huang TS, Hsieh BS. Anatomy instruction in medical schools: Connecting the past and the future. Adv Health Sci Educ Theory Pract 2006;11:209-15.
Ganguly PK, Chakravarty M, Latif NA, Osman M, Abu-Hijleh M. Teaching of anatomy in a problem-based curriculum at the Arabian Gulf University: The new face of the museum. Clin Anat 2003;16:256-61.
Abu-Hijleh MF, Chakravarty M, Al-Shboul Q, Kassab S, Hamdy H. Integrating applied anatomy in surgical clerkship in a problem-based learning curriculum. Surg Radiol Anat 2005;27:152-7.
Op Den Akker JW, Bohnen A, Oudegeest WJ, Hillen B. Giving Color to a New Curriculum: Bodypaint As a Tool in Medical education. Clin Anat 2002;15:356-62.
McLachlan JC, Regan De Bere S. How we teach anatomy without cadavers. Clin Teach 2004;1:49-52.
Barros NDE, Rodrigues CJ, Junqueira A, Jr R, Antonio M, Germano DEN, et al.
The Value of Teaching Sectional Anatomy to Improve CT Scan Interpretation. Clin Anat 2001;41:36-41.
Marker DR, Bansal AK, Juluru K, Magid D. Developing a radiology-based teaching approach for gross anatomy in the digital era. Acad Radiol 2010;17:1057-65.
Oh C, Kim J, Choe YH. Learning of cross-sectional anatomy using clay models. Anat Sci Educ 2009;2:156-9.
Alvarez A, Gold GE, Tobin B, Desser TS. Software tools for interactive instruction in radiologic anatomy. Acad Radiol 2006 May;13:512-7.
Brown B, Adhikari S, Marx J, Lander L, Todd GL. Introduction of Ultrasound into Gross Anatomy Curriculum: Perceptions of Medical Students. J Emerg Med 2012;43:1098-102.
Phillips AW, Smith SG, Ross CF, Straus CM. Direct correlation of radiologic and cadaveric structures in a gross anatomy course. Med Teach 2012;34:e779-784.
Kieu V, Stroud L, Huang P, Smith M, Spychal R, Hunter-Smith D, et al.
The Operating Theatre as Classroom: A Qualitative Study of Learning and Teaching Surgical Competencies. Educ Heal 2014;28:22–8.
Patel S, Mauro D, Fenn J, Sharkey D, Jones C. Is dissection the only way to learn anatomy? Thoughts from students at a non-dissecting based medical school. Perspect Med Educ 2015;4:259-60.
Lyon PMA. Making the most of learning in the operating theatre: Student strategies and curricular initiatives. Med Educ 2003;37:680-8.
Collins J. Modern approaches to teaching and learning anatomy. Br Med J 2008;337:665-7.
Khalil MK, Paas F, Johnson TE, Payer AF. Interactive and dynamic visualizations in teaching and learning of anatomy: A cognitive load perspective. Anat Rec B New Anat 2005;286:8-14.
Choudhury B, Gouldsborough I. The use of electronic media to develop transferable skills in science students studying anatomy. Anat Sci Ed 2012;5:125-31.
O´Byrne PJ, Patry A, Carnegie JA. The development of interactive online learning tools for the study of anatomy. Med Teach 2008;30:260-71.
Van Sint Jan S, Crudele M, Gashegu J, Feipel V, Poulet P, Salvia P, et al.
Development of multimedia learning modules for teaching human anatomy: Application to osteology and functional anatomy. Anat Rec B New Anat 2003;272:98-106.
Jastrow H, Hollinderbäumer A. On the use and value of new media and how medical students assess their effectiveness in learning anatomy. Anat Rec B New Anat 2004;280:20-9.
Peterson H. Web-based interactive 3D visualization as a tool for improved anatomy learning. Anat Sci Educ 2009;2:61-8.
Grinspan Z, Grinspan ZM, Olson TR, Cimino C. Anatomy Reports on the Internet: A web-based tool for student reports on cadaveric findings. Clin Anat 2007;20:215-21.
Abood A. Exploring the use of a facebook page in anatomy education. Anat Sci Educ 2013;7:199-208.
Azer SA. Can “YouTube” help students in learning surface anatomy? Surg Radiol Anat 2012;34:465-8.
Raikos A, Waidyasekara P. How useful is YouTube in learning heart anatomy. Anat Sci Ed 2014;7:12-8.
Seo J. Anatomy comic strips. Anat Sci Educ 2011;4:275-9.
Naug HL, Colson NJ, Donner DG. Promoting metacognition in first year anatomy laboratories using plasticine modeling and drawing activities: A pilot study of the “Blank Page” technique. Anat Sci Ed 2011;4:231-4.
Claire S, Mathias H. Student perceptions of an upper-level, undergraduate human anatomy laboratory course without cadavers. Clin Anat 2010;5:106-14.
Ganske I, Su T, Loukas M, Shaffer K. Teaching methods in anatomy courses in North American medical schools the role of radiology. Acad Radiol. 2006;13:1038-46.
Kusurkar RA, Croiset G, Mann KV, Custers E, Ten Cate OTJ. Have motivation theories guided the development and reform of medical education curricula? A review of the literature. Acad Med 2012;87:1-9.
Robinson AG, Metten S, Guiton G, Berek J. Using Fresh Tissue Dissection to Teach Human Anatomy in the Clinical Years. Academic Medicine 2004;79:711-6.
Brenner E. Human body preservation - old and new techniques. J Anat 2014;224:316-44.
Chen D, Chen D, Zhang Q, Deng J, Cai Y, Huang J, et al.
A shortage of cadavers: The predicament of regional anatomy education in mainland China. Anat Sci Ed 2018;11:397-402.
Johnson EO, Charchanti AV, Troupis TG. Modernization of an anatomy class: From conceptualization to implementation. A case for integrated multimodal-multidisciplinary teaching. Anat Sci Ed 2012;5:354-66.
Aquaisua AN. Plastination technology for anatomical studies in Nigeria: Opinion of teachers at medical institutions. Heal SA Gesondheid 2014;18:1-6.
Zhang L, Wang Y, Xiao M, Han Q, Ding J. An ethical solution to the challenges in teaching anatomy with dissection in the Chinese culture. Anat Sci Educ 2008;1:56-9.
Abdelkarim A, Ford TG. Advantages and disadvantages of problem-based learning from the professional perspective of medical and dental faculty. EC Dent Sci 2018;17:1-8.
Albanese M, Mitchell S. Problem-based Learning: A Review of Literature on Its Outcomes and Implementations Issues. Acad Med 1993;68:52-81.
Rengier F, Doll S, von Tengg-Kobligk H, Kirsch J, Kauczor H-U, Giesel FL. Integrated teaching of anatomy and radiology using three-dimensional image post-processing. Eur Radiol 2009;19:2870-7.
Ivanusic J, Cowle B, Barrington M. Undergraduate student perceptions of the use of ultrasonography in the study of “Living Anatomy”. Anat Sci Educ 2010;3:318-22.
Dettmer S, Tschernig T, Galanski M, Pabst R, Rieck B. Teaching surgery, radiology and anatomy together: The mix enhances motivation and comprehension. Surg Radiol Anat 2010;32:791-5.
Marker DR, Juluru K, Long C, Magid D. Strategic Improvements for Gross Anatomy Web-Based Teaching. Anat Res Int 2012;2012:1-9.
Alpi LK, Brown H, Lewis MJ. Computer-assisted learning for teaching anatomy and physiology in subjects allied to medicine. Med Teach 2003;25:204-6.
Atun R, Car J, Majeed A, Wheeler E. E-learning for undergraduate health professional education. In: Al-Shorbaji Najeeb AR, Car Josip, Majeed Azeem WE, editors. Villars-sous-Yens, Switzerland: WHO Library Cataloguing-in-Publication Data; 2015.
Allen E, Walls R, Reilly F, Allen E. Effects of interactive instructional techniques in a web-based peripheral nervous system component for human anatomy. Med Teach 2008;30:40-7.
Cárdenas L, Peña R. Ubiquitous learning: A systematic review. Elsevier 2018;35:1097-132.
Pereira J, Pleguezuelos E, Merí A, Molina A, Molina-toma MC, Masdeu C. Effectiveness of using blended learning strategies for teaching and learning human anatomy. Med Educ 2007;41:189-95.
Richardson MG. Blending web-based techinology and llive conference: Continuing the discussion. Med Educ 2008;42:1114-5.
Cook D. Where are we with research in e-learning? What are the advances in four years since the last e-learning symposium? In: e-learning Symposium AMEE pre-conference. Glasgow; 2010. p. 36.
Frehywot S, Vovides Y, Talib Z, Mikhail N, Ross H, Wohltjen H, et al.
E-learning in medical education in resource constrained low- and middle-income countries. Hum Resour Health 2013;11:1-15.
Selby G, Walker V, Diwakar V. A comparison of teaching methods: Interactive lecture versus game playing. Med Teach 2007;29:972-4.
Lochner L, Wieser H, Waldboth S, Mischo-Kelling M. Combining traditional anatomy lectures with e-learning activities: How do students perceive their learning experience? Int J Med Educ 2016;7:69-74.
Lujan H, DiCarlo S. First-year medical students prefer multiple learning styles. Adv Physiol Educ 2006;30:13-6.
Hubbard CJ, Miller JS, Olson D. A new way to teach an old topic: The cadaver-based anatomy short course for high school students. Anat Rec B New Anat 2005;284:6-11.
Hassanzadeh G, Hassanpoor N, Jalali A, Hassanzadeh N, Jafari M, Panahi N. Teaching Anatomy: Viewpoints of Iranian Anatomists. Thrita J Med Sci 2012;1:62-6.
Aziz MA, McKenzie JC, Wilson JS, Cowie RJ, Ayeni SA, Dunn BK. The human cadaver in the age of biomedical informatics. Anat Rec 2002;269:20-32.
Arroyo-Jimenez MDM, Marcos P, Martinez-Marcos A, Artacho-Pérula E, Blaizot X, Muñoz M, et al.
Gross anatomy dissections and self-directed learning in medicine. Clin Anat 2005;18:385-91.
Johnson JH. Importance of dissection in learning anatomy: Personal dissection versus peer teaching. Clin Anat 2002;15:38-44.
Arráez-Aybar LA, Castaño-Collado G, Casado-Morales MI. Dissection from the Spanish anatomist's perspective: Aims, attitudes, and related aspects. Anat Rec B New Anat 2004;281:15-20.
Quince TA, Barclay SIG, Spear M, Parker RA, Wood DF. Student attitudes toward cadaveric dissection at a UK medical school. Anat Sci Ed 2011;4:200-7.
Plaisant O, Courtois R, Toussaint P
J, Mendelsohn G A, John OP, Delmas V, Moxham BJ. Medical students' attitudes toward the anatomy dissection room in relation to personality. Anat Sci Ed 2011;4:305-10.
Inuwa IM, Al Rawahy M, Taranikanti V, Habbal O. “Steeplechase” online: Necessity sometimes is the catalyst for innovation. Anat Sci Ed 2011;4:115-8.
Collins JP. Are the changes in anatomy teaching compromising patient care? Clin Teach 2009;6:18-21.
Khalil MK, Payer AF, Johnson TE. Effectiveness of using cross-sections in the recognition of anatomical structures in radiological images. Anat Rec B New Anat 2005;283:9-13.
Bernard GR. Prosection demonstrations as substitutes for the conventional human gross anatomy laboratory. J Med Educ 1972;47:724-8.
Papa V, Vaccarezza M, Liston R. Teaching Anatomy in the XXI Century: New Aspects and Pitfalls. Sci World J 2013;2013:1-5.
Kriz W. The current potential of plastination. Anat embryol 2016;175:411-21.
Abu-Hijleh MF. The place of anatomy in medical education: Guide Supplement 41.1–Viewpoint. Med Teach 2010;32:601-3.
Miller SA, Perrotti W, Silverthorn DU, Dalley AF, Rarey KE. From College to Clinic: Reasoning Over Memorization is Key for Understanding Anatomy. Anat Rec 2002;269:69-80.
Collet T, Kirvell D, Nakorn A, Mclachlan JC, Collett T, Kirvell D, et al.
The role of living models in the teaching of surface anatomy: some experiences from a UK medical school. Med Teach 2009;31:90-6.
Bohl M, Francois W, Gest T. Self-guided clinical cases for medical students based on postmortem CT scans of cadavers. Clin Anat 2011;24:655-63.
Soyebi K. Changing students´ performance in and perception of radiology. Med Educ 2018;42:513-43.
Li L, Liu YX, Song ZJ. Three-Dimensional Reconstruction of Registered and Fused Chinese Visible Human and Patient MRI Images. Clin Anat 2006;231:225-31.
Sinav A, Ambron R. Interactive web-based programs to teach functional anatomy: The pterygopalatine fossa. Anat Rec B New Anat 2004;279:4-8.
Inuwa IM, Taranikanti V, Al-Rawahy M, Habbal O. Perceptions and attitudes of medical students towards two methods of assessing practical anatomy knowledge. Sultan Qaboos Univ Med J 2011;11:383-90.
Rizzolo LJ, Aden M, Stewart WB. Correlation of Web Usage and Exam Performance in a Human Anatomy and Development Course. Clin Anat 2002;15:351-5.
Voiglio EJ, Frasca D, Malezieux R, Moreau S, Rodier MN, Neidhardt JPH. Prospecting and evaluation of the anatomy sites on the internet. Surg Radiol Anat 1999;21:65-8.
Kim S, Brinkley JF, Rosse C. Profile of on-line anatomy information resources: Design and instructional implications. Clin Anat 2003;16:55-71.
El Bialy S, Jalali A, Abood A. Integrating Facebook into Basic Sciences Education: A comparison of a Faculty-Administered Facebook page and group. Austin J Anat 2014;1:1015.
[Table 1], [Table 2], [Table 3]