Enhancing student engagement in anatomy by integrating technology to modify a practical exam

Abstract

With the shift towards integrated organ and systems-based teaching in medical curricula, traditional anatomy courses have experienced fragmentation. This has led to declining student engagement with anatomy learning despite using technology for better visualisation.¹ As assessment drives learning, we hypothesised that transforming practical exams by integrating technology-assisted evaluations within an ‘Objective Structured Practical Examination setting’ would enhance students' engagement with learning gross anatomy, microscopy, embryology and anatomical skills.

A comprehensive station-based Anatomy Practical Exam (APEx) was developed, consisting of 15 knowledge-testing stations and two resting stations. These covered identifying gross and histological structures with their relationships and clinical relevance, X-ray interpretation and clinical examination skills via videos. A unique ‘living station’ tested understanding of surface landmarks critical for anatomical skills. Each station had a 3-minute limit and was set up in two parallel circuits with 34 students in each batch, catering for a class of 100 students. All stations underwent validation and reliability review by an educationist, emphasising concept integration and practical application. The formative APEx was piloted as compulsory to familiarise the students, and the summative APEx was set with a 55% passing cut-off, contributing 10% to the final assessment, reinforcing its importance with a must-pass requirement.

The first APEx examination in the Musculoskeletal module was well received, as students preferred APEx, calling it challenging due to its hands-on nature, an improvement over the previous ‘alternate to practical’ (ATP) exam that was picture-based slides. They rated it ‘more engaging and better aligned with our future expectations during clinical practice’. Another student said, ‘It has become necessary to visit the laboratory to work with the models and plastinates, which significantly enhanced our understanding while this hands-on preparation would not have been required for the ATP’. Based on this feedback, 6 to 10 hours of self-guided lab sessions have been scheduled across the modules to accommodate students' learning. Moreover, students reported that integration of simulated models and other media into the curriculum acted as an opportunity towards deeper learning. These sentiments were echoed by lab instructors who reported a notable shift in students' attitudes during anatomy laboratory sessions. External examiners further reiterated that during the year-end structured viva, students were better at identifying structures and responding to questions on their clinical significance than previous cohorts. To optimise logistics, modules were paired by regions: neurosciences with head and neck, gastrointestinal tract with the renal system, and cardiovascular with blood and inflammation, enabling cross-modular questions, for example, ‘identifying the cranial nerve and its nuclei involved in the patient's video with facial palsy’. In a nutshell, despite the increased effort required to set up the APEx, its positive impact on student engagement and understanding outweighed the logistical challenges. Combining real human material with technology-assisted tools and clinical applications, this innovative assessment approach has effectively bridged the gaps observed in traditional anatomical assessment.

Conceptualization: Zehra Jamil and Kanza Muzaffar. Methodology: Kanza Muzaffar, Rozmeen Akbar, Sadia Cassim, and Zehra Jamil. Writing—original draft reviewing: Rozmeen Akbar, Zehra Jamil, Kanza Muzaffar, and Sadia Cassim.

None.

No formal ethical permission was sought for piloting this assessment, whereas it was formally reviewed and approved by the Undergraduate Curriculum Committee, Aga Khan University, Karachi, Pakistan.