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Online Anatomy Cases: Building Clinical Context into Gross Anatomy Education as a Method for Increased Integration of Radiology into the Medical School Curriculum

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Online Anatomy Cases: Building Clinical Context into Gross Anatomy Education as a Method for Increased Integration of Radiology into the Medical School Curriculum

Allison M. Grayev, MD; Laura Gonzalez, MD; Karen Krabbenhoft, PhD; Amy Stickford Becker, BA; Christine Seibert, MD

Learning Objectives

Following completion of this activity, the learner will be able to:

1) Describe adult learning theory and its applications in curricular design

2) Construct a theoretical learning module for medical students in gross anatomy with focus on hybrid pedagogy

3) Evaluate opportunities at their institution for vertical and horizontal integration of radiology within the curriculum

Adult Learning Theory:  Andragogy

Having a working knowledge of andragogy helps the teacher plan appropriate activities for their adult learners. 

Key concepts include:

Moving from dependency to self directed learning

Drawing on accumulated knowledge from life experiences

Ready to learn when they assume new social roles

Thrives with problem-centered learning and wants to apply new knowledge

Has high internal motivation (TEAL 2011)

Self-directed learning involves the student as an active participant and helps deepen both knowledge acquisition and prepare students for life-long learning (Spencer & Jordan 1999). 

Additionally, having students tackle cases allows them to start to develop clinical reasoning skills, which can lead to further refinement and improved skills entering residency (Bordage 1994). 

Digital Pedagogy: Blended Learning

We have used a replacement model (Twigg 2003) in order to replace face-to-face lecture time, rather than supplementing it, with on-line activities (modules and PowerPoint © presentations). 

Self directed modules have been shown to be well received by students, although proving greater learning and retention has been difficult (Khalil 2010).    We have used Articulate© to create interactive modules for the students to complete.    Creating visually interesting modules has been important in getting student buy-in. 

The modules are not graded; however, the students are assessed at the beginning of each lab session with a 10 item quiz and there are radiology questions (from the module and annotated slides) included on this, as well as each unit exam.

This allows us to establish clear expectations, which then allows students to understand the minimal requirement for testing purposes, while allowing the freedom for self-directed learning.

Current Radiology Modules: Integrated Medical Anatomy

Our Integrated Medical Anatomy course has three components:  anatomy, histology and radiology.  We have termed our radiology portion of the course iBAR (Image Based Anatomy and Radiology) and it consists of 14 lecture hours in combination with 21 modules as well as a series of 21 annotated PowerPoint© presentations, spread over one semester.

In order to optimize the integration of the radiology content, the decision was made to link the online modules with dissections to keep the delivery uniform in time.  Our current curriculum has half of the students performing a dissection while the other half completes the radiology module.  At the end of the lab session, the students regroup and engage in a peer to peer teaching session.  The dissectors take the other students on a “tour” of the cadaver and the non-dissectors come prepared to teach their lab group about the pertinent radiology. 

The online clinical modules are currently hosted within the Integrated Medical Anatomy website, making them available only while the students are actively enrolled in that course. 

Proposed Model for Vertical Integration

The goal is to create an integrated anatomy - radiology website, which would host the cases for students in the clinical phases to use to review pertinent anatomy, with protected time during the curriculum.

The key in design is considering the steps of the “integration ladder” (Harden 2000).  We plan to build upon the current anatomy cases to have expanded clinical information for use during the clinical rotations – thus accomplishing two goals:

1)Bridge the gap between the preclinical and clinical years with an emphasis on reviewing pertinent anatomy
2)Illustrating the importance of medical imaging in the evaluation and treatment of patients

We are looking at models for integration within the appropriate clinical settings – i.e. review of abdominal imaging  via an appendicitis case would best fit during a surgical rotation.

Eventually, we would like to study the effect of this integration on clinical reasoning skills, as well as perception of radiology.

Call to Action

Perceived barriers to medical student teaching include a lack of established framework and a need to have a radiology champion.  Having a point person to assist with integration into the medical school curriculum is imperative and allows for standardization of content / interactions with the ability to modify for best practices in different settings.

When designing radiology content for an anatomy course (or other medical student teaching opportunity), clear goals and an organized framework are imperative from the start.

Key questions to consider:

How do my students learn?

What do my students expect?

How do I deliver content effectively?

How can technology ease my workload?

What do my students need to know or do? (Strawser 2015)


Bordage G “Elaborated Knowledge: A Key to Successful Diagnostic Thinking” Acad Med 1994;69:883-885.

Harden RM “The Integration Ladder: A Tool for Curriculum Planning and Evaluation” Medical Education 2000;34:551-557.

Khalil MK, Nelson LD and Kibble JD “The Use of Self-learning Modules to Facilitate Learning of Basic Science Concepts in an Integrated Medical Curriculum” Anat Sci Educ 2010;3:219-226.

Lin-Dunham JE, Ensminger DC, McNulty JA, Hoyt AE, Chandrasekhar AJ “A Vertically Oriented Online Radiology Curriculum Developed as a Cognitive Apprenticeship:  Impact on Student Performance and Learning” Acad Radiol 2016;23:252-261.

Spencer, JA and Jordan RK “Learner Centred Approaches in Medical Education” Brit Med J 1999;318:1280-1283.

Strawser, MG “Exploring Innovation” Hybrid Pedagogy August 2015

Teaching Excellence in Adult Literacy Fact Sheet 2011, teal.ed.gov/tealguide/adultlearning (accessed February 20, 2016)

Twigg, CA “Improving Learning and Reducing Costs: New Models for Online Learning” EDUCAUSE Review Sept/Oct 2003:28 – 36.


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