A HISTORICAL PERSPECTIVE OF
ANATOMICAL PEDAGOGY AT UKZN
A PILOT STUDY
1L Lazarus, 2R
Sookrajh, 1KS Satyapal
1Discipline of Clinical Anatomy, School of Laboratory Medicine and Medical Sciences,
2
University of KwaZulu-Natal, South Africa
Department of Curriculum Studies, School of Education Studies,
University of KwaZulu-Natal, South Africa
UKZN INSPIRING GREATNESS
INTRODUCTION
•
Cornerstone of medical education
•
Survived the test of time
•
Cadaveric dissection is the gold standard for anatomy teaching
•
Provides a platform of knowledge for all branches of medicine
•
International Federation of Association of Anatomists advocates
use of cadaveric material
Lazarus et al.
Persaud (1984)
Biasutto et al. (2014)
A HISTORICAL PERSPECTIVE OF ANATOMICAL PEDAGOGY AT UKZN : A PILOT STUDY
Teaching & Learning Conference 2014
IN THE PAST
Cadaveric dissection formed the key modality in the
delivery of the discipline
Pre & post merger
Lazarus et al.
A HISTORICAL PERSPECTIVE OF ANATOMICAL PEDAGOGY AT UKZN : A PILOT STUDY
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CHALLENGES
• Shortage of cadaveric material
• Under-preparedness and quality of student intake
• Anatomy is a difficult subject
• Increase in student numbers
• Reduction in number of medically qualified anatomy teachers
• “Any general scientist can teach anatomy”
Lazarus et al.
A HISTORICAL PERSPECTIVE OF ANATOMICAL PEDAGOGY AT UKZN : A PILOT STUDY
Teaching & Learning Conference 2014
WHY IS THERE A SHORTAGE OF
CADAVERIC MATERIAL?
• No large body donor programme
• Unclaimed bodies form main source
• Human Tissue Act No 65 of 1983
• Chapter 8 of the National Health Act 61 of 2003
• Access to cadaveric material ceased
• Interpretation of informed consent
• Peculiar provincial interpretation of Act
McQuoid-Mason (2011)
Lazarus et al.
A HISTORICAL PERSPECTIVE OF ANATOMICAL PEDAGOGY AT UKZN : A PILOT STUDY
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WHAT DID WE DO TO TRY TO SOLVE THE
PROBLEM?
Medico-legal symposium
(i) how to overcome the shortage of donations of human
tissue;
(ii) the need to update the current policy and regulations
regarding the use of human tissue;
(iii) whether a human tissue co-ordinating body should be
established;
(iv) the need for national guidelines for the use of human
tissue in teaching and research
Lazarus et al.
A HISTORICAL PERSPECTIVE OF ANATOMICAL PEDAGOGY AT UKZN : A PILOT STUDY
Teaching & Learning Conference 2014
HOW HAVE WE SURVIVED?
•
Donations
•
“Importation” of cadaveric material across trans-provincial borders from other
tertiary institutions - Universities of Stellenbosch (2012) & Orange Free State (2013)
Lazarus et al.
A HISTORICAL PERSPECTIVE OF ANATOMICAL PEDAGOGY AT UKZN : A PILOT STUDY
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HOW HAVE WE SURVIVED?
Resin cast
Plastic models
Plastinated lung
“Visual Learning Project”
Lazarus et al.
A HISTORICAL PERSPECTIVE OF ANATOMICAL PEDAGOGY AT UKZN : A PILOT STUDY
Teaching & Learning Conference 2014
AIMS
• Pilot study undertaken to analyze
& assess academic staff attitudes
towards the teaching of anatomy
• Prelude to a national survey
Lazarus et al.
A HISTORICAL PERSPECTIVE OF ANATOMICAL PEDAGOGY AT UKZN : A PILOT STUDY
Teaching & Learning Conference 2014
MATERIALS & METHOD
• Purposive selection of sample
• Interviews on Westville and Nelson R
Mandela School of Medicine
campuses
• Time frame range: 30-55 minutes
• Semi-structured interview schedule
• Informed consent taken
• Transcription of data
Lazarus et al.
A HISTORICAL PERSPECTIVE OF ANATOMICAL PEDAGOGY AT UKZN : A PILOT STUDY
Teaching & Learning Conference 2014
MATERIALS & METHOD
Trustworthiness/Rigor
• Re-reading of data
• Coded themes given to two external reviewers
• Technical accuracy
Lazarus et al.
A HISTORICAL PERSPECTIVE OF ANATOMICAL PEDAGOGY AT UKZN : A PILOT STUDY
Teaching & Learning Conference 2014
MATERIALS & METHOD
• Cadavers vs. computer assisted learning
• Reflect on curriculum, report on student’s areas of
expertise and
weaknesses within the discipline & make recommendations
• Protocol reference number: BE324/14
Lazarus et al.
A HISTORICAL PERSPECTIVE OF ANATOMICAL PEDAGOGY AT UKZN : A PILOT STUDY
Teaching & Learning Conference 2014
RESULTS
DEMOGRAPHIC DATA OF PARTICIPANTS
n=7
RACE
Medically qualified
YEARS OF
TEACHING
ANATOMY
35
Medically qualified
30
Indian
Medically qualified
22
Indian
Scientist Anatomist
3
African
B. Medical Science (UKZN); Masters in Medical Science
(UKZN)
Bachelor of Medical Science (Anatomy) (UKZN); Honours
in Medical Science (Anatomy) (UKZN); Master of Medical
Science (Clinical Anatomy) Cum Laude (UKZN)
Scientist Anatomist
3
Coloured
Scientist Anatomist
2
Indian
B. Medical Science (Anatomy) (UKZN); H. Medical Science
(Anatomy) (UKZN); M Med Science (Anatomy) (UKZN)
Scientist Anatomist
2
African
LEVEL
QUALIFICATION
DESCRIPTION
Senior Professor
LRCP,LRCS, LM (Royal College of Physicians & Surgeons
in Ireland); MD: General Surgery (Doctor of Medicine:
University of Natal); FRCPI (Fellow of the Royal College of
Physicians of Ireland); FICA (Fellow of the International
College of Angiology, USA); Fellow of the University of
Kwa-Zulu Natal; LLM (Medical Law) (University of KwaZulu Natal)
MB Ch B (Natal), Dip PEC (CMSA), FRCS Edinburgh),
ATLS (AEMS, Durban), FIACA
MB.ChB(University of Natal);
Master of Medical Science in Clinical Pharmacology
(University of Durban-Westville)
B. Sc. (Hons), M. Sc., Ph. D. (Lagos), Cert. Plastination
(Munich)
Professor
Senior Lecturer
Senior Lecturer
Lecturer
Lecturer
Lecturer
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A HISTORICAL PERSPECTIVE OF ANATOMICAL PEDAGOGY AT UKZN : A PILOT STUDY
Indian
Teaching & Learning Conference 2014
RESULTS
THEMATIC NUCLEI
• Types of teaching to health science students
Didactic vs. problem based learning
• Pedagogical tools in anatomy teaching
Cadavers vs. ancillary tools such as plastinates, plastic models,
moulds & computer assisted learning
• Gaps in curriculum
Adequate vs. inadequate knowledge
Lazarus et al.
A HISTORICAL PERSPECTIVE OF ANATOMICAL PEDAGOGY AT UKZN : A PILOT STUDY
Teaching & Learning Conference 2014
RESULTS
THEME 1
• No difference in teaching health science students
• “Health care is team care”
• Anatomy is a building block of all health professions
• More clinical input into medicine
Lazarus et al.
A HISTORICAL PERSPECTIVE OF ANATOMICAL PEDAGOGY AT UKZN : A PILOT STUDY
Teaching & Learning Conference 2014
RESULTS
THEME 2
CADAVERS = HALLMARK OF ANATOMY TEACHING
“This is the first time they are going to cut into a body or a person...so if they don’t -the next time they see a patient
they are going to be in surgery”
PLASTINATES, PLASTIC MODELS, MOULDS, COMPUTER ASSISTED LEARNING =
ADJUNCTS TO CADAVERS
“Balance is definitely what’s necessary or required. However, that being said it’s very difficult to say that cadavers can
be done away with no matter how sophisticated that computers are, for the simple reason is that when the medical
student qualifies the next time he picks up a scalpel he will be operating on a living person and the closest to that comes
when you work with a cadaver.”
RADIOLOGICAL IMAGES, CT SCANS, MR IMAGES, ULTRASOUND, SURFACE
ANATOMY = ANCILLARY ROLE TO DIFFERENT GROUPS OF STUDENTS
Lazarus et al.
A HISTORICAL PERSPECTIVE OF ANATOMICAL PEDAGOGY AT UKZN : A PILOT STUDY
Teaching & Learning Conference 2014
RESULTS
THEME 3
• ? Adequacy of knowledge in medical curriculum
• No head and neck component within themes
• “Improper education” & “unacceptable”
• May fall foul of appropriate accreditation body
• Head & neck anatomy sprocketed in other themes
Lazarus et al.
A HISTORICAL PERSPECTIVE OF ANATOMICAL PEDAGOGY AT UKZN : A PILOT STUDY
Teaching & Learning Conference 2014
DISCUSSION
THE DEBATE
Traditionalists vs. Modernists
Lazarus et al.
A HISTORICAL PERSPECTIVE OF ANATOMICAL PEDAGOGY AT UKZN : A PILOT STUDY
Teaching & Learning Conference 2014
DISCUSSION
PROBLEM-BASED LEARNING VS. MEMORY-BASED
LEARNING
• Anatomy is essential for all branches of health sciences
Hasan (2010)
• Creates a more usable body of knowledge
• Includes medical skills that are problem-solving
Turney (2007)
Lazarus et al.
A HISTORICAL PERSPECTIVE OF ANATOMICAL PEDAGOGY AT UKZN : A PILOT STUDY
Teaching & Learning Conference 2014
DISCUSSION
THE CADAVER DEBATE
• This study concurs with Azer & Eisenberg (2007);
Bockers et al. (2010); Sugand et al. (2010)
• Computer simulation & technology = artificial synthetic medium
Pawlina & Lachman (2004)
• Provides first visual and tactile experience of "human body & life"
Trelease et al. (2000)
• Prepares students to face death
Lazarus et al.
A HISTORICAL PERSPECTIVE OF ANATOMICAL PEDAGOGY AT UKZN : A PILOT STUDY
Granger (2004)
Teaching & Learning Conference 2014
DISCUSSION
THE CADAVER DEBATE
• Dissection provides 3-D visualization & learning
• “Practical dissection to the extent that, for the medical course, only 5 gross
anatomy lectures are delivered”
Prof Bernard Moxham, Cardiff University, UK
• Unparalleled experience of cutting through body layers to discover vital
structures
• Promotes communication & teamwork
Evans and Watt (2005)
Lazarus et al.
A HISTORICAL PERSPECTIVE OF ANATOMICAL PEDAGOGY AT UKZN : A PILOT STUDY
Teaching & Learning Conference 2014
DISCUSSION
THE DIGITAL DEBATE
• Allows for understanding spatial concepts
• Provides understanding of "hard to access" areas
Peterson et al., 2009; Lufler et al., 2010)
• Fast, reversible, repeatable images
• Amalgamation of two modalities
Lazarus et al.
A HISTORICAL PERSPECTIVE OF ANATOMICAL PEDAGOGY AT UKZN : A PILOT STUDY
Teaching & Learning Conference 2014
DISCUSSION
CORE ANATOMY CURRICULUM
• Reduction in time allocated to anatomy
• Absence of core anatomy curriculum - pruning & deleting of specific body
Bergman et al. (2014)
regions
• Directly affects ability of future doctors to practice medicine safely
• Clinicians blame anatomists for teaching too much detail
Pabst (1994); Whitcomb (2006)
• Core curriculum allows for streamlining of knowledge
Lazarus et al.
A HISTORICAL PERSPECTIVE OF ANATOMICAL PEDAGOGY AT UKZN : A PILOT STUDY
Teaching & Learning Conference 2014
RECOMMENDATIONS
• Consultation between University & Provincial Department of Health
• Re-implementation of a fully functional plastination unit
• Design of a fully equipped operational museum
• Design of a core curriculum without gaps
• Anatomists to engage in educational research
• Consult with educationalists on how best to
teach programme
Lazarus et al.
A HISTORICAL PERSPECTIVE OF ANATOMICAL PEDAGOGY AT UKZN : A PILOT STUDY
Teaching & Learning Conference 2014
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Böckers A, Jerg-Bretzke L, Lamp C, Brinkmann A, Traue HC, Böckers TM. The gross anatomy course: an
analysis of its importance. Anat Sci Educ. 2010; 3(1): 3-11.
Canby CA, Bush TA. Humanities in Gross Anatomy Project: a novel humanistic learning tool at Des Moines
University. Anat Sci Educ. 2010; 3(2): 94-6.
Evans DJ, Watt DJ. Provision of anatomical teaching in a new British medical school: getting the right mix.
Anat Rec B New Anat, 2005; 284(1): 22-7
Granger NA. Dissection laboratory is vital to medical gross anatomy education. Anat Rec (Part B: New Anat),
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(Part B: New Anat) 2004; 281: 9–11.
Petersson H, Sinkvist D, Wang C, Smedby O. Web-based interactive 3D visualization as a tool for improved
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Trelease RB, Nieder GL, Dørup J, Schacht Hansen M. Going virtual with QuickTime VR: new methods and
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A HISTORICAL PERSPECTIVE OF ANATOMICAL PEDAGOGY AT UKZN : A PILOT STUDY
Teaching & Learning Conference 2014
Thank you!
Lazarus et al.
A HISTORICAL PERSPECTIVE OF ANATOMICAL PEDAGOGY AT UKZN : A PILOT STUDY
Teaching & Learning Conference 2014