The Real Deal: Anatomy Uncapped Hazel Richards & Jan Meyer School of Anatomy, Physiology & Human Biology The University of Western Australia

Our scenario Guest co-ordinators of a third year Science dissection-based unit (ANHB3324 Human Structure and Function), run as a one-off under very different circumstances to usual Aimed to: o Offer a higher level undergraduate unit displaying the potential of gross anatomy/ dissection as a tool of scientific enquiry o Offer a dissection-based anatomy course at a level which satisfies preferences for admission to postgraduate medical programmes o Provide useful and equitable outcomes for our students

The challenge 1) Uncapped student heterogeneity 2) Uncapped student numbers How to deliver an undiluted experience for our students?

Uncapped numbers Average of 60 enrolments over last 5 years Increased to 160 in 2014  Why? Shift to graduate medical entry – Dissection unit attractive to individual students (“prerequisite” for entry) – Development of “pre-med” (Biomedical) feeder course Changes to degree models – Broadening units No increase in dissection material allocation No increase in space available

So in 2014: – Only 47% had passed 2213 – Another 35% had another more general yr2 anatomy unit (2212) – And 18% had no anatomy background Uncapped student heterogeneity Previously had prerequisite AHNB2213 – Rigorous regional anatomy Could no longer be enforced – Structure of Biomed course left no room – Offered as a broadening unit

– Online reading, videos on use of instruments & dissection techniques, ethics of dissection, how bodies are sourced and prepared, history of anatomical practice in Western Australia Monitored through LMS – Online quiz had to be completed successfully before proceeding – All students completed module and passed the quiz Coping with heterogeneity: Orientation Dedicated the first week to orientation

Coping with heterogeneity: Lectures – No decrease in content, but didn’t assume vocabulary – An additional lecture each week on the basic anatomical concepts underlying the anatomy of each of the established lectures … so the arm bone’s connected to the… Reworked all of the lectures in plain language

… but watching more lectures didn’t seem to help them achieve higher grades Students with the old prerequisite who viewed fewer lectures did worse High rate of online viewing maintained throughout semester Students without the old prerequisite were slightly more diligent in viewing recorded lectures… Number of 3324 lectures viewed Student grade by 3324 lecture engagement Percentage of students viewing 3324 lectures Coping with heterogeneity: Lecture engagement

Provided online access to all of the old prerequisite recorded lectures & lab notes Coping with heterogeneity: Provision of supplementary material Students accessed supplementary 2213 lectures less Viewed significantly more by students who had not done the unit But dropped to about 30% engagement by week 6 Percentage of students viewing 2213 lectures … Viewing old prerequisite lectures helped students without that background No effect on revising students Number of 2213 lectures viewed Student grade by 2213 lecture engagement

Coping with heterogeneity: Feedback – Formative practice content quizzes – Post-assessment reflection exercises (with suggestions for more effective study) – Feedback lectures, analyses, exemplars after first assessments  Equally high rate of completion of practice quizzes and reflections Gave feedback

Reduced each students’ dissection time to ½ semester – Half the students work in pairs dissecting one surface of one limb – Other half worked in pairs on a small scientific investigation Animal dissection or osteology Midsemester assessments Turned bodies over and student pairs swapped – Dissectors became investigators and vice versa How we coped with numbers “Wet & Dirty” Dissector “Clean & Dry” Lector

Coping with numbers and heterogeneity Logs To maintain engagement, all students had to ‘snoop’ and submit a weekly online log of observations of the human dissections – Had to cover both upper and lower limbs – Had to be particular observations of the actual bodies being dissected Weekly feedback on dissection logs High rate of completion of logs maintained by nearly all students – not informative

A natural experiment Splitting the students in half, and switching their roles mid- semester, provided potential for mid-semester and end-of- semester comparison of performance between: Dissecting and non-dissecting students The same students when dissecting and when investigating

How successful were we? Mid-semester assessments Students without 2213 did worse Having done a more general anatomy unit (2212) didn’t help neither both Practical test neither both Online quiz 1

So what did make a difference? Dissection Any sort of dissecting gave an advantage when considering the students as a whole Practical test 1 marks by activity Online quiz 1 marks by activity Dissection (human) Investigation (animal dissection) Investigation (osteology) Dissection (human) Investigation (animal dissection) Investigation (osteology)

Human dissection brought those without 2213 up to the level of those with 2213 doing other activities Practical test 1 mark with general level of performance (Quiz) taken into account Dissection (human) Investigation (animal dissection) Investigation (osteology) with 2213 no 2213 So what did make a difference? Dissection

The advantage of dissection With % improvement, av. 5% advantage No % improvement, av. 10% advantage Practical test 1 & 2 marks

BUT: We still had an issue with heterogeneity  2 =13.02,df=4,p=.011 F=15.2,df=1,150,p<.001 No2213 mean= 67.5, SD= 8.8 With2213 mean =73.1, SD= 9.0 The final unit grades of students without the old prerequisite were still significantly lower

An unexpected outcome of dissection logs All students had to ‘snoop’ and submit a weekly online log of observations of the human dissections A grass-roots peer teaching movement – The people dissecting each part started to give mini- demonstrations of the features of their dissection – The ‘snoopers’ started to give mini vivas to the dissectors

Why did dissection help? A practical, kinesthetic experience applicable to their future career, as well as doing something interesting in its own right Imbued with a sense of responsibility – a valuable opportunity to be relished, ‘make the most of it’ Progression – developed and built upon a skill over a number of weeks (not just a single lab session) Face-to-face time with tutors and lecturers Alignment – material learned through practical experience, assessed through practical means

Some take-home messages Coping with increased numbers Division of classes into mirrored halves: – Used fewer resources than simply ‘scaling up’ (staff, materials, space) – Incidentally allowed some evaluation of teaching and learning strategies (but, important to maintain equity) Coping with student heterogeneity Providing a ‘real deal’ experience for students had a bootstrapping effect – Especially in practical assessment. This hands-on experience improved student outcomes more than any other measure we tried Peer learning can happen without being planned – Students with stronger backgrounds helped those who were struggling