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DOI: https://dx.doi.org/10.18535/jmscr/v5i11.48

Anatomical knowledge among Medical, Dental and Health Science

Professionals
Authors
Htar Htar Aung , Htet Htet , Goh Pui San3, Stephanie Choo Cui Fen4
1* 2
1
Department of Human Biology, School of Medicine, International Medical University Malaysia
Email: [email protected]
2
Department of Pathology, School of Medicine, International Medical University Malaysia
Email: [email protected]
3
Semester 8, Chiropractic Program, International Medical University Malaysia
Email: [email protected]
4
Semester 8, Chiropractic Program, International Medical University Malaysia
Email: [email protected]
*Corresponding Author
Htar Htar Aung
Department of Human Biology, School of Medicine, International, Medical University, Malaysia
No. 126, Jalan Jalil Perkasa 19, Bukit Jalil 57000 Kuala Lumpur, Malaysia
Email: [email protected], Tel: +60 3 2731 7509

Abstract
The discipline of anatomy is an integral part of curriculum for Medical, Dental and Health Sciences
programs. The evolution in undergraduate medical school curricula has significantly impacted the
anatomy education. The application of anatomical knowledge plays a crucial role in daily clinical
practice. This review was aimed to evaluate the anatomical knowledge among the medical, dental and
health science professionals, and their perceptions on application of anatomical knowledge in clinical
practice. A computerized literature search which includes PubMed, Web of knowledge and Ovid Medline,
was performed. The studies in the English language and published in year 2000 onwards were included.
Most of the studies were done in UK and Spain followed by Australia, US and Canada. The studies
conducted among Medical and Chiropractic professions were 50% and 14% respectively. The rest of the
studies were done among dentistry, podiatry, physiotherapy, radiographer and nursing students. The
students with preclinical exposure scored significantly higher than those without preclinical exposure. The
medical students and clinical educators perceived that the application of anatomical knowledge is not
strong enough for clinical practice. The virtual medical museum, case-based learning, peer-assisted
learning, inter-professional forum and the recapitulation of anatomy in clinical years are suggested to
improve in anatomy education. The curriculum design, early clinical exposure, revision of course content,
adequacy of learning resources and assessment methods contribute to enhance the students’ learning and
their ability to apply the anatomical knowledge in daily practice.
Keywords: Anatomical knowledge, application, Medical, Dental, Health Science Professionals.

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Introduction studies in the English language and published in
The discipline of Anatomy is an integral part of year 2000 onwards that addressed the anatomical
the curriculum for Medical, Dental and Health knowledge and its application among medical,
Sciences program. In the recent decades, anatomy dental and health sciences programs were
teaching in many countries has undergone major included. Fourteen literatures were reviewed in
reform in pedagogy. The application and the this study.
retention of anatomical knowledge play a crucial
role in daily clinical practice; physical Anatomical knowledge among house officers,
examination, interpretation of images and medical and dental students
therapeutic procedures.(1) Although anatomy is The studies conducted on the anatomical
one of the fundamentals of medical curriculum, knowledge among the medical students were 5
there is a decline in terms of time and resources while for the dental student was only one (Table
allocated for anatomy.(2)New and innovative 1). Spielmann and Oliver(8) revealed that the
teaching methods of anatomy should be overall scores of the retention of anatomical
introduced to deliver the best possible outcome knowledge on the carpal bones of the medical
within the allocated time frame.(3) The sound students were lower than that of the senior house
knowledge of anatomy is also important for allied officers. The most of graduating medicalstudents
health professionals. For instance, the one of the couldn’t pass the multiple choice questions of a
board accreditation standards for Council of first year exam in the basic neurosciences.(9)
Chiropractic education Australia is basic science According to McKeow et al.(10), the score on the
subjects including anatomy.(4) In the chiropractic surface anatomy of the medical students who were
practice, anatomical knowledge is obviously exposed to the old curriculum was higher than
associated with the ability of performance in the those who undertook the system based curriculum.
clinics.(5)Because of the awareness, European Therefore, the effectiveness of learning anatomy
Higher Education Area has developed and in traditional and integrated curricula still remains
implemented a paradigm shift as an integration. a debate. In terms of radiographic anatomical
Health science subjects including anatomy are knowledge, the 4th year medical students have
integrated with clinical skills for better clinical poor retention of specific anatomical
reasoning.(6)Retention of anatomical knowledge is (11)
knowledge. In the similar study by Majid D et
not only to be pointed for and the preparation al., the clinical students with preclinical exposure
from the educators’ aspectis also needed to be scored significantly higher than the students
updated in such a way that the contents and mode without preclinical exposure in chest radiographic
of delivery should meet the needs of a modern anatomy.(12) In the study of application of
medical and health science professional world.(7) anatomical knowledge by the final year dental
Thus, this review was aimed to evaluate the students of integrated curriculum, an hour test was
anatomical knowledge among the medical, dental conducted to assess the students’ application of
and health science professionals and their anatomical knowledge that had been learnt in the
perceptions on application of anatomical second year. The test included the questions of
knowledge in clinical practice. One Best Answer (OBA) and Objective Structured
Practical Examination (OSPE). The performance
Materials and Methods of the students was weak in OSPE and the
A computerized literature search, which includes psychomotor skills of the students weren’t strong
PubMed, Web of knowledge and Ovid Medline, enough to apply the anatomical knowledge in the
was performed using the following keywords clinical practice.(13)
“anatomical knowledge” and “application”. The

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Anatomical knowledge among health sciences In the Physiotherapy program, the anatomy
students discipline includes a high specificity of
Table 1 summarized the studies conducted on the musculoskeletal system in their curriculum.
anatomical knowledge among health sciences Moreover, the different manual therapy techniques
students. A study on the preliminary assessment of mobilization of specific bones helped the
of the fifth-year chiropractic students’ knowledge physiotherapy students get the high score. On the
of anatomy on the carpal bone was done by Strkalj other hand, the medical students from this study
et al.(14) It revealed that the scores of the had not been to any clinical placements yet.(15)
chiropractic students were generally good because Valenza et al.(16)has concluded a study comparing
of the high number of hours dedicated in anatomy the retention of anatomical knowledge on the
curriculum. In addition, a cross-sectional study on carpal bone between third-year physical
the retention of anatomical knowledge among therapyand medical students at Universidad de
preclinical (second-year) and clinical (fifth-year) Granada. It revealed that physical therapy students
chiropractic students showed that the fifth-year had portrayed better anatomy retention of the
students performed better than the second-year carpal bones than the medical students, and it was
students.(5) Castillo-López et al.(6) conducted a statistically significant (p<0.001).In the study by
study using the tarsal bone test among the Hall and Durward(17), Multiple Choice Question,
podiatry students and the most of the students short-response answers and Practical
identified the bones correctly. There was no Radiographic Anatomy Examination (PRAE)
significant difference in performance of the first were conducted among the student radiographers,
and fourth-year students. Another cross-sectional and the test was repeated 10-22 months later
study on the anatomical knowledge of upper and without any announcement. Their scores were
lower limbs was done among medical, only different in PRAE and it depends on the
physiotherapy, nursing, and podiatry students. The method of assessment and period of time that had
scores of the physiotherapy and podiatry students elapsed. It is encouraged that various learning and
were higher than those of medical and nursing assessment plans are embraced to nurture a
students. It was statistically significant (p<0.001). profound approach for enhancement in learning.
Table. 1Studies on anatomical knowledge among health professionals
Anatomical area of Number of Author Year of
Study Place Participants
study participants (n) (Reference) study
Carpal bone Murdoch University, UK 2nd and 5th year Chiro 91 Meyer A(5) 2015
Tarsal bone University of Seville, Spain Podiatry 254 Castillo-López J(6) 2014
Carpal bone University of Edinburgh, UK Final year medical 50 Spielman and 2005
students and junior Oliver(8)
doctors
Neuroanatomy University of Saskatchewan, Medical students 24 Mateen FJ(9) 2008
Canada
Surface anatomy Queen’s University of Medical students 602 McKeow PP(10) 2003
Belfast, UK
Radiological anatomy Johns Hopkins University, 4th year Medical students 194 Feigin D(11) 2002
of the chest USA
Head and Neck Private University, Malaysia Final year dental students 58 HtarHtar Aung(13) 2016
Carpal bone Macquarie University, 5th year Chiro 84 Strkalj G(14) 2011
Australia
Carpal and tarsal University of Seville, Spain Medicine, Physiotherapy, 177 Diaz-Mancha J(15) 2016
Nursing and Podiatry
Carpal bone Universidad de Granada, Physical therapy and 134 Valenza MC(16) 2012
Spain medical
Radiography Glasgow Caledonian Radiographers 51 Hall A and 2009
University, UK Durward B(17)

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Perceptions on application of anatomical Undergraduate medical students, clinicians and
knowledge anatomy educators acknowledged that the
Vorstenbosch et al.(18) conducted a research to proposition of anatomy discipline is an important
determine the application of anatomical part of a medical curriculum. However, clinicians
knowledge by medical doctors in an attempt to perceived that anatomy education could not
delineate the nature of competency in anatomy. It contribute much in professional related
revealed that the junior medical doctors applied competencies, and they responded with a low
anatomical knowledge throughout the consultation agreement for the statement where anatomy
primarily during physical examination in a patient promotes professionalism, team work and
presenting with a shoulder complaint. Lazarus communication skills. This again does show that
MD et al.(19) revealed that the medical students some initiatives should be implemented in terms
and clinical educators perceived as insufficient of inter-professionalism activities, team-work,
application of anatomical knowledge in the communication and ethical concerns in pre-
clinics, and the advanced anatomy course clinical anatomy curriculum.(7) Case discussion
developed by clinicians and academic anatomists based on intervention of anatomy course was done
is essential in medical students’ clinical for introducing professionalism through gross
education.In terms of the importance of anatomy anatomy plenaries. There was a high student
topics, physicians perceived that medical imaging reflection and most of the participants suggested
is highly relevant for clinical practice.On the other that those sessions should be included as a part of
hand, they scored lowest for embryology and future anatomy curriculum. Clinicians have
lymphatic system.(20) Both the final year dental suggested that the anatomy teachings to be more
students and the lecturers slightly agreed that the related and integrated to clinical learning and
application of knowledge was strong in more importantly, exposure in clinical years of the
radiological anatomy. Similarly, they also rated curriculum.(21)Profound basic knowledge of
the median score for the confidence in applying anatomy will continue as an essential component
anatomical knowledge during clinical practice and of academic medical and health sciences
the adequacy of the level of knowledge on curriculum.(22)
clinically relevant anatomy.(13)
Approaches for improvement in Anatomy
education

Fig. 1 Educational strategies for nurturing work-ready graduates of health professionals through learning
anatomy

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Fig. 2 Approaches for improvement in anatomy education

Based on these previous findings, the anatomy in daily clinical practice. Annals
teaching/learning strategies of anatomy need to be Of Anatomy – Anatomischer Anzeiger
improved in order to produce the work readiness 2010; 192(6): 341-348. doi:
health professionals who can cope the changing 10.1016/j.anat.2010.05.002.
demand of health profession with competent basic 2. Gogalniceanu P, Madani H, Paraskeva PA,
science knowledge. It includes the virtual medical Darzi A: A minimally invasive approach to
museum, encouragement of active students’ undergraduate anatomy teaching. Anat Sci
participation, more interactive face to face Educ. 2008; 1(1):46-7. doi: 10.1002/ase.9.
sessions, case-based learning, interprofessional 3. Craig S, Tait N, Boers D, McAndrew D:
forum, recapitulation of anatomical knowledge in Review of anatomy education in
clinical years and usage of audiovisual methods Australian and New Zealand medical
(Fig 1). schools. ANZ J Surg. 2010;80(4):212-6.
The diagrammatic presentation of suggestive doi: 10.1111/j.1445-2197.2010.05241.x.
approaches for improvement in anatomy 4. Chapman PD, Meyer A, Young K,
education was summarized in Figure 2. Wibowo D, Walker B: Emphasis on
various subtopics in the anatomy
Conclusion curriculum for chiropractic training: An
The curriculum design, early clinical exposure, international survey of chiropractors and
revision of course content, adequacy of learning anatomists. J Chiro Educ 2015;29(1). dOI
resources, perceptions of the students and 10.7899/JCE-14-10.
educators, the assessment methods contribute to 5. Meyer A, Armson, A, Losco C, Losco B,
enhance the learning gross anatomy in health Walker B: Factors influencing student
professionals and its application in daily clinical performance on the carpal bone test as a
practice. preliminary evaluation of anatomical
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