114 - The Identification of Difficult Topics in Medical Gross Anatomy and a Peer-to-peer Intervention to Increase Confidence and Performance on a Mock Practical Exam

Poster Board Number: 114
There are separate poster presentation times for odd and even posters.
Odd poster #s – first hour
Even poster #s – second hour

Abstract Body : Introduction & Objective
Increasing medical student confidence and performance in gross anatomy is an important goal for medical educators. Several studies have shown that peer-to-peer teaching has a positive impact on both confidence and performance in gross anatomy. The current study aimed to identify challenging medical gross anatomy laboratory topics in a gastrointestinal (GI) course and utilize a peer-to-peer intervention to improve confidence and performance on these topics in the following endocrine/reproductive (END) course.

Methods
To identify challenging anatomical topics, 30 tagged structures on the GI mock practical were grouped into six buckets: nerves, vasculature, viscera, musculoskeletal, fascia/membranes, and regions/spaces. During the practical, students were asked to identify each structure and rate their confidence on a numerical scale from 1 (not at all confident) to 5 (extremely confident). MANOVA was performed to compare the average performance and confidence of each bucket. Post hoc analysis revealed two buckets with significantly lower confidence and performance. In the following END course, a 1-hour optional peer-to-peer intervention targeted these two buckets one week before the mock practical. During the intervention, students were asked to tag pre-selected structures at 10 stations. The tags were confirmed by a peer tutor. During the 30-item END mock practical, students indicated if they attended the intervention. Performance and confidence data were collected for each of the items. All procedures were carried out according to the protocol approved by the WMU Homer Stryker MD School of Medicine IRB (IRB 2022-0950).

Results
Forty-two (52%) students participated in the GI mock practical. MANOVA revealed a significant difference in confidence between the buckets (p < 0.001). Post hoc analysis demonstrated significantly lower confidence on the nerves (M=2.06) and viscera (M=2.21) buckets. Significant differences were also found between performance on each bucket (p < 0.001) with students performing significantly worse on nerves (M=0.35) and viscera (M=0.31). Fifty-four (67%) students attended the peer-to-peer intervention which was designed to help students practice the identification of nerves and viscera in the END course. Forty-three (53%) students participated in the END mock practical. On the END mock practical, students that attended the intervention improved significantly in both nerve and viscera categories. For viscera, average performance and confidence increased to M=0.66 and M=3.25. For nerves, average performance and confidence increased to M=0.49 and M=2.53 The two-sided p-values for confidence and performance in nerves and viscera were all < 0.001.

Conclusion & Significance
While the authors were not surprised that students found nerves challenging on the GI mock practical, they found it interesting that students struggled with viscera more than other topics such as vasculature. A 1-hour peer-to-peer active learning session on nerves and viscera applied to the END course significantly improved students’ confidence and performance on both nerves and viscera. Future research should examine student performance on non-mock practicals to further elucidate the impact of peer-to-peer instruction on confidence and performance.