121 - Anatomy Exam Performance: Virtual versus Dissection-based Learning Among First Year Medical Students

Poster Board Number: 121
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Abstract Body : Introduction
Anatomy educators have long debated the value of dissection-based anatomy courses over other learning tools, like online and virtual modalities. During the COVID-19 pandemic, numerous medical schools adapted by providing remote anatomical learning. In AY 2020-2021, the Clinical Anatomy block at University of Arizona College of Medicine – Phoenix (UACOM-P) was delivered entirely online utilizing 3D virtual anatomical models in lieu of dissection, providing an opportunity to study the effects of lab modality on student exam performance.

We hypothesize that lab modality (dissection vs. virtual) has an effect on exam performance. Specifically, we predict that students in a dissection course will have a higher proportion of correct responses for questions compared to virtual anatomy students. Further, we hypothesize that course modality will have an effect on correct responses by question type ("donor tag", illustration", and "text"), with students in a dissection course scoring higher than virtual anatomy students on donor questions.

Methods
This is a retrospective study of first-year medical student exam performance in a dissection versus virtual anatomy course (Research Office for Medical Education IRB 1805590926). Correct responses to exam questions were compared between dissection-based cohorts (2018-2019 n=161) and a virtual cohort (n=98). Four regional exams with USMLE-style multiple choice questions were administered (1: Thorax & Abdomen; 2: Pelvis, Perineum, & Lower Extremity; 3: Back & Upper Extremity; 4: Head & Neck). A total of 171 questions were utilized over the three study years, with only minor edits. The dissection cohort took practical exams that included structures tagged on donors and anatomical models. The virtual cohort took an online practical exam with tags on dissection photographs and illustrations. The proportion of correct responses to each question was compared between the two groups. Further analysis of responses was performed for question types (“donor tag”, “illustration”, and text). The correct percentage per question was compared using chi-square (X2) analyses.

Results
The virtual cohort performed significantly lower (85% vs 81%, p=0.002) for overall exam means, and non-significantly lower between exam pairs. X2 analyses show that 36 questions (21%) had significantly different proportions of correct responses (p< 0.05). The 36 questions were unequally distributed across four exams (Exam 2: 16 [44%]; Exam 1: 8 [22%]; Exam 3: 6 [17%]; Exam 4: 6 [17%]). When grouped by type, correct responses to “donor tag” and “text” questions were significantly lower in the virtual cohort (p< 0.05).

Conclusion
First-year medical students taking a dissection-based anatomy course performed higher overall on anatomy exams compared with a virtual cohort. Specifically, the virtual group scored significantly lower on “donor tag” and “text” questions. Anatomy courses provide medical students with foundational knowledge, 3D awareness, and critical thinking skills used throughout their careers. This study reveals gaps in learning during a virtual anatomy adaptation.

Significance
The debate over the modalities for anatomy instruction is ongoing. These data suggest students with virtual-only experiences in anatomy may be at a disadvantage in the future. Due to the specialized anatomical knowledge required, studies should investigate whether a dissection or prosection review would be beneficial for residents from virtual cohorts.