Abstract
Anatomy education employs diverse teaching techniques worldwide, causing debates over the effectiveness of traditional versus newer methods. This study sought to investigate medical students’ preferences for teaching methods in their institutions and provide recommendations for an optimal anatomy education model. In this cross-sectional study, all Jeddah medical students were invited to participate in an online survey. The response rate reached 30%, with 430/1424 students partaking, and a sample size of 349 was established using non-probability convenience sampling. Students were questioned about the methods used at their institutions, and the significance they attributed to each method. Additionally, their agreement with specific statements was assessed. Among 430 responses, diversity of anatomy teaching methods was reported across institutions. While all methods were deemed important, there were slight disparities in preferences, with cadaver dissection being the most favored (86.2%). Conversely, plastic models were rated the least preferred (29.9%). The preferred comprehensive and practical approach to understand and memorize anatomy was combining two or more methods (29.8%). No significant association was observed between gender and the importance of any method (p > 0.05). Based on students’ perceptions, cadaver dissection is the most suitable approach for achieving important teaching goals in the field of anatomy. However, combining dissection with digital models is the most preferred method. We recommend that medical schools not limit the methods used in teaching anatomy and look toward choosing preferred methods.
SUBJECTS:
1. Introduction
Anatomy, integral to comprehending the human body’s intricacies, is a cornerstone of medical education (Balta et al., Citation2017). The efficacy of teaching methods profoundly impacts students’ grasp of anatomical concepts and their clinical application (Al-Mohrej et al., Citation2017). Thus, ongoing evaluation and refinement of teaching approaches are imperative for optimal learning outcomes (Estai & Bunt, Citation2016).
Traditionally, cadaveric dissection was the primary method for anatomical education for centuries (Mwachaka et al., Citation2016). However, recent decades have seen a shift toward innovative methodologies, prompted by factors such as resource constraints, declining cadaver donations, and evolving educational philosophies aimed at enhancing learning efficacy (Chapman et al., Citation2013).
Medical schools worldwide employ diverse teaching methodologies. In medical schools, methods for teaching anatomy are classified into traditional and integrated curricula. The traditional teaching method is based on informative lectures and the dissection of a full cadaver by students to provide them with a three-dimensional view (Balta et al., Citation2017). However, the methodology of teaching anatomy has transformed with greater student engagement in computer simulations, models, imaging, and the Internet to improve the learning experience (Sugand et al., Citation2010). There are many conflicting views regarding the best techniques for delivering anatomical information. For example, some authors have stated that dissection is an important tool for learning anatomy (Shaffer, Citation2004). However, other authors have reported that dissection can cause physical and emotional problems among medical students (Evans & Fitzgibbon, Citation1992; Horne et al., Citation1990; Nnodim, Citation1996).
Numerous countries worldwide, including Australia, have abandoned dissection courses in recent decades and replaced them with more advanced and integrated approaches (Eppler et al., Citation2018). In UK medical schools, the main anatomy teaching method is cadaveric dissection, followed by prosection (Davis et al., Citation2014). In the Arabian Gulf region, including Saudi Arabia, most medical schools depend on the problem-based learning (PBL) technique (Cowan et al., Citation2010). In this approach, students engage with real-world clinical problems, initiating self-directed inquiry and research before reconvening with instructors to discuss their findings. PBL scenarios may involve clinical cases that require students to identify relevant anatomical structures, understand their functions, and consider their spatial relationships. Through these scenarios, students learn to integrate their knowledge of anatomy with other disciplines such as physiology, pathology, and radiology, mirroring the challenges they will face in clinical practice (Almulhem & Almulhem, Citation2022).
The students’ preferences of learning anatomy were investigated among two different Saudi institutions in Riyadh. It was found that student’s methods of learning were distributed equally between memorizing facts and learning by hands-on dissection, but students’ learning styles and preferences were predominantly affected by different cultural backgrounds, study level, and gender (Al-Mohrej et al., Citation2017). Understanding these preferences is crucial for tailoring teaching methods to the specific needs of diverse student populations. While there are studies on student perceptions of anatomy education in various countries (Abdullah et al., Citation2021; Bandyopadhyay & Biswas, Citation2017; Jaiswal et al., Citation2015; Tayyem et al., Citation2019; Triepels et al., Citation2018), there is limited research specifically focusing on Jeddah region. This study fills that gap by providing region-specific data, which can contribute to a more comprehensive understanding of global trends and variations in anatomical education.
By exploring students’ views toward different teaching methods and their effectiveness, this study can provide valuable insights for educators and curriculum designers in Jeddah’s medical schools. Understanding which methods are most favored and why can help inform decisions about curriculum design, resource allocation, and teaching approaches to enhance the learning experience and outcomes for medical students.
2. Methods
2.1. Setting and population
The online questionnaire designed for this study was directed toward medical students at different medical schools in Jeddah that are listed on the website of the Ministry of Education, including public institutions such as King Saud bin Abdulaziz University for Health Sciences (KSAU-HS), King Abdulaziz University (KAU) and, the University of Jeddah (UOJ), and private institutions such as Ibn Sina National College for Medical Studies (ISNC), Batterjee Medical College (BMC), and Fakeeh College for Medical Sciences (FCMS). All of these schools’ requirements consist of a six-year medical program in addition to an internship year to obtain a Bachelor of Medicine and Bachelor of Surgery (MBBS) degree. The sample size was calculated by using Raosoft software. The total number of medical students within Jeddah is 3840. The criteria considered were a confidence level of 95%, a margin of error of 5%, and a 50% response distribution. The recommended sample size was determined to be 349.
Using the non-probability convenience sampling technique, medical students at Jeddah who were enrolled in this study completed a self-administered questionnaire, which was distributed via email by students’ affairs department in their institutions and social media platforms by targeting each institution’s community and then reaching students personally via direct messages. The sample recruitment took place in the summer of 2021 and lasted for two months (June–July) to collect the required responses.
2.2. Questionnaire
This study was an analytical cross-sectional survey that utilized an online questionnaire to collect responses. The questionnaire was constructed based on previous literatures (Chapman et al., Citation2013; Davis et al., Citation2014; Estai & Bunt, Citation2016). The questionnaire contained 13 questions. The first four questions targeted demographic data and the anatomy teaching methods used in the respective participant’s institution. Questions 5–11 were rated on a Likert scale ((1) Strongly disagree, (2) Disagree, (3) Neutral, (4) Agree, (5) Strongly agree or (1) Not important, (2) Slightly important, (3) Neutral, (4) Important, (5) Very important) to evaluate the importance, advantages, and disadvantages of each method. The last two questions were open-ended and aimed to acquire more information about participants’ preferences in teaching anatomy. In order to assess the questionnaire’s validity, the validation process was divided into two main steps: content and face validity. for content validity, the questionnaire was reviewed by four anatomists, one biostatistician, and two medical educators. As per the feedback received from the reviewers, it has been suggested that providing a definition for each method of teaching anatomy would be beneficial to ensure clarity and eliminate any potential confusion regarding the concepts. Also, It was recommended to ensure that an equal number of sentences are allocated to advantages and disadvantages for each method in order to avoid any possible bias.
After taking their feedback into consideration, the questionnaire was distributed among medical students to test for face validity. The feedback received regarding the questionnaire was positive, with respondents indicating that it was clear, comprehensive, and relevant to the target group. The survey consisted of 43 items, and Cronbach’s alpha for the survey was 0.877.
2.3. Data analysis
The data were reviewed to identify any missing information or inaccuracies prior to statistical analysis. Data collected from the survey are presented as percentages, frequencies, and bar graphs to describe categorical variables (institutions, sex, educational level, and techniques used to teach anatomy). A chi-square test was used to compare categorical variables. The data were analyzed using the John’s Macintosh Project (JMP) software, version 10.0 (SAS Institute Inc., Cary, NC, USA).
2.4. Ethical consideration
Subject privacy and confidentiality were ensured and no identifiers were collected. Informed consent was obtained from all participants at the beginning of the questionnaire. This study was approved by the King Abdullah International Medical Research Center and its Institutional Review Board (protocol number SP21J/033/02).
3. Results
A total of 430 of 3840 students at Jeddah’s medical schools (KSAU-HS, KAU, UOJ, BMC, ISNC, and FCMS) participated in the analytical cross-sectional survey (first year to internship year; ). The response rate was 30% as 1424 surveys were distributed.
Table 1. Profile of study variables.
3.1. Teaching tools used in Jeddah’s medical schools
The results showed that different institutions use different methods to teach human anatomy. At KSAU-HS and UOJ, both plastinated cadavers and plastic models were used as teaching methods. At KAU, BMC, and ISNC, a combination of cadaver dissection, prosected cadavers, plastinated cadavers, and plastic models was used. The tools used at FCMS are cadaver dissection, plastinated cadavers, and plastic models.
3.2. The importance of teaching tools
In general, students’ evaluations showed that all of the listed methods of teaching anatomy are important. However, a small number of variations were found, with cadaver dissection the most important method according to students’ perceptions (). Medical students in Jeddah have different perspectives regarding the importance of the methods used to teach anatomy. Cadaver dissection was the most important method at KSAU-HS (n = 116; 91.3%), UOJ (n = 42; 89.3%), and FCMS (n = 45; 95.7%). On the other hand, KAU (n = 111; 84.7%) and BMC students (n = 30; 93.7%) reported that cadaver dissection and prosected cadavers were equally important. At ISNC (n = 44, 95.6%), prosected cadavers were the most agreed upon.In addition, students at at KSAU-HS (n = 30; 23.6%), KAU (n = 20; 15.2%), UOJ (n = 8; 17%), BMC (n = 6; 18.7%), and ISNC (n = 5; 10.8%) mostly agreed that plastic models are not important. FCMS students (n = 5; 10.6%) believed that the digital method was not important.
Figure 1. Students’ evaluation of anatomy teaching methods.
3.3. The preferred way of learning human anatomy
Students were asked about a comprehensive and practical approach to understanding and memorizing gross anatomy. The results showed that a combination of two or more methods (n = 54; 29.8%) was the most preferred approach for learning anatomy. This was followed by cadaver dissection (n = 43; 23.7%), a combination of all methods (n = 23; 12.7%), repetition (n = 15; 8.2%), digital models (n = 14; 7.7%), a practical approach (n = 7; 3.8%), linking information with reality (n = 6; 3.3%), observation before exploring theory and tutor guidance (n = 3; 1.6%), and finally, using plastic models, using plastinated models, spending more time, drowning, peer study, and self-studying (n = 1; 0.5%).
3.4. The best way to learn human anatomy
The results showed that the majority of the students (n = 371; 86.2%) agreed with the statement ‘Dissection is the best way to learn human anatomy’. However, the statement ‘Plastic models are the best way to learn human anatomy’ was rated at the bottom of the list (n = 129; 29.9%).
3.5. Advantages and disadvantages of the methods used to teach anatomy ()
Students were given many statements describing each tool to assess their opinions. The highest agreement regarding the cadaver dissection was that ‘it enhances active and deep learning’ (n = 399; 92.7%), whilst they mostly disagreed with it being ‘time-consuming and outdated’ (n = 208; 48.3%). In addition, the most frequently agreed-with statement regarding the prosected cadaver was that ‘it allows easy exposure to structures that require hours to find’ (safe time; n = 351; 81.5), while they disagreed that ‘it is flexible and available at any time’ (n = 56; 12.9%). Moreover, plastinated models were mostly reported as ‘odorless, allowing convenient storage, and ease of handling’ (n = 347; 80.6%), but it was noted that ‘structures and their relations cannot be easily observed’ (n = 77; 17.6%; (). Plastic models were mostly declared to be ‘safe and easy to handle’ (n = 372; 86.4%); however, the statement that ‘they do not show deep structures such as bones and deeper muscles’ had the highest disagreement (n = 61; 14.1%). Regarding digital models, the most-agreed statement was that ‘they provide students independence in choosing different views and angles that are difficult with a cadaver’ (n = 343; 79.7%), while participants disagreed almost evenly that plastic models ‘do not enhance understanding and retention of spatial information and relationships’ (n = 82; 19%) and that they ‘do not reveal anatomical variations’ (n = 84; 19.4%).
Table 2. Advantages and Disadvantages of Anatomy Teaching Methods.
Table 3. The importance of each method among private and public medical schools.
3.6. Comparison regarding the importance of teaching methods
No significant association was observed between sex and the importance of any method (p > 0.05). There was also no significant association between public and private medical schools in terms of the importance of cadaver dissection, prosected cadavers, or digital models (p > 0.05). However, significant results were found regarding institutions for plastinated and plastic models (p < 0.05), as private medical schools found that these models were important ().
In Jeddah, medical programs are divided into three phases: Phase I includes the first and second years, phase II includes the third and fourth years, and phase III includes the fifth and sixth years as well as the internship year. The results showed a significant association between the phases and the importance of prosected cadavers. Medical students in all phases agreed that prosected cadavers are an important method for teaching anatomy. In contrast, no significant association was found for the other methods ().
Table 4. The Importance of each method in regards to medical years.
4. Discussion
Anatomy improves our understanding of the body’s structures and functions. Significantly, it is essential in clinical practice for medical students and clinicians to develop clinical skills. This study aimed to explore the perceptions of students at medical schools located in Jeddah regarding the effectiveness of the current methods used to teach human anatomy in their institutions. In this study, the students emphasized the importance of active and engaged learning in improving their knowledge and understanding. Similarly, a previous study mentioned that an active learning strategy is considered an effective learning tool in anatomy, as students use their own creativity and intelligence in preparing muscle presentations (Singh et al., Citation2019).
Plastinated cadavers are the dominant method for teaching anatomy at KSAU-HS. In previous studies, students indicated that plastinated cadavers have proven to be practical for satisfying students’ needs at different levels. Anatomists favor plastinated cadavers owing to their multiple advantages (Estai & Bunt, Citation2016). Similarly, our results mostly reported that plastination has the benefits of ‘being odorless, allowing convenient storage, and ease of handling’.
The results indicate that all methods used in teaching anatomy are fundamental. However, slight variations make the traditional method, cadaver dissection, the most important method, followed in descending order by prosected cadavers, plastinated cadavers, digital models, and plastic models. These results are similar to those reported in another studies in which the majority of students agreed that cadaveric dissection was an important and essential method for teaching anatomy (Shaffer, Citation2004). This finding was also supported by most anatomists (80%) in Ireland and the UK (Balta et al., Citation2017), but our study differs in exploring students’ perceptions, not those of anatomists. However, three other studies found that dissection can cause physical and emotional problems in medical students (Evans & Fitzgibbon, Citation1992; Horne et al., Citation1990; Nnodim, Citation1996). Students agreed that cadaver dissection enhances active and deep learning, which was also agreed upon in another study, with participants indicating that cadaver dissection assists the understanding of three-dimensional (3D) structures through inquisitiveness and self-exploration (Sugand et al., Citation2010).
Moreover, similar to a study done in University College Cork (Abdullah et al., Citation2021), students preferred a combination of two or more methods, especially the combination of cadaver dissection and digital models Because most students admitted the importance of dissecting a cadaver, they preferred using it accompanied by digital approaches, as those provided them with independence in choosing different views and angles that are difficult with a cadaver. This was followed by cadaver dissection and using all methods. As indicated by the opinion of the students, the statement ‘Dissection is the best way to learn human anatomy’ was the most agreed upon, and the statement regarding plastic models was the least agreed upon. Likewise, according to research conducted in Ghana, the majority of medical students agree that cadaver dissection is the most useful teaching method in anatomy, aiding them in the comprehension and recollection of their knowledge. Clinically, it increases their examination skills, helps them comprehend the effects of trauma, is highly respectful of the human body, and makes studying fun (Alhassan & Majeed, Citation2018). Significantly, it facilitates achieving high marks on both oral and written examinations (Dissabandara et al., Citation2015). Similarly, some studies have reported the importance of cadaver dissection as indicated by student perceptions (Dissabandara et al., Citation2015; Thorat & Jadhav, Citation2010).
The results of this study showed no gender differences in the perception of the importance of the methods used in teaching anatomy. Both males and females agreed that cadaver dissection is the most important method and strongly believed that dissection enhances a profound understanding of the human body. Females believed that cadaveric dissection helped with acquiring clinical skills, while males believed it helped with recognizing anatomical variations. Our results contradict a study that reported that learning style preferences differ between males and females, which should be taken into consideration by anatomy instructors because by taking this diversity into consideration, students can achieve optimal performance and avoid untoward methods (Al-Mohrej et al., Citation2017). Another study conducted in Iran showed obvious variations between male- and female-preferred anatomy teaching styles. Female students preferred the aural teaching method, while male students favored the kinesthetic teaching method (Sarabi-Asiabar et al., Citation2015). Thus, identifying the teaching styles of learners at the beginning of their college journey is helpful as students become more aware of their preferred learning methods, allowing them to select better methods to enhance their learning, and graduates can gain sufficient knowledge and skills as a result of effective learning (Sarabi-Asiabar et al., Citation2015). In a comparison with another study conducted in Melbourne on first- and second-year medical students, female students had greater concerns about the smell of cadavers than male students in both years. However, neither sex raised concerns related to having thoughts about death during dissection. First-year medical students ranked cadaver dissection as their top choice when learning anatomy; second-year medical students considered cadaver dissection to be the second-most useful method in anatomy resources, giving many reasons in their paper. First, second-year medical students studied the central nervous system (CNS), which led them to recognize the limitations of the cadaver dissection method in viewing the anatomical space and solid structure of the skull. In addition, they have limited time for dissection because dissection of the head and neck requires extensive time, which influences their opinions (Azer & Eizenberg, Citation2007).
Similar to a study conducted at the UK Lead School of Medicine on students’ perceptions regarding anatomy teaching methods, it was documented that traditional methods of teaching anatomy were upheld by students, and anatomical models (e.g. plastic) ranked among the lowest-scoring methods, as shown in our study. However, Jeddah’s medical students graded digital models combined with traditional techniques as their top preference, in contrast to the UK lead school students, who ranked digital models among the lowest tools. While the previous study focused only on second-year students, this study was conducted across all seven medical years (Chapman et al., Citation2013). In addition, similar to what was reported in one study, reducing the number of teaching hours in the medical anatomy curriculum raised concerns about medical students’ anatomical knowledge (Balta et al., Citation2017). This concern is similar to that mentioned by some of Jeddah’s medical students regarding the necessity of more time for teaching anatomy. Additionally, a cross-sectional study conducted at KSAU-HS Riyadh revealed that the methods of teaching anatomy and students’ preferences should be considered. It was also found that there is no single ‘best’ method to learn anatomy as many factors affect the selection of the methods of learning anatomy (Al-Mohrej et al., Citation2017), which is similar to the results of our study.
5. Conclusion
In conclusion, the traditional method of cadaver dissection has been the gold standard for learning anatomy for hundreds of years, and, according to Jeddah’s medical students, it remains thus at the present time. With technological expansion, a combination of cadaveric dissection and digital models is preferred. We recommend that medical schools not limit the methods used in teaching anatomy and look toward choosing preferred methods. For example, dissection can be combined with the methods used in the institutions. In conclusion, to help provide enhanced education for students, further studies should be conducted using a randomized technique to determine anatomists’ perceptions of the effectiveness of the learning methods that are used at their institutions or conducting the same study in different cities in Saudi Arabia with higher response rate. In addition, future research should consider physicians [surgeons] as a population to determine the effectiveness of the methods used in their institutions.
Acknowledgment
The authors thank all participants for their responses and cooperation. Moreover, the authors would like to acknowledge the anatomists (Dr. Juman Almusaed, Dr. Bader Khawaji, and Dr. Nagi Bakhit) and the medical educator (Dr. Sabina Ahmed) for helping us build and validate the questionnaire.
Disclosure statement
No potential conflict of interest was reported by the author(s).
Additional information
Notes on contributors
Malak A. Alghamdi
Malak A. Alghamdiassistant professor of Anatomy at College of Medicine, King Abdulaziz University for Health Sciences.
Reem Bu Saeed
Reem Bu Saeed assistant professor of Anatomy at College of Medicine, King Abdulaziz University for Health Sciences.
Waad Fudhah
Waad Fudhah, Danah Alqarnia, Shahad Albarzan, and Sheifa AlamoudiMedical students at College of Medicine, King Abdulaziz University for Health Sciences.
Danah Alqarni
Waad Fudhah, Danah Alqarnia, Shahad Albarzan, and Sheifa AlamoudiMedical students at College of Medicine, King Abdulaziz University for Health Sciences.
Shahad Albarzan
Waad Fudhah, Danah Alqarnia, Shahad Albarzan, and Sheifa AlamoudiMedical students at College of Medicine, King Abdulaziz University for Health Sciences.
Sheifa Alamoudi
Waad Fudhah, Danah Alqarnia, Shahad Albarzan, and Sheifa AlamoudiMedical students at College of Medicine, King Abdulaziz University for Health Sciences.
Muhammad Anwar Khan
Muhammad Anwar KhanLecturer ofMedical Education at College of Medicine, King Abdulaziz University for Health Sciences.
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