Doing dissections differently: A structured, peer-assisted learning approach to maximizing learning in dissections

Abstract

Areas of difficulty faced by our veterinary medicine students, with respect to their learning in dissection classes, were identified. These challenges were both general adult-learning related and specific to the discipline of anatomy. Our aim was to design, implement, and evaluate a modified reciprocal peer-assisted/team-based learning format—Doing Dissections Differently (DDD)—to complement existing dissection classes, with the intention of enhancing both student learning and the student learning experience. Second year veterinary medicine students (n = 193), in their usual dissection groups, were randomly assigned to one of four roles: anatomist, clinician, radiologist, and learning resources manager. Students attended a preparatory workshop outlining the skills required for effective execution of their role. They were then asked to perform their roles throughout five consecutive musculoskeletal dissection classes. Student attitudes to dissection classes before and after DDD were evaluated by questionnaire (146 respondents). There was a significant (P = 0.0001) improvement after DDD in a number of areas: increased perceived value of dissection classes as an anatomy learning aid; improved appreciation of the clinical relevance of anatomy; increased use of resources before and during dissection classes; and longer preparation time for dissection classes. Before DDD, 45% of students felt that at least one peer did not contribute usefully to the group during dissection classes; no improvement was seen in this measure after DDD. Although the new format highlighted a potential need to improve teamwork, most students actively engaged with DDD, with dissection classes valued more highly and utilized more effectively. © 2012 American Association of Anatomists.

INTRODUCTION

Anatomy Teaching and Its Challenges

The subject of anatomy has long been central to medical and veterinary education and once formed the foundation of preclinical teaching (Bardeen, 1905); however, in recent years, the way in which anatomy is taught has undergone a multitude of changes. Gradual advances in scientific knowledge and experimental techniques have led to a need to teach other preclinical subjects in more depth (Warner and Rizzolo, 2006; Drake et al., 2009), with the result that increasingly fewer hours are dedicated to anatomy teaching. As early as 1923, a report by the American Association of Medical Colleges recommended that the time devoted to teaching anatomy should be restricted (AAMC, 1923; Keiller, 1923; Reid, 1931; Eldred and Eldred, 1961), and more recently, following the publication of Tomorrow's Doctors (GMC, 1993, 2003, 2009), many medical curricula in the United Kingdom have evolved to incorporate the teaching of general competencies such as communication skills and professionalism, leading to a reduction in traditional scientific content (Harden et al., 1997; McHarg and Kay, 2008; Jaarsma et al., 2009). Specific to the field of veterinary education, the release of the Pew National Veterinary Education Program Report (Pritchard, 1988) initiated a similar change in emphasis, with an increased focus on learning the necessary professional behaviors and attitudes of a veterinarian. Most recently, the publication of a list of Day One Competences by the Royal College of Veterinary Surgeons marked a major shift in the United Kingdom toward an outcome-based approach to veterinary education (RCVS, 2001).

These changes have led many academics to register concerns about the effect of reduced teaching hours on anatomical knowledge and clinical practice. Studies comparing anatomy test scores between traditional and new (post-1995, systems-based) medical curricula demonstrate that students taught under the traditional system scored better (McKeown et al., 2003). When differences in anatomical knowledge between students from different medical schools were explored, unsurprisingly, students who spent longer in anatomy classes, or who had increased frequency of exposure to anatomy, were found to hold better anatomical knowledge (Blunt and Blizard, 1975; Prince et al., 2003; Bergman et al. 2008). Other studies also support the fact time on task does result in increased knowledge of a subject (Verhoeven et al., 2002). It is therefore not unreasonable to suggest that the reduction in anatomy teaching hours experienced in recent years by the medical/veterinary professions may have impacted on the anatomical knowledge of students and graduates. This has been acknowledged by experienced clinicians and newly qualified doctors alike (Monkhouse, 1992; Prince et al., 2005; Ahmed et al., 2010, 2011), with studies indicating that recently qualified doctors feel poorly prepared for everyday practice because of their perceived lack of anatomical knowledge (Bagley et al., 2011), and that poor anatomical knowledge may negatively influence career direction and progression (Smith and Mathias, 2011). Given these potential implications, anatomy educators are faced with the challenge of finding alternative methods by which to enhance anatomical learning in the face of reduced contact hours (Sugand et al., 2010).

Of course, while changes to medical and veterinary curricula have provided challenges, they have also presented opportunities. The increased focus on the development of nonknowledge-based competencies does offer benefits to students, providing them with the essential social and professional skills they will need to become well-rounded practitioners in the future. Experience has shown that noncognitive skills are well adopted and engaged with when taught alongside traditional subjects such as anatomy (Sprunger and Smith, 2005; Burns et al., 2006; Lachman and Pawlina, 2006; Pawlina et al., 2006), and thus, teaching methods that combine a balance of the two should be encouraged.

Adult Learning Challenges

Malcolm Knowles (1913–1997), an American adult educator, coined the term “andragogy” and developed the concept that adults learn, or should be taught, differently from children (Knowles, 1968). According to Knowles (1984), adult learners should be taught in such a way that explains why certain knowledge/skills are taught (readiness); is task oriented, rather than requiring memorization (problem-oriented); acknowledges the diversity of learners (builds on past knowledge); and allows adults to learn on their own and from their mistakes (self-directed). As such, teaching that encourages “active-learning” (Mayer, 2004), requiring students to reflect on ideas, assess their own degree of understanding or skill, and participate actively, is closely aligned with Knowles' principles and has been suggested as a method to help students achieve a more meaningful learning experience (Michael, 2001; Novak, 2002; Michael, 2004). Active learning principles have been widely incorporated in basic science, and specifically anatomy, teaching in recent years (Chan and Wiseman, 2011), in particular using peer-assisted learning (PAL) (Nnodim, 1997; Johnson, 2002; Krych et al., 2005) and team-based learning (TBL) approaches (Nieder et al., 2005; Vasan et al., 2008, 2009, 2011).

Peer-assisted learning, defined as “People from similar social groupings who are not professional teachers helping each other to learn and learning themselves by teaching” (Topping, 1996), has been widely used for centuries, and can take many forms, from the more literal PAL, which involves students of a similar level teaching each other, to near-peer teaching, where more experienced students teach those who are less experienced. PAL is based on the principle of increasing the “active” component of learning, encouraging collaboration between classmates, and fostering development of professional skills such as communication, teamwork, and mutual respect for peers (Krych et al., 2005). PAL teaching methods reportedly fulfill the objectives of a constructivist learning environment by extending students' responsibility and ownership; promoting study, investigation, and problem solving in authentic, meaningful, and satisfying contexts; and utilizing dynamic learning activities that promote higher-level operations (knowledge construction) (Lebow, 1993; Wilson, 1996).

Peer-assisted learning studies have been used and evaluated widely in anatomy teaching, many with positive results in terms of improvement of student knowledge and skill acquisition (Nnodim, 1997; Krych et al., 2005; Nieder et al., 2005; Ballie et al., 2009; Schauseil-Zifp et al., 2010). Reported benefits of PAL depend on role, that is, tutor versus tutee (Annis, 1983), with tutors receiving benefits in terms of improved subject comprehension (“learning through teaching”) and improved instruction and communication skills, and tutees benefiting through the informal and nonthreatening environment that PAL fosters. Many examples of PAL initiatives to date involve (often more senior) students demonstrating aspects of anatomy to one another on their cadaver/dissection, and/or using PAL to plug a gap in teacher resources (Hendelman and Boss, 1986; Yeager, 1996; Nnodim, 1997; Johnson, 2002).

Team-based learning is a specific form of PAL, which sets out to link structured individual out-of-class preparation by students, with in-class team-based discussions (Vasan et al., 2008). It has been shown to be an effective method of conducting interactive small group peer teaching (Parmelee, 2007) with enhanced learning benefits (Vasan et al., 2009). TBL provides students with a structured, preparatory framework on which to build their learning (Vasan and DeFouw, 2005), and it is this which distinguishes TBL from traditional PAL. This “scaffolding” of preparatory activities is likely to be one of the keys to the success of TBL. A structured, scaffold approach has been implicated as a useful tool for easing the transition of the student from a pedagogical to an andragogical (adult) learning style, providing students with direction to learn more effectively (Rosenshine and Meister, 1992), but encouraging rather than enforcing independence. Such a scaffold can be gradually removed or adjusted, allowing students to participate at “an ever increasing level of competence” (Palinscar and Brown, 1984). This is particularly pertinent for teachers in higher education, as many undergraduate students are young individuals, moving into adulthood, and the use of scaffolds may ease the transition between two very different styles of learning.

Aim

To address both the general adult-learning related and anatomy-specific challenges introduced here, we set out to design, implement, and evaluate a system of teaching to complement existing dissection classes, with the intention of enhancing both student learning and the student learning experience. The specific aim of this study was to implement a modified PAL/TBL approach during dissection classes and to evaluate student perceptions of this new format.

MATERIALS AND METHODS

Educational Context

In 2007, the five-year undergraduate entry Veterinary Medicine (B.Vet.Med.) program at the Royal Veterinary College (RVC), London, UK, underwent radical and rapid change with the implementation of a new student-centered integrative curriculum. Didactic teaching was reduced to free up time for independent study and to encourage students to adopt a “deeper” and more active approach to learning (Marton and Saljö, 1976; Prosser and Trigwell, 1999). This reduction in instructional teaching presented a particular challenge within the discipline of anatomy. Previously, veterinary medicine students encountered some anatomical theory in lectures before dissection classes and had a large amount of time allocated to dissection classes to visualize, digest, and contextualize the material. Under the new curriculum, there are no traditional anatomy lectures, so students now predominantly encounter anatomy and its language only in dissection classes (Fig. 1). There has also been a 25% reduction in the time allocated to dissection classes, and a reduction in the provision of content support materials (e.g. detailed anatomy handbooks). Furthermore, students are required to integrate both knowledge and skill across a number of different disciplines simultaneously, for example, digestive physiology is now considered within the teaching of the anatomy of the alimentary system. This means that students are required to think not only about anatomical structures during dissections but also about function and complex processes within the body. Students therefore need to be focused and well prepared if they are to cope with, and get the most from, their timetabled dissection sessions.

Figure 1. Undergraduate students during dissection class at the Royal Veterinary College in London, UK.

Through our observation of teaching and learning precurriculum and postcurriculum change, we identified some “challenges,” which we considered consequences of student difficulties transitioning to an independent adult learning style and felt were prohibitive to effective teaching and learning in dissection classes:

• 1
  Student under-use of physical [e.g. models, skeletons, prosections] and online resources, and consequently an over-reliance on staff as a source of factual information.
• 2
  Student difficulty in identifying, and hence prioritizing, clinically relevant anatomy.
• 3
  Student difficulty in coping with a large volume of information in a short single session.
• 4
  Lack of student engagement, with some leaving early despite of severely reduced contact times.
• 5
  Varying commitment and preparation by individual students within a dissection group.

Year 2 students in the B.Vet.Med. program (n = 193) took part in the newly designed musculoskeletal teaching strand. Students gain entry onto the B.Vet.Med. course following completion of A Level or equivalent qualifications (most commonly when they finish secondary school education at 17–18 years of age). The cohort also contained a smaller proportion (12.5%) of graduate entry students from both United Kingdom and United States undergraduate bioscience (or similar) degree programs. The mean age of participants was 21 years (range 19–42 years).

During the particular teaching period studied, five dissection classes were scheduled: “Canine forelimb,” “Canine hindlimb,” “Equine forelimb,” “Equine hindlimb,” and “Equine distal limb.” These classes range in duration from 1.5–3 hours depending on subject matter and are voluntary, though in general receive high attendance. Because classes are short, a large body of anatomical knowledge and understanding needs to be assimilated by students in a relatively small number of dissection hours, and thus, time in class must be supplemented by effective preparation and further study so that all learning objectives can be achieved.

Basis and Rationale for Learning Design

To give dissections context and better align the content of sessions with students' perceptions of their learning needs (“readiness,” in terms of Knowles' andragogy; Knowles, 1984), it was considered necessary to emphasize the areas of functional anatomy, clinically relevant anatomy, and radiographic anatomy to greater effect during dissections. Given the time constraints, and taking into account that a large body of fundamental anatomical knowledge also needed to be acquired during classes, students were encouraged to focus on these three areas in their preclass preparation.

In light of the importance of promoting professionalism (including good communication, teamwork, and respect) and to encourage active learning (Krych et al., 2005; Michael, 2006), a PAL/TBL framework was adopted to support this preparation. We chose to use PAL reciprocally in the new teaching format, so that all students within a group were both tutors and tutees, ensuring every member had the opportunity to access all associated benefits. To facilitate this, four roles were created, one for each student in a dissection team, around which preparatory material was structured: anatomist, clinician, radiologist, and learning resources manager (LRM). Other studies have previously utilized role-playing effectively within the dissection room, citing it as useful for promoting active learning (Heyns, 2007). It was important that each student within a dissection team was given a different role to increase their sense of responsibility to the group. As a means of scaffolding, to foster a transition toward independent learning (Rosenshine and Meister, 1992), we created generic tasks assigned to each role. These tasks required independent research and work but were grounded in teacher-guidance, for example, by allocating students a specific clinical condition or paper to center their studies on. We called this format Doing Dissections Differently (DDD).

Doing Dissections Differently (DDD)

As discussed, students were randomly assigned one of four roles within a dissection team. Occasionally, this was not possible, where a group had only three members, so in these circumstances, the LRM role was not allocated, as the responsibilities of this role could most easily be shared among the group.

A 1-hour preparatory workshop was provided for each of the four roles by relevant teaching staff to introduce students to the new format and convey the skills and knowledge required to effectively fulfill their specific role. Anatomists were tutored by an anatomy lecturer (S.W.); they were asked to consider how the internal structure of a muscle influences its function and were given a demonstration of how to look for architectural muscle features during dissection. In addition, anatomists were provided with one peer-reviewed paper relating to each of the future dissection classes to aid their learning of the functional significance of structures to be encountered during dissection. They were asked to champion the functional aspect of anatomy and use their acquired knowledge to highlight the functional importance of structures to the rest of their team during dissection classes.

Clinicians were tutored by an anatomy demonstrator and practiced veterinarian (E.H.) and given a headline clinical condition relating to each of the dissection classes. They were introduced to clinical educational journals, such as In Practice, to enable them to research these clinical conditions for themselves in a self-directed manner. Clinicians were asked to teach their peers about the headline condition at a suitable time point (determined by them) during the dissection class.

Radiologists were tutored by a senior lecturer in equine diagnostic imaging (R.W.) and provided with a radiograph pack, containing one or two radiographs relevant to each dissection class. Their workshop taught them how to read a radiograph and encouraged students to use “post-it” type labels to mark anatomical structures on both their radiographs and corresponding skeletons. They were encouraged to study the radiographs with their group in this manner before each dissection class.

Learning resource managers (LRMs) attended a workshop run by a learning resources developer (S.P.) on how to use an online Wiki within the college's social learning platform (Blackboard, Washington, DC). This Wiki was utilized as a communication tool to allow groups to easily share online resources and links with one another in a private group-specific space. LRMs were asked to upload three resources (or details of useful resources) relating to the upcoming dissection classes in a timely manner (several days before the class) for the rest of the students in their group to access.

The tasks that each group member undertook were carefully chosen to guide student achievement of the learning objectives of the specific anatomy dissection class, and also to scaffold students' self-directed preparation for class and promote active learning. The generic tasks undertaken by each group member were constant for each of the dissection classes, altering only in the specific content of the class and thus material. Details of the individual roles were provided in a handout to all students so that they were aware of what other members of the team had been taught and asked to carry out. A summary of participant roles and our expectations of the students within those roles can be found in Table1. During dissection classes, it was very much the students' responsibility to chose appropriate time points to impart their knowledge, and teaching staff did not intervene beyond the workshop delivery.

Table 1. Roles Within a Dissection Team and Their Associated Designated Tasks

Evaluation of the DDD Format

Ethics approval for project evaluation was sought and obtained from the RVC Research Ethics Committee. Student perception of the new musculoskeletal strand design was evaluated by means of questionnaire (see Appendix). Questionnaires were paper-based and accompanied by a cover sheet stating that: submission of the questionnaire implied consent for entry of their data into the study; participation was not compulsory and was anonymous; and that nonparticipation would not adversely affect their studies or assessment. Questionnaires for both pre-evaluation and postevaluation were distributed ahead of tutorials, and once completed students were asked to place them into a box before the tutorial started. The teacher was not present at the time of completion. Questions sought to ascertain the following:

• 1
  Demographic data (sex, age)
• 2
  Perception of the value of dissection classes before and after DDD
• 3
  Perception of the clinical relevance of dissection classes before and after DDD
• 4
  Use of resources and amount of preparation before and after DDD
• 5
  Teamwork ethic before and after DDD
• 6
  The role(s) undertaken during DDD
• 7
  The level of enjoyment associated with carrying out specific roles
• 8
  The perceived level of importance of each of the roles
• 9
  Perception of the value of role induction workshops as preparation for DDD
• 10
  Positive and negative experiences of DDD

A quantitative approach was applied to statistically compare preopinion and postopinion for items 2–6 and to numerically describe items 7–9. Perception of dissection classes and workshops and information regarding resource-usage, preparation, and teamwork ethic were obtained using a four-point Likert scale to encourage respondents away from a neutral standpoint: 1 = Strongly agree; 2 = Agree; 3 = Disagree; and 4 = Strongly disagree. A qualitative approach was applied to gather authentic and potentially complex data relating to student perceptions (item 10); free-text sections of the postevaluation questionnaire enabled collection of these data.

Data Analysis

Quantitative data were analyzed in PASW statistics package, version 18 (SPSS Inc., Chicago IL) and descriptive statistics obtained. Pre- and post-DDD data were analyzed using Wilcoxon signed rank tests. Qualitative free-text data were analyzed using a thematic approach; data were manually coded into common themes, with all coding verified by a second coder for reliability. Reliability was measured as percentage agreement, which was 96 % for the dataset.

RESULTS

One hundred and forty-six surveys were completed and returned (76% response rate). Of these, 77% of respondents were female; 57% of respondents were 17–21 years of age; 39% were 22–30 years of age; and 4% were >30 years of age. Respondents were representative of the population studied.

Value and Relevance of Dissection Classes

After taking part in the new DDD class format, students valued dissection classes as a means of learning anatomy more highly: pre-DDD, the majority (75%) strongly agreed that dissection classes help them to learn anatomy, but this figure increased to 92% after participation in DDD classes (P = 0.0001; Fig. 2). Students also reported a heightened appreciation of the clinical relevance of anatomy following DDD: pre-DDD, 42% strongly agreed that dissections help them to appreciate the clinical relevance of anatomy; this rose to 76% after participation in DDD classes (P = 0.0001; Fig. 2).

Figure 2. Student perception of various aspects of dissection classes prior to (dark purple bars) and after (light purple bars) participating in the new Doing Dissections Differently (DDD) format. Four-point Likert scale represents: 4 = strongly agree, 3 = agree, 2 = disagree, and 1 = strongly disagree. Bars represent median ± interquartile range + indicates mean. a highlights significant differences at P < 0.05.

Use of Resources, Preparation, and Teamwork Ethic

Students reported an increased use of resources in their preparations for DDD dissection classes (P = 0.0001; Fig. 2), with 79% reporting some use of resources before class (previously this was only 51%). General preparation for dissection class (by reading through the study guide routinely provided) also increased from 80% of respondents doing this as a minimum, to 86% (P = 0.0001; Fig. 2). In addition, student use of radiographic resources increased during DDD dissection classes: 39% consulted radiographs during classes before taking part in the new format, compared with 79% while taking part in DDD (P = 0.0001; Fig. 2).

Pre-DDD, 45% of students reported that at least one member of the dissection team did not participate fully. No difference was seen in this measure after DDD (P = 0.495; Fig. 2).

Roles

Student enjoyment of performing a role varied: the majority of students enjoyed the anatomist and clinician roles (91% and 98%, respectively), whereas 100% of the radiologists reported enjoying this role; only 45% of LRMs enjoyed their role, with the majority of respondents (55%) disliking this position.

Students perceived the anatomist to be the most important role (ranked highest by 61%), followed by clinician (32%), radiologist (13%), and LRM (10%).

Role Induction Workshops

Students indicated that role induction workshops were useful for clarifying their role (median score 4: “strongly agree”), explaining the rationale behind PAL (median score 3: “agree”), preparing them for carrying out their role (median score 4: “strongly agree”), and highlighting helpful information sources (median score 3: “agree”; Fig. 3).

Figure 3. Student evaluation of preparatory workshops. Bars show median ± interquartile range. Four-point Likert scale represents: 4 = strongly agree, 3 = agree, 2 = disagree, and 1 = strongly disagree.

Positive and Negative Experiences

Four positive themes were identified in the free-text comments relating to the student experience of DDD. These are listed below:

• Preparation for dissection class

• Knowledge and learning

• Use of resources

• Group interactions.

Four negative themes emerged:

• Role design

• Workload

• Participation and team ethic

• Information anxiety.

Of the respondents, 94% entered positive free-text comments. Of these, 8% concerned use of resources (“I used more resources and found images online”); 29% described preparation for dissection class (“It made us prepare more,” “More targeted and efficient preparation,” “Made it essential to prepare as you were part of a team”); 40% described knowledge and learning (“Increased information coverage,” “Widened my learning,” “Increased motivation to study,” “Increased engagement”); and 23% described group interactions (“Each of us could make a more valid contribution to the dissection and learn more as a whole,” “Increased the discussion in our group,” “You had responsibility to your team so everybody contributed”).

Negative comments were entered by 78% of respondents. Of these, 18% mentioned time and workload (“It felt like a lot extra work,” “It took time away from other preparation I would do”); 17% described role design (“Some roles were more work than others,” “The LRM role was not that useful”); 16% pertained to information anxiety (“I was worried that I would miss out on information if I wasn't doing it myself,” “It relied too much on others to do adequate research”); and finally the largest percentage, 51%, concerned participation and team ethic (“Some people did not make any effort to prepare,” “People often failed to do their role meaning we missed out on a great opportunity”).

Future Use of the New DDD Format

Overall, 93% of respondents felt their learning was well supported by DDD. Eighty-eight percent of students reported that they would like to learn anatomy in a similar format during future dissection classes. However, only 16% were confident that their group would continue to use the DDD format without specific direction from staff.

DISCUSSION

Discussion of Results

Doing Dissections Differently had a positive influence on student learning behavior in a number of areas. Students reported an increase in preparation and use of resources, both before, and during dissection classes. We believe this positive learning behavior can be attributed to several aspects of the study design. The use of a PAL/TBL approach resulted in an increase in the active learning component of classes and is likely to have encouraged activation of prior knowledge (Haidet et al., 2004) and active knowledge construction (Schmidt et al., 1989), which are both key in the conceptual framework of andragogy (Knowles, 1984). The content of sessions was aligned more closely with the functional and clinical significance of the anatomy being studied, making the material more relevant, and thus, more easily digested by students (readiness to learn; Knowles, 1984). Finally, the use of a structured framework for individual preparation may have benefited students who are not yet comfortable with the self-direction implied in adult learning. The Staged Self-Directed Learning Model (Grow, 1991) proposes that learners advance through stages of increasing self-direction, and that teacher's can help or hinder this development. Good teaching has been proposed to match the learner's stage of self-direction, helping the learner to advance toward greater autonomy, with evidence suggesting that provision of a structure for learners enhances independent learning skills and can improve student “readiness” for self-directed scholarship (Dynan et al., 2008).

Our findings, that PAL/TBL seems to drive students to engage more with subject content, are in agreement with other studies (Topping, 1996; Ross and Cameron, 2007). Furthermore, student prior preparation for collaborative activity influences how effectively veterinary students learn from one another (Thurman et al., 2009)—our study also suggested that commonly this preparation is inadequate. Our role-based initiative specifically focused on structuring and encouraging preparatory activities, and as such, our students appear to have received highly positive benefits from using the supportive scaffold provided by this combined PAL/TBL approach. This is in accordance with other studies, which found modified TBL to benefit student performance, as well as faculty satisfaction (Vasan et al., 2011).

Many of our students reported benefits such as increased motivation and engagement during DDD. Adults are motivated to learn by internal rather than external factors (Knowles, 1984), suggesting that DDD may have had a beneficial influence on the internal motivation of our students. Motivation is a key aspect of becoming a self-regulated learner (Zimmerman, 2002), and theories of self-regulated learning suggest that continued student motivation is dependent on their development of self-efficacy and self-monitoring skills for assessing their own achievement of learning outcomes (McCombs, 1989). It is therefore likely that the increase in motivation and reported engagement in this study was codependent, entwined in the complex process of students moving toward self-regulation, and supported by the explicit scaffold structure provided by DDD. This move toward self-regulation is likely to have been an important factor in determining these positive learning behaviors. The new teaching format did not set out to target student motivation; however, the modifications we made to teaching delivery appear to have indirectly improved this aspect of our students' learning behavior.

Although many students reported positive group interactions during DDD, not all groups reported working effectively. Common criticisms of DDD related to nonparticipation and poor team ethic of some group members. Our data suggest that before DDD, many students were aware that one or more members of their group did not participate fully in team activities, even though our students are expected to undertake small group work frequently throughout their course (during modified problem-centered learning sessions, academic tutorials, and intramural rotations). As data were collected anonymously, it was not possible to determine whether these students were from the same or different dissection groups—hence it is not clear if 45% of groups were therefore ineffective, or whether this figure is reduced, given multiple group members reporting back with the same individuals/problems in mind. Regardless, even if this reflects the latter, this would mean a minimum of 11% (6 out of 49) of our groups were ineffectual, resulting in a compromised learning experience for all or some of these students. This lack of confidence in some members of the team is almost certainly related to the information anxiety felt by a proportion of students, who expressed concerns about missing out on important learning through having to rely on others to do adequate preparation on their behalf. This highlights that our students generally have concerns relating to group interaction with their peers, and that unfortunately the implementation of DDD did not improve this issue.

Student satisfaction during the teaching depended on the role that they had been assigned. The majority (84%) enjoyed their role, with the anatomist, clinician, and radiologist roles proving most popular; the LRM role was enjoyed the least (55% disliked this role). There may be several reasons for this, including that it had less context than the other roles, with students preferring the direct relevance of more clinically-oriented tasks (Knowles, 1984). Another factor may have been that it was computer-based, using a Wiki to communicate links to resources outside class. Perhaps, the use of physical as well as online resources could have been encouraged; an added benefit of this would have been that relevant material could have been brought along to and discussed during dissection classes, offering the LRMs a more active role within the sessions themselves, and not just in the preparation for them.

As well as disliking the LRM role, students reported that they did not find this role particularly important, which is surprising, given our (teachers') concerns relating to student underuse of resources. Therefore, it is important that modifications be made to this role in the future to ensure all students in a dissection team enjoy their roles more equally. Either the LRM role needs to be made more attractive and accessible to students, or a new fourth role should be created and the responsibilities of the LRM should instead be shared equally among all members of the group. Students who carried out a particular role reported a slightly higher rating for their perception of this role's importance; this was consistent across all roles, however, the difference was not statistically significant.

Limitations

Within the scope of this study, it was not possible to measure the direct impact of DDD on student learning outcomes such as exam results; however, other studies consistently show a strong positive link between learning behaviors such as level of motivation and academic success (Harris, 1940; Neisser et al., 1996; Busato et al., 2000). It would be of great interest to quantify the learning outcomes of DDD—short term, long term, and in terms of relevance to clinical skills and practice in the future—to evaluate the impact of the DDD on the highest level of Kirkpatrick's hierarchy (Results; Kirkpatrick, 1998).

This study focused on Year 2 students; however, student perceptions of the format, as well as any associated benefits may differ with year of study, and in particular with their stage of progression from pedagogical to andragogical learning practices. Furthermore, this study considered only students' perceptions of their learning behavior and made no attempt to directly quantify variables such as time preparing for class or number of resources utilized.

Practical Implications

One of the aims of DDD, particularly the PAL/TBL element, was to improve the working relationships within the dissection team (with the expectation that this would positively influence learning); however, our data suggest that no improvement was seen in group participation—certainly within dysfunctional groups—during the teaching period. Although this highlights that DDD was not needed to draw attention to nonparticipants (students already have an opinion on who contributes to group tasks), it does suggests that further thought and innovation are required to improve the teamwork ethic in some of our students. That individuals within groups, that functioned as a unit and engaged with DDD, reported such positive learning benefits, suggests that we must strive to find additional means by which to ensure that higher proportions of our student groups work well together. As well as an important professional skill, teamwork has been shown to drive and further learning with strong support in the literature for the cognitive benefits of productive peer interactions (Barron, 2003). Individuals who complete group tasks within a constructive and productive (“successful”) group have been shown to perform better at similar tasks individually later on (Barron, 2003).

The ability to work with others is an essential professional skill that our students must learn before clinical rotations (which demand teamwork) in veterinary hospitals, as well as an important future professional requirement in the workplace. For this reason, the RVC curriculum requires students at all stages to work in small groups, in various learning situations. Currently, a small amount of time is dedicated to preparing students for working in teams, but perhaps this is an area that could be targeted to improve our students' understanding of the need for, and benefits of, being part of a team. This has prompted the question, “Do students arrive at university with a competitive, individual approach, or is this implicitly accepted or encouraged by faculty and/or the curriculum?” We feel that competitive entrance criteria, on an over-subscribed program, may be an important factor in driving students to adopt such an approach to learning even before they enter university. Once accepted onto the program, students may then find it difficult to adjust to a more collaborative working environment. Alternatively, we may inadvertently foster such individualist beliefs as part of the “hidden curriculum” (Hafferty, 1998). We must strive to answer this question and to address the cause, but in the interim, an introduction to teamwork should be present, explicit, and embedded within the course from early in the curriculum—and should also be revisited and built on throughout the duration of the course. It may also be beneficial to consider how teamwork is assessed during the course, as assessment is an important driver of student behavior and learning (Wass et al., 2001).

Future Work

Doing Dissections Differently highlighted several key areas worthy of further investigation. As discussed, there were clear perceived benefits of DDD for our B.Vet.Med. Year 2 students; using second year students to pilot this teaching format provided a good comparison between already embedded versus newly acquired learning behaviors. To further our research, we plan to introduce this format earlier in the course to allow us to assess how students will respond to a gradual reduction in the scaffold structure. A long-term aim of the DDD teaching method envisages students transitioning from carrying out one role, to becoming independent learners, capable of carrying out all suggested tasks routinely on their own. Scaffolding can be gradually decreased as students become more proficient and confident in their learning (Rosenshine and Meister, 1992).

This study attempted to promote positive teamwork, with the finding that improving this characteristic across all students in all groups continues to be a challenge. We believe that by introducing a PAL/TBL format, like DDD, early on in the first year of study it might assist with embedding team ethic and collaborative thinking in our students before other behaviors become established. We have also recently introduced a teamwork exercise into our student selection process and would like to further explore links between group dynamics and academic/professional success.

CONCLUSION

We implemented and evaluated a reciprocal PAL/TBL protocol, called Doing Dissections Differently (DDD), to complement existing dissection classes, with the aim of enhancing both student learning and the student learning experience. Improvements were found in several areas: improved student appreciation of dissection classes for both learning anatomy and its clinical relevance; increased use of resources before and during dissection classes; and increased preparation time for dissection classes. Students reported increased motivation and engagement and a satisfaction with the structured nature given to their preparations. There was no change in the number of students reporting dissatisfaction with other team members after DDD, suggesting limited benefits of this format for improving teamwork. Finding a method to promote positive teamwork is vital to the long-term success of DDD, and further work is underway to address this issue, to enable us to provide all of our students' best preparation for future clinical and professional situations. As DDD was well received by students and there appear to be clear benefits for learning anatomy, the format will continue to be promoted in the musculoskeletal strand, and we are considering introducing it elsewhere in our anatomy teaching.

NOTES ON CONTRIBUTORS

EMMA R. HALL, B.Sc. (Hons), B.V.Sc, M.Sc., M.R.C.V.S., has recently returned to small animal veterinary practice after working for 18 months as an anatomy demonstrator at the Royal Veterinary College, University of London, London, United Kingdom.

RACHEL C. DAVIS, B.Sc., PhD., is an anatomist and educationalist, and currently serves as Learning Development Manager at the Royal Veterinary College, University of London, London, United Kingdom. Her work involves research and active interventions in supporting student learning and widening participation.

RENATE WELLER, D.V.M., Ph.D., M.R.C.V.S., F.H.E.A., is a senior lecturer in diagnostic imaging in the Department of Veterinary Clinical Sciences at the Royal Veterinary College, University of London, North Mymms, Hatfield, Hertfordshire, United Kingdom. She splits her time between biomechanical and educational research, teaching on the B.Vet.Med. Program and running the equine diagnostic imaging clinical service.

SONYA POWNEY, B.A., M.Sc., is a learning resources developer at the Royal Veterinary College, University of London, London, United Kingdom. Her expertise is in developing interactive multimedia programs to support learning and teaching at the college.

SARAH B. WILLIAMS, B.Sc. (Hons), Ph.D., F.H.E.A., is a lecturer in veterinary anatomy in the Department of Veterinary Basic Sciences at the Royal Veterinary College, University of London, London, United Kingdom. She teaches anatomy to students on the B.Vet.Med. Degree program and other undergraduate programs, and her research interests are in functional anatomy, biomechanics, and education.

APPENDIX

 

Table  . Questionnaire Completed by Study Participants