The future of anatomy teaching post‐pandemic: An academic viewpoint

The COVID‐19 pandemic caused major disruption to anatomical teaching worldwide with both lectures and practicals being moved online. Throughout this period anatomists were able to find new and innovative ways to teach and to aid student learning via a variety of delivery modes. This study aimed to interview anatomists who were involved in teaching undergraduate medical students at UK universities to document the changes that occurred and to understand academic perceptions of pandemic delivery to comprehend how anatomy education may change in the long term. Results suggest that academics are likely to continue to deliver anatomical lectures online post‐pandemic akin to a flipped classroom approach, although caution was noted regarding ‘at‐risk’ student groups. No academics wished to see continued delivery of practical classes online, however, resources designed or invested in during the pandemic will be integrated into practical classes or pre‐class preparation allowing for a more complete student experience. No clear picture emerged as to the preferred way staff and students will communicate in the current post‐pandemic hybrid working environment and beyond. This will likely only be resolved when a new pattern of home working evolves in UK institutions. This report is the first to detail the academic vision of anatomy teaching in a post‐pandemic world and will be useful to those adapting to these changes and for those pedagogical researchers targeting where anatomical education research should focus moving forward.

limited amount of new material to be delivered (Brassett et al., 2020).This allowed anatomists to use the UK summer break (June, July, and August) to train themselves in new technologies and develop educational resources for online learning (Byrnes et al., 2020;Papa et al., 2022).
Both nationally and internationally there was a switch to delivering anatomy lectures online (Cuschieri & Calleja Agius, 2020;Korkmaz & Gürses, 2020;Pather et al., 2020;Bockers et al., 2021;Consorti et al., 2021;Harmon et al., 2021;Lee et al., 2021;Yoo et al., 2021;Attardi et al., 2022) with a variety of packages used to deliver these; for example Panopto (Brassett et al., 2020), or PowerPoint (Roy et al., 2020).Both synchronous and asynchronous lectures were employed to facilitate learning to an oftentimes worldwide diaspora of students in different time zones (Dulohery et al., 2021).The mode of delivery was considered, and altered, for different cohort sizes or educational maturity of the students (Brassett et al., 2020) and short chunk lectures were strongly encouraged to aid students' attention (Evans et al., 2020).
Popular themes also emerged for the delivery of practical classes to students.Firstly dissection/practical workbooks, such as those outlined by Findlater et al. (2012), were converted to e-workbooks and used links to online cadaveric models such as those from anatomy TV, Acland's atlas or 3D photogrammetry packages (Brassett et al., 2020).
The Anatomical Society and the International Federation of the Association of Anatomists worked closely with medical schools to provide lists of resources to help students at home and help educators deliver practicals online (Cuschieri & Calleja Agius, 2020).Some departments allowed the use, with appropriate antemortem consent, of cadaveric photographs (Cuschieri & Calleja Agius, 2020), bespoke videos (Gupta & Pandey, 2020;Bockers et al., 2021), or live prosection demonstrations (Cheng, Esmonde-White, et al., 2021) with students acknowledging their moral and ethical responsibilities when viewing them at home (Muñoz-Leija et al., 2020).If in-house cadavers were not used dissection videos from external sources (Yoo et al., 2021), interactive dissections such as VH dissector touch (Brassett et al., 2020) or the Visible Human Project (Longhurst et al., 2020) were deployed.Virtual anatomy software, for example, Visible Body or Complete Anatomy, were often used in these seminars to aid student understanding (Brassett et al., 2020;Cheng, Chan, et al., 2021;Flynn et al., 2021).In addition, the conferencing platforms offered a variety of tools to aid the educator, including virtual whiteboards, screensharing, screen annotating, group typed chats, and breakout rooms (Byrnes et al., 2020).Quizzes were also reported to play a large part in these practical classes to ensure interactivity and for the academics to keep track of progress (Brassett et al., 2020).
Interestingly near peer teaching was often introduced for these seminars (Thom et al., 2021); likely due to the volume of sessions that had to be delivered.Histology practicals were also delivered online using virtual microscope systems (Bockers et al., 2021) as were anatomical journal clubs using Teams (Keet et al., 2021).
For the academic year 2020-2021 some medical schools adopted a hybrid approach including face-to-face practicals.These were undertaken with PPE such as visors, lab coats, and gloves.It also saw students placed in small bubbles (Barash et al., 2021), undertake on-site temperature screening (Yoo et al., 2021), and/or complete online pre-class symptom screening questionnaires (Ross et al., 2021;Tucker & Anderson, 2021).These safety adaptations often meant the classes had to be drastically altered and often a requirement for increased teaching hours was needed due to the smaller groups (Bockers et al., 2021;Bond & Franchi, 2021).
Prior to the pandemic anatomy was taught using dissection, prosections, medical imaging, living anatomy, lecture-based, and computeraided learning (Wolf, 2019).These have all, in some form, been derived from previous seismic changes in anatomy education (McLachlan & Patten, 2006;Shamsuddin Siddiquey & Shahzaman Husain, 2009;Sawchuck, 2012;Sahin & Çavuş, 2019;Naidoo et al., 2021).Will the pandemic of 2020 be seen as another seminal moment in the history of anatomy education?Will it fundamentally move anatomy to a subject that can be taught and learned from a distance?Certainly, if history shows this as a watershed moment it will not be because of the invention of new technologies as has previously been the case, but rather the forcing of a generation to change toward tools that are already developed.In addition, the proportion of anatomy teaching within medical curricula has been dropping over the last two decades (Fitzgerald et al., 2008), with some suggesting that it has already fallen below a safe level (Chapman et al., 2013).This is due to the increased understanding in all fields of medicine plus a general shift toward a system-based approach leaving a regional-based dissection difficult to fit in Estai and Blunt (2016).Will changes be brought about, using the lessons from pandemic teaching, to try to combat this issue?
This study documents, and gives the academic staff perceptions of, the changes to anatomy teaching that occurred during the COVID-19 pandemic in the United Kingdom.This was achieved by interviewing anatomists who were involved in teaching undergraduate medical students at UK universities with the aim of comprehending how anatomy teaching will change in the long term.In addition, this study aims to support the community of anatomists by informing educators making transitions in their teaching but also to direct educational research to relevant areas that may be currently lacking due to the novelty of post-pandemic anatomy teaching.

MATERIAL S AND ME THODS
This study was designed as an exploratory descriptive investigation within the interpretive paradigm.This was chosen as the study aimed to understand the motives and meanings behind modifications in future teaching practices (Kivunja & Kuyini, 2017).It also acknowledges the ontological position that interviewees responses will be shaped by their own experiences (Levers, 2013).
Both personal and interpersonal reflexivity was closely monitored during this study.As all authors had themselves taught during the pandemic personal experiences and views will naturally influence method, data collection and analysis (Duffy et al., 2021).In addition, interpersonal relationships and power dynamics were also considered between interviewer and interviewees.Discussion between authors at all stages of this study considered these biases and attempted to reduce them through using open questions in the interview stage and through checking of the analysis performed and themes generated.
The selection criteria for interviewees were as follows; participants had to have lectured and/or demonstrated anatomy to undergraduate medical students at UK institutions at some point during the COVID-19 pandemic (defined as March 2020 to February 2022 for the purposes of this study) and had aided in design changes of this delivery.

Ethical approval was granted by the University of Edinburgh
Medical Education Ethics Committee (reference number 2021/18).
Twelve lecturers were approached for interview via email with 10 responding.All interviews were conducted between October and December 2021.
Interviews were conducted by APB and organized in a semistructured format with a prescribed question set (see Table 1).An initial pilot interview was conducted between authors to determine the robustness of questions for answering overall research aims.
Interviewees were prompted to expand, elaborate, or explain answers to initial questions depending on the responses that were given.All interviews were conducted online and recorded using Microsoft Teams, and automatically transcribed.Following each interview, the recordings were rewatched and the transcription was corrected to accurately represent the conversation.
Thematic analysis followed the 6-phase step outlined by Braun and Clarke (2006) with an additional pre-step.This pre-step involved reviewing the recordings and correcting any automatically generated mistakes from completed transcripts.The first step involved reading all the transcripts for familiarization of the data.Coding was initially carried out by APB by highlighting relevant quotes by hand, on printed transcripts, to generate themes.Generated themes were subsequently discussed with all authors to refine and create additional subthemes that were subsequently named.Interviewees were anonymized and assigned a number which are referenced next to each quotation in the results.

RE SULTS
Ten academics at UK higher education institutions were interviewed for this study with teaching experience ranging from 2 to 10 years, and an age range of 25-37.Eight of the academics were female and two were male.All the academics interviewed were TA B L E 1 Guide questions used for semi-structured interview.

Summary of pre-pandemic teaching
All universities provided hands-on anatomy practicals before the pandemic with nine out of ten departments teaching via a systems approach while one PBL course was more fluid.Practicals being defined as teaching in a classroom setting via dissection, or using prosections, models, or medical images.Four of the courses used models to teach in a station-based approach, as did the three that used prosections (dissected specimens) with models.Stationbased teaching involves students rotating around the classroom to view different specimens, models, or to undertake different activities.This approach allows for students to see multiple different structures during a single class.Interestingly, the remaining three that used dissection also ran practicals involving models and prosections to supplement their teaching due to a lack of space and resources.Thus, none of the respondents reported running a complete, whole-body dissection course for this cohort (see Table 2 for summary).All institutions taught medical students during years 1 and 2 of their courses.Some institutions continued anatomical education post 2 years however this was greatly reduced and focused on more on recapping or introducing specific advanced topics.
All courses delivered anatomy lectures in some form with 7 of the 10 mentioning that they were delivered before the relevant practical.Of the three that did not, this was seen as a negative as the lecture was delivering core knowledge that was to be understood in the practical classes.Most courses recorded their live lectures and uploaded them afterward, with those who did not citing the use of cadaveric images.
Pre-pandemic there appeared to be variability with what online resources were available for students.All interviewees reported that they uploaded their practical workbooks, detailing the information, and the tasks to undertake in the practical, before the class, although not always in their complete format so that the practical was a reinforcement of knowledge.Some departments did deliver bespoke material online; for example, pre-practical videos which used models to prepare students for the prosections that they would see in class or full online courses of a specific, difficult, topic; embryology for example.
It is also important to note, when considering this study, that many of the anatomists commented that the existence of anatomy practicals allow for strong professional relationships to form between students and anatomy teachers that may not exist in other subject areas.

Academic view on how pandemic practices influenced student learning
As the interviews were focused on the changes to teaching that occurred during the pandemic the analysis led to two key themes being identified; 'Pandemic practices that were a success' and 'pandemic practices that were not a success'.Within these themes, pedagogical considerations and teaching practicalities were considered as they both contribute toward the student's ability to learn.Here we have tried to untangle what aspects of various educational techniques were helpful, or unhelpful, to student learning during the pandemic.This means, for example, that lectures will be included in both themes but considered how changes made to lectures during the pandemic helped or hindered learning.
These key areas feed together with how anatomy was previously taught at each institution to form an academic viewpoint as to how anatomy teaching should proceed.Taken with the students and institutions view of how anatomy should be delivered will determine how anatomy is delivered in the long term.This is visualized in Figure 1.

Lectures
Most lectures were pre-recorded and placed online via various platforms.Oftentimes these were allocated a timetabled slot to ensure that they were not overburdening the students.Interestingly, almost universally, the lectures were recorded in short bursts ranging from 7 to 15 min in length which the academics commented on as being well received by the students.Also, the online lecture allowed the addition of quizzes and self-assessments to aid in the active learning of students.Staff were at pains to make resources as interactive as possible.
It would help consolidate their learning, but also make them feel like they're doing something rather than just passively listening. [1] Positive comments were made regarding how students watched and digested the information presented with the online delivery allowing more flexibility.
you know what it's like with anatomy it, so it's a lot of information isn't it?… Listen to 10 minutes, then when they zone out, just pause. [2] The use of transcripts was seen as a plus for the students.
something that happened naturally is that I've started to include transcripts, and I've already had an email from a student saying how helpful it is to have the detailed transcript on there. [5] Home distractions have been pointed out as an issue for online lectures, however some academics flagged this as an issue in face-to-face lectures too and therefore suggest that watching lectures at home is beneficial.
People would be on their phones or talking.I think it's less distractions for students cause there less people chatting knowing each other and being distracting. [8] In addition to the perceived pedagogical advantages there is also an acknowledgement that there are practical advantages to a prerecorded lecture.All of which will help the student and therefore aid in their learning.First and foremost is the flexibility that a student will have regarding when to watch the lecture In addition, the pre-recorded lecture means students do not have to sit through back-to-back lectures and can give themselves breaks.The lectures can also be uploaded and therefore watched before classes ensuring that students come ready with questions which was not always the case pre-pandemic due to scheduling problems.
There was acknowledgment that lecture theater size would no longer be an issue with the pre-recorded or live online lectures.
Thus, students will likely be more comfortable at home as opposed to an overcrowded lecture theater.
There were also some advantages to the academic's workload and their ability to monitor the students.For example, academics can learn more about crude measures of student engagement due to the various metrics these packages offer.interviewed were clinicians, it was felt that it was far easier for a clinician to pre-record a lecture than taking time out of their clinic to deliver it face to face.
For the lecture to become a true online phenomenon it was pointed out that good practice must be adapted by all; for example, short lecture chunks, quiz breaks, and transcripts should be common place.This may not always be the case, especially when busy clinicians are asked to give lectures.

Practicals
During the early stages of the pandemic and when additional lockdowns were implemented various online resources were used to replace the time in the laboratories.This mainly consisted of providing images, 3D models, or videos to replicate the specimens or models that were used in the classrooms.The workbooks provided in the classes were modified for students to go through alongside these online resources allowing more preparation time for practical sessions.
The academics recognized the usefulness of these resources to aid the practical classes in the future.
We never linked to it before so now they actually got some images in there.They've got some links, they can have a look at the stuff before they come in and The extra resources generated by the online switch can be utilized to replace certain specific practicals as lab time gets squeezed and they can be used for students who are unable to attend a class.
They're great because we've had to, because we've for an increase in students we've had to decrease the amount of time they have in the lab.Another small advantage of the online practical is that everyone starts on the same station.This is never the case in station-based practicals.This, therefore, lends itself to the building of knowledge from the start to the end of the class and results in a more equitable experience for the students.
Practicals were also conducted as online seminars to allow an interactive element.There were unique advantages that the academics pointed out to this type of delivery.Students valued the anonymity that the online seminars provided.Making them more confident in giving answers to the questions.
You don't have to be using the camera you can just write on the slide so you can write your questions on the slides and we'll answer them.And they interacted really well with it.That way they really didn't want to switch on the mic, they don't wanna switch on the cameras but they were happy to ask question in the anonymous format. [3] It was also noted that these could be used for additional help in Pre pandemic we'd say there's this pre work but we wouldn't push them on it so much.We would still quite often didactically lead the session, whereas because of the pandemic they had to do the pre work because they were sometimes not with a tutor so we decided to keep the emphasis on them running the session and the tutor is there to kind of facilitate it more than lead it. [5] Academics cited some useful innovations in how they communicated with students during the lockdown, which again may help with their learning.Staff were able to create virtual offices which arguably made it easier for students to see them than having an in-person opendoor policy pre-pandemic.
We called it 'Ask an Anatomist' and it meant that students could actually book a one-to-one appointment with one of the teaching team to go over something they were unsure about 'so that went down an absolute storm and it was really good.[1] There was also an increase in virtual Q&As during the pandemic period, mainly to boost interaction but these were mostly seen in a positive light.
but in a fun, it was revision but it was like quite relaxed, quite fun.They were super competitive, and they came ready to ask questions. [1] It was noted that toward the later stages of the pandemic students were getting more used to the online environment and were speaking up more which was seen as a positive if more learning is carried out online in the future.

Lectures
A common theme that was identified in several interviews was the difficulty staff had in gauging the reaction of students in live online lectures and therefore not being able to tailor the lecture as it was happening.Ultimately this may lead to a more difficult learning experience for the student.
didn't get the same student feedback and in teaching live online, there's always that tiny bit delay, you can't interact quite as well because you can't pick up on people's social cues you can't see if the class is falling asleep because they've just switched off their monitors, and you that they're there with their phones just messing around just so their name is on the list.[8] This was felt to be particularly important for those perceived as the weaker students.
I think the less able students do need a member of staff there just to pick up on the fact that they're looking confused and you know and just to be able to say to them what is it you're not understanding. [8] Numerous times the example of being able to demonstrate movements in an anatomy lecture was pointed out as impossible to do in the online environment.Some academics commented that they felt students struggled to focus on video, others focused on their worry regarding students from poorer backgrounds struggling to keep up due to lack of up-to-date technology and others emphasized the need for undergraduates to be on campus and attend lectures for the overall immersive experience and the academic inspiration that should follow.
Finally, it was noted that any mistakes in a recorded lecture are far more damaging to a student's learning than it would be in a live class.
Whereas if you record it once, then spend a lot of time editing it, transcribing it and integrating questions and then somebody asks you about a mistake you realise it's a mistake then is a, I think they take it more as gospel. [3]

Practicals
Despite some of the advantages raised in the previous theme, it was clear that there were many disadvantages to running a practical class online.This was highlighted by many academics discussing the need to run catch-up sessions when they were safely able to do so.
Principally was the difficulty students have learning a 3D topic on a 2D screen.
No, I think anatomy Is a 3D topic, you can't learn it through a screen or from a textbook and I know we don't, we don't do dissection but even just had students having hands on with the models, getting to poke at weird knobbly bits and said I don't know what that is. [8] The need for interaction with the students was also strongly identified, it was felt that in small groups, in a noisy practical class, students are more likely to ask questions.This was not the case in online seminars.
So, when you walk around the practical room.They're constantly asking questions.Is this right?Is this this?… If they've got a question in the classroom they will put their hand up to ask but if they've got the same question at home they won't ask it. [6] Other innovations, such as the 'break out' room in online seminars met with academic disproval.Despite excitement in the early pandemic as to the usefulness of these, the academics commented that the students disliked them and many discontinued them.
Putting people into breakout rooms they just go silent, silent.You're speaking to yourself … 'They hated them, like with a passion and you could tell they hated them. [8] In the face-to-face socially distanced practicals that evolved in the latter stages of the pandemic it was recognized that students working on their own inhibited their learning and, due to the quietness of the class, prevented them from asking questions.
I was shocked at how much it changed the atmosphere in the room, it became a lot more kind of cold and less exciting but it's really difficult to see the ones that are actually just sat there feeling completely lost, not understand a word they're reading.[6] It must be noted that academics clearly felt that online practicals missed out a lot of the hidden curriculum that commonly exists in anatomy practicals.That of learning care and compassion through the treatment and respect given to the cadaveric material.
It's actually about professional behaviour, it's about acting in a proper manner and that's missing. [2]

DISCUSS ION
This was an exploratory study that collected views from academic members of staff teaching In UK medical schools between October and December 2021.This was a period of transition as COVID rules were still in force in UK countries although measures were being relaxed both legislatively and behaviorally.Taken together the interviews suggest that academics believe that anatomy teaching will not revert to pre-pandemic delivery with all discussing some aspects that they would like to see maintained.This is in line with two other surveys carried out during the height of the pandemic indicating that change to anatomy delivery is inevitable (Korkmaz & Gürses, 2020;Pather et al., 2020).
This should not be surprising; despite the view that anatomy is "traditional" anatomists have led the way in educational innovation and e-learning has been a main stay of anatomy pedagogy from well before the pandemic (Evans et al., 2020).Although this study was a small sample and taken only from UK perspective, results indicate that most anatomists would like to see a movement toward lectures being pre-recorded and delivered online, however, there is an acknowledgment that certain lectures are better suited in person.
There is a consensus that anatomy practicals should be carried out face-to-face although resources that were discovered or produced will likely be used to supplement learning post-pandemic.Finally, there was a mixed view on student staff communication postpandemic; both academically and administratively there were positives and negatives for communicating online (in addition to emails), and this response may be due to there being no clear outline yet of how anatomy education looks in the future.
Clearly, with the curriculum changes indicated in the survey and the 'inevitability' of change indicated in other studies, there is a serious need for research to inform practices (Evans et al., 2020).
The adjustments introduced during the pandemic, and those established beyond the pandemic, should be studied, and data should be derived to inform how practices should continue post-pandemic (Cuschieri & Calleja Agius, 2020;Das & Al Mushaiqri, 2021).At the very least student grades, mental wellbeing, and graduate skill sets should be closely monitored in any hybrid approach to ensure the education is fit for purpose (Gaur et al., 2020).

The future of the anatomy lecture
This study reports for the first time that, on balance, academics would like to see a continuation of anatomy lectures online in a post-pandemic environment.Academic staff interviewed here reported numerous advantages to conduct lectures pre-recorded and asynchronously.A major positive was the flexibility that it affords students.This is especially true of students who work during their studies.Indeed, this is more likely to help those students who come from a poorer socio-economic background and may even sway their decision to join university.Mature students who may have children will also benefit from the flexibility the recorded lecture allows.
Academics here noted that recorded lectures do away with having to schedule back-to-back lectures that often exceed 3 or 4 h and lead to poor learning due to fatigue.Furthermore, all academics know the pain of delivering a 9 am lecture to an undergraduate cohort and this is, in part, due to the campus commute which the online lecture would negate (Co et al., 2021).
Pedagogically there is an acknowledgment that students being able to pause, rewind, or rewatch lectures can only aid in student learning.Interviewees commented on the increased interactivity that can be embedded into recorded lectures compared to in-person format.Also features such as transcripts, if done properly, can aid student accessibility.Much is made of home distractions impeding online learning, however, responses here mentioned that lecture theaters provide their own unique set of distractions, and indeed it can be argued that learning at home provides for a more focused transfer of knowledge (Bockers et al., 2021).Interviewees also identified the advantages of being able to monitor usage analytics to both identify any students who may be struggling but also to reflect on their own practices.
Administratively, the recorded lecture will do away with the need to squeeze students into lecture theaters which are increasingly becoming tighter as courses grow (Rimmer, 2018).It also ensures the that students will get access to the theoretical learning before they attend a practical class.Something that is not always possible when conducting lectures live.
Academics are, however, acutely aware of the drawbacks of the online lecture.Both in this report, and in the literature, there is a concern amongst academics about students being able to access online lectures.Internet connectivity (Byrnes et al., 2020;Consorti et al., 2021) and poor hardware/resources (Byrnes et al., 2020) could lead to major problems and a widening of the educational gap from low socio-economic areas both domestically (Naidoo et al., 2021) and internationally (Roy et al., 2020).It may not even be resources that cause disparity between countries; for example, different regulations in cadaveric images may lead to disparity in education (Pather et al., 2020).
Student engagement with online lectures was an issue with 36% of staff citing it as a problem in a study by Longhurst et al. (2020).In addition, there is a fear that the staff-student relationship will suffer, something which is especially strong in anatomy education, with 21% of staff surveyed in the same study mentioning it.This may explain why as many as 78% of staff wanted to go back to an in-person format in a survey by Dulohery et al. (2021).Admittedly this appears a little high when compared to the responses in this study however this may be due to differences in the timing of the research (in the midst of COVID-19 compared to emerging) where socially there was an increased need for face-to-face interaction.
Most studies conducted using student surveys or opinions also point toward a preference for online lectures (Elzainy et al., 2020;Korkmaz & Gürses, 2020;Singal et al., 2021), with some specifically mentioning that they should stay post-pandemic (Cuschieri & Calleja Agius, 2020;Loda et al., 2020;Banovac et al., 2021).In studies where online was rated as less effective than face-to-face the online lectures were favored higher than anything else (Dost et al., 2020) suggesting a true pattern whereby students would not be averse to studying lectures from home.Reasons for this positivity were similar to the academic response; ease of studying, flexibility around study hours, lack of expensive commuting, and better study/life balance (Dost et al., 2020;Khalil et al., 2020;Co et al., 2021).Students are also aware about the loss of personal contact time that could result from online lectures.One focus group brought up the difficulty with getting stuck in an online lecture (Khalil et al., 2020), a problem that may be easily overcome with an academic in the room but in a hybrid world may involve emails and message boards, which all take time.In addition, there were student concerns regarding isolation, concentration issues while in the home environment, and family disturbances (Dost et al., 2020;Gaur et al., 2020).In a post-pandemic world, without COVID-induced isolation, this problem may solve itself.However, it is crucial to monitor if a hybrid model is introduced long term.
There is little in the way of quantitative measures comparing online anatomy lectures to traditional.Two studies conducted prepandemic showed positive results with one specifically showing increased attention and knowledge retention when students were taught with images, videos, and augmented reality (Co et al., 2021).
Another study, conducted during the pandemic showed that a blended approach with more online lectures had students scoring higher in the short answer questions, suggesting a deeper understanding of the concepts.It is difficult to say this was the cause for sure, as there were a lot more e-resources made available to the students and only a small reduction (11 h) for the face-to-face teaching (Yoo et al., 2021).
Given the opinions here, and in the literature, it is likely that online lectures will stay in some form post-pandemic, indeed 36% of staff surveyed in Chinese institutions felt that all theoretical delivery could be online (Cheng, Chan, et al., 2021).The apparent pedagogical and administrative advantages must not overshadow the very real educational disenfranchisement that some students would feel if this migration is not managed correctly.It is interesting to speculate that without the pandemic this may have taken decades or may never have fully caught on.Indeed this may be seen as a classic application of the theory of diffusion of innovation whereby novelties are more likely to be adopted if they are trailed and observed first (Rogers, 2003).

The future of the anatomy practical
COVID-19 has been an opportunity for staff to develop new resources with Longhurst et al. (2020) reporting that staff were excited at the opportunity.Can the resources that have been developed online help to ease the pressure on a subject that is continuously being squeezed for lab time?These pressures could increase even further as there still exists a fear that the pandemic may decrease the availability of cadavers (Ooi & Ooi, 2020;Singal et al., 2021).
Although anecdotally this has not been the experience of the authors.Nevertheless, despite these pressures, growing or otherwise, changes to education should always be driven by educational needs and not administrative forces.
There appears to be no willingness from faculty or from the student body (Cuschieri & Calleja Agius, 2020;Banovac et al., 2021) to replace face-to-face practicals with online versions, be that dissection, prosection, or model-based practicals.
Various staff and student surveys have shown this overwhelmingly; 96% of staff in the UK and ROI responded to say that they did not prefer online practicals (Dulohery et al., 2021).90% of one student study reported that dissection and practical work could not be replaced by online classes (Banovac et al., 2021), and only 7% in a Turkish study favored the transfer of learning hours from dissection into an online-based class (Korkmaz & Gürses, 2020) and a similar story was found in a small institute level study in Malta (Cuschieri & Calleja Agius, 2020).Willingness to have practicals as face-to-face is shown in the statistic that when covid rules permitted 80% of institutions brought back in-person practicals, presumably despite these being condensed socially distanced versions (Dulohery et al., 2021).
Only one study showed any difference with 6.1% of staff in West Bengal preferring to go back to pre-pandemic types of practicals (Roy et al., 2020).However, context is crucial here; this may be due to the timing of the survey during the height of the pandemic which meant 'going back' would have greater risk; this may have well been a COVID fear rather than a pedagogical decision.Therefore, it is the authors belief that face-to-face laboratory practicals in anatomy education are going nowhere.
There are many reasons for this; overwhelmingly staff believe that examination of cadaveric material is the gold standard (Brassett et al., 2020;Co et al., 2021) and over 50% of academics interviewed by Longhurst et al. (2020) cited the possibility of losing this as a major Whilst technology is improving academics feel that 3D online or software-based cadavers cannot replace the 3D spatial and tactile knowledge that is gained from the cadaver directly (Harmon et al., 2021) and this is echoed in a similar study carried out in German Universities were staff commented that students had a poorer 3D understanding of the cadaver (Bockers et al., 2021).In addition, students studying from one cadaver are likely to have a decreased appreciation for anatomical variation (Harmon et al., 2021).
Students have also commented on the need to study from cadaveric material.Whilst their responses are not as well articulated as academic staff there is a feeling in numerous studies that they will be 'missing out' and that their learning will be impacted (Franchi, 2020;Longhurst et al., 2020;Patra et al., 2021;Singal et al., 2021).Indeed, this is likely the case, but a further point to be aware of is that perception will play a part also.If students feel that they have not had the best educational experience in a specific area then their confidence will suffer.It can therefore be argued that this will become a self-fulfilling prophecy that will impact on their clinical capabilities.
Numerous studies have also pointed out the loss of the hidden curriculum that would occur if practical classes were removed or reduced (Longhurst et al., 2020;Barash et al., 2021).Many feel that learning from the cadaver in a clinical environment such as the dissection room is necessary for all clinicians (Flynn et al., 2021).Quite often students are taught to treat the cadavers as their first patient which would not be possible with a digital cadaver (Jones, 2021).
Therefore, there is a feeling that students would lose that care aspect with the cadaver which could carry over to them being less empathetic in clinic (Pearson, 2020).Other aspects of the hidden curriculum will also likely be affected; communication skills, peertutor interaction (Dulohery et al., 2021), teamwork, and problemsolving skills which help create a deeper understanding of anatomy (Romero-Reverón, 2020).
This study reports, for the first time, that student preparation for their practical classes will change in the future as a result of changes during the pandemic.During lockdown, there was a huge effort to upskill staff (Longhurst et al., 2020) and write material that could be used to replace the practical classes.Responses here indicate that most of these resources will be used in conjunction with the practical classes from now on.Either as pre-practical material, as revision material or to help students who were not able to attend the classes.This supplementation of practical classes is reflected in other COVID studies (Cuschieri & Calleja Agius, 2020;Longhurst et al., 2020;Cheng, Chan, et al., 2021) although some make the point that they will be of benefit only if aligned with the content and approach to the current curriculum (Pather et al., 2020).Student studies have also commented that they were impressed with the additional course materials produced (Banovac et al., 2021).
This study also reports that that online practicals that were used during lockdown will likely be used in some cases to supplement the lab class as an interactive seminar.Indeed, there are some advantages to having students sitting close to a screen.For example, Flynn As previously mentioned, the Rogers (2003) theory that staff are more likely to use innovations if they practice them will likely hold true for students as well, suggesting that students may be more inclined to use them if exposed to them in online classes.Also, responses here argue that that student will answer questions more in the online format as they can remain anonymous, something that seems impossible in the classroom environment.Finally, with the ongoing squeeze on timetables and rooms, there is an administrative advantage to holding seminars online and not having to book out rooms.These positives make it likely that to a varying degree across institutions, the COVID online practicals will stay as online seminars that supplement the practicals.
As with the extra resources, if these online seminars take off the students recognized the need to have them integrated properly into the curriculum and not just bolt-ons (Franchi, 2020).Overall this hybrid approach is something that students have said they are keen on with 80% of a student survey indicating that these students would apply for a hybrid course (Co et al., 2021).
Quantitative studies measuring the performance of online practicals are few and far between.Of those produced, they are quite varied in their approaches and quite often show contrasting views.
For example, one study conducted during the pandemic saw nearpeer teachers running tutorials off-and online and saw no difference in assessment scores, however, the in-person practicals only used models, palpation of colleagues, and drawing, so cadaveric material was not in use (Thom et al., 2021).Another COVID study conducted by Tucker and Anderson (2021) saw students perform significantly poorer on questions that they were unable to dissect for compared to the previous year and similar on questions they were able to dissect for compared to previous years.While interesting this does not account for the other variables in play, for example, student resources, internet connectivity, hardware, mental health, etc.In a well-designed future hybrid curriculum, these scores may be closer due to consideration of those variables.Other studies using virtual dissections or dissection videos have reported no difference in assessment scores (Attardi et al., 2018;Iwanaga et al., 2021).VR studies have also shown promising assessment scores with a recent study showing increased test scores when used, however, in this particular case, it was an additional resource and not used to replace traditional methods (Mateen & Kan, 2021).

The future of staff-student communication
Infused throughout the pedagogical discussion of an increased online curriculum is a need to consider how this will impact communication with the students.This encompasses administrative communication; for example, telling students when and how to log on to classes, academic communication; ensuring that students anatomical questions are answered, and also tion; the need to ensure that students who are struggling are listened to and feel cared about.
This study is the first to consider the effect of pandemic communication on how staff and students interact in the future.Results from this study suggested that while some lecturers may implement a 'virtual' office this was not widespread in the responses.This is interesting given that there is an increased likelihood that academics will work more from home.Will this translate into students having less access to 'pop in' to see their lecturers?Pather et al. (2020) also recommend the necessity of any hybrid approach to send clear guidance to students weekly (or even daily on occasions) to ensure that they are aware of their tasks.
Academic communication appears also to be a mixed bag with some academics reporting success with message board packages or increased e-mail communication during the pandemic.This and other studies have cited the anonymity of questions being a bonus for students (Iwanaga et al., 2021) with one study reporting 51% agree and 17% strongly agree that it was in fact easier to approach their teacher and get an answer online (Mehdar, 2020).Other responses here reported a distinct lack of student interaction.Surprisingly Q and A online sessions that took off during the pandemic appeared to have limited success and these appear to have been discontinued since.Indeed, some studies have shown that online communication leads to a lack of engagement in the learning experience (Attardi et al., 2016(Attardi et al., , 2018;;Gillett-Swan, 2017).
It is the author's belief that staff-student interaction is still in flux from all the different forms of lockdown that existed throughout the pandemic and still exist during the writing of this manuscript given that administrative and academic staff are still largely working from home.How this develops needs to be monitored closely during the next few years as hybrid curricula become more entrenched and formalized and staff working from home is seen as normal.

Limitations of the study
While this study has given an insight into how academics are likely to feed into post-pandemic educational conversations it has some limitations that need to be considered.Data were collected as the pandemic was constantly changing and therefore opinions may also be altered.It is limited to 10 respondents which is small given the number of anatomists teaching within the UK.The age range of interviewees was narrow, with the upper limit being 37.This may have had a skewing effect on the data, however, given that this is a study on the future of teaching it is likely that the views of this demographic will have a more pronounced effect.Finally, it is only canvasing opinions regarding medicine and in UK Universities.Different courses and/or international institutions may have different opinions regarding the way forward for anatomy education post-pandemic.
In only questioning academic staff we make no judgment about the quality of students learning and would like to repeat this work with students for a more complete picture.

CON CLUS IONS
As we continue to emerge from the effects of the COVID-19 pandemic the lessons learned during the pandemic will influence how we teach anatomy long term.Results here suggest that anatomy lectures will commonly be distributed online, but some topics will benefit from faceto-face delivery.Unsurprisingly anatomy practicals will continue to be applied in a face-to-face manner, however, the online resources that were created during the pandemic will, in most cases, continue to be used to supplement the classes or be used in an online seminar format.
Furthermore, new resources are more likely to be developed as staff are more skilled in these areas.Hybrid working will likely reduce direct contact between staff and students and there is a danger that students will have fewer opportunities to approach staff and therefore may suffer both academically and pastorally.This is something that should be monitored closely in this post-pandemic teaching environment.

1.
How did you teach anatomy to undergraduate medical students pre-pandemic?a. Was it systems of regions based?b.Did you teach using prosections/dissections/models or a combination of these?c.How did the anatomy teaching align with other areas of the curriculum?d.How many practical classes did a single student get per year?e.What staff members were present within the practical classes?f.What areas of a students learning were carried out online? 2. When COVID-19 first hit in March 2020 how did anatomy teaching change?a.How did you deliver learning outcomes previously covered in lectures?b.How did you deliver learning outcomes previously covered in practical classes?c.How did you communicate with students?Did this differ between general enquiries and anatomy specific questions? 3.For the academic year 2020-2021 how did anatomy teaching change?a.How did you deliver learning outcomes previously covered in lectures?b.How did you deliver learning outcomes previously covered in practical classes?c.How did you communicate with students?Did this differ between general enquiries and anatomy specific questions? 4. Reflecting on the initial response and the academic year 2020-2021 a.What do you feel worked well for the students?b.What do you feel worked well for the staff delivering the teaching?c.Is there anything that worked well enough that you would like to keep in a future, post-pandemic, anatomy curriculum?d.Is there anything that your department is doing now, that has changed because of the pandemic and is likely to stay that you do not agree with?anatomists with no clinical experience.Two of the interviewees changed institutions during the pandemic (defined for this study as March 2020 to February 2022), one began lecturing, two had maternity leave and one had long-term sick during this period.All experienced some teaching during the pandemic.Seven out of the ten began and ended the pandemic at the same university.Of the two participants that changed institutions, the responses relate to their original post so that all interviews discussed pandemic teaching at different institutions.Interview times ranged from 21 min to 1 h 15 min.All institutions went online for the remainder of the 2019-2020 academic year and all practiced a hybrid approach during the 2020-2021 academic year.
I think a lot of students who for instance have kids or have part time jobs or like other commitments or carers, I think it's really helped them in terms of things being more flexible like you know things are recorded and they are online and you know it you've got a child and they're sick and you physically can't make it to the lecture, well, its online and its I think it had made things a lot more accessible to people.[6]

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can look at, you know, when students have access to it, how many times you know have they watched the whole thing or it they only watch a little bit.It's quite fascinating and so being able to have that as is quite a good way of determining whether it's being useful for students.[1]It was commented on that academics saved time in the lecture slots too which meant they could deliver better online lectures or use the time to aid the students in a different way, although of course, this was after a large initial outlay of time.In addition, although none TA B L E 2 Summary of pre-pandemic teaching.U R E 1 A schematic representation of the factors that will influence anatomy tuition post-COVID-19 pandemic.
then it's going to be quite focused what they're looking at once they're in the lab.[9] complex subjects but not to be replaced by in-person seminars as the online version is more versatile.IfI give them a list of resources, I email it to them as well.Some of them won't even open any of the links … but if I sit and actually go through and like show them and they start to learn from it.In front of me, they actually feel like maybe they're getting it.[7]In addition to online practicals, most universities were able to adapt their face-to-face practicals in the academic year 2020-2021 to allow for students to attend labs.Although not overwhelming there were some advantages to this social distanced type of learning that were identified.Firstly, the a strict need to time the amount each student spent at a station.I really like the fact that they then forced students to have to look at what was on their station in a fixed length of time.Previously they would just sort of meander around the room, socially interact with people, have a good time, have a chit chat.[4]Also, one dissection course had to change from tutor-led to student-led during the pandemic but realized the advantage of this and will keep this going long term.
et al. (2021) point out that by using an online 3D model the student can 'see what the teacher sees' in regards to specific layers, rotation, orientation, and magnification, all done at the click of a button without having to walk around a circle showing each student.In addition, this study also indicated the ease with which online seminars can be used to show students online resources and get them to actively use them; in the classroom, you are relying on the students doing this at home.