Arthroscopy or ultrasound in undergraduate anatomy education: a randomized cross-over controlled trial

Abstract

BackgroundThe exponential growth of image-based diagnostic and minimally invasive interventions requires a detailed three-dimensional anatomical knowledge and increases the demand towards the undergraduate anatomical curriculum. This randomized controlled trial investigates whether musculoskeletal ultrasound (MSUS) or arthroscopic methods can increase the anatomical knowledge uptake.MethodsSecond-year medical students were randomly allocated to three groups. In addition to the compulsory dissection course, the ultrasound group (MSUS) was taught by eight, didactically and professionally trained, experienced student-teachers and the arthroscopy group (ASK) was taught by eight experienced physicians. The control group (CON) acquired the anatomical knowledge only via the dissection course. Exposure (MSUS and ASK) took place in two separate lessons (75 minutes each, shoulder and knee joint) and introduced standard scan planes using a 10-MHz ultrasound system as well as arthroscopy tutorials at a simulator combined with video tutorials. The theoretical anatomic learning outcomes were tested using a multiple-choice questionnaire (MCQ), and after cross-over an objective structured clinical examination (OSCE). Differences in student’s perceptions were evaluated using Likert scale-based items.ResultsThe ASK-group (n = 70, age 23.4 (20–36) yrs.) performed moderately better in the anatomical MC exam in comparison to the MSUS-group (n = 84, age 24.2 (20–53) yrs.) and the CON-group (n = 88, 22.8 (20–33) yrs.; p = 0.019). After an additional arthroscopy teaching 1% of students failed the MC exam, in contrast to 10% in the MSUS- or CON-group, respectively. The benefit of the ASK module was limited to the shoulder area (p < 0.001). The final examination (OSCE) showed no significant differences between any of the groups with good overall performances. In the evaluation, the students certified the arthroscopic tutorial a greater advantage concerning anatomical skills with higher spatial imagination in comparison to the ultrasound tutorial (p = 0.002; p < 0.001).ConclusionsThe additional implementation of arthroscopy tutorials to the dissection course during the undergraduate anatomy training is profitable and attractive to students with respect to complex joint anatomy. Simultaneous teaching of basic-skills in musculoskeletal ultrasound should be performed by medical experts, but seems to be inferior to the arthroscopic 2D-3D-transformation, and is regarded by students as more difficult to learn. Although arthroscopy and ultrasound teaching do not have a major effect on learning joint anatomy, they have the potency to raise the interest in surgery.

Ultrasound in undergraduate medical education: a systematic and critical review

“…Definitive evidence of the effectiveness of ultrasound‐based anatomy teaching would be derived from comparisons with other methods of instruction and evaluations of knowledge outcomes. We identified five such articles, in which cadaver‐based dissection was usually the comparator condition . These were mostly brief interventions (30 minutes to 3 hours), except that reported by Kondrashov et al .…”

“…and all used multiple‐choice tests of anatomy knowledge. Knobe et al . also measured differential performance on a clinical skills examination.…”

Gross anatomy videos: Student satisfaction, usage, and effect on student performance in a condensed curriculum

“…Clinical reasoning can be taught to a student before he/she has a full understanding of anatomy and pathophysiology (Kassirer, 2010), and preoperative, computer-assisted tutorials on human anatomy can have a positive impact on a clerk's level of knowledge and confidence in the operating room (Hong et al, 1996). There is value to teaching advanced emergency procedures to medical students with video as a modality (Tabas et al, 2005) and video arthroscopy can help students understand complex joint anatomy (Knobe et al, 2012). These resources have the potential to affect education in the later years and possibly improve patient care.…”

Teaching ultrasound in a curricular course according to certified EFSUMB standards during undergraduate medical education: a prospective study

“…So far ultrasound has only been incorporated into undergraduate medical student curricula only to a limited degree [3-8] and has not been systematically implemented as a curricular course to be learned by every student in undergraduate medical teaching [3]. Lately, numerous study groups have described their efforts to integrate ultrasound into a medical curriculum demonstrating the increased awareness of the relevance in undergraduate medical education [3,7,9-12].…”