Higher‐Order Assessment in Gross Anatomy: A Comparison of Performance on Higher‐ Versus Lower‐Order Anatomy Questions between Undergraduate and First‐Year Medical Students

Abstract

Gross anatomy is considered by many the backbone of medical education. While learning anatomy has a reputation of requiring mainly rote memorization, modern day anatomy education often involves instruction and assessment at cognitive levels that foster higher‐order thinking. In many instances, these higher‐order anatomical concepts are taught to graduate students in healthcare‐related fields, such as medicine. At this level, students are expected to apply and analyze anatomical information since that is what will ultimately be expected of them as professionals. In contrast, undergraduate anatomy education is typically more introductory in nature and often takes place in the setting of a large‐enrollment course that serves as a prerequisite for many health sciences degree programs. In this study, variables related to the assessment of higher‐order concepts in clinical anatomy were compared between first‐year medical students and undergraduate students enrolled in an upper‐level human gross anatomy course. Results demonstrate that undergraduate students perform lower than medical students overall, but the degree of difference in how they perform on higher‐ versus lower‐order questions is comparable. The most notable exception is on practical examinations, where undergraduate students tend to struggle more with applying and analyzing information. Exploration of additional variables provides insight into how the cognitive level being assessed affects the time it takes to answer a question and how different practical examination question types and formats influence student performance. Findings presented in this study have implications for designing anatomy courses and underscore the importance of blueprinting assessments.

Relationship between learning approach, Bloom’s taxonomy, and student performance in an undergraduate Human Anatomy course

“…The second set of examinations covers the thorax and abdomen, and the final set includes material related to the upper and lower limbs. Assessments include a mix of higher- and lower-order questions (Thompson & Giffin, 2021 ). Example lecture and practical examination question are provided in Table 1 .…”

“…All questions on the lecture and practical examinations were assigned a cognitive level using the Blooming Anatomy Tool (Thompson & O’Loughlin, 2015 ). These assignments were made by a single individual (ART), who has previously shown a high degree of intra-rater reliability when classifying examination questions (Thompson & Giffin, 2021 ). Questions were then separated into higher-order (Bloom’s apply and analyze) and lower-order (Bloom’s knowledge and comprehension) to permit more straightforward comparisons and reduce observer error (Thompson & O’Loughlin, 2015 ; Anderson et al, 2001 ).…”

“…Lower levels focus on memorization and comprehension, whereas higher levels incorporate aspects of cognition that include applying, analyzing, evaluating, and creating (Anderson et al, 2001 ). While Bloom’s taxonomy can be utilized in a variety of ways, there have been considerable research efforts focused on classifying examination questions based on cognitive levels and using this information to better understand student examination performance (Thompson et al, 2013 , 2016 ; Verenna et al, 2018 ; Morton & Colbert-Getz, 2017 ; Crowe et al, 2008 ; Thompson & Giffin, 2021 ; Thompson & O’Loughlin, 2015 ; Zheng et al, 2008 ).…”

Assessing the Wider Outcomes of Anatomy Education

“…Within the issue, quantitative and meta-analysis studies demonstrate the need to design assessments that effectively evaluate cognitive levels that match the level of learner, particularly when assessing clinical anatomy concepts (Thompson and Giffin, 2021), and appropriately accommodate differences in the spatial ability of students including the use of non-addictive visual signaling and minimizing redundant visuospatial information (Roach et al, 2021). Another report indicates that the assessment format should be designed to align effectively with the method of instruction and future application of knowledge in clinical practice (Fournier and Groh, 2021).…”

Three-Dimensional Virtual Anatomy as a New Approach for Medical Student’s Learning

“…Human anatomy is a fundamental subject of study in the process of teaching and training medical students, since anatomical knowledge is a requisite for safe and competent medical practice [ 1 , 2 , 3 , 4 , 5 ], and it is indispensable in medical curricula.…”