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Article

Knowledge Retention of Undergraduate Medical Students in Regional Anatomy Following a One-Month Gross Anatomy Course Setting

by
Veronica Antipova
1,
Martin Siwetz
1,
Maren Engelhardt
2,
Franz A. Fellner
3,4,
Simone Manhal
5,
Julian F. Niedermair
3,4,
Benjamin Ondruschka
6,
Amélie J. Poilliot
7,
Andreas Wree
8 and
Niels Hammer
1,9,10,*
1
Division of Macroscopic and Clinical Anatomy, Gottfried Schatz Research Center, Medical University of Graz, 8010 Graz, Austria
2
Institute of Anatomy and Cell Biology, Johannes Kepler University, 4040 Linz, Austria
3
Central Radiology Institute, Johannes Kepler University Hospital, 4020 Linz, Austria
4
Division of Virtual Morphology, Institute of Anatomy and Cell Biology, Johannes Kepler University, 4040 Linz, Austria
5
Office of the Vice-Rector for Studies and Teaching, Medical University of Graz, 8010 Graz, Austria
6
Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany
7
Anatomical Institute, University of Basel, 4001 Basel, Switzerland
8
Institute of Anatomy, Rostock University Medical Center, 18057 Rostock, Germany
9
Department of Orthopedic and Trauma Surgery, University of Leipzig, 04109 Leipzig, Germany
10
Division of Biomechatronics, Fraunhofer Institute for Machine Tools and Forming Technology (IWU), 09126 Chemnitz, Germany
*
Author to whom correspondence should be addressed.
Educ. Sci. 2024, 14(8), 905; https://doi.org/10.3390/educsci14080905
Submission received: 7 June 2024 / Revised: 14 August 2024 / Accepted: 16 August 2024 / Published: 19 August 2024
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Abstract

:
Background: In the achievement of optimal learning outcomes, knowledge retention presents a major concern for medical students and educators. Practical dissection courses facilitate the consolidation of knowledge of anatomy. Previously, it was shown that a regional anatomy dissection course is more beneficial over a 3-month than a 1-month duration for gathering pre examination knowledge. This study aimed to assess if follow-up anatomy interventions help consolidate regional anatomy knowledge and facilitate knowledge retention of undergraduate medical students. It was hypothesized that knowledge retention could be enhanced using post-dissection teaching interventions. Methods: Upon completion of the dissection course, Objective Structured Practical Examinations (OSPEs) were performed for the neck, thorax, and abdomen immediately before the start of the oral examinations, with follow-ups at 6 and 12 months. Between each of the examinations, virtual and in-person lectures and seminars on (radiologic) anatomy and pathology were held, including Cinematic Rendering, but without additional teaching on human tissues. Results: Significant improvements were observed for knowledge of the neck and abdomen regions in the 6- and 12-month follow-up OSPEs. The effects of knowledge gain were less marked in ethanol-glycerin- than in Thiel-embalmed tissues. Student perceptions regarding tissue quality correlated positively with their assessment of tissue suitability for examination preparation. In conclusion, even anatomy teaching interventions not utilizing human tissues may help consolidate and improve regional anatomy knowledge over a one-year term. Conclusion: Knowledge retention can be enhanced by accompanying virtual with physical teaching interventions.

1. Introduction

Anatomy forms a pillar of healthcare education and is a crucial component of medical science [1,2,3,4,5]. Dissection courses are considered to be among the most important subjects in medical school [6,7,8,9]. Anatomy dissection classes have a long tradition, as they offer a robust teaching tool to deliver anatomical knowledge [10,11,12,13]. Dissection offers students a unique opportunity to observe structures in situ with a texture resembling that of a living body to appreciate spatial relationships, variations, and pathologies [14,15,16]. Dissection promotes the development of medical professionalism, empathy and respect for the patient, and coping strategies for the dead and the dying [17,18,19]. Furthermore, dissection stimulates teamwork, communication skills, and attitudes relevant to the practice of medicine [16,20,21]. The cognitive process of understanding and memorizing the architecture of three-dimensional anatomical structures is enhanced by the tactile manipulation involved in active dissection, thus offering a chance to develop an appreciation for shape [22,23]. Although there is broad consensus that dissection is crucial in obtaining adequate knowledge of and practical skills in anatomy [24,25,26,27], the time devoted to dissection has decreased steadily in recent decades [4,28,29,30,31,32]. In some cases, it has been replaced by prosections or even been fully eliminated from the curricula [15,30,32,33,34,35,36,37]. At the same time, the extent of basic science and clinical knowledge students are expected to know has increased dramatically [38].
The quality and duration of the dissection course can be affected not only by financial constraints but also by the challenge of recruiting experienced staff, religious beliefs, time constraints, and infrastructural restrictions. We recently compared undergraduate student learning outcomes and the medical student’s ability to recognize anatomical structures after participating in a 1-month regional anatomy course compared with an otherwise identical 3-month setting. It was found that course exposure over 3 months was highly beneficial [39]. A substantial body of research shows that knowledge obtained over longer durations (spaced learning) results in better long-term retention than that learned over a shorter duration [40,41,42,43,44,45,46,47]. It remains unclear, however, if the drawbacks related to shorter course durations can somehow be compensated using additional teaching interventions.
To date, the body of literature has compared the knowledge retention of undergraduate students learning with prosections versus dissections [24,38]. Other studies analyzed knowledge retention in anatomy among the various medical disciplines [48,49,50,51] or at different stages in medical education [52,53,54,55].
The purpose of the present study was to assess the knowledge retention of undergraduate medical students who completed a 1-month-long regional anatomy dissection course in a 6- and 12-month follow-up. It was hypothesized that knowledge retention can be achieved for regional anatomy using non-contact modes of teaching interventions. It was further hypothesized that different methods of anatomical embalming result in differences in knowledge retention in different anatomical regions.

2. Materials and Methods

2.1. Study Cohort

First-year medical students of the Medical Faculty of the Johannes Kepler University (JKU) Linz were included in this study. These students were admitted to the regional anatomy course held at the Medical University of Graz in 2021. All participants gave their written and informed consent prior to their enrollment. Those students participating did so voluntarily, and the results of the study had no impact on their actual examination results. Ethical approval was obtained from the Medical University of Graz, Austria (33-500 ex 20/21).

2.2. Course Details on Anatomy in the Medical Curriculum

Gross anatomy is a first- and second-year subject taught to undergraduate medical students at JKU. Based on a memorandum of understanding and supporting agreement between JKU and the Medical University of Graz (MUG), the regional anatomy dissection course is conducted in the 2nd semester in a practical setting. Human corpses were bequeathed to the Division of Macroscopic and Clinical Anatomy of the MUG as part of an ongoing body donation program and in accordance with Austrian legislation concerning body donations. While alive, all body donors had given their informed consent for the donation of their tissues post mortem for research and teaching purposes ((accessed on 15 August 2024) https://anatomie.medunigraz.at/en/body-donation).
The total number of course participants was 120. The dissection course was comprised of 60 academic units (3 per day, 5 times per week, spread over four weeks). Twelve students were allocated per corpse, divided into two groups of six, and each student was assigned one or two anatomical regions for guided dissection, supervised by experienced gross anatomists and supported by student demonstrators. The ratio of students to demonstrators to academic teachers averaged 32 to 2 to 1, i.e., for every 32 students, the staff consisted of two demonstrators and one academic teacher.
The dissection course was accompanied by lectures on regional anatomy totaling 94 units of 45 min each: head, neck, upper and lower extremities, thorax, abdomen with 12 units each, 4 units body wall, 3 units back, 6 units retroperitoneal space, and 9 units pelvis. Moreover, students were allocated 18 units of self-directed study in the dissection room. Due to the COVID-19 pandemic, all lectures were made available online. Also, the MUG provided a 100-page dissection manual. In the remainder of the second semester, 12 h of lectures on the blood and lymphatic system were held. More detail on the undergraduate curriculum course of the Medical Faculty of JKU is presented in Figure 1, [39,56].

2.3. Embalming Procedures

The bodies used for the regional anatomy dissection course were embalmed using ethanol-glycerin [57] or Thiel embalming according to the ‘2002’ method [58].

2.4. Data Acquisition

Objective Structures Practical Examinations (OSPEs) are an established tool for the objective lead assessment of learning achievements and practical examinations of undergraduate students [59,60,61,62,63]. OSPEs are an effective method for the formative and summative assessment of undergraduate medical students during practical examinations [64]. These examinations remain the most efficient tool to assess the practical aspects of anatomical knowledge in a system where basic knowledge is integrated with the clinical or functional part of anatomy. They allow the assessment of knowledge and competence in anatomy, rather than the simple recollection of memorized facts which often occurs with simple in spot examinations used in many traditional settings [60,65,66].
The first OSPE examinations were conducted immediately following the completion of the dissection for each anatomical region prior to the respective oral examinations (pre examination, Pre Exam, Pre score).The follow-up OSPEs were carried out at 6- and 12-month intervals (6-month and 12-month scores) following the Pre Exam (Figure 1). Between both follow-up examinations, lectures on virtual anatomy, pathology, and further seminars were held in Linz [56], namely: 22.5 h of virtual anatomy, 27 hours of lectures, and 18 hours of seminars were held between the 6- and 12-month examinations (third semester). These focused on the anatomy of the cardiovascular, digestive, and urogenital systems. In the fourth semester following the 6-month follow-up examination, 22.5 h of virtual anatomy, 30 h of lectures, and 22.5 h of seminars were taught with a focus on musculoskeletal anatomy, neuroanatomy, and sensory systems. The lectures held by anatomists, neurologists, and orthopedists used other non-contact teaching interventions, such as sonography, plastinates, and models.
Virtual anatomy and pathology courses were held in the third and fourth semesters by the Division of Virtual Morphology at JKU. This course is conducted at the “JKU medSPACE”. Here, a 30-ft black box, including a wall-filling 8K-screen, was built in collaboration with Siemens Healthineers GmbH (Erlangen, Germany) and the Ars Electronica Futurelab (Ars Electronica Linz GmbH & Co KG, Linz, Austria). 45 h of lectures on anatomy and common pathologies are presented based on Cinematic Rendering reconstructions using the software Cinematic Anatomy CA VA70A (Siemens Healthineers) [67,68]. Using a gaming controller, the lecturer navigates through the real-time 3D stereoscopic renderings. Students are provided with active 3D shutter glasses. Additionally, clinical cases are presented using X-rays, computed tomography, magnetic resonance imaging, and video broadcasts from the operation theater, as well as live streaming from the dissection room.
In the OSPE, six to eight numbered tags were marked in the prosections of each of the regions, placed to uniquely identify certain anatomical structures [56,69]. Ethanol-glycerin- and Thiel-embalmed tissues were used with exactly the same tissues that were dissected and labelled. The structures of interest were exposed in a highly standardized manner. The study design and the choice of questions for the OSPE were carried out by experienced anatomists and one psychologist. In addition, the validity of the questions was confirmed by student performance during the dissection course in regional anatomy. The questions included in the OSPE were compared with examination outcomes and student performance as a part of previous research [56,69] accompanied by peer review of the examination questions. The original version has been adapted from the German “State Examination Catalogue”.
The two versions of the examinations were similar but non-significantly different regarding the level of difficulty [56,69]. One multiple choice question was asked for each tag, and the participants had to select the most suitable answer [56,69]. One minute was allotted per question, and participants were told not to manipulate the tags. In addition, OSPE examinations were held by the same examiner. In order to avoid influencing the students’ overall OSPE results, the examiner at no stage expressed their opinion on either ethanol-glycerin or Thiel fixations. The students were assigned randomly to the embalming method. The students were assigned alternating prosections, so they were assessed on the embalming method they dissected in class as well as the other one. During the course, the students had access to the other embalming types—not for dissection but for studying. During the dissection course and self-study, all students had consistent access to both embalming types. Based on the absolute numbers of correct responses, the scores were calculated for each region. In addition, students were asked about their own view on the suitability of ethanol-glycerin and Thiel embalming in terms of tissue preservation, colorfastness, tissue pliability, and the suitability for preparing for their anatomy learning experience [69]. For this purpose, a five-point Likert scale was deployed (1 = most suitable/strongly agree, 5 = most unsuitable/strongly disagree) [70]. In order to avoid falsifying or influencing the results of the students, the investigators were asked not to share their views on any of the survey items during the OSPE.

2.5. Statistical Evaluation

The data were analyzed using Prism version 9 (GraphPad Software Inc., La Jolla, CA, USA) and Microsoft Excel version 16.49 (Microsoft Corp., Armonk, NY, USA). The normal distribution was assessed using the D’Agostino and Pearson test. A Kruskal-Wallis test with post hoc correction (Dunn’s test) was used for between-group comparison of the pre and post examination assessments, and separated for ethanol-glycerin and Thiel embalming. Correlations between tag examination outcomes as well as tissue quality assessment were calculated with Spearman correlations. p values ≤ 0.05 were considered statistically significant.

3. Results

3.1. Demographical Information

A total of 105 participants completed the Pre OSPE examinations and surveys (63 females, 41 males, 1 unspecified), 92 the first (52 females, 38 males, 2 unspecified), and 88 the second OSPE (51 females, 37 males). The quality and suitability of the embalming were assessed by 163 students (39 females and 124 males).

3.2. Significant Improvements Were Observed for the Neck and Abdomen Regions in the 6- and 12-Month Interval

Overall improvements were observed when comparing the Pre score of the neck region (24.90 ± 18.29%) with the 6-month (34.82 ± 17.94%, p = 0.004) and 12-month (36.80 ± 18.79%, p < 0.001) scores, resulting in a 40% and 48% improvement from the baseline, respectively (Figure 2). No significant change was observed for the thorax region (Pre score 40.81 ± 16.46% vs. 6-month 41.75 ± 19.02% vs. 12-month 43.12 ± 19.52%),) and between the 6-month and 12-month scores of the neck and abdomen regions. Improvements were observed for the abdomen region when comparing the Pre score (32.12 ± 19.76%) with the 6-month (53.10 ± 16.84%, p < 0.001) and 12-month (54.55 ± 17.16%, p < 0.001) scores, resulting in a 65% and 70% improvement, respectively.

3.3. Subtle Difference on Cource Outcome Was Observed between the Embalming Types

The scores in the Pre examinations were higher in the abdominal regions embalmed with ethanol-glycerin (Ethanol) than in the tissues embalmed using the Thiel method (p < 0.001), the difference being 73%. A comparison of ethanol-glycerin and Thiel embalming revealed that improvements of the Pre vs. 6-month vs. 12-month scores were found primarily in Thiel-embalmed tissues for the neck (21.74 ± 15.82% vs. 36.26 ± 17.48% vs. 38.85 ± 16.87%, p ≤ 0.009) and abdomen (23.85 ± 16.70% vs. 49.38 ± 18.24% vs. 54.30%, p < 0.001) subgroups (Figure 3). The relative improvement related to the assessment with Thiel-embalmed tissue was 67% and 107% for the neck and abdomen regions when compared with the baseline, respectively. In the ethanol-glycerin subgroup, improvement was only seen when comparing the Pre and 6-month groups for the abdomen (41.28 ± 18.95 vs. 55.51 ± 16.07%, p = 0.024), reflecting a 35% improvement in examination scores.

3.4. Pre Examination Results between Regions Correlated Closely; However, Sparse Correlations Exist for the 6- and 12-Month Follow-Up Examinations

A number of weak correlations were observed within and between Pre examination scores across the anatomical regions (Table 1). These correlations did not seem to follow a specific pattern between the regions assessed. Any assessment on pliability in ethanol-glycerin (Ethanol) specimens did not seem to be connected to examination scores. Excellent preservation was weakly correlated to higher 12-month thorax examination scores. Similar findings were observed in Thiel-embalmed specimens: here, excellent preservation was related to higher Pre thorax examination scores. In addition, considering Thiel specimens, colorfast was correlated with lower examination scores in the Pre examinations of all regions.
In both Ethanol- and Thiel-embalmed tissues, perceptions of tissue preservation, colorfastness, and tissue pliability correlated positively with the suitability of the tissues to prepare for examinations (rEthanol ≥ 0.31, rThiel ≥ 0.46). Perceptions of Ethanol pliability correlated negatively with perceptions of Thiel pliability (r = −0.51), i.e., opposing assessments were found for this tissue feature. Further comparison of the Ethanol and Thiel subgroups yielded no different trends when compared with the pooled assessment.

4. Discussion

For the first time, this study analyzed the knowledge retention and the associated ability to identify anatomical structures in undergraduate medical students who completed a 1-month regional anatomy dissection course. Knowledge retention presents the combined effects of knowledge gain and retention [71,72,73]. Knowledge retention in anatomy is an important aspect of medical professional training and is a challenge for medical students [74,75,76,77,78,79]. Practicing clinicians believe that graduates of new medical curricula have limited knowledge in basic anatomy [27,49,52,80], and the loss of knowledge already perceived during their medical studies continues to be a major challenge for educators and students alike [54,81,82,83].

4.1. Knowledge Retention Appears to Be Positively Influenced by Continuous Teaching Interventions and Not Only by Course Duration

Undergraduate medical students improved their ability to identify visceral structures in the 6- and 12-month follow-up compared with their initial OSPE results achieved during a 1-month practical dissection course in regional anatomy. No improvement was found for the thorax region between the Pre vs. 6-month vs. 12-month OSPE scores.
These surprising results offer new insights, as learning over a longer duration, so-called spaced learning, results in better retention than when learned over a shorter duration, so-called massed learning [44,45,46,48,84]. Spaced learning can be described as an increased time commitment and an increased number of recall/learning episodes by a learner [48]. The undergraduate medical students in our study completed their entire regional anatomy dissection course in a short time frame of just one month. The learning outcomes and the ability to recognize anatomical structures of students participating in an otherwise identical setting taught over three months rather than one month appeared to be highly beneficial [39]. Only two-thirds of unrehearsed knowledge can be reproduced after one year, and less than 50% after two years [54,81,85]. The loss of unused, unrepeated, or unconsolidated knowledge is an ongoing process following a negatively accelerated forgetting curve [81,86,87]. In contrast, Custers and Cate found little to no decrease in retention in the first two years following the basic science study if test scores were corrected for rehearsal [81]. Additional processing of information after the initial learning is essential to improving long-term memory. This shift from learning to long-term knowledge retention benefits from the so-called spacing effect, i.e., an approach where educational contents are learned and retained more efficiently when repeated over time. Spaced learning can be achieved by repeating the initial content or by retrieving knowledge through testing. Repeated testing has been shown to produce better long-term retention when compared with repeated studying. In spaced education, the educational programs implement the spacing effect to improve retention of knowledge [88,89,90,91,92,93,94].
In our study, between the OSPEs, further lectures on virtual anatomy, pathology, and seminars using plastinates and plastic models were delivered [56]. These further teaching interventions in anatomy apparently not only had a positive influence on student knowledge retention of visceral regions, they also likely improved the ability to recognize the visceral structures of the neck and abdomen regions.
The results of the present research refute our first hypothesis that knowledge retention would likely be poor if course contents were delivered over a short teaching period, and the students who received distributed instruction thereafter had significantly better long-term retention of their anatomy knowledge than students who received mass instruction.
These results further give an example of non-spaced, massed learning plus additional interventions. Seemingly, the knowledge retention of undergraduate medical students depends not only on the course duration and time-distributed instructions, but it also depends on accompanying virtual and physical teaching interventions such as Cinematic Rendering. Other studies emphasized that spaced learning is more beneficial for long-term memory retention [45,90,95,96,97,98] and spatial learning enables more frequent and time-distributed retrieval options, which have been shown to increase long-term retention of knowledge [42,45,99,100].
Interestingly, Amabile and colleagues assessed whether students within a Doctor of Physical Therapy program receiving spaced instruction would have better long-term anatomy knowledge retention than students receiving massed instruction under otherwise similar course settings, given they had the same number of contact hours but different course durations [48]. No difference in pre- or post-test means nor percentage improvement was found between cohorts, indicating that spaced and massed instruction resulted in the same level of long-term anatomy knowledge retention. Burgess and co-workers presented a longitudinal study of student knowledge acquisition and retention following six annual intensive eight-week anatomy electives via whole body dissection [37]. Student assessments at 1 or 7 months following course completion yielded no difference in knowledge retention.
We recently evaluated undergraduate medical students learning outcomes and their ability to recognize anatomical structures. They participated in a 1-month regional anatomy course compared with an otherwise identical 3-month setting. It was found that course exposure over 3 months was highly beneficial [39]. This study demonstrated significant improvements in knowledge retention observed for the neck and abdomen regions in the 6- and 12-month interval. The knowledge retention achieved in the 12-month survey in the for this given cohort reached levels trending towards the 3-month regional anatomy course setting [39] in spite of the lack of contact with dissection-based regional anatomy.

4.2. Ethanol-Glycerin Embalming Appears to Offer Certain Advantages for Undergraduate Medical Students

Compared with Thiel, higher OSPE values were observed for the ethanol-glycerin-embalmed neck and abdomen regions in the Pre Exam. Tissues embalmed with ethanol-glycerin appeared to offer certain advantages to undergraduate medical students in recognizing anatomical structures. This corroborates former results that the benefits of Thiel embalming seen for postgraduate studies are not seen for entry-level medical students [69]. In postgraduate clinical workshops or surgical training courses, the requirements for the visual and haptic tissue features differ greatly from those for undergraduate medical students’ courses [57,58,101,102,103,104,105,106,107,108]. In contrast to postgraduate studies where the primary goal is to provide tissues that are as lifelike as possible, as provided by Thiel-embalmed tissues [109,110,111,112], undergraduate students seemingly prefer stiffer structures in the neck and abdomen, which are more easily distinguishable in terms of color [57,69,101,102]. The viscera of Thiel-embalmed bodies are much softer than those of ethanol-glycerin-embalmed corpses, causing them to collapse and thus making it more difficult for undergraduate students to recognize the anatomical structures [102,113,114,115]. In contrast, the hardening induced by ethanol-glycerin facilitates the separation of the skin from the subcutaneous tissue, the muscles from the surrounding fascia, or the intestine from the mesentery [57,101,102]. Over time, the visual advantage of what Thiel embalming offers begins to diminish, affecting students’ ability to identify structures in later dissection or training phases [102,116].

4.3. Preliminary Evidence Exists That Tissue Preservation, Colorfastness, and Pliability Promote the Suitability of the Tissues to Prepare for Examinations

In both ethanol-glycerin- and Thiel-embalmed tissues, student perceptions on tissue preservation, colorfastness, and tissue pliability correlated positively with their assessment on tissue suitability to prepare for examinations. Some weak correlations were observed within and between examination time points and anatomical regions, which seemed not to follow any specific pattern between the anatomical regions assessed. Seemingly, the quality of preservation was correlated with the success in recognizing thorax structures. Therefore, the preservation of ethanol-glycerin-embalmed specimens only weakly correlated with higher 12-month thorax examination scores. In Thiel specimens, the assessment of preservation and colorfastness was related to lower Pre examination scores.

4.4. Future Directions

Additional studies are necessary to better understand the factors influencing knowledge retention and the clinical impact of anatomy knowledge obtained in shorter versus longer dissection courses on regional anatomy. Moreover, it might be advantageous to evaluate whether results similar to those presented here also apply to other standard embalming techniques beyond ethanol-glycerin and Thiel fixation.

4.5. Limitations of the Study

A number of limitations apply to this study. Firstly, as part of the quality assurance approach in teaching, only a limited number of students were assessed. Secondly, due to the study design, there was no control group without interventions after the dissection course was tested. This was due to the fact that these interventions form part of the curriculum of the JKU and therefore cannot be removed. Furthermore, the OSPE has definite limitations as a method of assessing student performance, which is beyond the scope of this publication. Knowledge retention was only assessed for medical students and only after 6 and 12 months following the regional anatomy dissection course. Moreover, the Hawthorne effect may have an impact on the results of such studies. Finally, the given findings are limited to undergraduate medical teaching, and it remains unclear if the findings are applicable beyond the Austrian medical educational setting.

5. Conclusions

Undergraduate medical students improved their ability to identify the visceral structures 6 and 12 months following their initial learning window during a 1-month practical dissection course on regional anatomy. Knowledge retention among medical students seems to depend not only on the duration of the dissection course or embalming procedure but can be positively influenced by a combination of physical and virtual teaching after the dissection course. Therefore, even anatomy teaching interventions that do not use real human tissues can help consolidate and improve regional anatomy knowledge over a one-year period.

Author Contributions

Conceptualization, V.A. and N.H.; methodology, V.A., M.S., F.A.F., S.M. and N.H.; software, F.A.F. and J.F.N.; investigation, V.A., M.S., F.A.F., J.F.N. and N.H.; resources, M.E., F.A.F. and N.H.; data curation, V.A., M.S., F.A.F., J.F.N. and N.H.; writing—original draft preparation, V.A. and N.H.; writing—review and editing, V.A., M.S., M.E., F.A.F., S.M., J.F.N., B.O., A.J.P., A.W. and N.H.; visualization, N.H.; supervision, N.H.; project administration, V.A. and N.H. All authors have read and agreed to the published version of the manuscript.

Funding

This research received no external funding.

Institutional Review Board Statement

The study was conducted in accordance with the Declaration of Helsinki and approved by the Ethics Committee of the Medical University of Graz (33-500 ex 20/21).

Informed Consent Statement

Informed consent was obtained from all subjects involved in the study.

Data Availability Statement

The original contributions presented in the study are included in the article; further inquiries can be directed to the corresponding author.

Acknowledgments

The authors would like to express their sincere gratitude to the body donors who donated their bodies for research after their death. We would also like to thank their families for supporting this valuable decision. The artwork of Sandra Maria Pietras, Macroscopic and Clinical Anatomy, Medical University of Graz, Austria, is gladly acknowledged.

Conflicts of Interest

The authors declare no conflicts of interest.

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Figure 1. Undergraduate curriculum framing the 1-month regional anatomy course setting.
Figure 1. Undergraduate curriculum framing the 1-month regional anatomy course setting.
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Figure 2. Box plots comparing the Pre, 6- and 12-month examination scores of the neck, thorax and abdomen regions. The boxes indicate the 25th percentile, median and 75th percentile, whiskers the minima and maxima. Crosses depict the mean value. Significant improvements in 6- and 12-month examination scores were noted for the neck and abdomen regions.
Figure 2. Box plots comparing the Pre, 6- and 12-month examination scores of the neck, thorax and abdomen regions. The boxes indicate the 25th percentile, median and 75th percentile, whiskers the minima and maxima. Crosses depict the mean value. Significant improvements in 6- and 12-month examination scores were noted for the neck and abdomen regions.
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Figure 3. Box plots comparing the Pre, 6- and 12-month examination scores of the neck, thorax and abdomen regions separated for ethanol-glycerin (Ethanol)- and Thiel-embalmed tissues. The boxes indicate the 25th percentile, median and 75th percentile, whiskers the minima and maxima. Crosses depict the mean value. Significantly increased 6- and 12-month examination scores were primarily found in Thiel-embalmed tissues.
Figure 3. Box plots comparing the Pre, 6- and 12-month examination scores of the neck, thorax and abdomen regions separated for ethanol-glycerin (Ethanol)- and Thiel-embalmed tissues. The boxes indicate the 25th percentile, median and 75th percentile, whiskers the minima and maxima. Crosses depict the mean value. Significantly increased 6- and 12-month examination scores were primarily found in Thiel-embalmed tissues.
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Table 1. Spearman correlations were observed between pooled examination outcomes and tissue assessment.
Table 1. Spearman correlations were observed between pooled examination outcomes and tissue assessment.
Correlation r Valuep Value
Neck PreThorax Pre0.310.0006
Neck PreAbdomen Pre0.310.0007
Neck PreAbdomen 6 month0.310.0008
Thorax PreAbdomen 6 month0.280.0034
Abdomen PreAbdomen 6 month0.280.0032
Neck 12 monthThorax 12 month0.320.0221
Ethanol preservationThorax 12 month−0.350.013
Ethanol colorfastnessNeck 6 month0.310.038
Ethanol exam preparationThorax 12 month0.360.025
Ethanol preservation, color- fastness, pliabilityEthanol exam preparationr ≥ 0.31≤0.014
Thiel preservationThorax Pre−0.250.021
Thiel colorfastnessall regions Pre≥0.33≤0.022
Thiel exam preparationThorax 6 month−0.450.026
Thiel preservation, color- fastness, pliabilityThiel exam preparation≥0.46<0.001
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Antipova, V.; Siwetz, M.; Engelhardt, M.; Fellner, F.A.; Manhal, S.; Niedermair, J.F.; Ondruschka, B.; Poilliot, A.J.; Wree, A.; Hammer, N. Knowledge Retention of Undergraduate Medical Students in Regional Anatomy Following a One-Month Gross Anatomy Course Setting. Educ. Sci. 2024, 14, 905. https://doi.org/10.3390/educsci14080905

AMA Style

Antipova V, Siwetz M, Engelhardt M, Fellner FA, Manhal S, Niedermair JF, Ondruschka B, Poilliot AJ, Wree A, Hammer N. Knowledge Retention of Undergraduate Medical Students in Regional Anatomy Following a One-Month Gross Anatomy Course Setting. Education Sciences. 2024; 14(8):905. https://doi.org/10.3390/educsci14080905

Chicago/Turabian Style

Antipova, Veronica, Martin Siwetz, Maren Engelhardt, Franz A. Fellner, Simone Manhal, Julian F. Niedermair, Benjamin Ondruschka, Amélie J. Poilliot, Andreas Wree, and Niels Hammer. 2024. "Knowledge Retention of Undergraduate Medical Students in Regional Anatomy Following a One-Month Gross Anatomy Course Setting" Education Sciences 14, no. 8: 905. https://doi.org/10.3390/educsci14080905

APA Style

Antipova, V., Siwetz, M., Engelhardt, M., Fellner, F. A., Manhal, S., Niedermair, J. F., Ondruschka, B., Poilliot, A. J., Wree, A., & Hammer, N. (2024). Knowledge Retention of Undergraduate Medical Students in Regional Anatomy Following a One-Month Gross Anatomy Course Setting. Education Sciences, 14(8), 905. https://doi.org/10.3390/educsci14080905

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