Education: Anatomy teaching during Covid-19 pandemic

By Assistant Professor Sreenivasulu Reddy Mogali, Head of Anatomy

Anatomy is a cornerstone of medical education. The Covid-19 pandemic has disrupted anatomical education significantly and led to a temporary cessation of face-to-face practical teaching, and a shift to online delivery.

Face-to-face practical demonstrations and cadaveric or plastinated specimens are the gold-standard pedagogical tools for anatomy learning. Most of the LKCMedicine anatomy curriculum was delivered before Singapore entered the Circuit Breaker period, except for the Year 1 musculoskeletal (MSK) anatomy module. The situation led us to teach it exclusively online although the MSK anatomy is content-rich.

Although LKCMedicine's students are not new to e-learning and "flip-classroom" education techniques, learning anatomy without exposure to the plastinated specimens, bony materials, and microspores was something totally unexpected.

Yet, complete digitisation of our unique collection of plastinated specimens as well as the potted pathology specimens greatly aided online anatomy teaching during that period. We developed new online structured practical worksheets that displayed layered dissections and various views of prosected specimens and bones to augment practical demonstration videos that had been developed inhouse.

The visual recognition and identification of structures and their relationships are fundamental to anatomy learning. We think that having access to interactive illustrations of prosected specimens and practical demonstrations are crucial in simulating the elements of an actual practical despite physical separation from the anatomy laboratory and faculty.

The Covid-19 crisis gave us an opportunity to relook at and reinvent existing materials, and try new methods. Today, our curricular materials have been largely digitalised with fine quality images and are presented using a dedicated learning management system. Admittedly, there are areas that need improvements, such as fostering students' interaction and engagement with online content.

But we have thought of several ways to do this. For one, in collaboration with our digital learning team, the anatomy team developed new materials, augmented with interactive quizzes with an aim to enhance interaction and engagement, while providing instant feedback to students about their learning and knowledge. In the background, the learning management system provides reports to the faculty about the learners' engagement with the materials and how well they are learning.

This data is useful to better understand the students' needs, optimising their learning, and enhancing learning outcomes. Currently, this is piloted in AY2020-21 in the Year 1 Cardiorespiratory Module.

Feedback gathered shows that our students were satisfied with the online delivery of MSK anatomy, but they still prefer face-to-face practical sessions in the laboratory as it provides a more optimal learning environment. This feedback was expected given the complexity and 3D nature of the subject.

Therefore, it was a great relief when MOE announced the resumption of face-to-face classes but with a maximum of 50 students per class with safe distancing rules in place. We then put plans into action.

Organising the labs with safety measures in place requires meticulous planning, proper messaging to students, and coordination with other departments to execute plans accurately. The fact that we welcomed 162 freshmen this year – our biggest cohort to date – presented a bigger challenge: we had to optimise teaching resources and learning spaces.

Our plan includes conducting Anatomy practicals in two sessions and the Science practicals in three sessions to accommodate the cohort size. Each session is further split into three zones which are separated from each other by blinds. Each zone capacity is restricted to 50 individuals comprising students, faculty, and support staff.

 A lab safety briefing for M1 was conducted via Zoom and the recorded version was sent to M2 students to remind them of lab safety procedures. Students were grouped as per their TBL teams and safe distancing of one metre between teams was implemented with demarcation on the tables.

Members that form each team are fixed for the academic year. Students are not allowed to cross over at any time during the practical and are instructed to sanitise their work areas and seats before they leave. Staggered arrival and dismissal timings via zones were communicated to the students ahead of the practical sessions.

We are happy to share that on 18 August, 2020, we welcomed the M2 students for the first face-face anatomy practical session. All staff and students wore a mask, reported according to their time slots, and promptly followed safety check-in and logging of their temperature daily on the NTU portal. The session started with important Covid-19 reminders. And so, the GI anatomy module for M2 students has been successfully completed.

Next, on 31 August, the M1 students had their first-ever anatomy practical. They started their session with a pledge to honour the people who donated their bodies for science and also to uphold professional conduct. It was delightful to see students' interaction and engagement with the specimens to discover and comprehend the anatomical structures.

So far, the anatomy and science practicals have run successfully with safety guidelines in place. This would have not been possible without the cooperation of students, faculty, and supporting staff. We hope that the Covid-19 situation remains under control and are looking forward to the remaining anatomy and science practicals in this academic year to enrich our students' experience of the curriculum and maximise their learning.