Step 1 : Removal of passive , non-interacting demonstration from the practical
Replacement strategies for active dissection utilized new technologies such as virtual dissection tables ( Sectra , Anatomage ), plastinated specimens , or 3D-printed material [ 3-6 ]. When comparing the diverse approaches for anatomy learning , students prefer face-to-face dissection to online anatomy learning software [ 7 ].
Most of the new physical or virtual modes of presentation of anatomical structures have merits on their own and analysis of their usefulness often demonstrated small but statistically significant improvements compared to traditional prosections and cadaveric dissection . But the mode of presentation is only one component and subsequent challenges are to combine those into new strategies . The challenge of maintaining student-centered , self-directed education in the face of limitations in time and available space is added to the burden of building increased efficiency into teaching . Some effective learning , tools such as body painting , or the creation of models using play dough are time-intensive exercises , and therefore difficult to sustain in most curricula [ 8 , 9 ]. Nevertheless , with the move away from dissection , there is a clear need for active haptic interaction of students with physical 3-dimensional anatomical objects that mimic human anatomy as close as possible [ 7 , 10 , 11 ].
This study aimed to create meaningful anatomy practicals that can accommodate about 50 students at a time ( total n = 150 ), run for 60-90 min over 13 weeks of course work and provide as much opportunity as possible for the students to interact with the provided material . The result is a selfpaced process that involves working as a group with limited or no involvement of demonstrators . Self-directed group interaction with a reduction of didactic teaching to a minimum . In addition , the practicals should be easily applicable to remote teaching . In the latter case , the practical has to be adaptable to remote teaching classes that have access to plastic models , but not to human material , such as prosections or other cadaveric material .
This resulting narrative serves to provide short insights into rationales and contexts .
Step 1 : Removal of passive , non-interacting demonstration from the practical
Analysis of anatomy knowledge in students in the Netherlands and USA [ 15 , 16 ] showed that anatomical knowledge is dependent on “ total teaching time for anatomy , teaching in a clinical context , and revisiting anatomy topics in the course of the curriculum ” To redefine total teaching time as the time available to explore and practice the understanding of complex threedimensional structures we moved the demonstration and explanation of material from the faceto-face section of the practical and incorporated it into a pre-practical setting [ 17 ]. This has been shown to be an effective mode of delivery in different practical settings [ 17 ]. The same anatomical models that were available to the students in practicals were used to record model / prosectionspecific demonstrations of 5-20 min in length ( table 1 ). Every model and cadaveric prosection was explained in a video and provided to the students online in combination with learning checkpoint questions ( table 1 ). This removed the time traditionally used for demonstrator-style teaching , and simultaneously allowed students to prepare for the practical in their own time and with their own pace . The preparation transformed the practical from an environment where structures were encountered for the first time to a more revisionbased and known environment , with the premise that this should lead to higher efficiency in recognising of and interacting with anatomical structures .
We developed a new structure of anatomy-related practicals by the combination of different aspects of flipped classroom teaching [ 12 ], blended learning [ 13 ], self-directed learning [ 14 ], and guided learning . This is to match the unmet need for increased access to physical material , with restrictions in overall time and space . We divided the development process in four steps .