Methods
unique . Anatomists across the globe responded readily and creatively to this abrupt shift , the details of which can be found in numerous publications ( Evans and Pawlina , 2021 ; Franchi , 2020 ; Pather et al ., 2020 ; Attardi et al ., 2021 ; Birbara and Pather , 2021 ; Idris and Edris , 2021 ). Preliminary data from these adaptations demonstrates a mostly positive response from students , at least in the short term ( Evans and Pawlina , 2021 ). However , these studies fail to identify how students have maintained successful learning within these virtual adaptations .
Virtual education has been a lifeline during times when face-to-face encounters pose infection risks , however , it is not without its challenges ( Almarzooq , Lopes , and Kochar , 2020 ). Online learning , especially asynchronous courses , increases student feelings of isolation and disrupts senses of community ( Bridge , Jackson , and Robinson , 2009 ; Guimarães et al ., 2017 ). Anatomy-specific virtual learning is often complicated by a limited two-dimensional display of three-dimensional structures ( Nicholson et al ., 2006 ; Triepels et al ., 2020 ). Additionally , the cognitive load of navigating unfamiliar material in an unfamiliar virtual terrain exacerbates the challenges described above ( Iwanaga et al ., 2021 ; van Merriënboer and Sweller , 2010 ; Birbara and Pather , 2021 ). Combined with the negative effects of the pandemic on student wellbeing and motivation , successful anatomy education was particularly susceptible to compromise ( Zis et al ., 2021 ).
This threat to anatomical education prompted our investigation of student success during the 2020 cohort of human gross anatomy at LECOM ’ s three northern campuses . Particularly , we aimed to characterize the behaviors and attitudes that contributed to student success in gross anatomy , despite the stressors associated with virtual learning in a pandemic . Pre-pandemic medical education literature has provided a rich source of best practices for effective student learning and study techniques . For example , numerous studies suggest that active recall , spaced repetition , and self-testing are all essential to academic success ( Karpicke and Roediger , 2008 ; Augustin , 2014 ; Ghanbari , Haghani , and Akbarfahimi , 2019 ; Greving and Richter , 2018 ). In contrast , passive learning methods such as re-reading lecture handouts and notes are generally associated with poor academic performance , compared to more active techniques ( Aziz et al ., 2002 ; Triepels et al ., 2020 ). Prior investigations also indicate that delivery format of gross anatomy courses is not as important as prior academic performance in predicting student success ( Attardi and Rogers , 2015 ). Additionally , wellness literature emphasizes the often-overlooked role that mental health plays in ensuring student success ( Dyrbye et al ., 2014 Dyrbye and Shanafelt , 2015 ; Dyrbye , Thomas , and Shanafelt , 2005 ). As the aforementioned reports were generated before the COVID-19 pandemic , recent educational shifts grant an opportunity to determine if these factors remain predictive of learning success in a virtual format complicated by the stressors of the pandemic .
This study investigates how student demographics , education and professional background , wellbeing , and study methods differ between high and low performers during the virtual 2020 cohort of human gross anatomy at our institution . We hypothesize that students with an undergraduate degree in the biological sciences will have a higher gross anatomy grade than those who do not . We also expect gross anatomy grades to increase as the time between completion of undergraduate studies and matriculation to medical school decreases . Past work or volunteer experience in healthcare is predicted to be more frequently present in students with higher final course grade . Students who report behaviors and characteristics consistent with high levels of wellbeing and academic confidence are hypothesized to perform better than those without such qualities . Finally , students who report higher frequency of using evidence-based study methods , such as self-testing and proper scheduling , are hypothesized to perform better than students who do not exhibit such behaviors . Several of the identified factors are readily modifiable and therefore provide opportunity for intervention of at-risk students .
Methods
GROSS ANATOMY IN THE LECOM CURRICULUM
LECOM Erie is composed of three , geographically separated campuses : Erie , Seton Hill , and Elmira . First year medical students at all three locations synchronously take the human gross anatomy course during the first 12 weeks of the fall semester . Human gross anatomy is a comprehensive course , containing both lecture and lab components , and is worth 9 credits . During this twelve-week period , embryology and histology lectures complement the gross anatomy curriculum . Due to the COVID-