perceive themselves as academically struggling with gross anatomy content may be less likely to seek academic support ( Bynum et al ., 2021 ; Bynum et al ., 2019 ; Bynum , Teunissen , and Varpio , 2021 ). This hypothesis is supported by the significant decrease in final course grade associated with low comfort with seeking help and frequent feelings of embarrassment when struggling academically in our student population . The feelings of isolation associated with a virtual education may have also limited students ’ comfort with seeking help from professors or instructors ( Guimarães et al ., 2017 ).
STUDY TECHNIQUES
Several study techniques were demonstrated to modify student success during virtual gross anatomy . Cramming immediately prior to examinations was associated with a significant decrease in final course grade , consistent with most educational literature ( Yeh and Park , 2015 ; Roffler and Sheehy , 2022 ; Ransohoff et al ., 2021 ). This increase in cramming is likely associated with lastminute study routine changes and is an extension of difficulties adhering to pre-developed study schedules , echoing the results of cramming on the students ’ final grades ( Yeh and Park , 2015 ).
Even students who can maintain focus and adhere to study schedules do not have inexhaustible study potential ( Hudson , Van Dongen , and Honn , 2020 ). Despite this limitation , there was not a significant difference in final grade when students were compared based on break frequency during study periods . This is at odds with literature on the effects of rest on vigilance tasks ( Finkbeiner , Russell , and Helton , 2016 ), however , this may be explained by the very small proportion of students ( 3 %) who reported that they did not take breaks . Most of our students ( 40 %) reported taking a break every sixty minutes . Examining length of break revealed that students taking ten-minute breaks scored significantly higher than those students taking fortyminute breaks . This is consistent with reports that taking breaks improves performance , though the decrement in performance when returning to a task increases with the length of break ( Lim and Kwak , 2015 ). As expected , full concentration during non-break study periods is essential for optimal performance ( Xu et al ., 2020 ).
Studying in groups was associated with a significantly decreased final gross anatomy grade . While this finding is informative , it may reflect the difficulties of small group interactions in a virtual environment rather than ineffectiveness of group study ( Gillett-Swan , 2017 ). Crouch and Mazur ’ s work demonstrating a significant improvement in comprehension when implementing peer instruction lends support to this interpretation ( 2001 ). Though studying alone was not associated with higher gross anatomy grade , reports on histology study techniques indicate that most medical students actually prefer to study alone ( Selvig et al ., 2015 ). Further research is thus required to determine whether solo or group study sessions are most beneficial in the virtual setting . Overall , these findings are of limited applicability due to restrictions on social interaction that were in place during the COVID-19 pandemic .
The testing effect has demonstrated continual efficacy in knowledge acquisition and retention ( Karpicke and Roediger , 2008 ; Larsen , Butler , and Roediger , 2008 ). Karpicke and Roediger ’ s data confirm these principles by demonstrating a lack of recall improvement after repeated encoding in contrast to the remarkable improvement when students practiced serial retrieval ( 2008 ). An interesting development in our study was that testing was only associated with an increase in final grade when the students generated questions themselves . This indicates that the testing effect requires a deep interaction with the material for optimal benefit ( Greving and Richter , 2018 ; Augustin , 2014 ; Ghanbari , Haghani , and Akbarfahimi , 2019 ).
Students who reported difficulty identifying main ideas earned significantly lower grades than those who did not have such difficulties . These students may be suffering from cognitive overload , in which the bandwidth of working memory is outstripped by the information that must be engaged ( Sewell , Santhosh , and O ' Sullivan , 2020 ). Though lectures were largely unchanged during the pandemic , the decreased interaction with professors may have limited the students ’ ability to identify salient features of gross anatomy content . Cognitive overload may also account for the lower grades among students who had difficulty understanding what a question was asking of them , leading to disorganized mental schema and impaired information utilization .
Overall , it appears that educational behaviors contributing to success during a typical school year continue to provide benefits for students