Introduction
Methods
Introduction
The premise of medical education is that the content and delivery of the undergraduate curriculum influence the preparation of future practitioners for their roles . What is taught , in part , determines knowledge , competence and attitude as to what makes a good doctor . Therefore , one could argue that teaching time should be utilized to its full extent to prepare future doctors with the clinically relevant knowledge they will be using rather than just facts which are taught , assessed and then forgotten at the expense of vital clinical knowledge ( ten Cate et al , 2004 ).
The first years of a medical student ’ s undergraduate training form the foundation for clinical knowledge which develops with progression of the curriculum . Traditionally , the pre-clinical years of the medical program consist of developing sufficient knowledge about basic sciences such as understanding structure and biological functions , so that these can later be incorporated with further clinical knowledge and experience . Developing a medical curriculum is a demanding venture , requiring extensive time and financial resources , as well as motivated and competent educators . Having invested so much into a curriculum , one would want to ensure that what is being taught is being done so as effectively as possible - i . e . that what is being taught is being remembered . Therefore , with common concerns that the curriculum is overloaded ( Slavin and D ' Eon , 2021 ) and with an overemphasis on the recall of facts at the expense of scientific reasoning , one can question whether what we are teaching in the pre-clinical years is remembered , and if not , why not ?
Clinical ( or applied ) anatomy , the study of human anatomy as it relates to clinical practice
is not only essential for safe practice ( McLachlan and Patten 2006 ; Patel 2006 ) but it is the basis of all interventional medicine . Given the limited time dedicated to its teaching , clinicians ( as compared to students and anatomists ) reportedly prefer to see anatomy taught as an applied science as well as nesting it later in the clinical curriculum ( Sbayeh et al , 2016 ).
Students surveyed at the University of Malta reported that they could not remember much anatomy from the pre-clinical years , despite having been extensively taught and assessed on it previously ( Stabile , 2009 ). Moreover , students expressed concern that should they be required to recall any of it in any future scenario , they would be unable to do so . If students cannot remember ( and therefore use ) what they were taught , what is the purpose of investing significant resources to teach them ? If knowledge cannot be accessed or reproduced , why teach it in the first place ( Cox , 1987 )?
The concept of retention of knowledge has been studied for more than a century . One study showed that the curve representing the decline in retention of knowledge of anatomy was identical to that of the forgetting curve for nonsense syllables ( Ebbinghaus , 1913 ). Custers ( 2010 ) reviewed studies that investigated long-term retention of basic science knowledge in medical school and estimated 70 % retention after 1 year , 40 – 50 % retention after 2 years , and 30 % retention after 4 years . Poor knowledge reinforcement ( Larsen , Butler and Roediger III , 2009 ) and insufficient applicability to the clinical setting are thought to be the main factors responsible for this phenomenon . This suggests the need to focus on foundational concepts and principles , which will be useful for future practice , rather than on rote memorization of anatomical facts bereft of clinical context ( Shulman , 1970 ).
Detailed “ traditional ” or non-clinical ( also known as basic or pure ) anatomy with some clinical applications is taught during the first two years of medical school at the University of Malta , and is not formally revisited later . There is no information as to how much of this anatomical knowledge is retained . The aim of this study was to examine which type of anatomical knowledge is better retained by students and determine the factors that may influence this .
Methods
Context : The University of Malta Medical School utilizes a strictly pre-clinical / clinical approach over the first two and latter three years , respectively . All anatomy ( as well as physiology , biochemistry and an introduction to pathology ) is taught in Years 1 and 2 . Almost none of it is revisited in the later clinical years .
Approach : Towards the end of the academic year , all Year 1 to 5 medical students were asked to volunteer to sit for an anatomy test under examlike conditions . The test consisted of 100 best of four questions covering anatomy topics taught