Discussion
Discussion
It is generally accepted that a teaching approach which focuses on revisiting , reviewing and clinical application of anatomical knowledge ( spiral curriculum ) is reflected in better examination performance ( Harden , Sowden and Dunn 1984 ; ten Cate et al , 2004 ). For example , Blunt and Blizard ( 1975 ) reported that results on testing lower limb anatomy two years after the original instruction were no better than random guessing on test questions . Scores were still higher than the pass mark but students performed better in subjects which were reinforced by subsequent teaching and practice in the clinical years . Similar results were shown by ( Weggemans , Custers and ten Cate , 2017 ) with respect to retention of knowledge of cell biology and metabolism .
Somewhat unexpectedly , the results of our study show that the performance in non-clinical basic anatomy questions was better in the latter years of medical school compared to students in Years 1 and 2 . This suggests that , although not formally revisited in our medical school , basic anatomical knowledge is still improved by clinical contextualization , as previously reported by Bergman et al ( 2008 ).
This study also demonstrated that performance across both clinical and non-clinical anatomy domains improved over the years , with clinical anatomical knowledge improving more significantly , possibly reflecting consolidation of knowledge through application .
Swanson et al ( 1996 ) have shown that factual knowledge in subjects which are reinforced clinically is retained for longer . Using the USMLE Part 1 test as a reference point , knowledge loss was reportedly 2.9 %, but one could argue that since this examination only tests the important aspects of basic science subjects it cannot be used as an accurate estimate of all the topics taught in the pre-clinical years .
However , a decline in the ability to accurately state anatomical facts does not necessarily imply inability to apply anatomical knowledge . For example , the study of Balla et al ( 1986 ) showed no relationship between scores measuring neuroanatomical knowledge and the ability to make a correct clinical diagnosis ; and students who could recall more pre-clinical knowledge were not able to better apply it in the clinical setting . Similar findings were reported by Bergman et al ( 2008 ) who investigated medical students ’ knowledge of anatomy at eight Dutch medical schools . Factors such as teaching in a clinical context , the total teaching time devoted to anatomy , and revisiting anatomy topics not only affected test performance but outweighed factors such as whether the curriculum was problembased or traditional . This suggests that rather than teaching purely non-clinical anatomy in the early years and supplementing it later on with a clinical approach , an integrated system should be adopted from the start .
Lazić , Dujmović and Hren ( 2006 ) asked students in Years 2 and 5 to answer the same two sets of questions , one related to basic and the other to clinical sciences . Year 2 students scored better in the former and Year 5 students in the latter , while performing worse in the other questions respectively . This supports the notion that exam grades in the basic sciences do not necessarily predict clinical competencies . It also challenges the notion that there is a casual relationship between a basic anatomical background and clinical knowledge – had this been the case the Year 5 students who scored highest in clinical questions , would have done the same in basic science . This suggests that clinical and non-clinical types of information may not be learned and utilized together . It is unclear whether this is due to the fact that a background of basic sciences is not needed to learn clinical information or whether it is because the basic science topics were not revisited and integrated with a clinical application .
The fact that clinical knowledge can be learned without a complete understanding of its basic science background is further supported by the observation that a scientific based undergraduate training does not seem to improve performance by students during medical school ( Hall and Stocks , 1995 ).
More information is not necessarily better information , and information overload of facts that may only be relevant to specialists in those fields may be counterproductive ( Gunderman , 2006 ). In contrast , emphasizing and reviewing the main principles and concepts may be more beneficial to long term retention of knowledge . For example , there is evidence that reviewing and revisiting previously taught topics , while integrating them with clinical scenarios reinforces knowledge instead of simply elaborating it ( Gardiner , 1994 ).