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Korean J Med Educ > Volume 36(4); 2024 > Article
Hisham, Hadie, Kasim, and Shamsuddin: From crisis to opportunity: enhancing anatomy education in a post-COVID world: the Universiti Sains Malaysia experience

Abstract

The coronavirus disease 2019 pandemic has fundamentally reshaped anatomy education, offering invaluable insights to guide the future of anatomy pedagogy. As we transition into a post-pandemic era, it is crucial to integrate the lessons learned to create a more resilient, flexible, and effective educational environment. This paper examines the transformative strategies implemented at Universiti Sains Malaysia during the pandemic, focusing on the empowerment of blended learning, technology-enhanced tools, student-centered learning practical sessions, and enhancement of formative assessment. These strategies include integrating digital learning resources, such as the Virtual Anatomy Museum and online histology quizzes, with in-person instruction, fostering a supportive and interactive learning environment. Additionally, practical sessions were redesigned to emphasize collaborative learning, peer teaching, and developing critical thinking and communication skills. Formative assessments were integrated to provide continuous feedback and support ongoing learning. This comprehensive approach not only enhanced students’ understanding of anatomical concepts but also improved their emotional well-being and overall learning experience. The lessons learned from the pandemic have paved the way for a more innovative and adaptive anatomy education that is well-prepared for future challenges.

Introduction

The coronavirus disease 2019 (COVID-19) pandemic has fundamentally reshaped the landscape of anatomy education, offering invaluable insights that can guide the future of anatomy education. As we transition into a post-pandemic era, it is crucial to integrate the lessons learned to create a more resilient, flexible, and effective educational environment. The World Health Organization declared COVID-19 a pandemic in March 2020, leading to global disruptions in education systems [1]. Consequently, social distancing measures prompted an abrupt shift from traditional in-person classes to online teaching and learning strategies, which significantly transformed anatomy pedagogy [2]. This global disruption has emphasized the importance of the concepts of BANI (brittleness, anxiety, nonlinearity, incomprehensibility), indicating the need for prompt action in equipping anatomy education with a future-ready and future-proof curriculum. Given the nature of anatomy education, which typically requires hands-on learning experiences, anatomy educators need to design teaching and learning strategies that can accommodate both face-to-face and online learning.
Nevertheless, during the COVID-19 era, the students were hindered from participating in face-to-face learning and hands-on anatomy practical sessions that utilized cadaveric dissection, anatomical models, prosected specimens, and histological slides. To accommodate the restrictions, there was an increased reliance on technologyenhanced tools and internet services, such as teleconference software, web-based learning platforms and digital learning tools [3]. It was argued that full adaptation to online learning had posed challenges to educators as the transition was sudden and required extensive preparation, which eventually led to increased workloads within tight time constraints [4]. Many anatomy educators were not familiar with digital content but were expected to be proficient with new online teaching tools. They were also expected to explore innovative ways to effectively engage students in the virtual learning environment. Meanwhile, students faced difficulties in adapting to this new mode of learning, with issues ranging from technical challenges to a lack of personal interaction affecting their overall learning experience and engagement [5].
In this context of global adaptation, the teaching and learning of anatomy at Universiti Sains Malaysia (USM) underwent a significant transformation from conventional face-to-face lectures and practical classes to a blend of synchronous and asynchronous online sessions. This shift was facilitated by the extensive use of digital learning tools to enhance student engagement. At USM, lectures and practical sessions were delivered synchronously using the teleconferencing platform Cisco Webex (Cisco Systems Inc., San Jose, USA) which provided features such as whiteboard, screen sharing, and breakout rooms. During these synchronous classes, interactive online quizzes were integrated using tools like Mentimeter, Kahoot, and Quizizz. For gross anatomy practical classes, synchronous or recorded demonstrations of anatomical structures were conducted using plastic models and supplemented with the Complete Anatomy application, which offers interactive three-dimensional (3D) anatomical structures. Histological practical sessions utilized virtual histological slides, and the Google Jamboard application (Google LLC, Mountain View, USA) was employed to facilitate small group collaboration during practical sessions [6].
This profound shift, driven by the COVID-19 pandemic, had a considerable impact on anatomy education at USM, underscoring the challenges and adjustments necessary for effective online learning. All learning materials, including lecture notes, pre-recorded and live sessions, and assessments, were made available on the E-learn @ USM portal, which uses the Moodle platform (https://elearning.usm.my/). The E-learn portal proved to be a user-friendly and cost-efficient solution, enabling students to access course materials efficiently during virtual learning. Despite these advancements, the effectiveness of online learning remains debated, with some advocating for the irreplaceable value of in-person interactions [7]. The pandemic, however, highlighted the urgent need for adaptable and well-supported online educational environments to meet students’ learning needs [8]. In response, a mixed-method study was conducted to evaluate preclinical medical students’ perceptions of the anatomy education environment at USM during the pandemic [9]. These experiences not only reshaped students’ learning but also presented significant challenges to lecturers and institutions, emphasizing the necessity for effective strategies in both online and in-person educational settings. Consequently, this paper aims to reflect on the challenges and lessons learned in anatomy education from the USM experience during one of the most challenging periods in recent history. Ultimately, this transformative journey has not only strengthened our anatomy education system but has also paved the way for more resilient and adaptive educational practices in the future.

Post-pandemic reflections on anatomy education challenges at USM during COVID-19

The mixed-method study conducted by Ahmad Hisham [9] highlighted several significant challenges in anatomy education at USM during the pandemic, offering critical reflections for post-pandemic improvements. These reflections are based on the qualitative data gathered using a phenomenology research design. Thematic analysis was performed by using the ATLAS.ti software (https://atlasti.com/) to analyze an open-ended feedback question, distributed via Google Forms (Google LLC). The feedback explored students’ experiences and challenges in learning anatomy during COVID-19.
One primary challenge was the difficulties students faced in effectively visualizing anatomical structures through online platforms, especially those with low visuospatial abilities. Without tactile experiences and kinesthetic learning opportunities provided by physical models and specimens in traditional in-person classes, students struggled to construct 3D mental images of these structures. The absence of hands-on manipulation made it challenging for students to comprehend spatial relationships, appreciate anatomical textures and accurately perceive the relative sizes and positions of the structures. The study emphasized that sensory feedback is crucial for creating lasting mental maps of anatomical features, particularly benefiting kinesthetic learners who grasp concepts more effectively through physical interaction [9].
The transition to online classes also resulted in decreased face-to-face interaction, which forced students to rely more on self-directed learning without immediate guidance from lecturers. Novice learners, who depended on real-time feedback and clarification of doubts to understand complex anatomical concepts, found this shift particularly challenging. The lack of face-to-face interaction hindered collaborative learning experiences through group discussions, which are essential for gaining a deeper understanding of anatomical concepts from diverse perspectives. These discussions enhance critical thinking and problem-solving skills, and their absence left students feeling disconnected and uncertain about their understanding of anatomical structures. Additionally, impaired motivation and emotional well-being were significant challenges in learning anatomy during the pandemic. The online learning environment was less conducive compared to in-person classes, as students often had to deal with distractions from their home environments. The absence of non-verbal communication cues from lecturers, such as facial expressions and hand gestures, made the virtual class less engaging. Consequently, students found it challenging to focus and experienced increased feelings of isolation, anxiety, and boredom, which negatively affected their mental health and learning effectiveness.
The COVID-19 lockdown also posed significant technical and accessibility problems for students. The closure of the anatomy museum necessitated a shift of all resources to online platforms, which primarily affected students in rural areas and those from underprivileged backgrounds. Poor internet connectivity and limited computer access restricted their ability to utilize essential resources, including specific software that requires stable and fast internet. The abrupt transition to online learning presented challenges for both students and lecturers as many encountered difficulties with digital literacy and lacked the necessary technological skills to navigate the online environment.
Reflecting on these post-pandemic experiences, we have systematically addressed the identified challenges, resulting in the transformation and enhancement of anatomy education. By implementing pedagogical strategies and establishing robust support systems, we have effectively bridged the gaps between online and in-person educational settings, thus ensuring a reliable, resilient, and adaptive anatomy education system for the future.

Post-pandemic transformative strategies for anatomy education

The COVID-19 pandemic has played a crucial role in reshaping the landscape of anatomy education at USM. One of the lessons learned from this experience is the critical importance of a multimodal teaching approach in anatomy instruction for flexibility and adaptability. Therefore, it is imperative to implement hybrid learning by integrating robust digital learning tools with in-person instruction. There are four transformative strategies for anatomy education at USM: (1) empowering blended learning, (2) developing and utilizing technologyenhanced tools, (3) embodying student-centered learning during anatomy practical sessions, and (4) incorporating formative assessment during teaching.

1. Empowerment of blended learning

After the COVID-19 pandemic, anatomy education at USM has undergone changes to incorporate a hybrid learning approach, combining both in-person and online instruction. This blended learning approach has resulted in a more flexible and personalized learning experience for students. In-person anatomy classes now include interactive lectures and practical sessions, while online instruction involves pre-class activities such as short YouTube videos (YouTube, San Bruno, USA) followed by online quizzes. These videos serve to activate prior knowledge or introduce new concepts, helping students better comprehend the material covered during in-person sessions. The online quizzes further reinforce understanding of the pre-learning materials, allowing students to complete assessments at their own pace. A study conducted by Hadie et al. [10] at USM has shown that students who participated in pre-learning activities, such as watching YouTube videos and completing online quizzes, outperformed those who did not complete these assignments in terms of knowledge acquisition.
During the face-to-face sessions, the knowledge acquired from the pre-learning activities is strengthened through interactive quizzes and hands-on activities. This facilitates the comprehension of new information. The blended learning method allows for personalization by customizing instruction to meet individual needs. It also enhances engagement through the usage of interactive tools such as videos, quizzes, and discussion forums, making the learning process more dynamic. Moreover, blended learning provides improved access to a wide range of resources and experts beyond local availability by utilizing platforms like YouTube. Students can benefit from educational content created by renowned anatomists and medical educators from around the world, offering diverse perspectives and high-quality instruction. These videos frequently feature detailed explanations, demonstrations, and animations that enhance understanding. By incorporating such resources, students gain insights from global experts, which may not be locally accessible. This approach not only enriches the learning experience, but it also optimizes classroom time. This permits instructors to concentrate on interactive and hands-on activities that reinforce and expand on the online materials.

2. Development and utilization of technologyenhanced tools

The COVID-19 pandemic accelerated the advancement and usage of technology-enhanced tools in anatomy education. At USM, significant efforts have been dedicated to developing digital learning resources to supplement conventional learning methods. One of these resources is the Virtual Anatomy Museum, which is accessible through https://anatomymuseum.kk.usm.my/index.php/virtual-museum. It was developed to offer students the opportunity to access the learning resources virtually [11]. This free, user-friendly, and interactive web-based learning platform provides images of digitized anatomical models from various systems, featuring labelled structures with brief descriptions. In addition, a virtual histology slide gallery has been established, offering various high-resolution histological slides from different systems, thereby enhancing students’ learning experience with accessible and comprehensive digital content.
Moreover, an online histology quiz application has been developed to provide interactive, game-based learning. This digital tool allows students to assess their histological knowledge in an engaging and fun way, making the learning process more enjoyable and effective. The incorporation of these innovative digital learning tools ensures that students have continuous access to important educational resources. Therefore, a flexible and adaptable learning environment can be created by integrating these digital learning resources with in-person instruction. Apart from digital tools, 3D-printed neuroanatomy models using customized polymers have been developed to complement the virtual learning resources [12]. By leveraging 3D printing technology, accurate and detailed anatomical models can be produced to enhance students’ kinesthetic learning experience for a comprehensive understanding of human anatomy.

3. Embodiment of student-centered learning in anatomy classes

The COVID-19 remote learning experience indicated that students, particularly novice learners, struggled with limited collaborative learning opportunities, leading to an increased reliance on self-directed learning. This shift impaired students’ emotional well-being. Therefore, it is essential to focus on improving students’ well-being and learning experience by creating a supportive community that encourages active participation and provides emotional and academic support.
At USM, post-pandemic practical anatomy sessions have been redesigned to be more interactive compared to pre-pandemic sessions. Practical sessions now emphasize collaborative learning, where students are required to discuss and learn together. By working in small groups, students engage in peer-to-peer teaching, share knowledge, and solve problems collaboratively. This approach not only enhances their understanding of anatomical concepts but also fosters a sense of community and belonging. Instructors facilitate these sessions by guiding discussions, providing immediate feedback, and ensuring that all students are actively participating. This collaborative learning environment helps students to develop critical thinking and communication skills, which are essential for their future professional careers. Moreover, the interactive nature of these sessions helps to alleviate the sense of isolation and stress experienced during self-directed learning, contributing positively to their emotional well-being.
Additionally, the establishment of discussion forums and the formation of study groups offer students opportunities to engage in in-depth discussions of difficult topics and provide mutual support for each other’s learning. The implementation of student mentoring programs not only provides academic guidance but also emotional support, enhancing peer interaction to improve the overall student learning experience. Incorporating regular feedback mechanisms, including formative assessments and quizzes, enables lecturers to identify students’ weak areas and offer prompt, specific assistance, ensuring students feel better supported throughout their learning journey.

4. Incorporation of formative assessment during anatomy teaching

Formative assessments play a crucial role in enhancing the learning experience in anatomy education. These assessments include a variety of methods such as quizzes, interactive activities, and peer discussion. By incorporating frequent, low-stakes assessments, instructors can provide continuous feedback that helps students identify their strengths and weaknesses. This approach not only supports ongoing learning but also empowers students to take control of their educational journey.
In anatomy teaching at USM, formative assessments have been strategically integrated into interactive lectures and practical sessions to optimize student engagement and comprehension. Practical sessions apply the concept of objective structured practical examination (OSPE), where students are provided with several anatomical models or specimens at different stations, with important structures labelled. The students are required to find the correct answers with their group members and discuss them with the class at the end of the OSPE-based practical session. This method serves to reinforce key anatomical concepts and ensure that students grasp the material effectively.
Furthermore, anatomy instructors use formative assessment data to tailor their teaching strategies, directly addressing areas where students may struggle and offering additional support as needed. This responsive approach not only helps to pinpoint and rectify specific challenges but also fosters a dynamic learning environment that adapts to students’ evolving needs. By continuously integrating feedback mechanisms and adjusting instructional methods based on assessment data, the approach promotes a deeper understanding and retention of anatomical knowledge. Moreover, empowering formative assessment in anatomy teaching at USM involves creating a collaborative learning environment where students feel supported both academically and emotionally. This comprehensive strategy ensures that students receive targeted assistance and encouragement, enhancing their overall success in studying anatomy.

Implications of post-pandemic educational strategies beyond anatomy

The COVID-19 pandemic has emphasized the importance of adopting innovative strategies in medical education, extending beyond anatomy. For example, in fields like dentistry and nursing where hands-on learning is essential, blended learning provides flexibility and accessibility that allows students to integrate theoretical lessons with in-person practical sessions [13]. Additionally, the adoption of technology-enhanced tools, such as augmented reality and virtual simulations can provide immersive learning experiences that extend beyond conventional classroom settings [14]. Emphasizing studentcentered learning promotes independent and critical thinking, which is essential in clinical areas like medicine, gynecology and surgery [15]. Furthermore, the implementation of formative assessments offers continuous feedback, supporting the development of effective study skills [16]. Thus, enhancing academic performance in subjects requiring theoretical knowledge and practical application. Therefore, these strategies not only enhance anatomy education but also offer a comprehensive and robust framework for improving education across various medical disciplines in the post-pandemic era.

Discussion

1. Limitations and future challenges

Despite the transformative strategies in anatomy education at USM, several limitations may persist. Limited accessibility in blended learning is a common issue, as students do not have equal opportunity to use digital tools or access reliable internet outside the classroom. Furthermore, integrating technology-enhanced tools brings substantial costs for development and maintenance. Heavy reliance on technology can lead to technical problems caused by software errors or hardware malfunctions, hindering the learning process. Additionally, incorporating student-centered learning into a structured curriculum can be difficult, particularly when dealing with large cohorts of students within constrained time frames. Moreover, incorporating formative assessments into the curriculum demands significant time and resources for its development, implementation, and feedback. These limitations highlight the necessity for meticulous planning and the establishment of robust support mechanisms when implementing such educational strategies in anatomy education.
Moving forward, several challenges will emerge in ensuring the sustainability of blended learning models. Keeping both digital and physical educational resources up-to-date will require continuous institutional investment and support. Additionally, both faculty members and students must adapt to evolving educational technologies, which will necessitate continuous training and support. Addressing students’ mental health and well-being is another significant challenge. As blended learning models become more prevalent, educational strategies must incorporate comprehensive mental health support systems to assist students cope with the pressures of a hybrid learning environment. Therefore, it is important to focus on infrastructure development, invest in comprehensive faculty training, balance virtual and in-person learning experiences, and provide strong mental health support to adopt these educational strategies successfully.

2. Conclusion

The COVID-19 pandemic served as a catalyst for significant changes in anatomy education at USM, highlighting the importance of flexibility, adaptability, and innovation in teaching strategies. By embracing blended learning, technology-enhanced tools, student-centered approaches, and formative assessments, USM has created a more dynamic and supportive educational environment. These transformative strategies not only address the challenges posed by the pandemic but also prepare anatomy education for a future that demands resilience and continuous improvement. The experiences and insights gained during this period offer valuable guidance for the ongoing evolution of anatomy pedagogy, ensuring that it remains effective and relevant in a rapidly changing world.

Acknowledgments

The authors would like to thank the School of Medical Sciences, USM, for their support in completing this study. Special appreciation to the USM preclinical year students who were involved in this study.

Notes

Funding
This study was supported by the Universiti Sains Malaysia Research University Grant (RUI) 2019 (grant number: 1001/PPSP/8016120).
Conflicts of interest
No potential conflict of interest relevant to this article was reported.
Author contributions
SHAH conducted data collection and wrote the initial draft. SNHH designed the study concept and reviewed the final draft. FK contributed to study concept design and reviewed the final draft. SAS contributed to the study concept design, wrote the initial draft, and reviewed and edited the final draft. All authors have critically reviewed and approved the final draft and are responsible for the content and similarity index of the manuscript.

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