Medical Students Using Plastinated Prosections as Sole Learning Tool

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Presenter Last Name: 
Hoffman, PhD
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Medical students using plastinated prosections as a sole learning tool perform equally well on identification exams as compared to those performing dissections over the same regions

Hoffmann DS, May N, Thomsen T, Holec M, Andersen KH, Pizzimenti MA
Department of Anatomy and Cell Biology, The University of Iowa Roy J. and Lucille A. Carver College of Medicine, Iowa City, IA 52242
Funding: EDF grant from the UI Office for Consultation and Research in Medical Education

1. Plastination
Plastination is the process of impregnating tissues with polymer. It was pioneered by Gunther von Hagens, and is now internationally famous through popular museum exhibits like BodyWorlds or Bodies: The Exhibition.

2. Can plastination work in medical education?
Many medical, dental or veterinary schools use plastination as an adjunct to traditional anatomy methods, and to maintain these specimen libraries, several schools have opened smaller-scale plastination labs. The pictures shown below are examples of small regional specimens generated by the University of Iowa Plastination Facility. Even though plastinated specimens are being used by many medical schools, very little education research has been conducted investigating the effectiveness of plastinates as learning tools in anatomy.

3. Gross anatomy lab strategies
In order to consider what plastinated prosections can bring to the table, it is important to first consider what is known about other traditional laboratory methods of learning anatomy. The two most common approaches to laboratory learning of anatomy are dissection and viewing prosections.
-Dissection is the systematic process of uncovering the body’s structure. It can be very labor intensive and requires a lot of time of both the students and supervising faculty to ensure that dissections are done well and the structures are clearly visible.
-Prosection is a less-structured process whereby students observe specimens that have already been dissected. This process is labor-intensive for the faculty who prepare the dissections, but not for the student observers. An advantage of this approach is that students can observe the anatomy much more quickly.
-Research on these teaching methods shows a slight advantage of dissection over prosection in exam performance, but this is not a large difference. However, most students who are given the opportunity to learn in either way typically indicate that they feel they learn the material “better” through dissection because of depth of exposure and time on task.

4. How will plastination stack up against these traditional methods?
There are three major differences between learning through dissection and learning through prosection: Engagement level, Body context and Effort Reward ratio. The engagement level is automatically higher in dissection than prosection simply because the dissection task is complex and requires the full focused attention of the student participant. In dissection, the body context is always present and explored as the student uncovers the relational anatomy with her own hands. In looking at prosections, that context may be present or absent. For example, the student may learn from a prosected heart and position it in the mediastinum of the cadaver from which it came, or he may learn from a prosected heart that came from a storage bucket. Finally, the effort/reward ratio tends to favor prosection, particularly in areas with challenging dissections.
-Plastinated prosections will be likely be similar to traditional prosections in engagement level and body context. However, they will likely be an improvement in effort/reward ratio because the specimens are prepared to museum quality standards, far in excess of a traditional student prosection.

5. Hypothesis
We hypothesized that based on principles of engagement level and body context, students learning from only plastinated prosections would perform less well on identification exams.

6. Study design
Because this study has the potential to hinder the learning of the experimental group of students, we elected to conduct this study in a summer pre-matriculation program for incoming first year medical students who are looking for extra exposure prior to starting their studies. In this program students (n=26) take a mini version of anatomy and biochemistry complete with all the typical classroom and laboratory methods. This program was useful for this study because students were assessed as part of the program, but their grades were not consequential and any learning deficiencies would be rectified in their traditional fall semester anatomy course.
-We looked at plastination use in two different regions: The Heart and The Axilla. In the heart, Group A dissected and Group B viewed plastinated prosections. In the axilla, Group B viewed non-plastinated prosections and Group A viewed plastinated prosections. Thus, both groups had the opportunity to work with plastinated specimens. In addition, students in both groups learned the thorax, abdomen and forearm using non-plastinated prosections only, and both groups performed dissections of the lower limbs, so these two groups represented internal controls.
-Assessment was a 50 point pin/tag identification exam using both plastinated and non-plastinated specimens.

7. Results: Heart – Dissection vs. Plastination
-Students learning from plastinates performed as well or better than dissectors
-Main difference between groups was on identification of tags on non-plastinated specimens (students who learned from plastinates were more successful with identification of pins on non-plastinated specimens, suggesting that transfer between media was successful).

8. Results: Axilla – Plastinated vs. Non-plastinated Prosections
-Students learning from plastination performed as well or better than those using non-plastinated prosections.

9. Results: Control Regions
-Groups had identical mean scores in areas where methods were the same

10. Student feedback on “usefulness” of learning methods
-Students ranked the usefulness of the learning modalities on a 1-5 Likert scale
-5=highly useful, 1=not useful at all
-Plastinates ranked lowest, particularly for the heart
-*p<0.05 vs. other modalities; †p<0.05 vs. Axilla plastinates

11. Student positive comments about plastinates – Ease, Speed and Quality
-“Faster, can focus on learning instead of poking at fascia and fat”
-“Specimens had better dissections and more complete structures present”
-“It seemed like a more efficient use of my time”

12. Student concerns about plastinates
-Stiffness/physical differences
    -“Colors not as vibrant, didn’t get the ‘feel’”
    -“I was afraid they were going to break”    
    -“They were not very flexible”
-Orientation in the larger context of the body
    -“It’s hard to picture how the specimen relates/sits in the body”
    -“It was hard to orient myself in a larger scheme”
    -“Something is lost when you don’t actually do the dissection and see what you must go through    to get to the anatomy.”
-Changes in educational activity/engagement
    -“I feel I didn’t spend as much time”
    -“We were given a specimen and told to learn”
    -“There is less of a sense of discovery and work when the organ is just handed to you”
    -“Easier to start losing attention”
-When given the opportunity to choose their preferred learning strategy, 85% of the participants chose dissection as their preferred strategy. The rest chose non-plastinated prosections.

13. Future directions
-Validate these trends in a course with higher performance expectations
-Explore which types of regions are best suited to learning from plastinates.
    -If heart specimens were ranked lower than others, why?
-Determine how educational activities can be designed to enhance engagement level with plastinates.

14. Conclusions
-Plastinates are appropriate learning tools for medical-level gross anatomy.
-Students generally do not prefer plastinates over more traditional laboratory methods.

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