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The Need to Identify Anatomy-Related Competencies in Medical Education

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Title: The Need to Identify Anatomy-Related Competencies in Medical Education
Language: English
Authors: Syarifah Aisyah Syed Abd Halim (ORCID 0000-0001-8060-6499), Muhamad Saiful Bahri Yusoff (ORCID 0000-0002-4969-9217), Mohamad Nurman Yaman (ORCID 0000-0001-8299-8967), Nurhanis Syazni Roslan (ORCID 0000-0002-5833-1529), Tg Fatimah Murniwati Tengku Muda (ORCID 0000-0002-6164-6812), Ramiza Ramza Ramli (ORCID 0000-0001-8196-321X), Fairrul Kadir (ORCID 0000-0002-5945-714X), Siti Nurma Hanim Hadie (ORCID 0000-0001-9046-9379)
Source: Anatomical Sciences Education. 2024 17(9):1659-1667.
Availability: Wiley. Available from: John Wiley & Sons, Inc. 111 River Street, Hoboken, NJ 07030. Tel: 800-835-6770; e-mail: cs-journals@wiley.com; Web site: https://www.wiley.com/en-us
Peer Reviewed: Y
Page Count: 9
Publication Date: 2024
Document Type: Journal Articles
Reports - Evaluative
Education Level: Higher Education
Postsecondary Education
Descriptors: Medical Education, Anatomy, Competence, Undergraduate Students, Cognitive Processes, Psychomotor Skills, Clinical Experience
DOI: 10.1002/ase.2515
ISSN: 1935-9772
1935-9780
Abstract: A profound grasp of anatomy is indispensable for shaping competent and safe medical practitioners. This knowledge acquisition is pivotal in the early stages of medical education and remains crucial throughout clinical training. However, the evolving landscape of medical education has ushered in changes to the anatomy curriculum, marked by a reduction in contact hours and a streamlined content structure to accommodate novel subjects and teaching methodologies. This transformation has precipitated a quandary in defining the essential scope and depth of anatomical knowledge to be imparted. Traditionally, surgeons assumed the role of anatomy instructors until Flexner's recommendations catalyzed the integration of trained anatomists. Nevertheless, the varied backgrounds of anatomists and the heterogeneity in anatomy curricula across institutions have introduced potential disparities in the quality of graduates. Addressing these challenges mandates the identification of key anatomy competencies tailored for undergraduate medical students. The imperative lies in ensuring that these competencies span cognitive, psychomotor, and affective domains, offering not only comprehensiveness but also direct applicability to clinical practice. Hence, this viewpoint highlights the necessity of adopting a systematic approach that includes gathering input from various stakeholders in developing and implementing a universal anatomy core competency framework, ensuring graduates are equipped for the multifaceted demands of clinical practice. Overall, the manuscript provides a comprehensive overview of the challenges and opportunities in anatomy education, with a clear call to action for a transformative approach to meet the evolving needs of medical practice.
Abstractor: As Provided
Entry Date: 2024
Accession Number: EJ1451309
Database: ERIC
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  Value: <anid>AN0181259761;[8z8k]01dec.24;2024Dec04.05:48;v2.2.500</anid> <title id="AN0181259761-1">The need to identify anatomy‐related competencies in medical education </title> <p>A profound grasp of anatomy is indispensable for shaping competent and safe medical practitioners. This knowledge acquisition is pivotal in the early stages of medical education and remains crucial throughout clinical training. However, the evolving landscape of medical education has ushered in changes to the anatomy curriculum, marked by a reduction in contact hours and a streamlined content structure to accommodate novel subjects and teaching methodologies. This transformation has precipitated a quandary in defining the essential scope and depth of anatomical knowledge to be imparted. Traditionally, surgeons assumed the role of anatomy instructors until Flexner's recommendations catalyzed the integration of trained anatomists. Nevertheless, the varied backgrounds of anatomists and the heterogeneity in anatomy curricula across institutions have introduced potential disparities in the quality of graduates. Addressing these challenges mandates the identification of key anatomy competencies tailored for undergraduate medical students. The imperative lies in ensuring that these competencies span cognitive, psychomotor, and affective domains, offering not only comprehensiveness but also direct applicability to clinical practice. Hence, this viewpoint highlights the necessity of adopting a systematic approach that includes gathering input from various stakeholders in developing and implementing a universal anatomy core competency framework, ensuring graduates are equipped for the multifaceted demands of clinical practice. Overall, the manuscript provides a comprehensive overview of the challenges and opportunities in anatomy education, with a clear call to action for a transformative approach to meet the evolving needs of medical practice.</p> <p>Keywords: affective competency; anatomy competencies; anatomy core competencies; cognitive competency; psychomotor competency; safe clinical practice</p> <hd id="AN0181259761-2">INTRODUCTION</hd> <p>Anatomy stands as a paramount medical discipline with profound clinical significance, necessitating a comprehensive understanding for the assurance of safe clinical practice.[<reflink idref="bib1" id="ref1">1</reflink>] The spectrum of anatomy‐related competencies encompasses various facets, with surgical competency emerging as the most pivotal. Medical practitioners must possess a robust grasp of anatomical knowledge to execute clinical procedures with safety and precision.[<reflink idref="bib2" id="ref2">2</reflink>] Unfortunately, a global challenge persists, marked by the perceived insufficient anatomy knowledge by medical graduates, contributing to procedural, diagnostic, and surgical errors.[<reflink idref="bib1" id="ref3">1</reflink>] This predicament has, in turn, been correlated with a surge in medicolegal litigation claims.[[<reflink idref="bib3" id="ref4">3</reflink>], [<reflink idref="bib5" id="ref5">5</reflink>]] While anecdotal evidence links the decline in anatomy knowledge of medical graduates to an increase in medicolegal litigation, empirical support for such claims is scarce.[[<reflink idref="bib3" id="ref6">3</reflink>], [<reflink idref="bib5" id="ref7">5</reflink>], [<reflink idref="bib7" id="ref8">7</reflink>]] There is a paucity of evidence addressing the factors contributing to the decline in anatomy knowledge, as perceived by junior doctors or assessed by their superiors, leading to unoptimized clinical practice.[<reflink idref="bib8" id="ref9">8</reflink>] Nevertheless, it remains imperative to scrutinize the elements of core anatomy knowledge and related competencies in the pursuit of producing safe and proficient medical practitioners.</p> <p>In historical contexts, particularly during the Islamic Golden Age and the Renaissance era, anatomy held paramount importance in medical knowledge for diagnosis and treatment.[[<reflink idref="bib9" id="ref10">9</reflink>]] Scholars of that period considered anatomy not only as a scientific pursuit but also as a spiritual and divine responsibility in patient's treatment.[<reflink idref="bib10" id="ref11">10</reflink>] The practice of surgery, intertwined with a comprehensive understanding of anatomy, proliferated during this era, with stringent penalties imposed on surgeons for potential errors.[<reflink idref="bib11" id="ref12">11</reflink>] However, the evolution of medical education in the early 20th century brought about significant changes in anatomy curriculum, driven by factors such as the emergence of new medical subjects and a shift in pedagogical approaches.[<reflink idref="bib12" id="ref13">12</reflink>] Modern medical curricula have compressed anatomy contents and teaching hours due to the inclusion of new subjects like ethics, genetics, and integrative medicine.[<reflink idref="bib13" id="ref14">13</reflink>] Consequently, anatomy educators face challenges in efficiently imparting anatomical knowledge within this compressed framework, employing various teaching methods.[[<reflink idref="bib14" id="ref15">14</reflink>], [<reflink idref="bib16" id="ref16">16</reflink>]] Additionally, challenges arise from the lack of vertical and horizontal integrations in anatomy teaching, a decline in the number of qualified anatomists with a medical background, and a dearth of evidence regarding the effectiveness of diverse teaching methods in anatomy education.[[<reflink idref="bib2" id="ref17">2</reflink>], [<reflink idref="bib17" id="ref18">17</reflink>]]</p> <p>Clinicians and surgeons universally assert that anatomy teaching in medical schools does not adequately prepare students for clinical practice and future specialization training programs.[[<reflink idref="bib18" id="ref19">18</reflink>]] The modern anatomy syllabus notably falls short in emphasizing the revisitation of anatomy knowledge during clinical training, leading to inadequate preparation in anatomy clerkships and residency phases.[<reflink idref="bib2" id="ref20">2</reflink>] In response to these concerns, anatomists globally are striving to cultivate a conducive anatomy education environment for undergraduate students. This involves integrating anatomy input with clinical application, incorporation of innovative teaching methods, and utilization of high‐tech teaching tools.[[<reflink idref="bib15" id="ref21">15</reflink>], [<reflink idref="bib20" id="ref22">20</reflink>]] Nonetheless, there are substantial variations exist in anatomy curricula, encompassing topics, learning outcomes, contents, teaching hours, methods, and assessments. With a burgeoning number of medical schools, ensuring standardized quality across institutions, including the adequacy of anatomical knowledge upon graduation, becomes a formidable challenge. Thus, a thorough understanding of the enablers and disablers of anatomy‐related competencies for safe clinical practices can provide insight to anatomy educators on how to redesign the anatomy curriculum. This initiative serves as a foundational step toward addressing the shared expectations of stakeholders concerning anatomy‐related competencies among medical graduates.</p> <p>In a broader context, competence in medical education represents a pivotal aspect for healthcare professionals.[<reflink idref="bib22" id="ref23">22</reflink>] Competency‐based education seeks to tailor learning to the demands of practice, initiating the integration of medical school curricula across disciplines and a focus on the basic sciences that form the foundation for subsequent clinical training.[<reflink idref="bib23" id="ref24">23</reflink>] In other words, a pivotal aspect of competency‐based medical education involves the establishment of a framework comprising higher‐order and foundational competencies. The primary goal of this framework is to concentrate instructional efforts and facilitate effective learning.[<reflink idref="bib24" id="ref25">24</reflink>] Consequently, medical curricula all over the world are meticulously structured to achieve competence across major domains such as knowledge, skills, ethics, and professionalism.[[<reflink idref="bib25" id="ref26">25</reflink>]] Notably, anatomy plays a significant role in medical education, influencing these competencies since a good comprehension in anatomy is foundational for various medical activities, including patient examination, procedural skills, diagnosis, and patient management.[[<reflink idref="bib27" id="ref27">27</reflink>], [<reflink idref="bib29" id="ref28">29</reflink>]]</p> <p>Additionally, the proficiency of practitioners in comprehending and communicating the structures and functions of the human body is integral to educating patients. A comprehensive diagnosis and treatment of patients necessitates a thorough consideration of cognitive, psychomotor, and affective aspects. The affective dimension plays an essential role in enabling physicians to fulfill their responsibilities effectively. For instance, effective communication of clinical findings to both patients and relevant personnel requires a good knowledge in anatomy.[[<reflink idref="bib2" id="ref29">2</reflink>], [<reflink idref="bib30" id="ref30">30</reflink>]] Therefore, it is argued that a deficiency of anatomical knowledge among medical graduates poses a threat to the healthcare system, potentially compromising the competence required for safe clinical practice.</p> <p>The anatomy curriculum should not only focus on enhancing the acquisition and retention of core anatomical knowledge but also on improving various skills applicable in clinical settings.[<reflink idref="bib31" id="ref31">31</reflink>] In the pursuit of producing safe and competent graduates, an exploration of anatomy‐related core competency elements can bridge the gap between acquired and expected anatomical knowledge and skills. Nonetheless, the perspectives on the relevance of anatomy education to medicine and clinical practice vary among students, clinicians, and anatomy educators,[[<reflink idref="bib32" id="ref32">32</reflink>]] and thus, exploring anatomy‐related competencies should involve feedback not only from medical students and lecturers but also from practitioners actively utilizing clinical skills. It is noteworthy to highlight that incorporating input from all stakeholders ensures the validity and generalizability of the identified competencies.[<reflink idref="bib34" id="ref33">34</reflink>]</p> <p>Furthermore, there is a compelling need to design and implement a standardized anatomy core curriculum for each country to address issues in monitoring the quality of graduates.[[<reflink idref="bib17" id="ref34">17</reflink>], [<reflink idref="bib35" id="ref35">35</reflink>]] In many countries, curricular trends lean toward integration, student‐centered, and problem‐based learning, as well as community‐oriented medical education.[[<reflink idref="bib37" id="ref36">37</reflink>], [<reflink idref="bib39" id="ref37">39</reflink>]] Given these evolving educational approaches, it becomes increasingly crucial to develop a comprehensive understanding of how anatomy‐related competency contributes to safe clinical practice. Such insights are imperative for establishing the fundamental framework of the future standardized anatomy curriculum. This framework should not only align with current curricular trends but also encompass the diverse needs and expectations of the various stakeholders involved in medical education.</p> <hd id="AN0181259761-3">WHAT IS ANATOMY CORE COMPETENCY?</hd> <p>Anatomy competency typically refers to a foundational comprehension and mastery of the study of anatomy, encompassing knowledge of the structure and organization of the human body.[[<reflink idref="bib41" id="ref38">41</reflink>], [<reflink idref="bib43" id="ref39">43</reflink>]] It involves recognizing and comprehending the relationships between different body parts and systems.[<reflink idref="bib44" id="ref40">44</reflink>] On the other hand, anatomy core competency is defined as the essential proficiency of medical students in mastering and applying fundamental anatomy knowledge and practical skills crucial for clinical practice.[<reflink idref="bib42" id="ref41">42</reflink>] It also encompasses the responsibility of ensuring safe clinical practice while upholding professional behaviors, as well as promoting the development of interpersonal and intrapersonal skills.[[<reflink idref="bib45" id="ref42">45</reflink>]] These competencies play a vital role in medical education, offering benefits such as improved clinical proficiency, enhanced communication ability, prevention of medical errors and legal complications, ensured continuous learning, promotion of professional development, and heightened quality assurance.[[<reflink idref="bib24" id="ref43">24</reflink>], [<reflink idref="bib45" id="ref44">45</reflink>], [<reflink idref="bib47" id="ref45">47</reflink>]]</p> <p>There are various efforts by anatomists and medical educationists to establish anatomy core competencies or competencies related to basic sciences programs. These endeavors are designed in accordance with frameworks provided by diverse accreditation and credentialing bodies in medical education. For instance, Gregory et al. adopted six competency domains (i.e., patient care, medical knowledge, practice‐based learning and improvement, system‐based practice, professionalism, interpersonal, and communication skills) from the American Council for Graduate Medical Education (ACGME) competency framework in anatomy education.[<reflink idref="bib23" id="ref46">23</reflink>] Raubenheimer et al. proposed an assessment framework for anatomy that delineates three competency domains—foundational (knowledge), practical (skills), and reflexive (application in context)—adopted from the framework by the South African Qualifications Authority (SAQA, 2005).[<reflink idref="bib42" id="ref47">42</reflink>] Hefler and Ramnanan reported that anatomy education could facilitate the development of competencies relevant to the formal CanMEDS framework, established by the Royal College of Physicians and Surgeons of Canada to instill essential skills in training physicians.[<reflink idref="bib47" id="ref48">47</reflink>] They noted that instructional design in anatomy could promote the development of CanMEDs roles such as medical expert, professional, communicator, collaborator, leader, health advocate, and scholar.[<reflink idref="bib47" id="ref49">47</reflink>] While it does not spell out specifically the role of anatomy, it is understood that the undergraduate medical curriculum should be designed to align with the goal of producing competent graduates. Anatomy, in particular, provides foundational knowledge of the human body, which is essential for clinical practice. Therefore, it is imperative that anatomy instruction is thorough and comprehensive to effectively achieve this competency. Schoeman and Chandratilake described three domains of anatomy competence for preclinical medical students: knowledge, practical, and clinical competency.[<reflink idref="bib49" id="ref50">49</reflink>] Anatomy education plays a valuable role in laying down the essential foundational knowledge for these competencies. Additionally, employing strategies such as reflective practice, collaborative learning, and dissection‐based activities, has been identified as an effective means to develop professional competencies.[[<reflink idref="bib50" id="ref51">50</reflink>], [<reflink idref="bib52" id="ref52">52</reflink>]] Based on these sources, it is evident that anatomy core competency extends beyond cognitive skills, with higher expectations for preclinical year students to develop functional skills and professional behaviors that can prepare them for clinical training and practice. Another example is incorporating case‐based learning and interdisciplinary teaching sessions to allow students to see the relevance of anatomical knowledge in clinical settings. This approach not only reinforces the importance of anatomy but also introduces elements of clinical decision‐making and professional conduct early in their education.[[<reflink idref="bib2" id="ref53">2</reflink>], [<reflink idref="bib39" id="ref54">39</reflink>]]</p> <p>Cognitive competency refers to the effective utilization of cognitive skills and processes for tasks, problem‐solving, and decision‐making.[<reflink idref="bib53" id="ref55">53</reflink>] This encompasses skills such as memory, attention, perception, reasoning, and problem‐solving. In various contexts, cognitive competency proves crucial for academic success, job performance, and overall adaptive functioning. Aligning with the six levels of cognitive skills in Bloom's taxonomy (remembering, comprehension, application, analysis, evaluation, and creation of knowledge), it is pivotal to emphasize higher‐order cognitive skills in competency‐based education.[[<reflink idref="bib54" id="ref56">54</reflink>]] An example of an anatomy core competency involves applying surface anatomy knowledge for clinical procedures (Level C3 of Bloom's taxonomy) and analyzing the features of viscera in normal radiographic images (Level C4 of Bloom's taxonomy). Therefore, in developing anatomy core competencies, emphasis on application, analysis, evaluation, and creation of knowledge is crucial, following Bloom's taxonomy framework.</p> <p>Psychomotor competency pertains to the effective performance of physical or motor skills, involving muscle coordination, movement precision, and overall physical dexterity.[<reflink idref="bib56" id="ref57">56</reflink>] Evaluation of this competency often occurs through hands‐on activities to assess one's ability to perform specific physical actions. In medical education, achieving proficiency in psychomotor skills is essential for tasks such as physical examinations, clinical procedures, and surgical interventions. While simulation provides controlled environments for learning fundamental clinical skills, aligning trainees' abilities within specific procedural contexts presents a challenge for both faculty and trainees. Conducting clinical procedures requires the harmonization of optimal anatomy knowledge with skills in identifying surface anatomy and performing procedures smoothly.[[<reflink idref="bib57" id="ref58">57</reflink>], [<reflink idref="bib59" id="ref59">59</reflink>]] Therefore, integrating gross anatomy practical sessions with clinical skills training enhances students' ability to learn anatomy and appreciate the clinical significance of this knowledge and skill. The use of psychomotor learning taxonomies, such as Dave and Simpson Taxonomies, enables educators to systematically categorize and structure the progression of physical and motor skill development.</p> <p>Responsibility competency refers to an individual's capacity to fulfill commitments, meet obligations, and take ownership of their actions, showcasing reliability, accountability, and trustworthiness in personal and professional contexts. Demonstrating responsibility competency in medical education reflects the upholding of ethical and professional values, as well as the acquisition of generic intrapersonal and interpersonal skills contributing to safe clinical practices. In anatomy education, responsibility competency is closely tied to cadaveric‐based learning, demanding adherence to ethical guidelines and principles. Students are taught to approach cadavers with sensitivity and professionalism, highlighting the importance of consent, confidentiality, and responsible handling of human remains.[[<reflink idref="bib60" id="ref60">60</reflink>]] Therefore, it is essential to include responsibility competencies, both in the context of ethics and professionalism, as well as the acquisition of other generic skills, in the anatomy core competency framework. Utilizing Krathwohl's Taxonomy for affective learning would be advantageous in designing instructional frameworks and assessments subsequent to the establishment of these competencies.</p> <hd id="AN0181259761-4">TRANSLATING ANATOMY CORE COMPETENCIES INTO PRACTICE</hd> <p>Concerns have been raised regarding the absence of consensus and uniformity in the definition, development, implementation, and assessment of anatomy core competencies.[[<reflink idref="bib62" id="ref61">62</reflink>]] There is a substantial variation across countries with regard to anatomy competencies, posing challenges for benchmarking, quality improvement, and internationalization. Therefore, translating these competencies into practice necessitates a concerted effort to promote integrated syllabi, integrated teaching, and holistic assessments in anatomy. To ensure that the framework is universal and generalized to all anatomy curricula, there is a need for a collaborative effort in conducting a systematic method involving various stakeholders in identifying elements of anatomy core competencies. The development of the anatomy core competencies framework should include several cycles of review, discourse, and documentation to ensure holistic coverage of the competence elements. Identification of valid core competencies enables the redesign of a streamlined anatomy syllabus, focusing on must‐know knowledge, essential skills, and critical responsibilities, which can reduce cognitive burden, fostering enhanced learning outcomes. Additionally, it can make collaborative learning and sharing of educational resources across institutions easier.</p> <p>Moreover, anatomy core competencies serve as the foundation for integrated teaching and assessment in anatomy. Integrated curriculum, also known as interdisciplinary curriculum, began to gain popularity in the late 20th century as a response to the need for a more cohesive and interconnected approach to medical education. In the integrated curriculum, the traditional barriers between different departments or subjects have been dismantled to create a more cohesive and interconnected approach to education. This approach aims to relate and unite topics that were previously taught separately in different academic courses or departments, presenting them in a more meaningful and holistic way.[<reflink idref="bib64" id="ref62">64</reflink>] It is important to note that the integration of basic and clinical sciences is crucial as it helps to eliminate any barriers that exist between them.[<reflink idref="bib65" id="ref63">65</reflink>] By doing so, it enhances the student's ability to synthesize information across the subject areas, leading to improved learning outcomes and better‐equipped professionals. Through this integration, students acquire the necessary skills to apply their knowledge in a clinical setting, thus becoming better prepared to succeed in their professional careers. This has proven to be an effective way to enhance learning outcomes and prepare students for the complex and interdisciplinary nature of real‐world or authentic working environments.</p> <p>The acquisition of explicit anatomy competency serves as a viable solution to the issue of overcrowding curriculum, particularly in anatomy courses where the anatomy content is extensive, but the allocated teaching hours are limited.[<reflink idref="bib37" id="ref64">37</reflink>] This competency‐based approach helps to optimize teaching time by focusing on essential skills and knowledge, ensuring students develop a comprehensive understanding of anatomy and its clinical application.[<reflink idref="bib43" id="ref65">43</reflink>] Additionally, the integrated curriculum emphasizes teaching basic principles with the minimum essential information that all students should know in each part of the course. It is absolutely imperative to ensure the proper arrangement and integration of all anatomy competencies, encompassing the cognitive, psychomotor, and affective domains. The purpose of integration is mainly for cognitive comprehension, to help the students to understand and learn effectively. However, in a broader context, integration also offers significant advantages for the continuum of education, professional development, and practice. For instance, combining traditional didactic lectures and dissection with case‐based learning (CBL), problem‐based learning (PBL), team‐based learning (TBL), and peer learning approach, along with other innovative methods such as interactive computer‐assisted learning, technology‐enhanced multimedia, and radio imaging can effectively enhance anatomical knowledge and practical application. This approach also promotes better integration of factual knowledge with problem‐solving and professional behavior.[[<reflink idref="bib2" id="ref66">2</reflink>], [<reflink idref="bib66" id="ref67">66</reflink>]] Hence, simply creating an integrated curriculum and coordinating its delivery does not establish an integration.[<reflink idref="bib67" id="ref68">67</reflink>] Instead, having a clear competency mapping throughout the curriculum is essential, as it ensures that anatomy education and assessments mirror real‐world scenarios and prepare students for the complexities of clinical practice. Hence, it underscores the necessity of having clearly defined desired outcomes and teaching objectives to guide the assessment process. The longitudinal integration of anatomy core competencies throughout a medical student's education maintains a sustained emphasis on relevant skills and knowledge across various training stages, enabling students to develop robust anatomical knowledge and proficiency in the clinical procedure.</p> <p>An ideal approach for integrated teaching involves collaboration between educators from different disciplines in a trans‐disciplinary manner.[<reflink idref="bib67" id="ref69">67</reflink>] To contextualize the context into integration, it can be done through three dimensions. The cognitive dimension refers to the utilization of the learner's knowledge and connecting it with clinical practice.[<reflink idref="bib68" id="ref70">68</reflink>] It can be achieved when basic medical sciences are taught together with clinical subjects during team teaching or presented in a case‐based scenario or problem‐based learning. For instance, novice preclinical year students can integrate their surface anatomy knowledge of the anterior thorax by learning to place the ECG leads. Following that, they can integrate their knowledge of the conduction system of the heart while learning how to interpret the ECG waves. The second dimension is a physical dimension, where the training is conducted in an environment that is similar to that of a clinical setting. For instance, to apply surface anatomy knowledge for clinical procedures, the students can practice on a cadaver, high‐fidelity mannequin, or patient.[<reflink idref="bib69" id="ref71">69</reflink>] Similarly, to analyze the features of viscera in normal radiographic images or through ultrasound, students will use real radiological images and be exposed to ultrasound.[[<reflink idref="bib70" id="ref72">70</reflink>]] The third dimension is the affective dimension, where the integration of anatomy competency takes place. This integration is primarily attributed to duties and responsibilities that come with the learning process. The silent mentor program, for instance, is an excellent platform for instilling ethical and professional values in medical graduates.[<reflink idref="bib72" id="ref73">72</reflink>]</p> <p>The shift in assessment methodologies from focusing solely on theoretical knowledge to incorporating the practical application of anatomical skills reflects a broader recognition of the importance of hands‐on experience in preparing students for clinical practice. Anatomy core competencies emphasize the need for learners to not only comprehend anatomical concepts theoretically but also to be able to apply that knowledge in a practical and clinical setting.[<reflink idref="bib73" id="ref74">73</reflink>] In traditional assessments, students might have been primarily evaluated based on their ability to recall anatomical facts and concepts. However, the integration of core competencies in anatomy assessments recognizes that true proficiency in anatomy involves more than just rote memorization. Students are now expected to demonstrate their understanding through the practical application of their anatomical knowledge, simulating the challenges they will face in real clinical scenarios.[<reflink idref="bib73" id="ref75">73</reflink>] Moreover, the inclusion of elements related to professionalism and ethical behavior in anatomy assessments serves to underscore the importance of upholding high standards in the application of anatomical knowledge.[<reflink idref="bib51" id="ref76">51</reflink>] In a clinical setting, healthcare professionals not only need to possess technical expertise but also must adhere to ethical principles and exhibit professionalism in their interactions with patients and colleagues.[<reflink idref="bib74" id="ref77">74</reflink>] By assessing these aspects in anatomy education, institutions aim to produce well‐rounded healthcare practitioners who not only excel in their anatomical knowledge and skills but also exhibit the ethical and professional behavior necessary for successful and compassionate patient care. This comprehensive approach to assessment aligns with the broader goal of producing graduates who are not only academically proficient but also well‐prepared for the multifaceted challenges of clinical practice.</p> <hd id="AN0181259761-5">SETTING BOUNDARIES BETWEEN ANATOMICAL EDUCATION AND CLINICAL COMPETENCIES</hd> <p>The integration of anatomical education with clinical competencies aims to create a cohesive and practical learning experience for medical students. However, preclinical medical students' ability to master clinical competencies is limited due to their lack of prior knowledge to clinical subjects and exposure to clinical training.[<reflink idref="bib75" id="ref78">75</reflink>] Therefore, it is essential to establish clear boundaries between these two domains to ensure that both areas are effectively taught and assessed. Anatomy instruction primarily focuses on the structure of the human body, including relationships between body parts, organ morphology, and the physical basis of bodily functions. Students are expected to master anatomy content and develop skills in identifying anatomical features, whether as viscera, surface landmarks, or radiological images. This involves lectures, discussions, cadaver dissections, learning with anatomical models, and imaging techniques. In contrast, clinical competencies encompass applying anatomical knowledge to diagnose, treat, and manage patient conditions, including skills such as physical examination, clinical reasoning, and patient communication.[<reflink idref="bib76" id="ref79">76</reflink>]</p> <p>To delineate these areas clearly, specific learning outcomes representing core competencies for each domain in anatomy education should be emphasized in the curriculum. The core competency for pure anatomy content includes understanding major organ systems' structures and functions, identifying significant anatomical landmarks, and interpreting radiological images and dissection findings. On the other hand, the clinical competencies domain focuses on translating anatomical knowledge into clinical practice, such as performing physical examinations, informing clinical decision‐making, and effectively communicating anatomical information to patients and colleagues. Achieving these learning outcomes requires assessment methods that reflect the distinction between anatomy and clinical competencies. Tools such as objective structured clinical examinations (OSCEs) and integrated case‐based assessments can collectively assess basic anatomical knowledge and clinical skills, but detailed assessment rubrics are necessary to ensure clear differentiation between the two components.[<reflink idref="bib77" id="ref80">77</reflink>]</p> <p>Introducing integrated learning and assessment incrementally throughout the curriculum is crucial for its practical implementation. In the first year, students should focus on foundational anatomical education with basic integration, such as radiological anatomy and the application of anatomical knowledge in pathological conditions, assessed through theoretical questions and objective structured practical examinations (OSPE). In the second year, clinical skills can be introduced, with students learning to conduct physical examinations and basic clinical procedures, assessed through a combination of theoretical anatomy questions and OSCEs testing clinical application. Third‐year medical students could engage in integrated learning modules tackling clinical cases requiring in‐depth anatomical knowledge, with case‐based assessments evaluating both anatomical understanding and clinical reasoning. This integrated learning process would prepare them for future clinical training, which typically occurs during the fourth to sixth years of their studies. This incremental approach ensures continuous measurement and reinforcement of both skill sets.</p> <hd id="AN0181259761-6">CONCLUSION</hd> <p>In conclusion, the multifaceted landscape of anatomy education is undergoing significant shifts and challenges, necessitating a re‐evaluation of core competencies to align with the evolving needs of medical practice. The establishment of a universally accepted anatomy core competency framework is imperative for promoting standardized education, addressing the varying expectations of stakeholders, and ensuring graduates are well‐equipped for safe and proficient clinical practice. Continuous research is vital in developing this anatomy competency, which, in turn, could illuminate the path toward developing a streamlined anatomy curriculum that includes a lean syllabus, assessments, learning objectives, and pedagogical activities. The anatomy core competencies discussed—cognitive, psychomotor, and responsibility—provide a comprehensive foundation for developing well‐rounded healthcare professionals. Additionally, there is a possibility of the emergence of another competency that further enhances the holistic development of healthcare professionals. Their integration into medical curricula, coupled with collaborative efforts from students, educators, clinicians, and policymakers, can enhance the quality and effectiveness of anatomy education worldwide. Nevertheless, to ensure pragmatic implementation of anatomy core competency in medical curricula, it is crucial to set clear boundaries between anatomical education and clinical competencies and to develop tailored assessment strategies. This ensures that students achieve the necessary proficiency in both areas. Such an approach not only enhances learning outcomes but also provides a structured pathway for students to transition from foundational knowledge to clinical practice. By acknowledging the challenges, embracing evolving educational approaches, and prioritizing the integration of anatomy core competencies into medical training, the medical community can better prepare future practitioners for the complexities and responsibilities of clinical practice.</p> <hd id="AN0181259761-7">AUTHOR CONTRIBUTIONS</hd> <p> <bold>Syarifah Aisyah Syed Abd Halim:</bold> Conceptualization (equal); formal analysis (equal); project administration (equal); resources (equal); writing – original draft (equal); writing – review and editing (equal). <bold>Muhamad Saiful Bahri Yusuff:</bold> Supervision (equal); writing – original draft (equal); writing – review and editing (equal). <bold>Mohamad Nurman Yaman:</bold> Supervision (equal); writing – original draft (equal); writing – review and editing (equal). <bold>Nurhanis Syazni Roslan:</bold> Resources (equal); writing – original draft (equal); writing – review and editing (equal). <bold>Tg Fatimah Murniwati Tengku Muda:</bold> Resources (equal); writing – original draft (equal); writing – review and editing (equal). <bold>Ramiza Ramza Ramli:</bold> Resources (equal); writing – original draft (equal); writing – review and editing (equal). <bold>Fairrul Kadir:</bold> Resources (equal); writing – original draft (equal); writing – review and editing (equal). <bold>Siti Nurma Hanim Hadie:</bold> Conceptualization (equal); funding acquisition (lead); supervision (lead); writing – original draft (equal); writing – review and editing (equal).</p> <hd id="AN0181259761-8">FUNDING INFORMATION</hd> <p>This work was supported by the Ministry of Higher Education Malaysia for Fundamental Research Grant Scheme under project code FRGS/1/2020/SSI0/USM/02/10.</p> <hd id="AN0181259761-9">CONFLICT OF INTEREST STATEMENT</hd> <p>The authors declare no conflict of interest.</p> <ref id="AN0181259761-10"> <title> REFERENCES </title> <blist> <bibl id="bib1" idref="ref1" type="bt">1</bibl> <bibtext> Singh R, Tubbs RS, Gupta K, Singh M, Jones DG, Kumar R. 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Educ.), is an associate professor of Medical Education and Director of Center of Academic Excellence, Universiti Malaysia. He teaches psychometric assessment, educational research methodology, and curriculum planning and development to postgraduate students and faculty members.</p> <p>Mohamad Nurman Yaman, M.B., Ch.B., M.M.Ed, Ph.D. (Med. Educ.) is an associate professor in the Department of Medical Education, Faculty of Medicine, Universiti Kebangsaan Malaysia. In addition to teaching generic soft skills to undergraduate students and generic medical education modules such as curriculum development, teaching and learning methodologies, quality assurance and assessment to postgraduate students, he also conducts faculty development programs such as curriculum review and program accreditation to the faculty members. His research focuses on students' selection and training module development.</p> <p>Nurhanis Syazni Roslan, M.B., B.Ch., B.A.O., M.Sc., Ph.D., is a lecturer in the Department of Medical Education, and Examination Chairperson in School of Medical Sciences, Universiti Sains Malaysia. Her research focuses on medical professionalism, students assessment, curriculum, and mental wellbeing.</p> <p>Tg Fatimah Murniwati Tengku Muda, (M.D., M.Sc. in Clinical Anatomy) is an associate professor and the Head of Anatomy and Physiology Department, Faculty of Medicine, Universiti Sultan Zainal Abidin. She teaches Anatomy to undergraduate medical students. Her research focusses on anatomy and medical education.</p> <p>Ramiza Ramza Ramli, M.B.B.S., M.M.E.D. (ORL‐HNS), is a Professor in Otorhinolaryngology, Head and Neck Surgery and the Head of Otorhinolaryngology Department, School of Medical Sciences, Health Campus, Universiti Sains Malaysia. He teaches Otorhinolaryngology to undergraduate and postgraduate students. He focusses on clinical research particularly in Otorhinolaryngology.</p> <p>Fairrul Kadir, (M.D., M.M.E.D. Emergency) is an associate professor and the Deputy Dean of Academics and Internationalization Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah. He teaches Emergency Medicine to undergraduate and postgraduate students. He focusses on clinical research particularly in emergency medicine.</p> <p>Siti Nurma Hanim Hadie, M.D., MSc. (Clinical Anatomy), Ph.D. (Med. Educ.), is an associate professor and the Head of Anatomy Department, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, Malaysia. She teaches Anatomy to undergraduate medical and postgraduate surgical‐based students. Her research focusses on medical education and anatomy instructional design and competency‐based education.</p> </aug> <nolink nlid="nl1" bibid="bib10" firstref="ref11"></nolink> <nolink nlid="nl2" bibid="bib11" firstref="ref12"></nolink> <nolink nlid="nl3" bibid="bib12" firstref="ref13"></nolink> <nolink nlid="nl4" bibid="bib13" firstref="ref14"></nolink> <nolink nlid="nl5" bibid="bib14" firstref="ref15"></nolink> <nolink nlid="nl6" bibid="bib16" firstref="ref16"></nolink> <nolink nlid="nl7" bibid="bib17" firstref="ref18"></nolink> <nolink nlid="nl8" bibid="bib18" firstref="ref19"></nolink> <nolink nlid="nl9" bibid="bib15" firstref="ref21"></nolink> <nolink nlid="nl10" bibid="bib20" firstref="ref22"></nolink> <nolink nlid="nl11" bibid="bib22" firstref="ref23"></nolink> <nolink nlid="nl12" bibid="bib23" firstref="ref24"></nolink> <nolink nlid="nl13" bibid="bib24" firstref="ref25"></nolink> <nolink nlid="nl14" bibid="bib25" firstref="ref26"></nolink> <nolink nlid="nl15" bibid="bib27" firstref="ref27"></nolink> <nolink nlid="nl16" bibid="bib29" firstref="ref28"></nolink> <nolink nlid="nl17" bibid="bib30" firstref="ref30"></nolink> <nolink nlid="nl18" bibid="bib31" firstref="ref31"></nolink> <nolink nlid="nl19" bibid="bib32" firstref="ref32"></nolink> <nolink nlid="nl20" bibid="bib34" firstref="ref33"></nolink> <nolink nlid="nl21" bibid="bib35" firstref="ref35"></nolink> <nolink nlid="nl22" bibid="bib37" firstref="ref36"></nolink> <nolink nlid="nl23" bibid="bib39" firstref="ref37"></nolink> <nolink nlid="nl24" bibid="bib41" firstref="ref38"></nolink> <nolink nlid="nl25" bibid="bib43" firstref="ref39"></nolink> <nolink nlid="nl26" bibid="bib44" firstref="ref40"></nolink> <nolink nlid="nl27" bibid="bib42" firstref="ref41"></nolink> <nolink nlid="nl28" bibid="bib45" firstref="ref42"></nolink> <nolink nlid="nl29" bibid="bib47" firstref="ref45"></nolink> <nolink nlid="nl30" bibid="bib49" firstref="ref50"></nolink> <nolink nlid="nl31" bibid="bib50" firstref="ref51"></nolink> <nolink nlid="nl32" bibid="bib52" firstref="ref52"></nolink> <nolink nlid="nl33" bibid="bib53" firstref="ref55"></nolink> <nolink nlid="nl34" bibid="bib54" firstref="ref56"></nolink> <nolink nlid="nl35" bibid="bib56" firstref="ref57"></nolink> <nolink nlid="nl36" bibid="bib57" firstref="ref58"></nolink> <nolink nlid="nl37" bibid="bib59" firstref="ref59"></nolink> <nolink nlid="nl38" bibid="bib60" firstref="ref60"></nolink> <nolink nlid="nl39" bibid="bib62" firstref="ref61"></nolink> <nolink nlid="nl40" bibid="bib64" firstref="ref62"></nolink> <nolink nlid="nl41" bibid="bib65" firstref="ref63"></nolink> <nolink nlid="nl42" bibid="bib66" firstref="ref67"></nolink> <nolink nlid="nl43" bibid="bib67" firstref="ref68"></nolink> <nolink nlid="nl44" bibid="bib68" firstref="ref70"></nolink> <nolink nlid="nl45" bibid="bib69" firstref="ref71"></nolink> <nolink nlid="nl46" bibid="bib70" firstref="ref72"></nolink> <nolink nlid="nl47" bibid="bib72" firstref="ref73"></nolink> <nolink nlid="nl48" bibid="bib73" firstref="ref74"></nolink> <nolink nlid="nl49" bibid="bib51" firstref="ref76"></nolink> <nolink nlid="nl50" bibid="bib74" firstref="ref77"></nolink> <nolink nlid="nl51" bibid="bib75" firstref="ref78"></nolink> <nolink nlid="nl52" bibid="bib76" firstref="ref79"></nolink> <nolink nlid="nl53" bibid="bib77" firstref="ref80"></nolink>
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Items – Name: Title
  Label: Title
  Group: Ti
  Data: The Need to Identify Anatomy-Related Competencies in Medical Education
– Name: Language
  Label: Language
  Group: Lang
  Data: English
– Name: Author
  Label: Authors
  Group: Au
  Data: <searchLink fieldCode="AR" term="%22Syarifah+Aisyah+Syed+Abd+Halim%22">Syarifah Aisyah Syed Abd Halim</searchLink> (ORCID <externalLink term="https://orcid.org/0000-0001-8060-6499">0000-0001-8060-6499</externalLink>)<br /><searchLink fieldCode="AR" term="%22Muhamad+Saiful+Bahri+Yusoff%22">Muhamad Saiful Bahri Yusoff</searchLink> (ORCID <externalLink term="https://orcid.org/0000-0002-4969-9217">0000-0002-4969-9217</externalLink>)<br /><searchLink fieldCode="AR" term="%22Mohamad+Nurman+Yaman%22">Mohamad Nurman Yaman</searchLink> (ORCID <externalLink term="https://orcid.org/0000-0001-8299-8967">0000-0001-8299-8967</externalLink>)<br /><searchLink fieldCode="AR" term="%22Nurhanis+Syazni+Roslan%22">Nurhanis Syazni Roslan</searchLink> (ORCID <externalLink term="https://orcid.org/0000-0002-5833-1529">0000-0002-5833-1529</externalLink>)<br /><searchLink fieldCode="AR" term="%22Tg+Fatimah+Murniwati+Tengku+Muda%22">Tg Fatimah Murniwati Tengku Muda</searchLink> (ORCID <externalLink term="https://orcid.org/0000-0002-6164-6812">0000-0002-6164-6812</externalLink>)<br /><searchLink fieldCode="AR" term="%22Ramiza+Ramza+Ramli%22">Ramiza Ramza Ramli</searchLink> (ORCID <externalLink term="https://orcid.org/0000-0001-8196-321X">0000-0001-8196-321X</externalLink>)<br /><searchLink fieldCode="AR" term="%22Fairrul+Kadir%22">Fairrul Kadir</searchLink> (ORCID <externalLink term="https://orcid.org/0000-0002-5945-714X">0000-0002-5945-714X</externalLink>)<br /><searchLink fieldCode="AR" term="%22Siti+Nurma+Hanim+Hadie%22">Siti Nurma Hanim Hadie</searchLink> (ORCID <externalLink term="https://orcid.org/0000-0001-9046-9379">0000-0001-9046-9379</externalLink>)
– Name: TitleSource
  Label: Source
  Group: Src
  Data: <searchLink fieldCode="SO" term="%22Anatomical+Sciences+Education%22"><i>Anatomical Sciences Education</i></searchLink>. 2024 17(9):1659-1667.
– Name: Avail
  Label: Availability
  Group: Avail
  Data: Wiley. Available from: John Wiley & Sons, Inc. 111 River Street, Hoboken, NJ 07030. Tel: 800-835-6770; e-mail: cs-journals@wiley.com; Web site: https://www.wiley.com/en-us
– Name: PeerReviewed
  Label: Peer Reviewed
  Group: SrcInfo
  Data: Y
– Name: Pages
  Label: Page Count
  Group: Src
  Data: 9
– Name: DatePubCY
  Label: Publication Date
  Group: Date
  Data: 2024
– Name: TypeDocument
  Label: Document Type
  Group: TypDoc
  Data: Journal Articles<br />Reports - Evaluative
– Name: Audience
  Label: Education Level
  Group: Audnce
  Data: <searchLink fieldCode="EL" term="%22Higher+Education%22">Higher Education</searchLink><br /><searchLink fieldCode="EL" term="%22Postsecondary+Education%22">Postsecondary Education</searchLink>
– Name: Subject
  Label: Descriptors
  Group: Su
  Data: <searchLink fieldCode="DE" term="%22Medical+Education%22">Medical Education</searchLink><br /><searchLink fieldCode="DE" term="%22Anatomy%22">Anatomy</searchLink><br /><searchLink fieldCode="DE" term="%22Competence%22">Competence</searchLink><br /><searchLink fieldCode="DE" term="%22Undergraduate+Students%22">Undergraduate Students</searchLink><br /><searchLink fieldCode="DE" term="%22Cognitive+Processes%22">Cognitive Processes</searchLink><br /><searchLink fieldCode="DE" term="%22Psychomotor+Skills%22">Psychomotor Skills</searchLink><br /><searchLink fieldCode="DE" term="%22Clinical+Experience%22">Clinical Experience</searchLink>
– Name: DOI
  Label: DOI
  Group: ID
  Data: 10.1002/ase.2515
– Name: ISSN
  Label: ISSN
  Group: ISSN
  Data: 1935-9772<br />1935-9780
– Name: Abstract
  Label: Abstract
  Group: Ab
  Data: A profound grasp of anatomy is indispensable for shaping competent and safe medical practitioners. This knowledge acquisition is pivotal in the early stages of medical education and remains crucial throughout clinical training. However, the evolving landscape of medical education has ushered in changes to the anatomy curriculum, marked by a reduction in contact hours and a streamlined content structure to accommodate novel subjects and teaching methodologies. This transformation has precipitated a quandary in defining the essential scope and depth of anatomical knowledge to be imparted. Traditionally, surgeons assumed the role of anatomy instructors until Flexner's recommendations catalyzed the integration of trained anatomists. Nevertheless, the varied backgrounds of anatomists and the heterogeneity in anatomy curricula across institutions have introduced potential disparities in the quality of graduates. Addressing these challenges mandates the identification of key anatomy competencies tailored for undergraduate medical students. The imperative lies in ensuring that these competencies span cognitive, psychomotor, and affective domains, offering not only comprehensiveness but also direct applicability to clinical practice. Hence, this viewpoint highlights the necessity of adopting a systematic approach that includes gathering input from various stakeholders in developing and implementing a universal anatomy core competency framework, ensuring graduates are equipped for the multifaceted demands of clinical practice. Overall, the manuscript provides a comprehensive overview of the challenges and opportunities in anatomy education, with a clear call to action for a transformative approach to meet the evolving needs of medical practice.
– Name: AbstractInfo
  Label: Abstractor
  Group: Ab
  Data: As Provided
– Name: DateEntry
  Label: Entry Date
  Group: Date
  Data: 2024
– Name: AN
  Label: Accession Number
  Group: ID
  Data: EJ1451309
PLink https://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=eric&AN=EJ1451309
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        Value: 10.1002/ase.2515
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      – Text: English
    PhysicalDescription:
      Pagination:
        PageCount: 9
        StartPage: 1659
    Subjects:
      – SubjectFull: Medical Education
        Type: general
      – SubjectFull: Anatomy
        Type: general
      – SubjectFull: Competence
        Type: general
      – SubjectFull: Undergraduate Students
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      – SubjectFull: Cognitive Processes
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      – SubjectFull: Psychomotor Skills
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      – SubjectFull: Clinical Experience
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      – TitleFull: The Need to Identify Anatomy-Related Competencies in Medical Education
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            NameFull: Muhamad Saiful Bahri Yusoff
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            – D: 01
              M: 12
              Type: published
              Y: 2024
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              Value: 1935-9780
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