CLINICALLY RELEVANT ANATOMICAL KNOWLEDGE RETENTION AMONG MEDICAL GRADUANDS: A GLOBAL MEDICAL EDUCATION CONCERN?
Previous research shows that core information taught early in medical school undergoes a knowledge decay as the emphasis shifts to clinical medicine. In recent times senior doctors and academic authors have made comment on the lack of knowledge of even basic anatomy, with some efforts made to quantify this knowledge decline. The aim of this study was to ascertain how knowledge retention is impacted in clinical years and which factors contribute to the enhanced retention.
A panel of experienced clinical anatomists, clinicians and 2 final year medical students were involved in the selection of multiple choice questions (MCQ) from institutional course material and past anatomy examinations. Initially, 40 clinically relevant questions were selected. After a process of careful consideration, a number of questions were excluded and some of them were updated. The final assessment tool consisted of 12 MCQs covering different organ systems and the number of questions from each block was representative of the relative times spent on studying different system blocks of anatomy.
The carpal and tarsal bone naming tests which have previously been used as tools to assess anatomical knowledge retention were also used. The data on basic demographics, intended future career and past anatomy experience were also collected. Additionally, we asked the participants to indicate their perception about the applicability of the knowledge tested in each 12 MCQs for safe clinical practice as an intern.
Out of 150 students in this cohort, 90 participated; 47% male and 53% female. About 15% of the participants had been anatomy tutors at tertiary level. Regarding future career 54.4% were undecided, while 21.1% preferred a medical specialty, 11.2% preferred general surgery and 7.8% preferred general practice. The average score for the carpal bone, tarsal bone and MCQ tests (Mean+SD) were 52.9+37.3, 51.4+38.9 and 57+19.6 respectively. There was no statistically significant difference for any of the test scores based on gender or anatomy teaching experience. The highest average was scored for the cardiovascular and neurological anatomy questions while the lowest average was scored for the reproductive anatomy question. Students with an interest in pursuing surgical/radiological career recorded significantly higher scores for all 3 tests. The carpal and tarsal tests demonstrated moderate but significant correlation with the MCQ scores. On average only 6.5% of the participants did not agree with the relevance of the questions to safe clinical practice.
The results indicated that the level of anatomy knowledge retained among the medical graduands about to start their internships is not satisfactory. The only factor which was associated with significantly higher anatomy score was the future career aspiration to do specialties that demand sound anatomy knowledge. Considering the fact that the knowledge tested in these questions has direct relevance to common clinical problems as agreed by the academics, student authors as well as participants; it is safe to assume that in this cohort of medical students, the issue of decaying important anatomical knowledge required for safe medical practice is real. It is important to review the adequacy of vertical integration of basic sciences including anatomy and introduce pragmatic measures to allow students to revisit the basics concepts during clinical years.