Abstract:

Background and objectives:
The early integration of imaging technologies and hands on palpatory techniques into Anatomy teaching has the potential to enhance spatial understanding, promote clinical reasoning, and increase student engagement during the foundational stages of medical training. This study presents the protocol of an innovative educational intervention aimed at incorporating surface ultrasound and palpatory anatomy (ECO-PALP) into the course Human Musculoskeletal Anatomy for first year medical students.

Methods:
A crossover design will be implemented, using the pre existing administrative allocation of students into Group A and Group B within the Human Musculoskeletal Anatomy course. These administratively defined groups will serve as the study cohorts and will determine the sequence of exposure to the intervention.
The intervention will be embedded into two major didactic units: the upper limb and the lower limb. Group A will first receive three ECO-PALP sessions during the upper limb unit, in which students will explore anatomical landmarks through guided palpation combined with real time ultrasound visualisation of superficial structures. Group B, during this same period, will complete the upper limb unit following the standard instructional approach.
In the second phase of the course, the conditions will be reversed: Group B will receive the ultrasound supported intervention during the lower limb unit, while Group A will complete the corresponding content using traditional methods. This crossover strategy will allow comparison both across groups and across anatomical regions, while controlling for inter group variability, sequence effects, and differences in baseline performance.
Assessment will follow a multimodal approach. Cognitive learning outcomes will be measured through knowledge tests at the end of each unit. The impact on practical competencies will be evaluated through a mini OSCE including short stations focused on the identification of superficial anatomical structures and the recognition of their basic sonographic correlates. Student perceptions will be captured using validated Likert scale questionnaires aimed at exploring satisfaction, perceived usefulness, and perceived contribution of the intervention to their understanding of anatomy. Short open ended questions will complement the quantitative data to collect qualitative insights regarding strengths, challenges, and suggestions for improvement. In addition, global academic performance in each unit will be compared between intervention and control conditions.

Conclusion:
This protocol seeks to evaluate the feasibility, acceptance, and educational impact of incorporating surface ultrasound and palpatory anatomy into early medical school anatomy teaching using a crossover methodology. The expected findings may contribute to the development of more interactive, clinically contextualised, and learner centred instructional strategies that enhance anatomical understanding and better prepare students for subsequent clinical training.

Keywords:

Ultrasonography, Palpatory anatomy, Medical students, Musculoskeletal anatomy, Anatomy education.