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 Table of Contents  
ORIGINAL ARTICLE
Year : 2020  |  Volume : 9  |  Issue : 2  |  Page : 63-65

Perceptions and attitudes of medical students toward the use of digital surgical operative video in lecture – A better anatomical understanding


1 Assistant Professor, Department of Anatomy, Goa Medical College, Bambolim, Goa, India
2 Associate Professor, Department of Surgery, Goa Medical College, Bambolim, Goa, India

Date of Submission03-Feb-2020
Date of Decision12-Mar-2020
Date of Acceptance02-May-2020
Date of Web Publication10-Sep-2020

Correspondence Address:
Medora C Dsouza Dias
Villa A – 17, Sapana Harmony, Gogol, Fatorda, Margao - 403 602, Goa
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/NJCA.NJCA_6_20

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  Abstract 


Background and Aims: There are numerous variations in the branching of the internal iliac artery (IIA), which are important during any pelvic surgery. An aberrant/accessory obturator vessel is the most common source of hemorrhage during pelvic surgery and to prevent this, one needs to have a good knowledge of pelvic vascular anatomy. Our aim was to enhance the learning process of the branching pattern of the IIA in MBBS students in order for them to better understand the concept of aberrant/accessory obturator artery (OA) and corona mortis (CM). Materials and Methods: First-year MBBS students after completing their routine dissection of branches of the IIA, were shown a video of laparoscopic femoral hernia reduction surgery and their feedback was taken. Results: Nearly 95.82% of the students agreed that they observed and understood aberrant OA, 99.16% of the students agreed that they observed and understood accessory OA, 98.33% of the students agreed that they observed and understood the CM concept, and 100% of the students felt that more such videos should be incorporated and discussed in future interactive lecture teaching. Conclusion: This study incorporates the levels of competency as per AET-COM teaching module in the knowledge domain, i.e., “Knows” and “Knows-How.” This study proves that learning anatomy can be made more interesting for and be better conceptualized, visualized, and understood by students by incorporation of relevant surgical/clinical video clips during conventional teaching.

Keywords: Aberrant obturator artery, corona mortis, laparoscopic hernia surgery, lecture


How to cite this article:
Dsouza Dias MC, Patil RT. Perceptions and attitudes of medical students toward the use of digital surgical operative video in lecture – A better anatomical understanding. Natl J Clin Anat 2020;9:63-5

How to cite this URL:
Dsouza Dias MC, Patil RT. Perceptions and attitudes of medical students toward the use of digital surgical operative video in lecture – A better anatomical understanding. Natl J Clin Anat [serial online] 2020 [cited 2020 Dec 1];9:63-5. Available from: http://www.njca.info/text.asp?2020/9/2/63/294750




  Introduction Top


First-year MBBS students routinely dissect out branches of the internal iliac artery (IIA) in the human cadaver and usually find obturator artery (OA) arising from the anterior division of IIA.[1] OA can also originate from the common iliac, inferior epigastric, gluteal, internal pudendal, or external iliac arteries.[2] An aberrant/accessory OA is often a common source of hemorrhage during pelvic surgery and when anastomotic, it is called “corona mortis” (CM).[3],[4],[5]

Trying to teach human anatomy, only by dissecting cadavers, may not prepare students in a clinical setting, so we need to use a method incorporating a three-dimensional concept by supplementing dissection and lectures with e-learning.[6],[7]

With the aim of enhancing learning, we tested the importance of incorporating a video of a laparoscopic procedure during a conventional lecture in teaching anatomy of the accessory/aberrant OA and the CM concept to first-year MBBS students of Goa Medical College.


  Materials and Methods Top


First-year MBBS students upon completion of their routine cadaveric dissection for branches of IIA, took part in this study which was carried out in February 2018 after obtaining approval of the Ethics Committee of Goa Medical College. A short video clip of a laparoscopic femoral hernia reduction surgery was shown to supplement the understanding of the branching pattern of IIA, with emphasis on abnormal/aberrant OA and the CM concept. The video presentation, which lasted approximately 10 min, was preceded by an introduction to laparoscopic surgery after which the surgeon explained and demonstrated the gross anatomy of this region. The video also showed the in situ disposition of the abdomino-pelvic organs and was paused as required at intervals while the structures encountered were explained in order, hence giving the students time to observe, understand, and correlate all of the major structures such as the parietal peritoneum, Coopers' ligament, and contents of the femoral hernia and its proximity to the aberrant OA.

A questionnaire was distributed to the students who gave their valuable feedback on this video presentation as a method of enhancing the learning of abnormal/aberrant OA and the concept of CM. The questionnaire included a 5-point Likert scale which was provided for registering the students' understanding of the concept of CM. The students were also provided space for any additional comments on the presentation itself.


  Results Top


Totally, 130 first-year MBBS students took part in this study, out of which 120 (92.3%) students filled the feedback forms. After being shown the video clip of the surgical procedure, the observations among students were recorded, as shown in [Table 1].
Table 1: Observations of student feedback of video clip viewing as an adjunct to lecture teaching

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Nearly 100% of the students felt that more such videos should be incorporated and discussed in interactive lecture teaching. Most of the additional comments were about interest and insight generated, creating a clearer path to the visualization of anatomical structures.

One particular student related the fact that until the day the video was shown, he was attending anatomy lectures for attendance only (out of compulsion for fulfilling mandatory required minimum attendance) and after attending the video presentation, he felt that this lecture was really interesting and worthwhile and he was glad he had attended this lecture.

The responses of the students to the video presentation are summarized in a bar diagram in [Figure 1].
Figure 1: Student responses to video clip viewing as an adjunct to lecture teaching. Oa: Obturator artery; cm: Corona mortis

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  Discussion Top


The conventional method of teaching anatomy through cadavers, helps preclinical medical students to understand the relationships of structures to each other, but does not give them a clear concept of their appearance in the living; they get to appreciate this only when they begin their surgical clinics.

Both students and staff were in favor of cadaveric teaching being supplemented by surgical videos.[8],[9],[10] In fact, Biasutto et al. in their study had seen better scores among the group of students who learned by interacting between dissection and using various digital learning resources.[11]

In the present study, by exposing the students to the surgical video clip, they have been able to appreciate the clinical relevance of human anatomy learned in the first-year MBBS course. Applying this anatomical knowledge in clinical postings might be easier if such clinical videos are incorporated during initial anatomical teaching itself, as it highlights the relevant living anatomy.

This study incorporates the levels of competency (Anatomy (AN) 48.3; 15.4) as per the Attitudes Ethics and Communication (AET-COM) teaching module in the knowledge domain, i.e., K = knows the branching pattern of the IIA and the concept of aberrant/accessory OA and CM. The KH = knows-how level of competency is also activated wherein the student can understand, analyze, and discuss the CM concept in relation to aberrant/accessory obturator versus a normal OA and its implications in laparoscopic femoral hernia reduction surgery.[12]

The 21st-century undergraduate medical curriculum has moved forward from a more passive, didactic, and a too detailed course, toward more clinically relevant methods of teaching, such as incorporating relevant laparoscopic video clips into the preclinical anatomy course.[13] Fitzpatrick et al. reported some medical schools that use laparoscopic training using embalmed cadavers, but other authors retort that this use is restricted to surgical residents to revise their basics in human anatomy and for developing their laparoscopic surgical skills.[14],[15],[16],[17],[18],[19]

Our students' written feedback highly supported the use of laparoscopic surgery recordings during didactic lecture teaching, and most of them appreciated the great efforts spent to give them a “key-hole view” into the abdominal cavity of a living subject. Many students opined that they would like to see more such videos during their anatomy course as it would help them to visualize and hence appreciate living human anatomy better.

According to Older, teaching anatomy is in a downward spiral, hence we need to improvise our teaching methods to encourage and facilitate learning in students.[20] Laparoscopic surgeries can be recorded and used in emphasizing the three-dimensional relationship of organs in the living patient, which will allow the preclinical MBBS students to apply relevant human anatomy learned during their preclinical course later in their clinical practice and also helps them take decisions regarding their future field of specialization.


  Conclusion Top


Anatomy education has undergone enormous transformation in the last decade. Traditional topographic anatomy taught by the system of didactic lectures with cadaveric dissection has been supplemented by various other interactive teaching methods such as problem-solving, models, learning strategies, and digital teaching tools.

The positive responses of the students in this study prove that anatomy topics and dissections can be made more interesting for and better conceptualized, visualized, and understood by incorporation of surgical/clinical video clips during didactic lecture teaching.

Acknowledgment

The authors would like to thank Mr. Vishvesh V. Naik I/C Computer Graphics and Multimedia Section, Goa Medical College, Bambolim, Goa, for his valuable support and expertise in computer graphics including video and multimedia lecture presentation.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Williams P, Bannister L, Berry M, Collins P, Dyson M, Dussek J, et al. Gray's Anatomy: The Anatomical Basis of Medicine and Surgery. 38th ed. Edinburgh: Churchill Livingstone; 1995. p. 1560.  Back to cited text no. 1
    
2.
Rao VT, Srinivasarao Y, Raj SS. An anomalous origin of obturator artery and its clinical importance in humans. Int J Anat Res 2013;1:2-6.  Back to cited text no. 2
    
3.
Dondelinger RF, Trotteur G, Ghaye B, Szapiro D. Traumatic injuries: Radiological hemostatic intervention at admission. Eur Radiol 2002;12:979-93.  Back to cited text no. 3
    
4.
Pick JW, Anson BJ, Ashley FL. The origin of the obturator artery. A study of 640 body-halves. Am J Anat 1942;70:317-44.  Back to cited text no. 4
    
5.
Hollinshead HW. Anatomy for Surgeons. Blood Vessels of the Pelvis. London: Hoeber-Harper II; 1958. p. 681-6.  Back to cited text no. 5
    
6.
Collins JP. Modern approaches to teaching and learning anatomy. BMJ 2008;337:a1310.  Back to cited text no. 6
    
7.
Kumar PA, Norrish M, Heming T. Laparoscopic surgery recording as an adjunct to conventional modalities of teaching gross anatomy. Sultan Qaboos Univ Med J 2011;11:497-502.  Back to cited text no. 7
    
8.
Davis CR, Bates AS, Ellis H, Roberts AM. Human anatomy: Let the students tell us how to teach. Anat Sci Educ 2014;7:262-72.  Back to cited text no. 8
    
9.
Patel SB, Mauro D, Fenn J, Sharkey DR, Jones C. Is dissection the only way to learn anatomy? Thoughts from students at a non-dissecting based medical school. Perspect Med Educ 2015;4:259-60.  Back to cited text no. 9
    
10.
Jaffar AA. YouTube: An emerging tool in anatomy education. Anat Sci Educ 2012;5:158-64.  Back to cited text no. 10
    
11.
Biasutto SN, Caussa LI, Criado del Río LE. Teaching anatomy: Cadavers vs. computers? Ann Anat 2006;188:187-90.  Back to cited text no. 11
    
12.
Reconciliation Board, Academic Committee of MCI. Attitude, Ethics and Communication (AETCOM) Competencies for the Indian Medical Graduate; 2018. Available from: https://www.mcindia.org>uploads>2019/01>Aetcom_book. [Last accessed on 2019 Nov 27].  Back to cited text no. 12
    
13.
Turney BW. Anatomy in a modern medical curriculum. Ann R Coll Surg Engl 2007;89:104-7.  Back to cited text no. 13
    
14.
Fitzpatrick CM, Kolesari GL, Brasel KJ. Teaching anatomy with surgeons' tools: Use of the laparoscope in clinical anatomy. Clin Anat 2001;14:349-53.  Back to cited text no. 14
    
15.
Gogalniceanu P, Madani H, Paraskeva PA, Darzi A. A minimally invasive approach to undergraduate anatomy teaching. Anat Sci Educ 2008;1:46-7.  Back to cited text no. 15
    
16.
Cundiff GW, Weidner AC, Visco AG. Effectiveness of laparoscopic cadaveric dissection in enhancing resident comprehension of pelvic anatomy. J Am Coll Surg 2001;192:492-7.  Back to cited text no. 16
    
17.
Jiménez AM, Aguilar JF. Laparoscopy: Learning a new surgical anatomy? Anat Sci Educ 2009;2:81-3.  Back to cited text no. 17
    
18.
Anderson D, Duggan N, Al-Ali S, Windsor J. A study of different methods for visualizing anatomy laparoscopically in embalmed cadavers. J Anat 2004;204:238.  Back to cited text no. 18
    
19.
Glasgow SC, Tiemann D, Frisella MM, Conroy G, Klingensmith ME. Laparoscopy as an educational and recruiting tool. Am J Surg 2006;191:542-4.  Back to cited text no. 19
    
20.
Older J. Anatomy: A must for teaching the next generation. Surg J R Coll Edinb Irel 2004;2:79-90.  Back to cited text no. 20
    


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