146 - Does Prosection Prepare Students for the Clinical Setting? The Long-term Impact of Prosection Anatomy

Poster Board Number: 146
There are separate poster presentation times for odd and even posters.
Odd poster #s – first hour
Even poster #s – second hour

Co-authors:

Harleen Saini, MS - Tufts University School of Medicine; Daniel Kent - Tufts University School of Medicine; Emma Mitchell-Sparke, MPhil - Tufts University School of Medicine; James Kubilus, PhD - Tufts University School of Medicine; Rebecca Lufler, PhD - Tufts University School of Medicine

Abstract Body : Introduction: The hidden curriculum has been explored in cadaveric dissection experiences yet is limited in prosection learning. Further, many studies investigate anatomy knowledge outcomes and few follow applications in a clinical setting. The aim of this study was to examine how prosection learning impacted short and long-term: (1) perceptions of knowledge application in a clinical setting and confidence in clinical skills; and (2) factors affecting specialty choice.

Methods: Surveys were administered to medical students taught by prosection at two timepoints: after completion of anatomy (Y2) and after completion of third year rotations (Y4). Surveys assessed student perceptions on how prosection learning impacted anatomical knowledge application in a clinical setting and confidence in clinical skills such as physical exam, technical skills, professional development, coping with death and dying, and teamwork. Students were asked to identify a specialty and factors that contributed to that choice. Specialties were considered surgical (S) or non-surgical (NS) based on AAMC Classifications. Responses were compared using Mann-Whitney U tests. This study was given Exempt Determination by Tufts University/Tufts Medical Center IRB (#1793).

Results: 54 Y2 students (27%) and 57 Y4 students (29%) responded to surveys. After clinical rotations, confidence in whether prosection anatomy prepared students with adequate anatomical knowledge decreased in imaging interpretation (p = 0.002), physical exam (p = 0.006), and differential diagnosis skills (p = 0.002). Confidence in whether prosection contributed to professional development (p = 0.007) and ability to contribute to the healthcare team (p = 0.007) also decreased. Of the 20 students with matched data,13 (65%) changed specialties. One student switched from a S to NS specialty and no students changed from a NS to S specialty. 31% of Y2 students believed that their anatomy experience contributed to specialty choice compared to 24% in Y4. Y4 students indicated that factors such as job compensation (p < 0.001), job stability (p < 0.001), and application competitiveness (p = 0.002) contributed to their specialty choice more than their anatomy lab experiences. All students who strongly agreed that their anatomy experience influenced specialty chose a S field.

Conclusion: Initial confidence in multiple skills was not maintained after completing clinical rotations, indicating that prosection may not provide skills associated with the anatomy hidden curriculum. There was limited change between S and NS fields, suggesting that the decision to pursue a type of residency is made early in training. Non lab factors influenced specialty choice, but surgically inclined students factor anatomy training into their decision most.