Retention of Clinical versus Non-Clinical Anatomical Knowledge

Abstract

Context and Objectives: Detailed anatomy is taught during the first two years of medical school at the University of Malta and is not revisited later. Neither is it primarily clinically contextualized. This project aimed to determine whether clinically applied anatomical knowledge is better retained by students.
Methods: 250 students in Years 1 to 5 submitted voluntarily to a written test, under examination conditions, comprising 100 anatomy questions which included a combination of non-clinical and applied clinical questions. Student scores were compared across different years using unpaired t test and ANOVA for statistical analysis.
Results: Overall, the non-clinical anatomy test performance was best in Year 5 and worst in Year 2 (68±14 vs 57±16%, p=0.037). Year 1 students performed the worst in clinical anatomy questions (76±12 vs 52±15, p<0.0001) compared to students in all other years. Students in Years 1 and 2 performed better in non-clinical than applied clinical anatomy questions (+9±10%); Years 3, 4 and 5 students scored equally in both (0±9%); Years 4 and 5 students responded more accurately to applied clinical questions (-6±6%; p<0.0001). Compared to Years 1 and 2, thoracic and gastrointestinal anatomy scores improved in Years 3 onwards (p < 0.0001).
Discussion: Pre-clinical and clinical students performed better in non-clinical and applied clinical anatomy questions respectively, reflecting the better retention of clinically relevant anatomy. The finding that final year students performed better in applied clinical questions suggests that anatomical content taught in a clinical context can be better retained, in spite of minimal reinforcement over the years.
Conclusions: By the end of this medical programme, clinical anatomy knowledge is better retained than the non-clinical. Even if not vertically integrated, anatomy should be taught more in a clinical context to be better retained by future junior doctors.