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While active learning strategies have been promoted by researchers as practices to increase performance and retention, some practices have been shown to have unintended negative effects on students such as increasing anxiety. Students often report the debilitating effect of test-taking anxiety on their performance. This study investigated the use of an exam preparation process utilizing clicker questions to help human anatomy students at a community college cope with test-taking anxiety by practicing answering timed questions and regularly confronting the specific impact of anxiety on their performance. Students completed early and late semester surveys which measured self-reported test-taking anxiety levels and social anxiety in response to various teaching practices. There was no difference in test-taking anxiety between students who received clicker questions and students who did not. However, when comparing test taking anxiety across a subset of students who took both the early and late surveys, independent of treatment, a significant decrease in test taking anxiety was observed from the start to the end of the semester. Students also reported a change in effectiveness of teaching practices, rating lectures as effective early in the semester, while emphasizing active learning more at the end of the semester.

Student-generated videos (SGVs) are gaining popularity and have been increasingly incorporated into undergraduate curricula in many disciplines. Through the creation of their own educational digital videos, students learn course content and transferrable skills. However, the use of SGVs in anatomy and physiology (A&P) is virtually undocumented. In this mixed-methods study, students in online and face-to-face A&P courses independently created short videos about relevant physiological phenomena. The results indicate that perceived and actual learning, as well as enjoyment, were positively impacted by the creation of the SGVs. Though it was not required, students watched their peers' videos over 12,000 times in the online course and over 1,100 times in the face-to-face course. These findings demonstrate the value of SGVs in the A&P lecture classroom for the first time.

Human Anatomy and Physiology courses are "gateway" courses that students must pass with high grades in order to proceed through their program of study. However, student pass rates are often low, resulting in students attempting the course multiple times and delaying their graduation. Supplemental instruction performed by peer leaders is one mechanism that has been used to increase student success. The goal of this study was to evaluate the effectiveness of peer-led supplemental instruction by comparing predicted and actual course grades. We learned that students predicted to earn a C achieved higher grades when they utilized supplemental instruction. While those students performed better than predicted, supplemental instruction did not improve ABC rates for the class. We conclude that supplemental instruction can be of benefit for some students.

In the United States, there is a demand for registered nurses. To be admitted into the nursing program, students need to complete prerequisite courses such as human anatomy and physiology. Many students find human anatomy and physiology challenging due to the nature of the content. Poor performance in human anatomy and physiology can preclude a student from enrolling in the nursing program. Professors can support students in their learning activities with strategies that can have a positive impact on learning and improve learner outcomes. The objectives of this study are to use consistent formative assessments such as pre-course assessment, course syllabus quiz, reading assignments (pre-learning), in-class activities (during learning), and post-learning activities to engage students in a human anatomy and physiology course. It is important to share these strategies for engaging students with other educators of allied health students. Data were collected on students' performance on pre-course assessment, course syllabus quiz, pre-learning, during learning, and post-learning activities (n=9). Pre-course assessment, course syllabus quiz, and post-learning quizzes were completed on Moodle. Pre-learning reading assignments were completed using McGraw Hill Connect embedded within Moodle. During learning and post-learning activities were completed in the classroom. The mean data for different forms of formative assessment are pre-course assessment (67.8%), course syllabus quiz (84.4%), pre-learning reading assignments (99%), during learning activities (94.2%), and post-learning activities (78.8%). The data show that consistent formative assessments can be used to engage students in active learning, help them prepare for summative assessments, and impact knowledge with positive learner outcomes.

Community outreach and service-learning are common components of medical and health profession programs. Outreach programs can provide diverse service-learning opportunities for students to work collaboratively with their communities. Many educational accrediting bodies require service-learning activities for students. The discipline of anatomy is uniquely suited for outreach as it engages students with the community and provides relevant, health-related educational materials and information. Anatomy is often a general interest to many and can aid in the promotion of students pursuing health professions careers. The objective of this work is to describe three unique anatomical outreach programs that integrate components of community service, service-learning, and/or pathway program initiatives in innovative ways. These programs are presented to inspire and/or be adapted in other medical or health professions programs. Variety in these programs range from duration, target audience age, resource and financial requirements, and necessary collaborations. The authors provide tips for success and potential pitfalls to consider. These three examples serve as successful, contemporary, and diverse approaches to anatomical outreach that can be implemented into medical or health professions education programs.

Medical educators and programs are deeply interested in understanding and projecting the longitudinal developmental trajectories of medical students after these students are matriculated into medical schools so appropriate resources and interventions can be provided to support students' learning and progression during the process. As students have different characteristics and they do not learn and progress at the same pace, it is important to identify student subgroups and address their academic needs to create more equitable learning opportunities. Using latent class growth analysis, this study explored students' developmental trajectories and detected group differences based on their coursework performance in Anatomy within the two years of preclinical education in one medical school. Four subgroups were identified with various intercepts and slopes. There were significant group differences between these subgroups and their standardized scores in MCAT and UCMLE Step 1. The study provides evidence about the heterogeneity of the student population and points out future research directions.

Plastination, a permanent preservation method for human tissues and organs, is increasingly being used in anatomy education. However, there is a paucity of systematic reviews and meta-analyses summarizing the educational efficacy of plastinated specimens. This meta-analysis compared the assessment scores of students exposed to plastinated specimens against those exposed to other common instructional methods. A systematic search was conducted through four databases, from 2000 to July 2022. Titles and abstracts of the retrieved records were screened according to predetermined eligibility criteria. Of the 159 records screened, 18 were subjected to full-text review. Among the 18 studies, five articles reported post-intervention test scores for intervention (plastinated) and control (other modalities) groups. Studies were subjected to GRADE quality assessment, and four studies with moderate to high ratings were included for meta-analysis. Students' perceptions (n = 15 studies) were qualitatively analyzed using an inductive narrative analysis. No significant effect was detected between the intervention (n = 417) and control groups (n = 422) (standardized mean difference = 0.08; 95% CI [-0.36, 0.52]; p = 0.73). Four themes emerged from students' perceptions: ease of use, motivation to study, spatial understanding, and learning preference. Overall, student performance outcomes comparing the use of plastinated specimens versus other instructional modalities are very limited. This meta-analysis suggests that knowledge gained from plastinated specimens is comparable to learning achieved through other modalities; though this outcome should be interpreted with caution as there is currently insufficient evidence for definitive conclusions.

In 1993, an increase was observed in the spatial IQ scores of the volunteers who listened to Mozart's sonata K448 for 10 min, and this phenomenon entered the literature as the "Mozart effect." Other studies have shown that this effect is particularly evident in spatial skill tests. A large body of research has provided evidence that spatial ability is associated with success in learning anatomy. In this study, Kastamonu University Faculty of Medicine students were divided into two groups during 16-h practical training spanning 30 days. While one of the groups listened to Mozart's K448 sonata as the background music in all lessons, the control group attended the lessons in their standard form. At the end of each lesson, all students solved a modified mental rotation test including questions involving anatomical structures. Before starting the study, after the first laboratory class, on the 15th and 30th day of the study, blood samples were taken from the participants, and plasma brain-derived neurotrophic factor (BDNF) levels were determined. The effect of time on mental rotation score and plasma BDNF level was significant (p < 0.001 for both). The effect of group was also significant (p < 0.001 for both). Pairwise comparisons showed significance in the fifth, sixth, seventh, and eighth mental rotation test (p < 0.001, p = 0.041, p < 0.001, p < 0.001, respectively) and in the third (Day 15) and fourth (Day 30) BDNF measurement (p < 0.001 for both). Our findings may indicate that specific background music may be useful for anatomy teaching.

Traditional teaching methods struggle to convey three-dimensional concepts effectively. While 3D virtual models and virtual reality platforms offer a promising approach to teaching anatomy, their cost and specialized equipment pose limitations, especially in disadvantaged areas. A simpler alternative is to use virtual 3D models displayed on regular screens, but they lack immersion, realism, and stereoscopic vision. To address these challenges, we developed an affordable method utilizing smartphone-based 360° photogrammetry, virtual camera recording, and stereoscopic display (anaglyph or side-by-side technique). In this study, we assessed the feasibility of this method by subjecting it to various specimen types: osteological, soft organ, neuroanatomical, regional dissection, and a dedicated 3D-printed testing phantom. The results demonstrate that the 3D models obtained feature a complete mesh with a high level of detail and a realistic texture. Mesh and texture resolutions were estimated to be approximately 1 and 0.2 mm, respectively. Additionally, stereoscopic animations were both feasible and effective in enhancing depth perception. The simplicity and affordability of this method position it as a technique of choice for creating easily photorealistic anatomical models combined with stereoscopic depth visualization.

An increasing number of practicing physician assistants (PAs) are using ultrasound (US) in clinical settings. However, a lack of US learning objectives for PA students limits the optimal integration of this imaging modality in PA curricula. This study surveyed PA program directors across the United States to create a list of US learning objectives for PA students and to gauge their attitudes toward integrating US into anatomy curricula. Thirty-one of the 280 PA program directors responded to the survey. While 87% of participants reported that their institution includes ultrasound in its curriculum, 71% disagreed that the state of the use of ultrasound throughout their PA curriculum is fine and needs no modification. Based on the responses of the survey participants, this study categorized US learning objectives into high, medium, low, and no agreement for integration in PA curricula. As over half of the learning objectives (73%, 43/59) had high agreement for inclusion in curricula, this study demonstrates an opportunity for educators to include US in PA curricula.

Recently, there has been an emphasis on keeping the study of anatomy using donor material confined to the domain of medical and allied healthcare professionals. Given the abundance of both accurate and inaccurate information online, coupled with a heightened focus on health following the COVID-19 pandemic, one may question whether it is time to review who can access learning anatomy using donors. In 2019, Brighton and Sussex Medical School (BSMS) obtained a Human Tissue Authority Public Display license with the aim of broadening the reach of who could be taught using donor material. In 2020, BSMS received its first full-body donor with consent for public display. Twelve workshops were delivered to student groups who do not normally have the opportunity to learn in the anatomy laboratory. Survey responses (10.9% response rate) highlighted that despite being anxious about seeing inside a deceased body, 95% felt more informed about the body. A documentary "My Dead Body" was filmed, focusing on the rare cancer of the donor Toni Crews. Viewing figures of 1.5 million, and a considerable number of social media comments highlighted the public's interest in the documentary. Thematic analysis of digital and social media content highlighted admiration and gratitude for Toni, the value of education, and that while the documentary was uncomfortable to watch, it had value in reminding viewers of life, their bodies, and their purpose. Fully consented public display can create opportunities to promote health-conscious life choices and improve understanding of the human body.

While traditional anatomy education often emphasizes passive learning and rote memorization, it seldom employs constructivist theories that focus on active, hands-on experiences for effective learning. This study tests the hypothesis that tactile experiences with modeling clay enhance geometric mental representation more effectively than verbal descriptions. We examine the potential of clay modeling to reflect and evaluate students' mental representation of anatomical structures. Utilizing a prospective randomized, open, blind endpoint (PROBE) design, we engaged 36 participants divided into three groups: blind, visually impaired, and a control group. The primary outcome measure was the difference between post-touch score and pre-touch score, which gauged the efficacy of tactile intervention in enhancing the participants' capacity to mentally reconstruct a well-designed anatomical fiction structure. Scoring was executed using a double-blind double-evaluation methodology, positioning clay model reconstruction as both an objective reliable assessment and a pedagogical tool. The analysis demonstrated a pronounced improvement in mental representation of anatomical structures, particularly in spatial comprehension and detailed textural discernment, with the mean score soaring from 47.81 pre-touch to 85.09 post-touch. Distinct cognitive processing adaptations were evident across groups, with the blind group excelling in tactile acuity and the visually impaired group showing the most significant gains in spatial understanding post-intervention (Cohen's d = 2.74). The application of modeling clay as a tactile intervention tool can significantly improve the learning of anatomy among medical students. The study underscores the value of active, multisensory engagement and customized teaching strategies for effective anatomy education among this demographic.

Immersive virtual reality (i-VR) is a powerful tool that can be used to explore virtual models in three dimensions. It could therefore be a valuable tool to supplement anatomical teaching by providing opportunities to explore spatial anatomical relationships in a virtual environment. However, there is a lack of consensus in the literature as to its effectiveness as a teaching modality when compared to the use of cadaveric material. The aim of our study was to compare the effectiveness of i-VR in facilitating understanding of different anatomical regions when compared with cadaveric prosections for a cohort of first- and second-year undergraduate medical students. Students (n = 92) enrolled in the MBBS program at Queen Mary University of London undertook an assessment, answering questions using either Oculus i-VR headsets, the Human Anatomy VR™ application, or prosection materials. Utilizing ANOVA with Sidak's multiple comparison test, we found no significant difference between prosections and i-VR scores in the abdomen (p = 0.6745), upper limb (p = 0.8557), or lower limb groups (p = 0.9973), suggesting that i-VR may be a viable alternative to prosections in these regions. However, students scored significantly higher when using prosections when compared to i-VR for the thoracic region (p < 0.0001). This may be due to a greater need for visuospatial understanding of 3D relationships when viewing anatomical cavities, which is challenged by a virtual environment. Our study supports the use of i-VR in anatomical teaching but highlights that there is significant variation in the efficacy of this tool for the study of different anatomical regions.

Recent controversies over the mismanagement of body donors in US medical schools have raised public concerns over the ethical treatment of bodies in "anatomical gift" programs. Despite widespread moral outrage at such cases, medical students may still make seemingly inconsequential mistakes or jokes that in fact constitute acts of disrespect. This may partially be attributed to the process of desensitization in working with human remains, and indicates a further need to inculcate into medical students the ethical responsibilities of working with body donors. Donation agreement statements that lack specific information about the respectful treatment of bodies in the anatomy laboratory may serve as an additional point of concern for potential donors seeking reassurance about the future treatment of their bodies. This viewpoint draws from the anecdotal experiences of medical students to portray two scenarios of medical students' disrespectful conduct toward body donors, and constructs an account of moral respect for human remains based on respect for posthumous autonomy and respect in attitude. It then provides suggestions for US medical schools to incorporate this ethical framework into their anatomy curricula to instill respectful dispositions in its students and facilitate a more robust informed consent process for potential donors who entrust their bodies to medical students.

Anatomical education is pivotal for medical students, and innovative technologies like augmented reality (AR) are transforming the field. This study aimed to enhance the interactive features of the "AEducAR" prototype, an AR tool developed by the University of Bologna, and explore its impact on human anatomy learning process in 130 second-year medical students at the International School of Medicine and Surgery of the University of Bologna. An interdisciplinary team of anatomists, maxillofacial surgeons, biomedical engineers, and educational scientists collaborated to ensure a comprehensive understanding of the study's objectives. Students used the updated version of "AEducAR," named "AEducAR 2.0," to study three anatomical topics, specifically the orbit zone, facial bones, and mimic muscles. "AEducAR 2.0" offered two learning activities: one explorative and one interactive. Following each activity, students took a test to assess learning outcomes. Students also completed an anonymous questionnaire to provide background information and offer their perceptions of the activity. Additionally, 10 students participated in interviews for further insights. The results demonstrated that "AEducAR 2.0" effectively facilitated learning and students' engagement. Students totalized high scores in both quizzes and declared to have appreciated the interactive features that were implemented. Moreover, interviews shed light on the interesting topic of blended learning. In particular, the present study suggests that incorporating AR into medical education alongside traditional methods might prove advantageous for students' academic and future professional endeavors. In this light, this study contributes to the growing research emphasizing the potential role of AR in shaping the future of medical education.

Exploring student motivation to learn is a research area that has rapidly expanded over the past decade, especially as the COVID-19 pandemic continues to influence education. In the field of anatomy, most research about motivation to learn targets medical and other health professional students, but little is known about factors that drive students enrolled in science degrees. The aims of this mixed-methods study were to determine: (1) what motivates undergraduate university science students to learn anatomy, and whether motivation differs between cohorts (second- and third-year) and gender; and (2) the impact of COVID-19 on motivation to learn. Students (n = 171) completed a survey (the Science Motivation Questionnaire II [SMQII] and questions about learning experiences during the pandemic) and a subset (n = 12) participated in focus groups/interviews. Quantitative data were analyzed using a combination of parametric and non-parametric statistics, and a general inductive approach was applied to qualitative data. Grade, intrinsic, and career factors were consistently identified as the key components of motivation. No statistically significant differences were found for motivation components between level of study or gender. Students reported that the COVID-19 pandemic negatively impacted motivational components, but it had also fast-tracked the development of online learning, with both positive and negative connotations. Students value traditional in-person lectures but support a blended approach of traditional and online teaching methods for learning anatomy. Educators should utilize these findings when considering how to teach and support science students in ways that embrace motivational components to foster success in those studying anatomy.

The study of organism structural composition, known as anatomy, is essential in comprehending the intricate arrangements of life and plays a crucial role in medical education and practice. It bridges foundational and clinical disciplines, shaping medical education, and practice. With evolving technology, medical education faces new challenges necessitating pedagogical innovations. This article explores the changing landscape of anatomical education, encompassing teaching methods, and curricular shifts. Advancements in information technology and bibliometrics shed light on anatomy's evolution, yet research on anatomy teaching reform (ATR) remains scarce. This study employs advanced analytical tools like CiteSpace and VOSviewer to uncover research hotspots and frontiers in ATR. By scrutinizing focal points and emerging directions in ATR, this research provides insights into the future of pedagogical strategies and clinical research in anatomy.

In recent years, there has been a growing recognition of the importance of integrating ultrasound into undergraduate medical curricula. However, empirical evidence is lacking as to its effect on anatomy learning and related student cognition. Therefore, the present study compared the impact of echocardiography-based instruction with narrated videos on students' understanding of anatomical relationships, as well as the interaction with students' autonomous motivation, self-efficacy beliefs, mental load, and attitudes. Second-year medical students were given the opportunity to enroll in a supplementary booster course about cardiac anatomy. On the base of a randomized controlled trial with a cross-over design, we studied the effect of taking this course on spatial anatomical knowledge. After completing a pre-test (T0), students were allocated randomly to either the echocardiography-based teaching condition (cohort A) or the narrated anatomy video condition (cohort B). Next, participants were crossed over to the alternative intervention. Immediately after each phase in the intervention, students were asked to rate their mental load. Additionally, a spatial anatomical knowledge test, an autonomous motivation scale, and a self-efficacy scale were administered before (T0) and after the first intervention (T1) and at the end of the study (T2). Finally, each student completed a perception-based survey. The study design allowed a comparative evaluation of both interventions at T1, while the cross-over design facilitated the assessment of the most optimal sequencing in the interventions at T2. A total of 206 students participated (cohort A: n = 99, cohort B: n = 107). At T1, no significant differences in the knowledge test and the autonomous motivation scale were observed between cohorts A and B. However, cohort A showed higher self-efficacy beliefs compared to cohort B (p = 0.043). Moreover, cohort A reported higher levels of perceived mental load (p < 0.001). At T2, the results showed that neither sequence of interventions resulted in significant differences in anatomy scores, autonomous motivation, or self-efficacy. However, a significant difference in mental load was found again, with students in cohort B reporting a higher level of mental load (p < 0.001). Finally, based on the perception-based survey, students reported favorably on the echocardiography experience. In conclusion, the hands-on echocardiography sessions were highly appreciated by the medical students. After participating in the ultrasound sessions, they reported higher levels of self-efficacy beliefs compared to the video-based condition. However, despite embodied cognition principles, students in the echocardiography condition did not outperform students in the narrated anatomy video condition. The reported levels of mental load in the ultrasound condition could explain these findings.

Human body donors play a crucial role in anatomical education, research, and clinical skills training, and those interested in anatomical donation may bequeath their bodies to body donation programs (BDPs). The purpose of this study was to evaluate the perspective of body donors on the donation process in order to make recommendations for improvement that align with donor values. A survey was administered via email to 2145 individuals that had enrolled in The Ohio State University's BDP and yielded a 40% response rate. Results showed that a majority of registered donors do not place high importance on detailed consent options during the enrollment process, but do value BDP oversight, such as through the use of an oversight committee to supervise the program. Only 9.1% of donors felt that their loved ones should be permitted to make changes to their consent forms after they have passed. Although 96.2% of participants would allow photos/videos to be taken of their donated bodies, females were significantly less likely to consent to this than males (p = 0.001), as well as less likely to allow their donations to be utilized for anatomy outreach (p = 0.023). Racial minorities were significantly less trusting of the university to treat their donation with dignity and respect compared to White registrants (p = 0.034). Suggestions for improving BDP protocols include the implementation of an annual newsletter for registrants, improving methods to spread awareness about donation, increasing transparency during the consent process, and creating resources for donors' families.

Three-dimensional (3D) modeling is a recent, innovative approach to teaching anatomy. There is little literature, however, to suggest how 3D modeling is best used to teach students and whether or not students can gain the same level of understanding as they might use more traditional, hands-on, teaching methods. This study evaluated the use of a 3D modeling software in both a flipped classroom curriculum and as an active learning tool in comparison to traditional, physical model-based teaching. Pre- and post-course content-based assessments were used to evaluate students' learning. Our findings indicated no significant difference between standard and flipped classroom learning; however, the students who used 3D modeling software as an active learning tool significantly underperformed students in the standard group (F(2,1060) = 112.43, p < 0.0001). These findings suggest that these technologies may not yet be useful as a primary means of instruction. Possible explanations may include cognitive overload in navigating the system, intrinsic limitations of the software, or other factors. Further development and research of these technologies is necessary prior to their adoption into teaching practices in anatomy.

It can be difficult for some students to learn three-dimensional anatomical structure concepts. While virtual reality (VR) systems have been reported as helpful for learning, there has been scarce research on either VR teaching strategies or the influence of visually induced motion sickness (VIMS) in the context of large anatomy classes (i.e., over 100 students). The study thus aimed to (1) establish a VR anatomy instruction video for a large class; (2) determine how many students experience VIMS when watching a VR anatomy instruction video; (3) evaluate the influence of VIMS on VR anatomy video-based learning; and (4) examine whether a small screen size alleviates VIMS. Laboratory course students viewing a VR anatomy instruction video about the vascular system were invited to participate in the questionnaire survey. Anatomy faculty and staff participated in an experimental trial to determine whether small screen size could alleviate VIMS. The Likert scale survey revealed that students reported the VR strategy as advantageous and appropriate for large classes, but that it cannot replace practical dissection. Of the total participants, 32% reported experiencing VIMS, and 40% of those experiencing VIMS agreed that this could negatively impact their learning through a VR anatomy instruction video. Adjusting the screen size from large to small significantly delayed the onset of VIMS. In conclusion, the VR anatomy instruction video strategy is feasible and helpful for large classes, but educators should consider VIMS when planning their use of this teaching approach.

Neuroanatomy is a notoriously challenging subject for medical students to learn. Due to the coronavirus disease-19 (COVID-19) pandemic, anatomical education transitioned to an online format. We assessed student performance in, and attitudes toward, an online neuroanatomy assessment compared to an in-person equivalent, as a marker of the efficacy of remote neuroanatomy education. Participants in the National Undergraduate Neuroanatomy Competition (NUNC) 2021 undertook two online examinations: a neuroanatomically themed multiple-choice question paper and anatomy spotter. Students completed pre- and post-examination questionnaires to gauge their attitudes toward the online competition and prior experience of online anatomical teaching/assessment. To evaluate performance, we compared scores of students who sat the online (2021) and in-person (2017) examinations, using 12 identical neuroradiology questions present in both years. Forty-six percent of NUNC 2021 participants had taken an online anatomy examination in the previous 12 months, but this did not impact examination performance significantly (p > 0.05). There was no significant difference in examination scores between in-person and online examinations using the 12 neuroradiology questions (p = 0.69). Fifty percent of participants found the online format less enjoyable, with 63% citing significantly fewer networking opportunities. The online competition was less stressful for 55% of participants. This study provides some evidence to suggest that student performance is not affected when undertaking online examinations and proposes that online neuroanatomy teaching methods, particularly for neuroradiology, may be equally as effective as in-person approaches within this context. Participants perceived online examinations as less stressful but raised concerns surrounding the networking potential and enjoyment of online events.

Anatomy has been integral to medical and health education for centuries, it has also had a significant role in wider public life, as an educational resource, a link to their health, and also as a darker deterrent. Historically, public engagement in anatomy is hallmarked by public dissections of convicted criminals across the globe. Artists, specifically non-medical men, such as Leonardo da Vinci, are reported to have participated in public dissection. Dissection would later rekindle public interest in anatomy as graverobbing led to the reform and regulation of anatomy in many countries. In recent years, there has been growing interest from the public in learning more about their bodies as health and well-being become of paramount importance, particularly following the COVID-19 pandemic. Anatomy sits in a prime position to direct and instigate conversations around health, well-being, and body image. Every human on earth possesses a perfect resource to look at and learn about. Models, art-based anatomical activities, and crafts provide active learning opportunities for the wider public around anatomy. Most recently, apps, games, and extended reality provide novel and insightful learning opportunities for the public relating to the body. Finally, training and resources must also be made available from institutions and professional bodies to anatomists to enable them to deliver engagement in an already congested and educationally heavy schedule. This resurgence of interest in anatomical public engagement sees anatomy re-enter the public spotlight, with more appropriate resources and educational settings to offer engagement with the aim of benefiting the public.

As a result of the COVID-19 pandemic, anatomy education was forced to adopt online modes of delivery. Previous research on student views revealed areas of strong preference (asynchronous lectures) and strong dislike (virtual specimens) in online anatomy courses. The current study seeks to compare the views of a single cohort of students experiencing both online and in-person undergraduate introductory anatomy and physiology courses. This comparison can highlight what students consider beneficial to their education and can inform future hybrid course offerings. Q-methodology was used to assess the opinions of students. Students sorted 41 statements on anatomy education in a quasi-normally distributed grid based on their degree of agreement with the statements. The rankings underwent a by-person factor analysis which categorized students with shared perceptions into groups. Data were collected from 246 students in the primarily online fall semester and 191 students in the primarily in-person winter semester. Analysis revealed three distinct factors (groups) in the cohort. Factor one (n = 113 (fall), n = 93 (winter)), was satisfied overall with the course materials and delivery. Factor two (n = 52 (fall), n = 18 (winter)) had a deep dislike of online learning, and factor three (n = 37 (fall), n = 49 (winter)) had a strong preference for online learning. While many students were comfortable in both online and in-person learning environments, this was not the case for all learners. The strengths and weaknesses of each teaching modality suggest the opportunity to explore hybrid learning as an option for future course offerings and specifically highlight valuable aspects to incorporate from each environment.

Preparing students for the transition to graduate-level education with greater learning demands in a condensed time frame is a challenging process for health professions educators and incoming students. Prematriculation programs offer a solution for exposing students to the foundational sciences in preparation for the academic rigor of a doctoral program. This retrospective study assessed whether incoming students enrolled across 3 yr of a 2-day online anatomy workshop, offered in July and August before the start of their first semester resulted in improved anatomy knowledge. Whether this acquired knowledge translated to improved anatomy outcomes in the first semester of a Doctor of Physical Therapy program was also assessed, while also accounting for variables of gender, ethnicity, and grade-point average. Knowledge acquired during both days of the workshop resulted in statistically significant improvements in anatomy postquiz scores compared to the baseline prequiz (P < 0.001). Multivariate regression analyses demonstrated statistically significant relationships between the first-semester anatomy practical score and workshop participation (P = 0.04) as well as a predictive value of gender (P = 0.01). Evaluating a timing effect on the predictive value of the online anatomy workshop demonstrated statistically significant effects of the prematriculation workshop on both first-semester anatomy practicals for August (P = 0.03 for practical 1; P = 0.04 for "practical" 2) but not July workshop participants. Findings from this study support the utility of an online prematriculation anatomy workshop to prepare students for graduate-level anatomy learning expectations in a doctoral allied health program.

Mnemonic devices are memory aids that make it easier to recall information and are widely used by students studying anatomy and physiology. Simple musical instruments and toys can serve as mnemonic devices for students learning the functional anatomy of the larynx: balloons can help learners understand and recall how sound is produced; tuning pegs can help learners understand how tension affects vocal pitch; fingers on a fretboard can help learners understand how pitch is further modulated; and a common coach's whistle can demonstrate how vocal volume is controlled. Using instruments and toys engages adult learners and helps them connect complex laryngeal anatomy with previous experiences.

The revised two-factor Study Process Questionnaire and the Approaches and Study Skills Inventory for Students are two instruments commonly used to measure student learning approach. Although they are designed to measure similar constructs, it is unclear whether the metrics they provide differ in terms of their real-world classification of learning approach. The purpose of this study is to compare outcomes of these two inventories in a study population from an undergraduate (baccalaureate) human anatomy course. The three central goals of this study are to compare the inventories in terms of 1) how students are classified, 2) the relationship between examination performance, time spent studying, and learning approach, and 3) instrument reliability. Results demonstrate that student classifications of corresponding scales of each inventory are significantly correlated, suggesting they measure similar constructs. Although the inventories had similar reliability, neither was consistently strong in predicting examination performance or study habits. Overall, these results suggest that the two inventories are comparable in terms of how they measure learning approach, but the lack of correspondence between learning approach scores and measurement outcomes questions their validity as tools that can be used universally in classrooms.

Concept maps help detect misconceptions and provide revision exercises to assess comprehension once a topic has been introduced. A concept map is a schematic drawing used to show the connection among the concepts in propositional form. A concept map is a helpful tool for illustrating the relationships between main concepts and sub-concepts. The main objective of the study was to identify misconceptions about the human digestive system among higher secondary students using concept maps. The data was collected from higher secondary students XI class students) (N = 388) with the help of students' preliminary concept maps and researcher-made concept map tools. Findings of the study showed that secondary school students hold misconceptions related to the human digestive system, i.e. few (22.68%) students have misconceptions such as 'Human Digestive System is the process by which hard food is converted into simple diffusible assimilable nutrients', few (19.32%) students have misconceptions such as 'Alimentary Canal starts with the throat," etc. The present paper will help use concept maps for the identification and remediation of students' misconceptions.

The purpose of this pilot study was to define what changes were experienced in the Fall 2020 semester by students in an undergraduate anatomy and physiology of speech and hearing course and highlight any differences in the experience of first-generation college students (FGCS). An online survey was administered to a single class of undergraduate students. Results indicated that students experienced a variety of challenges related to the pandemic and virtual learning. Differences in the experiences of FGCS compared to traditional students included increased hours worked and feelings of being overwhelmed and spending less time on course content each week. Future research is warranted to investigate these trends within a more representative population and identify ways that academic support can be utilized to improve student success.

In the fall of 2021, a cohort of second-year osteopathic medical students took part in a regional dissection experience led by their peers. During the students' first year of medical school, when they would have normally participated in anatomy dissections, they instead took part in a prosection-based gross anatomy course due to COVID restrictions. Many students requested the opportunity to learn dissection techniques, dissect regions of interest for specialties, and participate in this medical school "rite of passage" when COVID restrictions eased. This article describes the planning and implementation of a regional dissection program for 42 second-year medical students that occurred outside normal curricular hours at the West Virginia School of Osteopathic Medicine (WVSOM). This program was led by two second-year osteopathic medical students who had previously performed a full donor dissection as well as assisted in teaching at the college level. One of the main advantages of this program was the use of a limited number of donors compared to the large number of students who were able to participate in dissection in a meaningful way. A disadvantage was that each pair of students was only able to dissect one region of the body during their sessions. A quality improvement survey was conducted after the experience and 26% of participants provided feedback for potential future programs at WVSOM. Students reported enjoying the experience and becoming more comfortable using dissection instruments. This dissection program could be used as a template for an anatomy elective, a brief introduction to dissection, or a summer course.

A traditional anatomy lab using microscope slides to examine the structures of the integumentary system was enhanced to increase connections to the real world, student engagement, and interest in the topic by adding a forensic storyline where students examined structures of the integument in order to "solve the crime". Student perceptions regarding the addition of the storyline to the lab found that 88% of students reported that the storyline increased the connections they made between the lab and the real world. Eighty-six percent of students stated that the storyline increased their interest in the lab and 83% said that it made them more engaged in the lab. Sixty-three percent of students felt that the storyline helped them to learn the material better. A five-step strategy guided the conversion of a typical hands-on anatomy lab exercise into an engaging experience based on a storyline using materials commonly found in the lab. This strategy serves as a template to transform lab exercises into experiences that use both a storyline and a hands-on activity as drivers of student learning.

Anatomy and Physiology (A&P) is a foundational sequence of courses required for students to complete as a prerequisite prior to admission to a range of graduate health programs and degrees, some of which include medical schools, nursing, occupational and physical therapy, exercise science, cardiovascular technologist, diagnostic medical sonography, dental hygienist, respiratory care, and radiography. While undergraduate A&P course content is fairly standard, differences in curricula, as well as differences in the student populations within these classes exist. In this paper we examine ways in which a more inclusive teaching environment can be created to support an increased sense of belonging for LGBTQIA+ students within anatomy and physiology courses, potentially leading to higher retention and success rates (Fenaughty et al. 2019; Garvey et al. 2017; National Academy of Sciences 2017; Snapp et al. 2015). Inclusive teaching has largely been absent within STEM disciplines, leading to negative perceived classroom experiences within STEM courses (Snapp et al. 2015; Garvey and Rankin 2015). Faculty can help to reduce barriers to success faced by gender and sexual minority students by growing in cultural competency, using inclusive vocabulary, and infusing their courses with accurate content that allows all students to see themselves in the curriculum.

The correlation of anatomy with pathophysiology is not intuitive for many medical students. Despite detailed cadaver dissections and three-dimensional models, board-style clinical correlation questions can still be challenging for first-year students. To facilitate understanding in this regard, prosections were developed to illustrate the clinical correlations taught in the upper extremity, thorax, and head and neck. Brief, focused videos were introduced into lecture material leading to a 37% relative gain in performance on 30 exam items covering the related clinical correlations.

The development of Augmented Reality (AR) media is the goal of this research. The research method used in this research activity is development research. This method is carried out in nine steps. Research data were collected through interviews, observation and questionnaires. The instruments used to measure the quality of teaching materials are assessments from material and media experts and student response questionnaires. Based on the validation results by learning media and material experts, the categories "Good", or 79.05% and "Very Good", or 87.67%, were obtained. In a small-scale trial involving ten students, 81.6% was obtained, while in a large group test involving 30 students, 88.8% was obtained. Student responses also showed satisfaction with the developed Augmented Reality (AR) media, namely the "very interesting" criterion. This research is limited to product revisions, and further research should consider mass products. This research has a novelty in learning media: Augmented Reality (AR) in anatomy courses.

Creative thinking is an unorthodox way of thinking to produce fresh and new ideas. Creative thinking can be trained using innovative learning strategies. This study aimed to explore creative thinking aspects in the Digital Mind Maps (DMM) created by Universitas Islam Riau, Indonesia, students who were enrolled in Human Anatomy and Physiology course. A rubric containing four aspects of creative thinking, namely fluency, flexibility, originality, and elaboration. The result of the analysis showed that fluency obtained the highest score (95.64) of all aspects, and the lowest score was reported by elaboration (61.43). Findings from this study suggest that students' DMM can be used to determine their creative thinking level because DMM contains distinguished creative thinking details. Based on the results, it can be concluded that the participants' creative thinking has been properly developed. Therefore, it is advisable for lecturers to use DMM to monitor the development of their students' creative thinking.

The advent of virtual reality (VR) in education offers unique possibilities for facilitating cooperative learning strategies, particularly in fields demanding intricate spatial understanding, such as gross anatomy. This study investigates the impact of integrating cooperative learning strategies within a VR-based gross anatomy curriculum, focusing on enhancing students' anatomy knowledge and skills. We analyzed the performance of two cohorts of first-year nursing students across five semesters (2016-2020), where traditional learning methods were used in the first three semesters (2016-2018), and a VR-based cooperative learning approach was adopted in the last two semesters (2019-2020). Our findings suggest that the VR-based cooperative learning group achieved significantly higher scores in their gross anatomy laboratory courses compared to their counterparts learning through traditional methods. This research provides valuable insights into how the integration of VR technology and cooperative learning strategies can not only enhance learning outcomes but also improve the VR learning experience by reducing motion sickness. It accentuates the potential of VR-based cooperative learning as an impactful educational tool in anatomy education. Future research should further explore the optimal integration of VR and cooperative learning strategies in diverse course types and their potential to enhance educational outcomes and the learning experience.

Pursuant to pedagogical changes necessitated by the COVID-19 pandemic, this study was designed to determine which aspects of an online anatomy course students most preferred and most disliked using Q-methodology. Data were collected in fall 2020 and winter 2021, and 166 student responses were analyzed via by-person factor analysis. Three distinct subgroups were identified: Group 1 (n=66) reported being comfortable with the technology skills required for studying anatomy online; Group 2 (n=50) reported dissatisfaction with several elements of course delivery, including evaluations, laboratory assignments, and the amount of lecture content, believing that they were essentially "teaching [themselves]"; Group 3 (n=29) was characterized by being happy with tutorial activities and the guidance received from teaching assistants. Common to all groups was the preference for physical rather than virtual specimens and for faculty-made practice questions as opposed to the overwhelming number of online specimens available for review. There was an overall positive attitude shift among students regarding online delivery across semesters. Given ongoing uncertainty surrounding the pandemic, these findings provide important considerations for future potential online/blended classes on anatomy education.

Human anatomy and physiology?is?considered one of the most difficult courses a student can take in a pre-health professional major in the US (Slominski, et. al., 2017). Research has revealed benefits of the use of art and anatomy within medical education, including improved clinical observational skills, greater understanding of disease and patient perspectives, and greater ability to empathize (Bell & Evans, 2014). Bell and Evans (2014) argue that observational skills are often overlooked in medical education. Use of art assignments in a graduate anatomy and physiology course will be discussed with reference to design and learning outcomes.?The purpose of this study?was to?evaluate?the relationship between art and medical education for audiology students. This study aimed to incorporate STEAM education (art assignments, the teaching effect, and community outreach) into audiology curriculum. Auburn University's Au.D. class of 2022 participated in this study, consisting of 10 students. The Student Assessment of Learning Gains (SALG) questionnaire was conducted and provided qualitative and quantitative evidence supporting the integration of art in the Doctor of Audiology curriculum. BASE (pre) and SALG (post) outcomes assessed that the use of STEAM assignments can help improve the retention of the anatomy and physiology within of the auditory system. Cross-tabulations of pre and post course responses show a positive increase in student understanding of course material. A positive perception that art assignments enhanced student confidence and clinical observation skills related to the course was observed. Many students felt they had a great gain in understanding covered topics. The effects of utilizing the teaching effect and community outreach were also positively seen by student participants. Students' opinions following coursework and cross-tabulations support a place for art in health education and healthcare.

The human nutrition model is relevant in Biology education. Researchers and policymakers propose the introduction of modelling practices in science education, including the representation of the model. Despite being scarce, previous studies have shown that the guideline given to students conditions their performance when representing their models. This study addresses how the context given to 79 preservice teachers (PSTs) in two cohorts at the end of a modelling sequence conditions the representations of the nutrition model constructed by them. The contexts were a child running and a lactose intolerant person. Written explanations and drawings of PSTs were analyzed according to the components-mechanisms-phenomena (CMP) framework. PSTs of both cohorts expressed a more developed nutrition model in a running context than in an intolerance context with respect to CMP aspects, which was shown by statistically significant differences. Therefore, the conclusion is that the context conditions the expression of the model. In this case, it was the context that appealed directly to the circulatory system and implied the use of energy, the one that led to a more complete representation of the human nutrition model.

In early 2022, the Human Anatomy & Physiology Society (HAPS) Curriculum & Instruction Lab Survey subcommittee launched the third survey of instructors for introductory undergraduate-level courses in human anatomy and physiology. This manuscript presents analyses of questions regarding the laboratory activities and learning outcomes (LOs) section of the survey and compares results to the first (2014) and second (2017) offerings of the lab survey. Laboratory instruction continues to be a valued component of anatomy and physiology instruction, although a greater variety of resources are now being used. New questions on curriculum development revealed that respondents utilize many techniques and resources to develop their curricula, though respondents at 2-year institutions report significantly lower levels of influence on their A&P curricula compared to respondents at 4-year institutions. Identification of anatomical structure LOs appeared to be prioritized over LOs for each structure's physiological role. Dissections, plastic model manipulations, use of human subjects for physiological experiments, and use of computer simulations have remained stable across all three surveys, although use of anatomical donors and computer simulations have increased over time. Collectively, we observed respondents developing intentional, outcome-directed changes to laboratory instruction while also being limited by historical practices at their institutions. Results also indicated that the COVID-19 pandemic has increased the speed at which instructors are making long-term curricular changes.

In 2022, a subset of the Human Anatomy and Physiology Society (HAPS) Curriculum & Instruction Committee administered the third offering of the HAPS lab survey. This survey included a three-part framework of (1) demographics, (2) lab activities and learning outcomes, and, (3) the impact of a global pandemic on instruction. Here we report on demographics of respondents, their institutions, and students. Survey results related to lab activities and outcomes, and COVID-19 impacts, will be addressed in subsequent manuscripts. The duration of teaching service has been stable with 54.3% to 58.3% of respondents serving at least ten years in their current position, and 88% of respondents working at a single institution. Job responsibilities focused on teaching (98.9%) as well as multiple other commitments including service and lab and/or course coordination. The number of respondents with a terminal degree increased and there has been a decrease in the percentage of respondents working at 2-year institutions, with 50% of respondents working at 4-year institutions, of which a slight majority had graduate programs. Career goals of enrolled students remained focused on allied-health and instructors indicated nursing as the most common student career goal, with a range of other careers also mentioned. Overall, the results affirmed the importance of anatomy and physiology (A&P) instruction and the multiple roles that A&P instructors serve at their institutions.

Visualizing effects of images on improved anatomical knowledge are evident in medical and allied health students, but this phenomenon has rarely been assessed in nursing students. To assess the visualizing effect of images on improving anatomical knowledge and to use images as one of the methods of gross anatomical knowledge assessment in nursing students, the present study was repeated over two semesters. The results show that the percent class average (%) was significantly (P<0.006) increased with the inclusion of more anatomical images in a multiple-choice anatomy exam compared to a similar exam with fewer images and was significantly (P<0.002) decreased by reducing the number of images by 50% compared to image-rich exams. However, examinations with an equal number of images did not alter the class average. The percent score of individual questions from the examinations with images plus text was significantly (P<0.001) higher than the same questions with text only in both semesters. The findings of this study indicate that image inclusion in anatomy examinations can improve learning and knowledge, may help reduce cognitive load, recall anatomical knowledge, and provide a hint to an exam question.

The Anatomy Outreach Program (AOP) at The Ohio State University aspires to enhance anatomical knowledge and appreciation of the human body through interactive laboratory experiences. In May 2022, the AOP held a 3-day outreach event called Anatomy Outreach Days (AOD). AOD exposed more than 300 high school students across Ohio to various human anatomical donor materials, a facilitator panel, and an anatomy-themed game room. Anatomy Outreach Team (AOT) members were recruited to facilitate the different activities with student participants. AOT facilitators guided students through nineteen anatomy stations across five laboratory spaces, spending roughly ten minutes per station. At these stations, students were taught using human anatomical donor materials such as hearts, lungs, and joint prostheses or participated in activities like listening to heart sounds. Post-event Likert-based surveys evaluating student and teacher experiences of the event were distributed following the event; 48 student responses and 7 teacher responses were received. Participant satisfaction with their experience at AOD was rated as 'excellent' with a score of 4.56 for students and 4.86 for teachers. The survey results also showed that students and teachers would highly recommend AOD to their peers. It was concluded that the logistical format of AOD at The Ohio State University was conducive to a positive experience for student and teacher participants.

Engaging students in active learning has proved to transform reflexive knowledge into true learning of material in medical education. Histology is one subject area that consistently presents as a challenge for medical and undergraduate students. The large amount of complex information needed to completely understand and interpret histological images is something that is many medical students do not fully grasp in the pre-clinical stages. Pedagogical studies that use physical objects and hands on learning have been shown to motivate and encourage students to self-learn such complex topics. This application of using physical objects and hands on learning, however, is not the easiest to translate to the cellular level. The Histo-Kitchen was designed to help students manage the vast amount of information and acquire knowledge in a meaningful and creative way. By incorporating food items into an active learning session, students were able to stretch their imagination and find representative items for common histological specimen representations. Based on post-session discussions, students found the activity to be beneficial to their learning and greatly enjoyed participating in the activity, often citing it as the most fun they have had learning histology. By providing students with opportunities to interact with complex material in creative and novel ways, students are able to learn in an environment that can be both engaging and enjoyable.

Digital anatomy programs such as the Primal Program™, BodyViz™, Complete Anatomy™, or Cengage™, provide rich learning opportunities with the ability to remove anatomical layers, highlight specific structures, and rotate images. However, supporting the diverse learning styles of today's anatomy students requires more than access to digital learning tools. This article describes sequential changes made in an anatomy course for a doctor of physical therapy (DPT) program. The DPT program moved from cadaver dissection to digital anatomy in the years 2020-2023. The most significant change was moving from the cadaver table, where there was rich student engagement during dissection, to a robust digital program with less student interaction and more screen learning. Throughout this transition, additional learning modalities were added. Tutorial stations were the most effective learning modality developed. At each station, faculty taught a focused topic (e.g. rotator cuff muscles), using multiple modalities such as a mounted skeleton, digital program, and Therabands™ to simulate muscles. Students learned how to integrate modalities and benefited from active engagement as faculty asked questions. These tutorial stations reinstated the learning environment of the cadaver tables and were optimal when students were allowed as much time as needed to gain confidence at each station. A post-survey sent to all enrolled students in the course each year identified the tutorial stations as the most preferred learning modality in 2023. To summarize, moving to a digital learning paradigm benefits from creative problem solving and persistent effort to support diverse student learning styles and student engagement.

YouTube contains videos that provide information about many health conditions. Patients and healthcare professionals frequently use YouTube to obtain information. The calcaneal spur (heel spur) is a bony outgrowth of the calcaneal tuberosity in the form of osteophytes. In this study, we aimed to determine the quality and reliability of YouTube videos about the calcaneal spur, whose prevalence increases with age and is more common in those with osteoarthritis. Search was made with the keywords 'Calcaneal spur' and 'heel spur'. Of the 300 videos reviewed, 104 were included in the study. The number of days since the videos were uploaded, the number of views, likes, dislikes, comments and the duration of the videos were recorded. The DISCERN tool and the Global Quality Scale (GQS) were used to evaluate the reliability and quality of the videos. Most of the video presenters were healthcare professionals (79.80%). In 65.4%, the target audience was patients. 61.4% of the videos were low quality, 32.69% medium quality, 5.77% high quality. There was no difference between health professionals and non-health professionals in terms of quality and reliability. This study showed that most of the information provided by YouTube videos about the calcaneal spur is not reliable and inconsistent. YouTube should consider collaborating with database platforms, which is constantly updated and equipped with evidence-based information, to provide reliable health information on many health issues, including the calcaneal spur.

This study aims to investigate the impact of integrating Problem-Based Learning (PBL) and Organ System-Based Curriculum (OSBC) on medical students' academic achievement and career maturity within the context of medical education. An experimental design was employed, involving students from a medical school in China. Participants were randomly assigned to either a control group with a traditional curriculum or an experimental group receiving an integrated PBL and OSBC curriculum focused on cardiovascular system diseases. The intervention spanned four weeks. The results indicate that the experimental group demonstrated significantly higher academic achievement immediately after the intervention compared to the control group. This improvement persisted in a follow-up test conducted one month later. Career maturity also improved in the experimental group, albeit with a less sustained effect. The study underscores the potential of integrated teaching strategies in medical education for enhancing critical thinking and practical skills. However, long-term improvements in career maturity may necessitate further refinement of teaching methods. These findings contribute to the ongoing discourse on effective medical education strategies and emphasize the importance of a comprehensive approach to prepare students for academic excellence and clinical competence. Future research with larger sample sizes and consideration of additional influencing factors is recommended to gain deeper insights into the dynamics of medical education.

Retention of information is essential for transfer of knowledge from one course to another. Human anatomy and physiology (A&P), offered as a 2-semester course at Notre Dame of Maryland University, is a foundational prerequisite for many health-related programs. For this study the researcher attempted to quantify the knowledge retention decline in the transition from human A&P I to human A&P II. Two cohorts of female traditional college students were administered a cumulative final exam immediately on completion of human A&P I. One cohort (CS1) was given the same test 48 days later. A second cohort (CS2) was given the same test 48 days and 144 days later. There was a significant decline in retention of information in CS1, however, CS2 exhibited no significant decline at either 48 days or 144 days. Interestingly, there was no significant difference between both cohorts on the initial test, an indication that both cohorts were equivalently prepared. Further study is required to understand the disparity in retention decline between the 2 cohorts.

To reduce academic dishonesty and strengthen learning outcomes, I adopted in-depth oral examinations as my benchmark and summative assessments in a Human Anatomy & Physiology course taught in an online asynchronous setting. This decision led my students and me down the transformative path of mastery learning. This was a "threshold experience" for my students who were learning how to think and express themselves as physiologists. This was also a threshold experience for me as I explored the scope of the oral examination in promoting skill acquisition while nurturing a relationship-rich learning environment. By employing "deliberate practice" principles including basic drills, one-on-one weekly check-ins, and small group recitation sessions, students exceeded benchmarks for conceptual understanding, mastery of fundamentals, and application of concepts to clinical scenarios. Students consistently reported that they were happy within this learning environment. With meticulous planning, it is possible to motivate students to learn for mastery and acquire expertise by employing oral exams as the pivotal assessment strategy in an online course thereby also making academic dishonesty almost irrelevant.