Defining core clinical anatomy for undergraduate medical education in Zambia using a new needs assessment strategy
Banda, Sekelani Stanley
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The research problems, for this study, were that, a) there was no agreement on what constituted core clinical anatomical knowledge for undergraduate medical education, b) there were no studies, based on investigational findings, which had identified and/or described the anatomy required for clinical practice, c) there were no studies, based on investigational findings, which had defined and/or described how anatomy is used in clinical practice. Core clinical anatomy is defined as the minimum knowledge of anatomy that students must study to prepare them for their future roles as doctors.The problem concerning identifying the core clinical anatomy was compounded by the different and specific requirements of the many clinical specialties, consequently the objective of the study was directed at defining core anatomy for undergraduate medical education only. Four research questions were investigated: a) what is the amount and nature of anatomical knowledge in clinical methods? b) Which anatomical knowledge determines success and/or failure in clinical situations? c) Is there a difference between anatomical knowledge that clinical students and clinicians possess compared to that which preclinical medical students possess? And, d) Can the detail of anatomical knowledge required for diagnosis, investigation, and treatment of a clinical condition be determined consistently? An important hypothesis, that guided this study, was that the anatomy used in clinical practice was different fi-om that taught in the traditional anatomy courses, and, as such, efforts to identify core clinical anatomy should not concentrate on traditional anatomy. This study investigated the anatomy required for general clinical practice as a needs assessment strategy for defining core anatomy for undergraduate medical education. This work could be the first to use investigational methods for defining core clinical anatomy for undergraduate medical education. Previous studies have relied mainly on expert opinion. The methods used to identify the anatomy required for clmical practice were: content analysis for anatomical terms in Hutchinson's Clinical Methods (Swash, 1989); 2,216 hours of contact with clinical practitioners as a participant observer; collection of 221 critical incidents of clinical situations in which knowledge of anatomy had contributed to either success or failure of a clinical outcome. In addition, medical records of the national referral hospital, a regional hospital, a district hospital, and urban clinics were also reviewed to identify the clinical (14) recognise developmental basis of clinical conditions, and 15) comprehend histological reports.In addition, the study identified several clinical conditions, procedures, and operations that required significant detail of anatomy for diagnosis and concepts, interpretation of investigations, and for treatment. The cases requiring significant detail of anatomy knowledge were identified and ranked consistently. All the above findings were used to generate content for the core clinical anatomy course for undergraduate medical education and a curriculum was developed. Some of these findings have been implemented on a pilot basis, as developmental testing, in the UNZA clinical anatomy course.The implications of this study are that: a) the study may have contributed toward defining what clinical anatomy is (this is important because clinical anatomy had different meanings in the literature), b) the focus for identifying core anatomy for undergraduate medical education may shift from that based on identifying what is of clinical relevance in traditional anatomy to that based on considering the anatomy needs of clinical practice, c) the clinical anatomy courses, available worldwide, could benefit from the evidence from this study, and d) the UNZA clinical anatomy course can now be revised on the basis of more rational and scientific findings.
- Medicine