Clinical Investigation
Teaching the Anatomy of Oncology: Evaluating the Impact of a Dedicated Oncoanatomy Course

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Purpose

Anatomic considerations are often critical in multidisciplinary cancer care. We developed an anatomy-focused educational program for radiation oncology residents integrating cadaver dissection into the didactic review of diagnostic, surgical, radiologic, and treatment planning, and herein assess its efficacy.

Methods and Materials

Monthly, anatomic-site based educational modules were designed and implemented during the 2008–2009 academic year at Duke University Medical Center. Ten radiation oncology residents participated in these modules consisting of a 1-hour didactic introduction followed by a 1-hour session in the gross anatomy lab with cadavers prepared by trained anatomists. Pretests and posttests were given for six modules, and post-module feedback surveys were distributed. Additional review questions testing knowledge from prior sessions were integrated into the later testing to evaluate knowledge retention. Paired analyses of pretests and postests were performed by Wilcoxon signed-rank test.

Results

Ninety tests were collected and scored with 35 evaluable pretest and posttest pairs for six site-specific sessions. Posttests had significantly higher scores (median percentage correct 66% vs. 85%, p < 0.001). Of 47 evaluable paired pretest and review questions given 1–3 months after the intervention, correct responses rates were significantly higher for the later (59% vs. 86%, p = 0.008). Resident course satisfaction was high, with a median rating of 9 of 10 (IQR 8-9); with 1 being “less effective than most educational interventions” and 10 being “more effective than most educational interventions.”

Conclusions

An integrated oncoanatomy course is associated with improved scores on post-intervention tests, sustained knowledge retention, and high resident satisfaction.

Introduction

Gross anatomy has been part of a long-standing tradition in medical education. However, hours devoted to teaching anatomy have been declining 1, 2, 3. Up to 71% of residency directors report that incoming residents either require a refresher anatomy course or are “seriously lacking in anatomic knowledge” (1).

Radiation oncologists require an intimate understanding of anatomy, in the diagnosis and staging of disease via physical, radiologic, and pathologic examinations, and in the appropriate selection of therapies (4). An intimate knowledge of anatomy must be cultivated to further one's expertise in the field. However, reviewing gross anatomy via cadaver prosections is not a traditional part of the radiation oncology residency. This is in contrast to many surgical subspecialties; for example, cadaver lab experience is a required by the Accreditation Council for Graduate Medical Education for all otolaryngology residency programs 5, 6, 7, 8, 9.

The “oncoanatomy” course at the Duke University Medical Center was designed in 2005 to address this need (10). The course goal was to reintegrate the often-forgotten gross anatomic relationships (usually learned in the first year of medical school) with relevant oncologic problems. We herein assess the educational impact of this initiative.

Section snippets

Course description

The “oncoanatomy” course at Duke is based on monthly modules addressing a specific body region or tumor site where anatomic relationships are particularly pertinent to radiation oncologists (10). This analysis is limited to the 2008–2009 academic year for modules listed in Table 1. Module subjects were determined by the chief resident (J.C.) in conjunction with the residency program director (W.R.L.) for each semester. This is submitted to the primary anatomist for the project (R.M.), and the

Aim #1: to assess the immediate educational impact of the modules

Ninety pretests and posttests were evaluable from ten residents from six completed modules. Of the residents, six were postgraduate year (PGY)-2, two were PGY-3, one was PGY-4, and one was PGY-5. The median number of tests per resident was 10 (interquartile range [IQR] 8–10). Thirty-nine paired pretests and posttests were evaluable, with a median of four test pairs per resident (IQR 4–4). The median pretest score was 66% (IQR 53–82%) vs. a posttest median of 85% (IQR 71–94%), p < 0.001 for

Discussion

This study demonstrates that integrating the gross anatomy lab into a coherent oncoanatomy course is a useful educational intervention, as measured on objective tests. We also demonstrate that the knowledge gained during these interventions is maintained for at least 3 months.

Oncology practice requires an in depth understanding of anatomy, for the diagnosis and staging of disease via physical, radiologic, and pathologic examinations, and for the appropriate selection of therapies. For the

Conclusion

An integrated oncoanatomy course is a useful educational intervention based on objective testing, sustained knowledge retention, and high attendee satisfaction.

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    Conflict of interest: none.

    Supported in part by an Innovations Grant from the Duke University School of Medicine office of Graduate Medical Education.

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