Preliminary Results of a National Survey on the Integration of Anatomical Variations in Medical School Curricula
Authors: Goldberg Chelsea , Royer Danielle 
Published: November 2023

Lack of knowledge of the normal range of anatomical variations has been linked to medical errors and malpractice. Some medical residency programs suggest earlier training in anatomical variations, yet integration of variations at the undergraduate medical education (UME) level is poorly understood. We surveyed medical schools to determine the inclusion of anatomical variations in anatomy curricula and to gauge attitudes towards the value of such training. Online survey requests were sent to anatomy teaching faculty at 119 of the 132 accredited allopathic medical schools in the USA for which contact details were available online. The IRB‐exempt anonymous survey contained 35 questions divided into 4 main sections: 1) Likert scale questions rating the perceived importance of 74 specific anatomical variations in 8 categories (skeletal, muscular, arterial, venous, nervous, organ, miscellaneous, relationship); participants also reported whether each variation is taught at their institution, 2) forced‐choice questions asking how variations are taught and assessed, 3) Likert scale questions evaluating faculty perceptions of the importance of anatomical variations to UME and medical training in general, and 4) forced‐choice and open‐ended questions capturing faculty and school demographics. One‐way ANOVA with Tukey pairwise post‐hoc tests compared perceived importance ratings across variation categories. To‐date, responses were received from 29 faculty, representing 24.4% of schools contacted (22% of MD schools nationally). Nearly half of respondents (45%) have taught anatomy 25+ years, and 86% are PhD‐trained anatomists who are current course/block directors. Of the categories surveyed, relationship variations were rated highest in perceived importance (weighted average = 4.2 ±0.36), while muscular variations were rated lowest (2.7 ±0.37). ANOVA results showed significant differences between categories (p < 0.001), while post‐hoc tests found significantly higher perceived importance ratings for the relationship variation category compared to skeletal (p = 0.001), muscular (p < 0.001), venous (p < 0.001), and miscellaneous categories (p = 0.001). Anatomy faculty identified 2 relationship variations as most crucial: femoral triangle order (average rating = 4.6 ±0.63, taught by 85%), and brachial plexus composition (average = 4.6 ±0.64, taught by 93%). While survey results highlight extensive variability in the inclusion of variations in medical anatomy, students are formally tested on variations in 52% of schools surveyed. More than half of faculty surveyed (58.2%) ranked dissection as the primary way students are exposed to variations. There is strong consensus among faculty of the overall benefit of learning about variations (average = 4.2 ±0.8), with UME noted as the best time to introduce this topic (average = 4.1 ±1.0) versus during residency (average = 2.2 ±1.15) or in clinical practice after residency (average = 1.4 ±0.78). Although medical school curricula vary in their emphasis on anatomical variations, anatomy teaching faculty appear to strongly value the integration of variations at the UME level. Survey results will guide the creation of an interactive educational resource to enhance student awareness of the range of normal anatomical variations, with a focus on variations in anatomical relationships, which may boost preparation for clinical practice and reduce medical errors.