Gross Anatomical Knowledge Loss in Fourth‐Year Nursing Students
Authors: Narnaware Yuwaraj (Raj) 
Published: May 2022

Human anatomy and physiology are considered a cornerstone of health‐related professional education and serve as a prerequisite for future nursing courses (McVicar et al., 2015). Numerous research studies show great difficulty in transferring fundamental knowledge of these courses to clinical and subsequent years of these disciplines (Bhangu et al., 2010; Narnaware and Neumeier, 2020; Narnaware, Y. 2021a). However, most of the knowledge acquisition, transfer/lost, and retention studies have been carried out in medical and allied health students and have been assessed rarely in nursing students. We have previously shown that the second‐and third‐year nursing students lose approximately 29.0% and 31.0% of their second and third‐year anatomical knowledge, retaining about 71.0% and 69.0% within two years (Narnaware and Neumeier, 2020; Narnaware and Neumeier, 2020b). However, anatomical knowledge transfer/loss, retention, and application in fourth‐year nursing students have not been assessed yet. The present study's main objective, therefore, is to assess the anatomical knowledge loss among fourth‐year nursing students and determine if the retention level is organ system‐specific. To evaluate the knowledge loss in fourth‐year nursing students, they were quizzed on eleven anatomy organ systems using the online quizzing system Kahoot. Each Kahoot quiz included nine to eleven knowledge and comprehension level multiple‐choice questions. These scores were compared to first‐year quiz scores on the same content to determine overall knowledge loss over the fourth year. Data were statistically analyzed using SPSS II, and means were compared using two‐way ANOVA. The scores are shown for each organ system by reporting the mean and standard deviation (±SD). Statistical significance was set at P < 0.05 for all tests. The results show that there was a significant decrease in the overall mean score from 83.05 ± 8.34 (± SD) in the first year to 53.9 ± 9.4 (±SD) in the fourth year (P=0.0001) (Figure 1). This equates to a 29.6% loss and 70.4% overall retention of anatomical knowledge over two years. However, there was no significant difference in mean scores between the third‐year and four‐year nursing students. The mean score in fourth‐year nursing students was higher by approximately 3.4% than the third‐year students. System‐specific knowledge loss shown in table 1 was highest for the head and neck lymphatic (55.7%), cranial nerves (44.1%), lymphatic (37.6%), and special senses (37.0%). This system‐specific knowledge loss was followed by the integumentary system (28.2%), vascular system (27.6%), muskulo‐skeletal (26.6%), and nervous system (25.1%). The loss was the lowest for the genitourinary system (21.2%), respiratory system (13.9%), and gastrointestinal system (12.0%). The present study reveals that nursing students lost more knowledge in the fourth‐year than first‐year and comparatively less than third‐year but retained much higher anatomical knowledge than medical and allied health students reported. This study provides knowledge retention for different body systems. It also identifies where nursing students' knowledge retention gaps exist so that those can be addressed by developing a robust interventional strategy for nursing students in the future.