Educational Dilemma? Investigating How We Teach Anatomic Variation in Medical School Curricula
Authors: Buongiorno Cody , Wilson Charlotte , Goldberg Chelsea , Royer Danielle 
Published: April 2020

Introduction

Variation is a crucial component of literacy in anatomic education. Establishing a sufficient understanding of normal range variation is imperative for safe clinical practice, as ignorance of variation can lead to serious medical errors.

Objective

This study explores how anatomic variation is currently integrated in undergraduate allopathic medical education in the USA and elucidates the attitudes of anatomy faculty towards variation for clinical training.

Methods

A 4‐part voluntary survey was constructed in Qualtrics and disseminated to 139 accredited USA allopathic medical schools. Part 1 employed Likert scale questions rating perceived importance of specific anatomic variations for medical education and allowed respondents to indicate which specific variations are formally taught in their curriculum. A total of 50 variations were selected from musculoskeletal, circulatory, nervous, and organ systems categories. Part 2 used ranking questions to measure how variations are taught at each institution. Part 3 utilized Likert scale questions to determine faculty perceptions on integrating anatomic variations into medical education. Part 4 captured major curricular formats and career demographics of respondents. This study was approved exempt by the Colorado Multiple Institutional Review Board.

Results

We received responses from 31% (N= 44) of allopathic MD programs in the USA. Overall, survey results coincide with findings from a pilot study conducted in 2015. Faculty surveyed deemed circulatory and organ variations to be generally more essential for clinical training than nervous and musculoskeletal variability, but in all categories some variations were rated as important. We found that respondents agreed cadaveric dissection or prosection is the most effective method of introducing anatomic variability into medical education (x̄ 4.27, SD ±0.84), learning about variations helps improve clinical reasoning in medical students (x̄ 4.25, SD ±0.74), and it is important for medical students to appreciate the omnipresence of variability (x̄ 4.64, SD ±0.57). Results also indicated 88.6% of respondents agreed or strongly agreed that pre‐clinical medical education is the optimal time to introduce variation. While teaching about variation is believed to be clinically relevant, 38.6% of surveyed medical schools do not assess students on their knowledge of variations, and 77% of respondents agreed or strongly agreed that introducing the concept of variability is difficult without focusing on specific examples, suggesting barriers to the integration of variation in medical education. A mixed‐method theme analysis is in progress to explore respondent comments.

Conclusion

Overall this study expands upon prior work showing that inclusion of normal range of variation into pre‐clinical medical education is valuable, while suggesting challenges surrounding teaching methods and assessments for variability. Further challenges to developing reliable knowledge of variation in undergraduate medical education may include a reduction in anatomy contact hours and decreased reliance on cadavers. Future directions will include a comparative survey of physician perceptions towards anatomic variations in clerkship clinical training.