Effectiveness of a Three‐Drawing Strategy for Self‐Assessment and Metacognitive Awareness of Anatomical Knowledge
Authors: Cabezas Jany , Goodwin Michael 
Published: May 2022

Anatomy is often taken as a pre‐health prerequisite early in students’ undergraduate career. Universities accept students with varying backgrounds and study skills, so it is imperative for students to approach scientific rigorous subjects in an efficient manner. Anatomy is a visual science where drawing may help students with knowledge retention and retrieval. Prior research in active learning shows improved retention by drawing histological tissue (Balemans et al., 2015) and benefits of multiple iterations of drawing anatomical structures (Backhouse et al., 2016). Multiple drawings studies with initial free recall for metacognitive awareness have not been published. In this research, active learning through drawing is explored in a three‐drawing approach with consideration for metacognitive application and self‐assessment. A previous pilot study with a small group of undergraduate anatomy students indicated the effectiveness of this drawing strategy. This current study expands on the pilot, by utilizing the three‐drawing strategy in a large‐enrollment, undergraduate anatomy class.A three‐drawing template was provided to a 5‐credit hour undergraduate Basic Human Anatomy course (ANAT‐A215) during a face‐to‐face active learning session in a flipped classroom (480 students with 1 lecture and 12 lab sections). Lecture content was presented asynchronously via lecture recordings and face‐to‐face lecture instruction provided interactive activities, two of which were dedicated to the drawing activities of this study. Upon completion, students were provided with the opportunity for 2 points extra credit for drawing submissions. Drawing 1, “What you think you know,” was completed by free recall without any references. Drawing 2, “What you see,” had students observe, analyze, and draw the structures into the template based off a Human Anatomy textbook image. Drawing 3, “What you learned,” involved free recall drawing without any resources immediately after drawing 2. A scoring rubric with a range of 0‐15 points was used to compare anatomical accuracies with shape, structure proportion, orientation, and drawing and labelling of both bone/muscle features across drawing 1 and drawing 3. The first author led the interactive drawing sessions and developed both the three‐drawing activity and scoring rubric.Results suggest that students tend to fall into three groups. In the first group, students do not improve (as may be expected) in their drawings. In the second group, students have a strong initial grasp of the anatomical structures capturing appropriate shape, labelling, and features from the initial drawing 1 and demonstrate marginal improvement in drawing 3. The third group show great improvement comparing drawing 1 to drawing 3; drawing 1 might not show recall of the structures nor features labelled and improvement in drawing 3 includes structure shapes, features, and labelling of muscle/bone. In a broad scope, an overall improvement in scores is seen for most students—particularly in structure shape, recall of structures, and labelling of features. These results suggest the use of a three‐drawing learning strategy in anatomy is beneficial to student learning and self‐assessment. Using this approach, students can assess their perceived knowledge vs. learned content ultimately encouraging self‐regulation, content engagement, and self‐assessment for reflection on areas that might need further improvement.