Journal of the Anatomical Society of India

ORIGINAL ARTICLE
Year
: 2021  |  Volume : 70  |  Issue : 2  |  Page : 75--80

A new method in anatomical education of medical faculty: Storytelling


Tuncay Colak1, Ayla Tekin Orha1, Ozan Tavas1, Elif Aksu1, Dilsat Guzelordu1, Ismail Sivri1, Belgin Bamac1, Serap Colak2,  
1 Department of Anatomy, Medical Faculty, Kocaeli University, İzmit, Kocaeli, Turkey
2 Department of Sports Management, Faculty of Sports Science, Kocaeli University, İzmit, Kocaeli, Turkey

Correspondence Address:
Dr. Ismail Sivri
Department of Anatomy, Medical Faculty, Kocaeli University, Umuttepe, İzmit - 41380, Kocaeli
Turkey

Abstract

Introduction: The difficulty to learn anatomy makes it crucial to find the best way to effectively transfer the anatomic knowledge from educators to students. Stories can be used as an advantageous tool, which makes information more rememberable by stimulating cognitive behavior. Material and Methods: In order to determine the efficiency of the storytelling technique on the effects of grade point average in the anatomy session, stories were told to term II medical students (n = 132) at the end of the theoretical neurological lesson. A questionnaire with 12 questions was distributed to the students belonging to the pilot study. Grade point average, as well as gender and age (mean: 19.95 ± 0.995) of the students was the other parameters. Results: More than 90% of the students agreed that storytelling helps them to understand the subject and more than 70% of the students agreed that storytelling helps them to gather their attention. Furthermore, the statistical comparison with the previous 2 years demonstrated that the grade point average of the storytelling years was higher than the others. Discussion and Conclusion: Therefore, we believe that incorporating a storytelling learning style into the traditional anatomy curriculum, will be advantageous for education and will have a positive effect on the grade average. If we are able to revive the story in the minds of the students, we think that the lessons will be more permanent in their memory.



How to cite this article:
Colak T, Orha AT, Tavas O, Aksu E, Guzelordu D, Sivri I, Bamac B, Colak S. A new method in anatomical education of medical faculty: Storytelling.J Anat Soc India 2021;70:75-80


How to cite this URL:
Colak T, Orha AT, Tavas O, Aksu E, Guzelordu D, Sivri I, Bamac B, Colak S. A new method in anatomical education of medical faculty: Storytelling. J Anat Soc India [serial online] 2021 [cited 2021 Oct 26 ];70:75-80
Available from: https://www.jasi.org.in/text.asp?2021/70/2/75/320252


Full Text



 Introduction



Anatomy is a primordial education for medical schools, as it is accepted as a core course for all other subsequent medical courses. Hence, the anatomy curriculum is usually taught as a combination of theoretical courses and laboratory sessions. As the part of understanding anatomy, appreciation of the architecture of the human body, interpretation of clinical images, effective physical examination; topography of the organs and its variations are indispensable topics of knowledge for the medical student. Due to the large volume of participants presented in anatomy courses as well as due to the utilization of Latin terminology during teaching, students usually adopt a strategy of superficial learning. Superficial learning strategies negatively impact the retention of anatomic knowledge and usually much of the anatomic knowledge is not retained after the examinations. In fact, it is known in the literature that 25% of the knowledge can be lost after only 1 year.[1],[2] “Therefore, evaluation of knowledge retention could elucidate the most effective methods of teaching basic sciences such as anatomy to ultimately increase the clinical acumen.”[3]

The successful anatomy course contributes to a successful achievement of academic learning, as it constitutes the infrastructure of the other courses in medical sciences. Hence, anatomy education is usually a combination of theoretical lectures and dissection sessions. When we consider the difficulty of learning anatomy, it will be important to find the best way to transfer effectively the knowledge from the educators to students. Preservation of knowledge depends on intelligence as well as on learning strategies. Different approaches to teaching anatomy are being used around the world, but the best way would be to implement a technique that allows longer retention of the knowledge in the student's mind. In this sense, stories are advantageous tools, which use both visual and auditory learning styles. Thus, it can be said that stories can stimulate cognitive behavior. According to Uri Hasson, a story is the only way to activate the certain parts of the brain and thus it makes information more rememberable, because it has the effect that listeners plant the ideas presented in the stories into their minds, and hence, they involve the story in their life experience.[4],[5] Unfortunately, storytelling is not yet a method which is frequently used in medical schools. By referring to the literature, storytelling reflects the teacher's enthusiasm and evokes interest in the subject by the students who implement the story in their lives. Furthermore, as the chosen subject becomes more meaningful, storytelling can be an important way to improve satisfaction and to reflect learning in students.[6]

Therefore, it seems that combining multiple pedagogical techniques which complement each other can be beneficial in teaching modern anatomy.[7] Furthermore, we think that storytelling will be more permanent as it affects the cognitive features of the brain. Teaching the anatomy course by incorporating it to their daily life could also stimulate an empathic response in students. In this context, hypothesis was that if storytelling is more rememberable and can also activate the brain, then it may also increase the performance of the students during examinations [Figure 1]. Hence, to improve the understanding of the anatomy lesson, we aim to determine the efficiency of the storytelling both in the satisfaction of the medical students and also in their grade point average as an academic success indicator.{Figure 1}

 Material and Methods



This study was approved by the Deanery of the Faculty of Medicine of the University. The participants of the study were Term II students of Medical faculty. Sixty-six girls (50%) and 66 boys (50%) participated in the questionnaire. The mean age of the students was 19.95 ± 0.995 [Table 1].{Table 1}

The storytelling technique was used at the end of the lessons of the Neurological System Committee to the term 2 students belonging to the Faculty of Medicine. Stories were prepared by faculty members and researchers of the Department of Anatomy. Participants were repeated with storytelling technique after the theoretical course. The Evaluation of Storytelling Agreement Scale Questionnaire for Learning Anatomy was applied to determine the effectiveness of the technique as well as the satisfaction level of the students. The questionnaire consisted of 12 Likert type questions with an agreement scale between 1 and 5 [Table 2]. The scale score of 1 signified disagreement with the statement and 5 signified complete agreement with the statement. Furthermore, in order to understand and highlight the personal idea of the students, an open-ended question was also included in the questionnaire. In addition, to determine the effect of the storytelling in the grade average of students, neuroanatomy examinations score of 3 consecutive education years of term 2 students was compared. The collected data were analyzed under the IBM SPSS 22.00 Statistical Package (IBM SPSS Statistic for Windows 22.00, NY, USA) software. The descriptive statistics of the collected data were evaluated. Chi-square and Spearman correlation test were used to assess whether there was a relationship among gender and age with agreement score of the questionnaire. Hence, statistical analyses of the agreement score demonstrated that there was no statistical difference between agreement score related to gender and age (P > 0.05). Mann–Whitney U-test was used to analyze the term 2 students' grade average belonging to the academic years of 2015–2016, 2016–2017 without applying storytelling and the term 2 students of the academic year 2017–2018 where storytelling was applied.{Table 2}

 Results



The statistical analyses of the agreement score with gender and age of the term 2 students demonstrated that there was no statistical difference between agreement score relation to gender and age (P > 0.05).

The distribution of the agreement score percentages is described in [Table 2]. The table demonstrates clearly a high percentage of students who were strongly in agreement or have completely agreed with the storytelling technique. More than 90% (Q7) of the students strongly or completely agreed with the fact that visual components increase the efficiency of the storytelling and it helps them in understanding the anatomy topics. Once more, 90% (Q11) of the students strongly or completely agreed that storytelling was helpful to understand the lectures related to classical theoretical anatomy lesson. Furthermore, more than 70% (Q4, Q5) of the students strongly or completely agreed with the fact that storytelling helps them to gather their interest and attention regarding the lesson and leads them to listen to the lessons until the end. Furthermore, more than 70% (Q12) of the students did not agree with the idea that storytelling lowers the value of the anatomy lesson. The most commonly encountered answer of the open-ended question was that the storytelling technique needs to be applied to other wide curriculum lessons as well as like histology and embryology.

[Table 3] represents the mean grade average of term 2 students belonging to academic years of 2015–2016 and 2016–2017 (the periods where storytelling techniques were not applied) and also the term 2 students of 2017–2018 academic year (where storytelling was applied). No statistical difference was found between the academic periods of 2015–2016 and 2016–2017 (P = 0.779) where storytelling was not applied during their anatomy education. However, a statistically significant difference was found between the grade average of the term 2 students with storytelling compared to other groups without storytelling (P = 0.026; P = 0.017).{Table 3}

 Discussion



The preparation of our stories was especially based on the special anatomical topics that cannot remain in the mind or be easily recalled with the traditional teaching methods. The teaching topics were chosen from daily life with a funny story to capture the students' attention. According to Neuhauser, as the stories become more rememberable, funny and believable, then they could be more effective as educational tools for teachers.[4] The believability is related to the fact that stories are involved in real-life human life experiences. Stories make information more rememberable because they get us involved in the actions and intentions of the characters. Creating a story based on the anatomical lesson related to human life could stimulate the empathic response of the students. Particularly, the specific situations, the small details, the vivid images of human experience enhance the capability to memorize and to recall the information more easily. Therefore, educational programs that focus on the diversity and the capacity for perspective could benefit from this technique.[8]

As anatomy is a critical course for doctors to practice medicine safely, anatomy courses need to be attractive and rememberable. In a study conducted to facilitate the comprehension of the anatomy, a different teaching approach has been applied to 1st-year medical students by anatomy teachers. They applied simultaneous sketch drawing, as an interactive learning technique. As a result, more than 80% of the students agreed with the fact that learning anatomy concepts with this method is simpler. They preferred to attend these anatomical classes and found that this class was less boring as compared to classical teaching. These students also found that sketching was a good method for learning anatomy in-depth. Also, more than 60% of the students agreed with the idea that sketching anatomical figures simultaneously with the professor helped them to learn anatomical concepts more easily. They also found that sketching makes anatomy more attractive as a subject and thus it has reduced the time for learning.[9] Similar to this study, when the agreement scale was analyzed, it was observed that more than 90% [[Table 3], Q7] of the students strongly or completely agreed with the fact that visual components increase the efficiency of the storytelling and they help them to understand their anatomy course. Once more, 90% [[Table 3], Q11] of the students strongly or completely agreed that storytelling was helpful for understanding the anatomy lectures. Furthermore, more than 70% [[Table 3], Q4-Q5] of the students strongly or completely agreed with the fact that storytelling helps them to gather their interest and attention about the lesson and leads them to listen to the lessons until the end. Furthermore, more than 70% [[Table 3], Q12] of the students did not agree with the idea that storytelling lowers the value of the anatomy lesson. The most commonly encountered answer to the open-ended question was that the storytelling technique needs to be applied to other wide curriculum lessons such as histology and embryology. In addition, gender and age of students were the other parameters which were analyzed statistically [Table 1]. The answers' scale score of the questionnaire was analyzed with the agreement score. The fact that there was no statistically significant correlation between these data (P > 0.05) showed that the gender or the age of the student did not influence the anatomical storytelling technique; thus all the students were satisfied with this new educational technique. Furthermore, the grade average of the term II students (2017–2018 education year) with storytelling was higher than term II students of previous years without storytelling. In this context, storytelling can make the subject more rememberable, as it activates the parts of brain and involves the subject in the life of students. Hence, this can increase the knowledge retention and therefore can lead to a higher-grade point average. In another study, Kieser et al. used spontaneous storytelling in problem-based learning in clinical anatomy teaching in half of the 3rd-year dentistry class. For the purposes of the study, they explained the chosen lesson in two ways. One group was lectured by the storytelling method and the other group was taught with the classical theoretical method. They encountered positive feedback, as the satisfaction was higher with students “with stories” than those “without stories.” They define that “factor analysis provides evidence that storytelling nurtures reflective learning, while students work on their clinical anatomy problems.”[6]

Another method used to teach anatomy is the utilization of interactive computer programs. Interactive computer programs have been designed to allow the student to learn anatomy independently, but we thought that the cooperation of the teacher to teach anatomy using interactive methods will enhance the learning ability of the students. A study was attempted to define the best way to teach anatomy to medical students and they determined as a result that cadaver dissection accompanied by three-dimensional (3D) computerized programs was the best way to teach anatomy. Hereby, only the 3D computerized program alone was not enough to understand the anatomy. They stated that the imaging structures cannot fully replace the concept of direct contact with tissues and other anatomical elements and they suggested to involve the best association teaching models as a complement of each other.[10] It is accepted that conducting a dissection in a laboratory environment involves active student participation, and thus represents the main means of highlighting the anatomical formations. But the dissection activity cannot always be conducted by all the students at the same time considering the high number of medical students. For this reason, we suggest applying the storytelling technique during theoretical lessons to a large group of students at the same time and to subsequently consolidate the lesson with dissection. Moreover, it will be possible to improve students' active participation in storytelling during anatomical lessons.

To improve anatomy learning, several teaching methods have been used by different faculty. For example, McMenamin incorporated the painting technique during teaching anatomy. By painting the body with nontoxic paints, the researcher integrated clinical skills with the teaching sessions, which included clinically important aspects of the musculoskeletal system, the respiratory system, the head and the neck. They stated that adding body painting as a tool in clinical anatomy teaching will consolidate the surface anatomy and clinical skills teaching.[11] Another different technique to teach anatomy is the peer-teaching method. Peer teaching is the way to transfer some basic lecture from senior students to classmates or underclassmen, in other words, some students take on a teaching role to share their knowledge with other students. The peer teachers and all other students in class start their learning course from the beginning in accordance with their capabilities and provide cognitive harmony. Cognitive harmony allows more appropriate level explanations during teaching. Furthermore, peer teachers have the opportunity to enhance their communication skills and their public speaking abilities.[12] Therefore, peer-teaching was described as a useful program and students defined that it fulfills their aims of providing an effective environment for developing deeper learning in anatomy.[13],[14] Furthermore, incorporating the peer teaching in the classical anatomy curriculum can provide an effective method for a perfect anatomy teaching.[15] In future, it will be useful to apply the storytelling method by peer-teaching in anatomy education.

 Conclusion



Multiple teaching techniques have been used in medical schools to promote a deep knowledge of anatomy and to improve understanding of the subject. The chosen teaching approach needs to help the anatomy teachers to constitute an adequate curriculum with their students and also the approach needs to be suitable for students. Therefore, incorporating anatomy storytelling technique into the traditional anatomy curriculum will be advantageous for anatomy education and it will enhance the fundamental knowledge which needs to be recalled throughout the educational and professional life of the student. In addition, storytelling enhances knowledge retention which leads to a higher-grade average. Furthermore, completing the storytelling with visual effects will be more efficacious for teaching anatomy.

Story example 1: Thalamus

The Thalamus Wedding Salon consists of three main divisions. A long corridor named internal medullary lamina, splits the salon into the anterior, medial and lateral compartments. In the middle of the Thalamus Salon, there is a pillar called interthalamic adhesion that connects the right and left Thalamic Salon. In the anterior part of the Thalamus Wedding Salon there are 3 tables named anterodorsal (where the groom is sitting), anteromedial (where the bride is sitting) and anteroventral (where the mother-in-law is sitting) nuclei. As the mother-in-law is sitting on the anterior part of the Thalamus Wedding Salon, spontaneous attention and memory recognition functions are very active in this part (She can remember who brought which present). While the bride spreads both the sense of fear (due to the mother-in-law) and joy (due to her spouse), the groom spreads the sense of excitement. If an incident damages the mother-in-law, then Amnesia will occur in the anterior part of the Thalamus Wedding Salon.…

Story example 2: Median nerve versus ulnar nerve

One day in the brachial plexus ulnar nerve challenged the median nerve. Who will innervate more muscles in the upper extremity. The race starts. Upon arriving to brachium, they realized that musculocutaneus nerve has already innervated the anterior part and decided to take different paths. While the median nerve took the fossa cubiti path, ulnar nerve went through groove for the ulnar nerve. Then median nerve squeezed through two heads of pronator teres muscle and relieved, no muscle in anterior antebrachium was taken yet. It took the middle lane and innervated as many muscles as possible. Then, the ulnar nerve reaches the backside of the antebrachium and shocked upon the scenery. The posterior part of both brachium and antebrachium was taken by the radial nerve. However, the race was not over yet. The ulnar nerve took the medial lane and innervated the flexor carpi ulnaris muscle and medial half of the deep digital flexor muscle. It was a start none the less. The race in the antebrachium was won by the median nerve but the hand has not been concluded yet. The ulnar nerve saw that the median nerve is trying to get through carpal tunnel which is under the flexor retinaculum. Ulnar nerve found a faster route with less traffic and went over the flexor retinaculum. With the happiness of reaching the hand before anyone, the ulnar nerve innervated most of the hand muscles. Then, the median nerve reaches the hand and got surprised. Most of the hand muscles were already taken either by ulnar nerve or radial nerve. Then, it realized that no one reached the thumb yet. As a last effort median nerve innervated abductor pollicis brevis muscle, superficial head of flexor pollicis brevis muscle, opponens pollicis muscle and the first and the second lumbrical muscles. The race on the hand was won by the ulnar nerve.

Story example 3: Oculomotor nerve

Oculomotor nerve has bought itself a tiny flat from the upper floors of the famous housing estate mesencephalon. The name of the flat was oculomotor nucleus. Having only little amount of money it could only afford a two-room flat. Hence, it put his parasympathetic neurons in one room and somatic motor neurons on the other. Every morning axon bundles from both rooms left the mesencephalon and met at the cafe interpedincular fossa and formed oculomotor nerve. Oculomotor nerve would then take the bus named cavernous sinus. It liked the front seat and always sits by the window. Hence, it would travel on the lateral wall of the cavernous sinus. After getting off of the bus, it went through a tunnel called a superior orbital fissure. Then, it separated into two braches called superior ramus and inferior ramus to finish things faster. Superior ramus was thinner, so it climbed over the optic nerve, crossed it superiorly and reached superior rectus muscle and superior levator palpebrae muscle. Inferior ramus, on the other hand, stood on its way and visited the medial rectus muscle, inferior rectus muscle, inferior oblique muscle, and ciliary ganglion.

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