Assessing the applied anatomy knowledge of medical students: the effect of visual resources on preparing them to become new doctors
Anatomical examinations are timed examinations that assess topographical and/or applied knowledge of anatomy with or without the inclusion of visual resources i.e. cadaveric resources, cadaveric images, radiology and/or clinical findings images. Although advances in the multimedia learning theories have led to greater understanding of how we process textual and visual material during learning, the evidence with regard to the use of illustrations within written assessments is scarce. This study investigates whether the presence or absence of images (cadaveric, clinical findings and radiological images) within clinically oriented single best answer questions has a significant influence on medical students' performance. A questionnaire was also included to determine the effect of students' characteristics and preferences in learning and assessments on their performance. Second year medical students (n=175) from six UK medical schools participated voluntarily. All questions were categorised as to whether their stimulus format was purely textual or included an associated image. The type of images and deep components of images (whether the question is referring to a bone or soft tissue on the image) was also taken into consideration. Further investigation was carried out on the question difficulty and the regional anatomy of the questions. These examination scores were then analysed along with students' responses collected on the questionnaire. This was further illustrated with students' feedback. The study demonstrates that inclusion of images, the deep component of an image, question difficulty and regional anatomy impact students' performance. Moreover, students' preferences play an important role in their performance. Anatomical and radiological images are critical in the medical profession in investigating and examining a patient's anatomy, and this study set out a way to understand the effects of these images on commonly employed written assessments. This study has shown that image factors and student factors impact on the students' performance. Further research is needed to refine these examinations.