Approaches to Learning Anatomy

The process of learning has several meanings. In one aspect, it can be regarded as an outcome (a process that demonstrates what learning has occurred) or as a means to an end (Louw et al., 2009); in another aspect, learning is seen as “a process whereby knowledge is created through the transformation of experience” (Kolb, 1984, p. 38). This section explores students’ approaches to learning anatomy.

Much of the research in educational psychology over the past four decades has provided an understanding of how students learn. Marton and Saljo (1976) have made significant contributions in this area. They introduced the term approach to learning to

characterise how students approach a learning task. In a study of students learning anatomy, Eizenberg (1988) identifies five approaches to learning: avoid the task, memorise factual information, memorise chunks or sections of information, understand some aspects of anatomy, and comprehend the anatomical structure/site and its

components as a whole—that is, grasp the common functions shared by organs and how they can be grouped into systems. These approaches suggest that the process of

memorising and understanding might not be mutually exclusive after all, and that some memorisation is essential to scaffold later understanding. Studies by other authors characterise three distinctive approaches that students take to learning—surface approach, deep approach and strategic approach (Biggs, 2003; Louw et al., 2009; Newble & Entwistle, 1986; Ramsden, 2003)—which are all related to different learning outcomes (Ramsden, 2003). The learning approach adopted by a student depends on a variety of factors (none of which are fixed): their conception of learning (recognising what they are learning and why), their perception of the context in which learning takes place (Ramsden, 2003), the influence of their past learning experiences, their intentions for learning (to pass examinations or to understand) and their preferences for learning (Smith et al., 2014; Smith & Mathias, 2007). That is, depending on the topic, content, delivery style and assessment methods, students can adopt one learning style for one activity and a different learning style for another activity. Learning styles can also be based on students’ personal attributes, goals and cultural differences (Mitchell, Xu, Jin, Patten, & Gouldsborough, 2009). The next section will closely examine the different learning approaches and their outcomes.

Surface Approaches

The surface approach is referred to as superficial learning and is characterised by rote memorisation of facts and regurgitation of material in assessment tasks (Smith et

al., 2014), often without links to or connections made with other content. Students who adopt this approach often aim to achieve only the basic requirements for a task (Smith & Mathias, 2007), which in most cases involves an intention to memorise information and recite it back for assessment purposes (Louw et al., 2009; Pandey & Zimitat, 2007; Ramsden, 2003). As part of this approach, students often develop mnemonic devices, which are memory tools or devices that assist with remembering large pieces of

information through the formation of a set of lists, phrases, words or steps. Mnemonics are used by most medical students in anatomy, and they usually form the foundation upon which students build their knowledge. For example, to remember the cervical nerve root supply of the phrenic nerve, students often remember the phrase ‘C 3, 4, 5 keeps the diaphragm alive’.

It has been assumed that in the early stages of the pre-clinical curriculum, when students are novices in the field of medicine and are exposed to a vast array of science and non-science disciplines, they are more inclined to adopt surface approaches— particularly for content-rich subjects, such as anatomy, as a way of coping with the large volumes of information they must grapple with (Smith et al., 2014). Studies that investigate how undergraduate medical students learn anatomy show that if students are not motivated to learn and do not appreciate the importance and relevance of the basic science disciplines for their course of study (similar to the principles of andragogy), they fail to make the connection between the two. Consequently, these students adopt surface (superficial) approaches to cope with large volumes of information (Smith & Mathias, 2007, 2011), and they fail to associate what they memorise with its application in clinical practice (Louw et al., 2009). Further, students who learn by rote report that learning is a difficult task and that their primary aim for adopting this approach is to pass their examinations (Smith & Mathias, 2007). This may be linked to a lack of

sophistication rather than a lack of motivation. Subsequently, these students perform worse in anatomy than those who aim to understand content through a deep-learning approach (Louw et al., 2009; Ward, 2011).

Deep Approaches

The deep approach involves an active search for meaning through learners’ willingness and motivation to understand the content being taught and to apply this material to a variety of settings. By engaging in deep learning, students focus on significant concepts related to problem-solving while using prior knowledge and knowledge from different courses upon which to build new and existing information (Louw et al., 2009; Ramsden, 2003). This model of learning is one that educators aim to have students adopt when approaching the learning of a subject. Studies have proven that medical students prefer to use a deep approach to learning (Smith & Mathias, 2007; Ward, 2011) so they can experience high-quality learning and the subsequent

application of knowledge (Smith & Mathias, 2007). In the context of anatomy, deep learning occurs when students can relate the importance of anatomical structures to their clinical significance, thereby finding meaning in clinical problems. This integration of the basic science with the clinical science leads to conceptual coherence (Woods, 2007). That is, it allows learners to create a conceptually coherent mental map in which basic science concepts are organised and subsequently form the framework for developing clinical reasoning (Kulasegaram et al., 2015).

As a discipline, anatomy has its own language to describe the organisation of the body and to distinguish between different structures in the body. The language requires students to make a considerable effort to learn or memorise anatomical terms, identify structures and apply knowledge to clinical practice. Therefore, it is “one discipline area where the distinctions between deep- and surface-learning strategies are blurred”

(Pandey & Zimitat, 2007, p. 8) because students often employ a combination of the two approaches to achieve the course outcomes (Pandey & Zimitat, 2007; Smith et al., 2014). That is, both approaches are often considered a necessary part of developing and consolidating knowledge. Therefore, a surface approach should not be considered a bad one because it provides an infrastructure for constructing meaning and understanding (Hattie, 2009).

Strategic Approaches

Another form of learning adopted by students is the strategic approach, which is based on or driven primarily by assessments. Students choose a mixture of surface and deep approaches when preparing for examinations. Those who adopt a strategic

approach base their decision on their perception of which learning method will generate the best outcome in the assessment (Smith et al., 2014; Ward, 2011). Strategic learners will at times be able to distinguish between factual knowledge, which warrants a surface approach, and knowledge that is essential for clinical understanding, which warrants a deep approach (Smith & Mathias, 2007). Given that students are under immense pressure to pass examinations to progress further in their course, more students are using the strategic approach. Research shows that the mean grades of students who use the strategic approach are significantly higher than the grades of those who primarily use a deep or surface approach (Ward, 2011). Such research needs to be explored further to determine the long-term consequences of students who employ the strategic approach because one could hypothesise that a superficial understanding of anatomy and learning for assessment purposes only could result in information not being transferred to long-term memory.