gms | German Medical Science

Background: The exponential growth of image-based diagnostic and minimally invasive interventions requires a detailed three-dimensional anatomical knowledge and increases the demand towards the undergraduate anatomical curriculum. This randomised controlled trial investigates whether musculoskeletal ultrasound (MSUS) or arthroscopic methods can increase the anatomical knowledge uptake.

Methods: Second-year medical students were randomly allocated to three groups. Additionally to the compulsory dissection course, the ultrasound group (MSUS) was taught by eight, didactically and professionally trained, experienced student teachers (Fifth-year’s medical students) and the arthroscopy group (ASK) was taught by eight experienced physicians. The control group (CON) acquired the anatomical knowledge only via the dissection course. Exposure (MSUS and ASK) took place in two separate lessons (each of 75 minutes, shoulder and knee joint) and introduced standard scan planes using a 10-MHz ultrasound system as well as arthroscopy tutorials at a simulator combined with video tutorials. The theoretical anatomic learning outcomes were tested using a multiple-choice questionnaire (MCQ), and after cross-over an objective structured clinical examination (OSCE). Differences in student’s perceptions were evaluated using Likert scale-based items.

Results: The ASK-group (n=70, age 23.4 (20-36) yrs.) showed a significantly better anatomical knowledge (MCQ) in general in comparison to the MSUS-group (n=84, age 24.2 (20-53) yrs.) and the CON-group (n=88, 22.8 (20-33) yrs.; p=0.019). There were significant knowledge benefits of the students in the shoulder area after the arthroscopy tutorial (p<0.001), while in the knee area (p=0.317) as well as other anatomic areas (p=0.456) no differences could be detected between any of the three different trial groups. The final examination (OSCE) showed no significant differences between any of the groups with good overall performances. In the evaluation, the students certified the arthroscopic tutorial a greater advantage concerning anatomical skills with higher spatial imagination in comparison to the ultrasound tutorial (p=0.002; p<0.001) (see Figure 1 [Fig. 1]).

Conclusions: The additional implementation of arthroscopy tutorials to the dissection course during the undergraduate anatomy training is, with respect to complex joint anatomy, profitable and attractive to students. An intended simultaneous teaching of basic-skills in the musculoskeletal ultrasound should be performed by medical experts, but seems to be inferior to the arthroscopic 2d-3d-transformation, and is regarded by students as more difficult to learn [1], [2], [3], [4], [5].