EDITORIAL article Front. Med., 19 February 2024Sec. Family Medicine and Primary Care Volume 11 - 2024 | https://doi.org/10.3389/fmed.2024.1380046

delivering anatomical education designed to help prepare students in becoming safe and competent medical and allied healthcare practitioners. Despite the critical role that anatomists play in the early stages of student learning, little is known about the identity of anatomists, and how their journeys and experiences have shaped the ways they perceive and embody their role. The aim of this study was to provide anatomists with a reference to take comfort in the shared experiences of other anatomists, to provide individuals and managers with real-life situations that anatomists may come across in their career, and to generate a sense of belonging within the anatomy community. Through a survey data collected from 161 anatomists, it includes demographic characteristics, access to training and support provision, and availability of network and career opportunities. In addition, information was collected that focussed on aspects of wellbeing and lived personal experience in the workplace. The results of this study provide significant evidence for the need to develop a more inclusive, diverse, and supportive environment for anatomists in both the work place as well as within professional societies and at conferences. Self-identifying female anatomists experience more discrimination overall (p=<0.01), with specific elements such as barriers to career progression (p=0.004) and work-related mental health issues (p=0.02). Individuals, teams and managers have a distinct role to play in ensuring that everyone can work and thrive in a culturally safe work environment.

The COVID-19 pandemic instigated a paradigm shift in healthcare delivery with a rapid adoption of technology-enabled models of care, particularly within the general practice primary care setting. The emergence of the Metaverse and its associated technology mediums, specifically extended reality (XR) technology, presents a promising opportunity for further industry transformation. Therefore, the objective of this study was to explore the current application and utilisation of XR technologies within the general practice primary care setting to establish a baseline for tracking its evolution and integration. A systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) was conducted and registered with the international database of prospectively registered systematic reviews as PROSPERO-CRD42022339905. Eleven articles met the inclusion criteria and were quality appraised and included for review. All databases searched, inclusive of search terms, are supplied to enhance the transparency and reproducibility of the findings. All study interventions used virtual reality technology exclusively. The application of virtual reality within the primary care setting was grouped under three domains: (1) childhood vaccinations, (2) mental health, and (3) health promotion. There is immense potential for the future application of XR technologies within the general practice primary care setting. As technology evolves, healthcare practitioners, XR technology specialists, and researchers should collaborate to harness the full potential of implementing XR mediums.

Back in 1996, the report to UNESCO of the International Commission on Education for the Twenty-first Century highlighted four pillars of education (Delors et al., 1996). These pillars were framed within the context of education throughout life; Learning to Know, Learning to Do, Learning to Live Together, and Learning to Be. ‘Learning to Know’ emphasizes the combination of having a broad general knowledge with the opportunity to delve deeper into a smaller number of subjects. It also encompasses the ability of learning to learn so that an individual can benefit effectively from learning opportunities. ‘Learning to Do’ covers the acquisition of various skills and the ability to use these skills appropriately in work and social environments. ‘Learning to Live Together’ extends out to the understanding of those around us, appreciating interdependence and the need to work together. ‘Learning to Be’ focuses on maximizing an individual's potential by developing one's personality and competencies in order to act with autonomy, judgment and responsibility. The report also recognized that in the past, formalized education had focused on the development of knowledge, often at the expense of other learning and that we need to shift future education to fully encompass all four pillars by design. Why is this relevant to anatomy education, particularly now? As we deal with pedagogical change, emerging approaches and technologies and assesses the fundamental effects of a health pandemic on the future delivery of anatomy education, these pillars of education can provide an ideal guiding framework in helping to determine what anatomy education will look like in the future, especially in light of the disruption caused by the Covid-19 pandemic, and ensuring that we focus on a more rounded and inclusive approach to learning. Anatomical education has been changing and evolving in a variety of ways over recent decades. Some of these changes are in response to new emerging pedagogical approaches such as moves to a blended learning construct (Pereira et al., 2007; Green & Whitburn, 2016; Khalil et al., 2018), integrated curricula (Evans & Watt, 2005; Klement et al., 2011, 2017), an emphasis on interprofessional learning (Hamilton et al., 2008; Herrmann et al., 2015; Smith et al., 2015) and near-peer teaching (Evans & Cuffe, 2009; Morris et al., 2018; Harrison et al., 2019). The rise of digital innovations has enabled virtual dissection (Darras et al., 2020; Wainman et al., 2021; Duraes et al., 2022), three-dimensional (3D) printing (McMenamin et al., 2014; Smith et al. 2018; Ye et al., 2020), ultrasound (Swamy & Searle, 2012; Smith & Barfoot, 2021; Lufler et al., 2022), gamification (Ang et al., 2018; Rudolphi-Solero et al., 2022; Tan et al., 2022) as well as virtual and augmented reality (Moro et al., 2017; Uruthiralingam & Rea, 2020; Zhao et al., 2020; Jiang et al., 2022) to become common features in many programs. Technology has also started to disrupt the way in which students are assessed with interactive e-assessments being increasingly utilized (Elzainy et al., 2020; Chakrabarti, 2020; Bogomolova et al., 2021). In recent years, there has also been a fundamental recognition that anatomy education needs to be redesigned to play a greater role in preparing learners for practice by helping them to develop a new range of skills and attributes (Roxburgh & Evans, 2021). This includes the explicit incorporation of nontraditional discipline-independent skills (NTDIS) (Evans et al., 2018; Evans & Pawlina, 2020; Lachman & Pawlina, 2020) and professional identity formation (PIF) (Pawlina, 2019; Abrams et al., 2021; Darici et al., 2022) into many anatomy courses with an emphasis on communication (Evans, 2013; Lochner et al., 2020; Yohannan et al., 2022), teamwork (Vasan et al., 2009, 2011; Huitt et al., 2015), critical reasoning (Elizondo-Omaña et al., 2010; Kassirer, 2010; Rajprasath et al., 2020), interprofessional learning (Smith et al., 2015; Zheng et al., 2019; Lochner et al., 2020), and professionalism (Pawlina et al., 2006; Palmer et al., 2020; Khabaz Mafinejad et al., 2021). Overall, such changes and innovations has led to many educators shifting away from an approach that purely focuses on lectures, conventional laboratory practical sessions and time-honored assessments to one that exposes the educator and more importantly the learner to a more varied and multifaceted format and one increasingly aligned to the UNESCO four pillars of education (Delors et al., 1996). The transformative journey that anatomy education has been following has been accompanied by a rise in anatomical scholarship and education-focused research as exemplified by the increasing number and more importantly the quality of publications seen in journals such as Anatomical Sciences Education and the contributions to health-related conferences and symposia. This work has been an active part of the drive for change in, and the continual evolution of, anatomy education and has provided the platform for demonstrating new pedagogies and innovative approaches, allowing effective and assessed practice to be shared and enabling the discussion and challenge of ideas. Importantly, there has been an increasing emphasis on evaluating the effect of teaching interventions on the student learning experience and learning gain. This is essential in providing confidence to educators, institutions, accrediting bodies as well as learners that what is being introduced is pedagogically sound and evidence-based. In early 2020 an unexpected disruption to the provision and evolution of anatomical education intervened. The declaration of the Covid-19 pandemic in March 2020 caused a primary global health concern and by May 2022, there were over 518 million confirmed cases of Covid-19 and over six million deaths reported globally (Wang et al., 2020; WHO, 2022). The pandemic has had a profound effect across society, leading to far-reaching health, geopolitical and economic consequences. The education sector was far from immune to the pandemic with many countries initially implementing nationwide closures of schools, colleges and universities, with others under severe restrictions (Evans et al., 2020; Smith & Pawlina, 2021). For most anatomy educators, delivery of teaching had to shift rapidly to remote and online learning as opportunities for face-to-face teaching was all but removed (Evans et al., 2020; Papa et al., 2022). The challenge faced by many educators was far from trivial as although anatomy education had embraced new approaches including digital innovation as detailed above, face-to-face interaction and practical-based learning opportunities were still, quite appropriately, the mainstay of many anatomy courses. Apart from the governmental and institutional imposed constraints, which included restrictions in access to cadaveric and other materials, educators were faced with a shortage of resources and appropriate platforms for online teaching, a lack of time to make changes, and for many, an unfamiliarity with some of the available technologies. This was compounded by questions around how to convert materials and approaches for online, which approach to use, what technology to focus on and of course how to assess students. Despite the challenges, anatomy educators responded quickly, effectively and often innovatively. The changes seen demonstrated the richness of talented staff, the ability to be agile in responding to the needs of learners as well as dealing with the pace of change (Alkhowailed et al., 2020; Byrnes et al., 2021; Kapoor & Singh, 2022). The pandemic led to range of new or adapted approaches, often digitally-based, to be introduced into the curriculum to replace or adapt existing approaches in order to meet the perceived limitations of remote delivery. In some cases, this involved expanding the reach or extent of an existing approach or assets while for others the introduction of totally new interventions was required. Whichever the case, a great deal of time, effort, and commitment on behalf of educators and other staff was required as well as additional or differentiated resourcing. Digital interventions included live streaming of dissection and other practical demonstrations via anatomy studios (de Carvalho Filho et al., 2021), provision of virtual dissection (e.g., Anatomage, Sectra, etc.,), live and recorded lectures and dissections, the comprehensive use of video conferencing platforms (e.g., Zoom, Microsoft Teams etc.,) for synchronous and asynchronous delivery, and more effective use of learning management systems. Three-dimensional virtual applications and atlases became more widespread and new learning interfaces and platforms were introduced to support approaches such as simulation, and gamification. Other changes included the inclusion of more interactive formative assessment opportunities, online approaches to summative assessment and use of artificial intelligence (AI) in grading. Publications in the literature in the last two years confirm that a range of changes in anatomical education delivery were implemented and assessed world-wide (Brassett et al., 2020; Longhurst et al., 2020; Pather et al., 2020; Cheng et al., 2021; Harmon et al., 2021; Attardi et al., 2022; Özen et al., 2022). Perceptions, performance, satisfaction and well-being of students in the Covid-19 imposed online curricular environment emerged as a frequent theme for many publications (Cuschieri and Calleja Agius, 2020; Franchi, 2020; Srinivasan, 2020; Harrell et al., 2021; McWatt, 2021). Educators shared their experiences, best practices, and recommendations regarding digital transformation of anatomy teaching (Cuschieri & Calleja Agius, 2020; Pather et al., 2020; Böckers et al., 2021; Thom et al., 2021); as well as discussed issues and concerns related to teaching faculty (Patra et al., 2020, 2021). Scientific reports were published from a number of different anatomy programs and disciplines (Darici et al. 2021; Singal et al., 2021; Yoo et al., 2021; Al-Alami et al., 2022; Mahdy & Sayed, 2022) with some authors exploring their vision how the post-Covid anatomical sciences education might look like in the future (Jones, 2021; Ross et al., 2021; Lachman & Pawlina, 2022). Overall observations from these reports and others suggest that in terms of positive outcomes the shift in approach resulted in a significant driver to migrate to an online environment, the development of a range of new resources, a faster pace of pedagogical change, the introduction and learning of new technologies and a more personalized learning experience for students. However, a number of report outcomes point to a range of problem issues such as a lack of learner engagement, issues with assessments, difficulties with online access, learner isolation, and concerns over mental health and wellbeing, restricted interaction between educators and students, staff exhaustion, and rushed curriculum planning (Cecilio-Fernandes et al., 2020; Sani et al., 2020; Pokryszko-Dragan et al., 2021). The absence of hands-on practical experience was seen as the major disadvantage for students. Learning from such outcomes is important for individual educators, course leaders, institutions as well as the discipline of anatomy education. The results of the transition to remote and online anatomy learning provision should be actively used to shape future direction and identify where efforts should be focused. As has been noted, it is impressive the way in which anatomy educators have responded to the challenges of teaching in the midst of the Covid-19 pandemic, but as identified above, what about the effects on future provision? What long-term disruption might or should the period of the pandemic have on the design and delivery of anatomical education? It would certainly be a missed opportunity if we simply returned to way things were done and did not respond to the questions that have been posed during the pandemic, or failed to build on, use and adapt the innovations and approaches that have been used in the past two years or so. Therefore, determining how we provide anatomy education in the future should be influenced by the disruption of the pandemic and the opportunities identified. Disruption is not new and has been shown to be a trigger for innovation and change but also a threat for those areas that fail to respond effectively or in a timely manner. In the business world, disruptive innovation “is a process whereby a smaller company with fewer resources is able to successfully challenge established businesses and is gradually moving upmarket to challenge the industry leaders” (Christensen, 1997; Christensen et al., 2015). There are a number of classical examples of disruptive innovation in business such as the fall of Blockbuster and the rise of Netflix, the introduction of Uber and its effect on the taxi transportation industry, the closure of Borders bookstore as a result of its failure to transition to digital and online publication. Likewise, some innovations also fail to make the desired impact such as Google Glass, the Theranos health start-up and the Ford Edsel. And that is the point, some disruptive innovations succeed, and others do not but what they all have in common is that they challenge our thinking and enable us to critically assess ideas and concepts, which can lead to change or affirmation of the efficacy of current approaches. How does this relate to education? Disruption, both large and small has been a congruent element of education for centuries. Whether it has been the transition of the slate to paper to the screen, or chalk to the pen/pencil to the keyboard, or perhaps more fundamental changes to the approach to teaching such as the appearance of the Khan Academy, the flipped classroom or introduction of massive open online courses (MOOCs). Whatever the disruptive innovation in education, the importance is that they disrupt the norm. The impact that innovations have in the educational field can be brief or longer-term and can be influenced by global changes in teaching strategies, systematic efforts for change, or at a local level such as a new intervention by an individual educator. Some of these innovations therefore start out small but can go on to have national or global influences in teaching pedagogy, academic development and learning opportunities. Despite challenge and disruption, some existing approaches have stood the test of time, at least up until now such as the lecture or for anatomy education, cadaveric dissection. However, dissection may undergo some adjustments in the future, especially for novice undergraduate anatomy students in order to maximize the students' experience and their knowledge gain from using the precious gift of the human body (Onigbinde et al., 2021; Lachman & Pawlina, 2022). How to respond longer term to the disruptive influences the pandemic has thrown upon anatomy education needs appropriate consideration and requires a robust assessment of the changes, innovations and interventions introduced. This includes primarily the impact on student learning of the approach, but also the financial, logistical and strategic viability that will enable a sustainable change to be made. There has been an abundance of contributions to the anatomical education literature since the start of the pandemic and as seen, these have largely focused on sharing details of implemented practices, and discussions and commentaries on the challenges and opportunities faced by students and educators, often informed by analyses that include the results of surveys and focus groups. Such reporting has been insightful and valuable but has yet to focus specifically on the effects on learning gain and long-term viability. There is a growing need for more in depth and systematic evaluation of the interventions and innovations used during this disruption in order to appropriately inform the efficacy of changes to practice and influence future decision making (including limiting future threats to delivery), which often sits outside the remit of the individual educator or course leader. There is a danger that some approaches or innovations become embedded into the course provision without appropriate evaluation with potential downstream consequences on learning, student experience or sustainability. Likewise, some interventions are likely to be dismissed as a continuing approach as they were seen as a temporary measure or appeared less effective at the time of first use. Appropriate evaluation of such approaches is still needed to determine whether the approach (and all the work that went into it) in fact has longer-term potential and might highlight adaptations and refinements that could be made to improve or transform efficacy. A focus on multi-modal approaches to evaluation including an emphasis on effectiveness, learner satisfaction, staff impact, value/cost and learning gain is therefore essential in order to properly assess the substantive value of making changes that will underpin the makings of a future approach. The Covid-19 pandemic has provided an unexpected experimental environment for testing educational innovations in the anatomical sciences and the opportunity to scientifically evaluate the outcomes of these as well comparing against the effectiveness of pre-Covid-19 provision. This will help to ensure that the level and quality of scholarship in anatomy education also benefits. If we return to the opening message of this editorial and the four pillars of education (Delors et al., 1996), how do these inform the design and rollout of a future approach to anatomical education? The pillar of ‘Learning to Know’ suggests the need to maintain a continuous focus on anatomical knowledge and understanding in order to secure a student's solid academic base, but also providing better opportunities for learners to be able to critically analyze and research. This can be enabled through a range of teaching approaches delivered as part of a holistic curriculum. This pillar also recognizes the need for more attention on enabling the capacity for learning to learn and preparation for life-long learning. Anatomy often appears as an early subject in many health education programs, and as such needs to do more in supporting students in preparing to be effective learners. The lessons outlined above, particularly those related to guiding learners, if implemented effectively and in a student-centered way would be enabling of this. The ‘Learning to Do’ pillar focuses on the acquisition of various skills and the ability to use these skills and the knowledge learned appropriately in work and social environments. For anatomy this would focus on the ability of students to develop a range of technical and related skills through face-to-face and simulated laboratory opportunities and use these to apply to their knowledge to clinical cases and environments. While this is embedded in many current anatomy curricula, the emergence of new pedagogies and technologies provides exciting and potentially more enabling opportunities for students to learn and apply knowledge and skills. A transformation in the approach to assessment as outlined in lesson five is also essential so that students learn what is expected, where their learning gaps are and the importance of focusing on application of knowledge and skills. ‘Learning to live together’ is a pillar that relies on, amongst other things, the ability to communicate, resolve conflict and be aware of and respond appropriately to cultural sensitivities. The emergence of NTDIS in anatomy education provides a focus for ensuring that we provide students with a wider learning opportunity that will prepare them appropriately for their future role in clinical practice. This relies on being able to integrate these skills into a holistic curriculum, using appropriate learning technologies and pedagogies, supporting and guiding students as they develop and using assessment as a tool for learning. The final pillar, ‘Learning to be’ embraces the need to develop self-esteem, emotional intelligence and higher-level critical thinking. Within anatomy this can be achieved through a more explicit focus on professionalism, and the development of professional identity. The incorporation of PIF pedagogies and NTDIS within a holistic anatomy curriculum therefore provides effective opportunities to achieve this. The ability to touch on all these aspects within the anatomy curriculum requires effective planning and design and one which generates a balanced, appropriately loaded approach that supports rather than hinders the learner. It is important that anatomy education is not developed in isolation from other disciplines and instead ensure appropriate integration is achieved. By using the recent evolution in pedagogies as well as the current pandemic disruption we can also learn from and inform other disciplines. Simply going back to the way things were done before Covid-19 is a missed opportunity for anatomy education to enhance the experience for learners, incorporate lessons learned from this unexpected experimental Covid-19 environment and build on the recognized foundations as a discipline that is continually evolving in its approach. Much of what is suggested in the five lessons presented or captured within the four pillars of education will not be a surprise or new to many educators, but we all have a responsibility to bring these elements together to frame a future anatomy education provision post the pandemic and one that provides the opportunity to reset expectations, increase learning gains, personalize the student learning experience, enable and empower educators and lead to change in anatomical sciences education.

The lecture has been around for centuries and has featured as a popular and frequent component in higher education courses across many disciplines including anatomy. In more recent years, there has been a growing shift toward blended learning and related pedagogies that encourage active participation of students in both face-to-face and online learning environments. Unfortunately, in many cases, the lecture, which has typically focused on the transmission of information from educator to student has not been adapted to become a more learner-oriented approach with opportunities for students to actively interact and engage. As a result, the future of whether the lecture should continue has once again become a center of debate. The consequence of the Covid-19 pandemic and its aftermath have added to this with institutions now looking to stop all lectures or offer them in an online format only. This commentary argues that lecture-style components could still feature within face-to-face and online provision, but only if they are used sparingly within a blended curriculum, have a defined use that aligns well to learning outcomes, are assessed as the most effective method pedagogically, and importantly integrate approaches and activities that promote student engagement. Anatomy educators have demonstrated for years that they are able to be at the forefront of pedagogical change and evidenced during the pandemic their agile and innovative ability to adapt and do things differently. Therefore, the fate of the lecture, at least in anatomy, may well be in their hands.

The use of extended reality (XR) technology in education offers many advantages for transferring knowledge and practical skills training at the higher education level. As a result, many Universities over the past 5 + years have undertaken pilot programs to both develop XR content and assess how to best implement it within existing teaching and learning systems. Unfortunately, very few of these efforts have included structured evaluation or documentation. As such, limited published evidence exists to inform processes and approaches that may assist or hinder broad scale implementation. This leads many Universities to unnecessarily commit significant time and resources to testing identical or similar approaches, resulting in repeated identification of the same or similar challenges. In response to this situation, The University of Newcastle, Australia decided to systematically document the approach for selection, development and implementation of four new virtual-reality (VR) teaching applications. The current paper contains a detailed intrinsic case study, outlining the process and critical elements that shaped the selection of suitable teaching content, software development, hardware solutions and implementation. Details are provided on how decisions were made, what components were considered helpful, challenges identified, and important lessons outlined. These findings will be useful to organisations and individuals as they look to develop pathways and processes to integrate XR technology, particularly within their existing training and educational frameworks.

Extended reality (XR) technology is an emerging teaching tool within the higher education sector. Many institutions are currently running pilot projects, primarily assessing individual XR teaching tools typically being led by innovative/technology-driven teaching staff, which may introduce a self-selection bias and may not represent the general attitudes of the broader staff and student population. We applied a mixed-methods approach to gain insight into end-user acceptability, value areas, barriers, and opportunities for the adoption of XR in teaching at an Australian University. A university-wide online survey and targeted interview sessions with XR technology users show a general readiness for broad adoption of XR technologies in university education. Whilst existing XR teaching applications were described as “successful,” relatively few applications were sustainably integrated into the curriculum. Our data highlights the existing barriers for the successful transition from individual use-cases of XR tools to broader adoption across university institutions.

The coronavirus disease 2019 (Covid-19) pandemic has induced multifaceted changes in anatomical education. There has been a significant increase in the employment of digital technologies coupled with the upskilling of educators' capacity and altered attitudes toward the digitalization process. While challenges remain, learners have demonstrated capabilities to adapt to digital delivery, engagement and assessment. With alternative and innovative teaching and learning strategies having been trialed and implemented for almost two years, the key question now is what the pedagogy will be for anatomy education beyond the pandemic. Here we discuss some of the changes in anatomy education that have taken place as a result of the Covid-19 pandemic and importantly present some outlooks for evidence-based anatomy pedagogy as the world enters the post-pandemic phase and beyond. The authors conclude that the anatomy discipline is ready to further modernize and has the opportunity to use digital technologies to evolve and enhance anatomy education to ensure students are provided with the learning experience which will prepare them best for the future.

The approach to anatomical teaching and learning has undergone significant shifts in recent years as anatomy educators have challenged conventional pedagogical thinking and responded to disruptions within curricula constructs, the effect of technology and demands of healthcare professions (Drake et al., 2009; Rizzolo et al., 2010; Sugand et al., 2010; Estai and Bunt, 2016; Guimarães et al., 2017; McBride and Drake, 2018). As a result, practice has changed to ensure that students are provided with effective learning experiences that prepare them appropriately and include integration of outcomes and competencies that spread across knowledge, skills, and attribute domains. Such change has led to the augmentation of traditional approaches, inclusion of innovative solutions and advances, and a growing evidence-based culture when it comes to curriculum design, delivery, and evaluation. With assessment, it could be argued that change has been slower and less fundamental. This is somewhat surprising given the emphasis on multifaceted, active, and authentic approaches being driven within medical education over a number of years (Schuwirth and van der Vleuten, 2020). While change for change's sake is to be avoided, it is important that assessment reflects the changing learning and teaching pedagogies and provides the optimal opportunities for students to demonstrate their learning gain. This requires an emphasis on the practice of “assessment for learning” to ensure students are aware that reliance on a purely fact-based approach to learning anatomy will not prepare them appropriately for the future. Student involvement in the design and evaluation will help change the perception away from this long-held predisposition to learn for assessment. This special issue of Anatomical Sciences Education, titled “Assessment in Anatomy Education” showcases the work of anatomy educators in pursuing the challenge of adapting and transforming assessment and also includes contributions from those outside anatomy to provide commentary, insight, and provocation. Among the authors are those who have been leading the charge for advances in assessment practices for many years, as well as those that are beginning to establish themselves as a new generation of anatomical pedagogical practitioners. Within the issue, quantitative and meta-analysis studies demonstrate the need to design assessments that effectively evaluate cognitive levels that match the level of learner, particularly when assessing clinical anatomy concepts (Thompson and Giffin, 2021), and appropriately accommodate differences in the spatial ability of students including the use of non-addictive visual signaling and minimizing redundant visuospatial information (Roach et al., 2021). Another report indicates that the assessment format should be designed to align effectively with the method of instruction and future application of knowledge in clinical practice (Fournier and Groh, 2021). Merzougui and colleagues investigate the impact of different question types and format on student perception versus student performance (Merzougui et al., 2021), while the effect of contextual information and images on student performance and the way in which students perceive clinically oriented questions, in particular, is also described (Sagoo et al., 2021). Adaptation of the traditional identification-based “spot-test” assessment to include a multiple-choice format is introduced and shown to be a suitably reliable and challenging alternative to a free-response question approach (Douglas-Morris et al., 2021). The creation of a team-based Objective Structure Practical Examination demonstrates an effective mode for evaluating integrated ultrasound competencies that include both anatomical knowledge and other non-technical skills including teamwork and professionalism (Weiskittel et al., 2021). Moro and colleagues provide a systematic review that points to the benefit of testing three-dimensional spatial understanding as a priority in anatomy and how both innovative virtual and augmented reality can be employed as suitable assessment modalities (Moro et al., 2021), while Bogomolova et al. highlight, in their viewpoint commentary, that the use of three-dimensional visualization technologies allows for the development of active and augmented assessment scenarios that include interaction between assessor and examinee (Bogomolova et al., 2021). The introduction and validation of a smartphone virtual reality bell-ringer application demonstrate the potential for three-dimensional visualization technologies to be incorporated into portable, affordable and accessible assessment tools for anatomy (Brewer-Deluce et al., 2021). The growing importance for assessment to straddle both the need for the certification of achievement and determining readiness to progress, and the expectation to drive and enhance learning and provide preparation for lifelong learning is explored by Ryan and Wilkinson (2021). They describe three different approaches that include the educational impact of assessment, development of assessment literacy, and provision of systems of assessment. In a new type of article for Anatomical Sciences Education, Roxburgh and Evans (2021) take a perspective approach to look at the way in which other disciplines, in this case, the world of design can inform and challenge the development of assessment within the anatomical sciences, with an emphasis on designing active and holistic assessment regimes that encompass both formative and summative approaches. The articles within this special issue illustrate that the approach to assessment within the anatomical sciences is being challenged, analyzed, and adapted. In the future, the increasingly integrated nature of healthcare curricula, the growing influence of technology, and the changing working environment that graduates will enter and the associated skills and knowledge sets that will, therefore, be required strongly indicate that assessment strategies across medical and health education will need further transformation. For anatomy, this will require continuing to extend beyond disciplinary boundaries to collaborate with others to provide creatively designed, authentic assessments that meet changing learner, professions, and societal needs. Anatomy educators are already recognized as pedagogical change agents as demonstrated by the expanding numbers of quality and creative outputs within the literature. However, the recent COVID-19 pandemic has demonstrated that educators can also be agile and respond quickly to adapt learning and teaching to accommodate changing and challenging online and face-to-face modalities (Evans et al., 2020; Longhurst et al., 2020; Pather et al., 2020). This suggests that anatomy educators are well placed and fully capable to take up these assessment challenges.

Medical and healthcare practice is likely to see fundamental changes in the future that will require a different approach to the way in which we educate, train, and assess the next generation of healthcare professionals. The anatomical sciences will need to be part of that challenge so they continue to play a full role in preparing students with the knowledge and ever increasingly the skills and competencies that will contribute to the fundamentals of their future capacity to practice effectively. Although there have been significant advances in anatomical science pedagogy, by reviewing learning and assessment in an apparently unrelated field, provides an opportunity to bring a different perspective and enable appropriate challenge of the current approaches in anatomy. Design learning has had to continually reimagine itself in response to the shifting landscape in design practice and the threats associated with technology and societal change. Design learning has also long used a student-centric active pedagogy and allied authentic assessment methods and, therefore, provides an ideal case study to help inform future changes required in anatomical learning and assessment.

Anatomy educators are focused on designing and developing learning and teaching approaches that provide for the most effective learning experience, lead to measurable learning gain and prepare students for the next phase of their learning journey and career track The eagerness of educators to evaluate and challenge approaches and pedagogy has seen an exponential increase in scholarship within anatomical education over recent years as demonstrated by the number and quality of published outputs across many educational journals including Anatomical Sciences Education Such activity bodes well for the provision of effective learning opportunities for students, the continued advancement of evidence-based practice in the teaching of the anatomical sciences, and the ability to adapt and respond to disruptions within the higher education environment

Driven by demand for high standards in university education, efforts have been made in the UK to address the perceived imbalance between teaching and research. However, teaching is still perceived by many as having less credibility and is attributed less importance. The purpose of our research was to explore how distinct types of academic job profiles (‘research’ or ‘education’ focused, or ‘balanced’) impact on biomedical scientists' perceptions of the lecturer role. Specifically, we investigated the experiences of biomedical scientists in ‘post‐1990’ medical schools, which are known for their commitment to excellence in both research and education. We conducted 22 face‐to‐face, semi‐structured interviews with biomedical scientists in five schools. Focusing on experiences of work, the interviews covered: ‘motivations’, ‘role expectations’, ‘teaching’, ‘research’ and ‘career’. The recorded qualitative data were transcribed and then analysed thematically. Our results, offering an insight into the working lives of biomedical scientists in medical education, suggest that in settings with a dual emphasis on education and research, individuals on ‘balanced’ contracts can experience a strong pull between research and teaching. In addition to posing significant challenges with respect to workload management, this can impact profoundly on professional identity. In contrast to the balanced role, ‘research’ or ‘education’ focused roles appear to have clearer requirements, leading to higher employee satisfaction. We conclude that to assist the educational mission of Higher Education, attention should be paid to balanced contracts, to (a) ensure employee support, (b) mitigate against negative perceptions of teaching, and ultimately, (c) guard against staff attrition.

Pregnancy is a time of profound anatomical and physiological reorganisation. Understanding these dynamic changes is essential to providing safe and effective maternity care. Traditional teaching methods such as the use of static cadaver specimens are unable to illustrate and give appreciation to the concurrent fetal and maternal changes that occur during this time. This chapter describes the development of the Road to Birth (RtB) a collaborative, multi-modal, digital anatomy program, aimed to provide undergraduate midwifery students with a novel, visual, interactive and accessible, pregnancy education tool. The RtB digital anatomy program provides users with an internal view of pregnancy and fetal development, spanning 0–40 weeks of pregnancy, up to the immediate postpartum period. Users of the program have the opportunity to observe, interact and manipulate detailed 3D models and visualise the growth of a fetus and maternal anatomical changes simultaneously. The program is inclusive of detailed digital fetal and placental models that display both normal and pathological birth positions. The models are accompanied by written educational content that is hypothesised to support both technical and non-technical skill development. The RtB program has been deployed and tested amongst two international cohorts of undergraduate midwifery students. Findings indicate that the RtB as a mobile application and as an immersive virtual reality program have the potential to be useful pregnancy education tools with further empirical testing underway.

Anatomical Sciences EducationVolume 13, Issue 3 p. 279-283 Editorial Going Virtual to Support Anatomy Education: A STOPGAP in the Midst of the Covid-19 Pandemic Darrell J.R. Evans, Darrell J.R. Evans orcid.org/0000-0001-9425-6303 School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, AustraliaSearch for more papers by this authorBoon Huat Bay, Boon Huat Bay Yong Loo Lin School of Medicine, National University of Singapore, Singapore, SingaporeSearch for more papers by this authorTimothy D. Wilson, Timothy D. Wilson orcid.org/0000-0001-7102-2491 Schulich School of Medicine and Dentistry, Western University, London, Ontario, CanadaSearch for more papers by this authorClaire F. Smith, Claire F. Smith orcid.org/0000-0002-4366-8591 Brighton and Sussex Medical School, University of Sussex, Brighton, United KingdomSearch for more papers by this authorNirusha Lachman, Nirusha Lachman orcid.org/0000-0002-9995-6154 Mayo Clinic College of Medicine and Science, Mayo Clinic, Rochester, MinnesotaSearch for more papers by this authorWojciech Pawlina, Corresponding Author Wojciech Pawlina [email protected] Mayo Clinic College of Medicine and Science, Mayo Clinic, Rochester, Minnesota Correspondence to: Dr. Wojciech Pawlina, Department of Anatomy, Mayo Clinic College of Medicine and Science, Mayo Clinic, 200 First Street SW, Rochester, MN 55905. USA. E-mail: [email protected]Search for more papers by this author Darrell J.R. Evans, Darrell J.R. Evans orcid.org/0000-0001-9425-6303 School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, AustraliaSearch for more papers by this authorBoon Huat Bay, Boon Huat Bay Yong Loo Lin School of Medicine, National University of Singapore, Singapore, SingaporeSearch for more papers by this authorTimothy D. Wilson, Timothy D. Wilson orcid.org/0000-0001-7102-2491 Schulich School of Medicine and Dentistry, Western University, London, Ontario, CanadaSearch for more papers by this authorClaire F. Smith, Claire F. Smith orcid.org/0000-0002-4366-8591 Brighton and Sussex Medical School, University of Sussex, Brighton, United KingdomSearch for more papers by this authorNirusha Lachman, Nirusha Lachman orcid.org/0000-0002-9995-6154 Mayo Clinic College of Medicine and Science, Mayo Clinic, Rochester, MinnesotaSearch for more papers by this authorWojciech Pawlina, Corresponding Author Wojciech Pawlina [email protected] Mayo Clinic College of Medicine and Science, Mayo Clinic, Rochester, Minnesota Correspondence to: Dr. Wojciech Pawlina, Department of Anatomy, Mayo Clinic College of Medicine and Science, Mayo Clinic, 200 First Street SW, Rochester, MN 55905. USA. E-mail: [email protected]Search for more papers by this author First published: 10 April 2020 https://doi.org/10.1002/ase.1963Citations: 214Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onEmailFacebookTwitterLinkedInRedditWechat LITERATURE CITED Al-Tawfiq JA, Hinedi K, Ghandour J, Khairalla H, Musleh S, Ujayli A, Memish ZA. 2014. Middle East respiratory syndrome coronavirus: A case-control study of hospitalized patients. Clin Infect Dis 59: 160–165. 10.1093/cid/ciu226 PubMedWeb of Science®Google Scholar Ayittey FK, Ayittey MK, Chiwero NB, Kamasah JS, Dzuvor C. 2020. Economic impacts of Wuhan 2019-nCoV on China and the world. J Med Virol 92: 473–475. 10.1002/jmv.25706 CASPubMedWeb of Science®Google Scholar Barry DS, Marzouk F, Chulak-Oglu K, Bennett D, Tierney P, O'Keeffe GW. 2016. Anatomy education for the YouTube generation. Anat Sci Educ 9: 90–96. 10.1002/ase.1550 PubMedWeb of Science®Google Scholar Chen NS, Ko HC, Kinshuk, Lin T. 2005. A model for synchronous learning using the Internet. Innovat Educ Teach Int 42: 181–194. 10.1080/14703290500062599 Web of Science®Google Scholar Craig S, Tait N, Boers D, McAndrew D. 2010. Review of anatomy education in Australian and New Zealand medical schools. ANZ J Surg 80: 212–216. 10.1111/j.1445-2197.2010.05241.x CASPubMedWeb of Science®Google Scholar CSSE. 2020. Center for Systems Science and Engineering. Coronavirus COVID-19 Global Cases by the Center for Systems Science and Engineering (CSSE) at Johns Hopkins University (JHU). Whiting School of Engineering. Johns Hopkins University, Baltimore, MD. URL: https://gisanddata.maps.arcgis.com/apps/opsdashboard/index.html#/bda7594740fd40299423467b48e9ecf6 [accessed 20 April 2020]. Google Scholar de Wit E, van Doremalen N, Falzarano D, Munster VJ. 2016. SARS and MERS: Recent insights into emerging coronaviruses. Nat Rev Microbiol 14: 523–534. 10.1038/nrmicro.2016.81 CASPubMedWeb of Science®Google Scholar Dormido H, Leung A. 2020. Charting the global economic impact of the coronavirus. Bloomberg L.P., New York, NY. URL: https://www.bloomberg.com/graphics/2020-global-economic-impact-of-wuhan-novel-coronavirus/ [accessed 20 April 2020]. Google Scholar Dreon O, Shibley IA Jr, Wilson TD. 2019. The Power of Blended Learning in the Sciences. 1st Ed. Ann Arbour, MI: The Part-Time Press. 164 p. Google Scholar Durosaro O, Lachman N, Pawlina W. 2008. Use of knowledge-sharing web-based portal in gross and microscopic anatomy. Ann Acad Med Singapore 37: 998–1001. PubMedWeb of Science®Google Scholar Estai M, Bunt S. 2016. Best teaching practices in anatomy education: A critical review. Ann Anat 208: 151–157. 10.1016/j.aanat.2016.02.010 PubMedWeb of Science®Google Scholar Evans DJ, Pawlina W, Lachman N. 2018. Human skills for human[istic] anatomy: An emphasis on nontraditional discipline-independent skills. Anat Sci Educ 11: 221–224. 10.1002/ase.1799 PubMedWeb of Science®Google Scholar Fincher RM, Wallach PM, Richardson WS. 2009. Basic science right, not basic science lite: Medical education at a crossroad. J Gen Int Med 24: 1255–1258. 10.1007/s11606-009-1109-3 PubMedWeb of Science®Google Scholar Finnerty EP, Chauvin S, Bonaminio G, Andrews M, Carroll RG, Pangaro LN. 2010. Flexner revisited: The role and value of the basic sciences in medical education. Acad Med 85: 349–355. 10.1097/ACM.0b013e3181c88b09 PubMedWeb of Science®Google Scholar Gbolahan BalogunW. 2019. Using electronic tools and resources to meet the challenges of anatomy education in Sub-Saharan Africa. Anat Sci Educ 12: 97–104. 10.1002/ase.1831 PubMedWeb of Science®Google Scholar Gillett-Swan J. 2017. The challenges of online learning: Supporting and engaging the isolated learner. J Learn Design 10: 20–30. 10.5204/jld.v9i3.293 Web of Science®Google Scholar Guy R, Byrne B, Dobos M. 2018. Optional anatomy and physiology e-learning resources: Student access, learning approaches, and academic outcomes. Adv Physiol Educ 42: 43–49. 10.1152/advan.00007.2017 PubMedWeb of Science®Google Scholar Harden RM. 2006. Trends and the future of postgraduate medical education. Emerg Med J 23: 798–802. 10.1136/emj.2005.033738 CASPubMedWeb of Science®Google Scholar Heylings DJ. 2002. Anatomy 1999-2000: The curriculum, who teaches it and how? Med Educ 36: 702–710. 10.1046/j.1365-2923.2002.01272.x CASPubMedWeb of Science®Google Scholar Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, Zhang L, Fan G, Xu J, Gu X, Cheng Z, Yu T, Xia J, Wei Y, Wu W, Xie X, Yin W, Li H, Liu M, Xiao Y, Gao H, Guo L, Xie J, Wang G, Jiang R, Gao Z, Jin Q, Wang J, Cao B. 2020. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet 395: 497–506. 10.1016/S0140-6736(20)30183-5 CASPubMedWeb of Science®Google Scholar Jones DS. 2020. History in a crisis—Lessons for Covid-19. N Engl J Med 382: 1681–1683. 10.1056/NEJMp2004361 CASPubMedWeb of Science®Google Scholar Kumar Ghosh S, Kumar A. 2019. Building professionalism in human dissection room as a component of hidden curriculum delivery: A systematic review of good practice. Anat Sci Educ 12: 210–221. 10.1002/ase.1836 PubMedWeb of Science®Google Scholar Lai CC, Shih TP, Ko WC, Tang HJ, Hsueh PR. 2020. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and corona virus disease-2019 (COVID-19): The epidemic and the challenges. Int J Antimicrob Agents 55: 105924. 10.1016/j.ijantimicag.2020.105924 CASPubMedWeb of Science®Google Scholar Lochner L, Wieser H, Waldboth S, Mischo-Kelling M. 2016. Combining traditional anatomy lectures with e-learning activities: How do students perceive their learning experience? Int J Med Educ 7: 69–74. 10.5116/ijme.56b5.0369 PubMedWeb of Science®Google Scholar Martin F, Bolliger DU. 2018. Engagement matters: Student perceptions on the importance of engagement strategies in the online learning environment. Online Learn 22: 205–222. 10.24059/olj.v22i1.1092 Web of Science®Google Scholar Mayer RE, Moreno R. 2003. Nine ways to reduce cognitive load in multimedia learning. Educ Psychol 38: 43–52. 10.1207/S15326985EP3801_6 Web of Science®Google Scholar McBride JM, Drake RL. 2018. National survey on anatomical sciences in medical education. Anat Sci Educ 11: 7–14. 10.1002/ase.1760 PubMedWeb of Science®Google Scholar Older J. 2004. Anatomy: A must for teaching the next generation. Surgeon 2: 79–90. 10.1016/S1479-666X(04)80050-7 CASPubMedWeb of Science®Google Scholar Ozer MA, Govsa F, Bati AH. 2017. Web-based teaching video packages on anatomical education. Surg Radiol Anat 39: 1253–1261. 10.1007/s00276-017-1889-9 PubMedWeb of Science®Google Scholar Palmer MJ. 2020. Learning to deal with dual use. Science 367: 1057. 10.1126/science.abb1466 CASPubMedWeb of Science®Google Scholar Pan SQ, Chan LK, Yan Y, Yang X. 2020. Survey of gross anatomy education in China: The past and the present. Anat Sci Educ 13: 387–397. 10.1002/ase.1952 Web of Science®Google Scholar Pawlina W, Drake RL. 2017. Bridges are waiting to be built: Delivering point-of-care anatomy for everyday practice. Anat Sci Educ 10: 305–306. 10.1002/ase.1714 PubMedWeb of Science®Google Scholar Pawlina W, Lachman N. 2017. Basic sciences and curriculum oncomes. In: JA Dent, RM Harden, D Hunt (Editors). A Practical Guide for Medical Teachers. 5th Ed. Elsevier Ltd. p 172–179. Google Scholar Pickering JD, Swinnerton BJ. 2019. Exploring the dimensions of medical student engagement with technology-enhanced learning resources and assessing the impact on assessment outcomes. Anat Sci Educ 12: 117–128. 10.1002/ase.1810 PubMedWeb of Science®Google Scholar Racheva V. 2018. Social aspects of synchronous virtual learning environments. AIP Conf Proc 2048: 020032-1–020032-9. Google Scholar Rockarts J, Brewer-Deluce D, Shali A, Mohialdin V, Wainman B. 2020. National survey on Canadian undergraduate medical programs: The decline of the anatomical sciences in Canadian medical education. Anat Sci Educ 13: 378–386. 10.1002/ase.1960 Web of Science®Google Scholar Sbayeh A, Qaedi Choo MA, Quane KA, Finucane P, McGrath D, O'Flynn S, O'Mahony SM, O'Tuathaigh CM. 2016. Relevance of anatomy to medical education and clinical practice: Perspectives of medical students, clinicians, and educators. Perspect Med Educ 5: 338–346. 10.1007/S40037-016-0310-4 PubMedWeb of Science®Google Scholar Slagter van Tryon PJ, Bishop MJ. 2009. Theoretical foundations for enhancing social connectedness in online learning environments. Dist Educ 30: 291–315. 10.1080/01587910903236312 Web of Science®Google Scholar Trelease RB. 2016. From chalkboard, slides, and paper to e-learning: How computing technologies have transformed anatomical sciences education. Anat Sci Educ 9: 583–602. 10.1002/ase.1620 PubMedWeb of Science®Google Scholar Turner C, Rowan C. 2020. University students campaign for refund as they say remote learning should not cost £9,250-per-year. The Telegraph, 25 March 2020. Telegraph Media Group Limited, London, UK. URL: https://www.telegraph.co.uk/news/2020/03/25/university-students-campaign-refund-say-remote-learning-should/ [accessed 30 March 2020]. Google Scholar UNESCO. 2020. United Nations Educational, Scientific and Cultural Organization. COVID-19 educational disruption and response. UNESCO, Paris, France. URL: https://en.unesco.org/themes/education-emergencies/coronavirus-school-closures [accessed 20 April 2020]. Google Scholar Velavan TP, Meyer CG. 2020. The COVID-19 epidemic. Trop Med Int Health 25: 278–280. 10.1111/tmi.13383 CASPubMedWeb of Science®Google Scholar Wang D, Hu B, Hu C, Zhu F, Liu X, Zhang J, Wang B, Xiang H, Cheng Z, Xiong Y, Zhao Y, Li Y, Wang X, Peng Z. 2020. Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China. JAMA (in press; https://doi.org/10.1001/jama.2020.1585). 10.1001/jama.2020.1585 Web of Science®Google Scholar Wilson TD. 2015. Role of image and cognitive load in anatomical multimedia. In: LK Chan, W Pawlina (Editors). 2015. Teaching Anatomy: A Practical Guide. 1st Ed. New York, NY: Springer International Publishing. p 237–246. 10.1007/978-3-319-08930-0_27 Google Scholar Wong JE, Leo YS, Tan CC. 2020. COVID-19 in Singapore—Current experience: Critical global issues that require attention and action. JAMA (in press; https://doi.org/10.1001/jama.2020.2467). 10.1001/jama.2020.2467 Web of Science®Google Scholar Woods NN. 2007. Science is fundamental: The role of biomedical knowledge in clinical reasoning. Med Educ 41: 1173–1177. 10.1111/j.1365-2923.2007.02911.x PubMedWeb of Science®Google Scholar Zureick AH, Burk-Rafel J, Purkiss JA, Hortsch M. 2018. The interrupted learner: How distractions during live and video lectures influence learning outcomes. Anat Sci Educ 11: 366–376. 10.1002/ase.1754 PubMedWeb of Science®Google Scholar Citing Literature Volume13, Issue3Special Issue:Covid‐19 and Anatomy EducationMay/June 2020Pages 279-283 ReferencesRelatedInformation

Physician training is built on a model that frames development as moving from novice to expert through a series of milestones, measurable competencies, and outcomes (Epstein and Hundert, 2002; Leach, 2002; Carraccio et al., 2008; ten Cate et al., 2010; Holmboe et al., 2016; ACGME, 2018). One well-known articulation of this framework, the Dreyfus Model, stages the individual from novice to advanced beginner to competent, proficient, and then expert (Dreyfus and Dreyfus, 1980). Within medicine, continuing professional development (CPD) and the expectation that medical professionals will be held accountable for knowledge and skills improvement is a mainstay of their expertise (Leach, 2002; Ericsson and Pool, 2016). To this end, a focus on practice with measurable outcomes and feedback is considered cornerstone for determined competency. On the contrary, while it may be natural to assume experience (number of years in practice) to be a proxy for expertise, studies have shown these to have a consistent negative relationship (Ericsson, 2004; Durning et al., 2010). In light of such findings, medical educators stress the role of deliberate practice in validating the development of expertise (Ericsson, 2004; Causer et al., 2014; Ericsson and Pool, 2016). As long as the practice of medicine continues to maintain a sorority with basic sciences (Sbayeh et al., 2016) authentic expertise as it relates to scientific, clinical, and technological advancement as well as the evolving social needs of the patient, the responsibility for up-to-date-expertise becomes an imperative for all professionals (Turney, 2007; Burgess and Ramsey-Stewart, 2015). Within such an environment, basic science education has to meet current practice demands by evolving into “authentic learning” practices that emphasize teamwork, leadership, interprofessional learning, and reflection (Pawlina and Drake, 2016). In the current teaching and learning environment expert productivity, deliverables and formal evaluation have become imperatives governing much of what we do and how we perform as teachers, facilitators and anatomists. For many anatomy educators, student evaluations of teaching have stood as the “grim reaper” for quality improvement. Despite the growing evidence questioning the reliability of student feedback (Uttl et al., 2017; Mullikin et al., 2019), its impact as a measure of faculty teaching performance remains the default standard for most; mainly because it is the only metric available or used by many departments and institutions. Often instructors who are more likable, charismatic, animated, or entertaining receive disproportionally better evaluations (Delucchi, 2000; Titus, 2008). In the absence of other objective metrics and under unremitting pressure from university administration, instructors may be unduly inclined to accentuate the entertainment value in course delivery at the expense of knowledge, expertise, and pedagogy; or to inflate grades, since students with higher grades are more likely to provide more positive feedback on teaching (Adams and Umbach, 2012; Rowan et al., 2017). While student perceptions of teacher effectiveness must not be discounted as a driver for self-improvement, it is essential to reflect on what it may take to establish, maintain, and uphold professional identity within an expertise in the complex embodiment of what it means to become an “expert.” In the context of the professions of anatomical sciences, the debate continues to gain momentum with arguments for and against such CPD expectations (Rizzolo and Drake, 2008). Within the diverse field of anatomical sciences, no one benchmark can, or should, be applied. Furthermore, standardization of knowledge competency with congruent pedagogic skills (Berman, 2015) will be met with challenge and not surprisingly, resistance. In the realm of anatomy education, it is easy to lose sight of the fact that familiarity of subject content, if left unchallenged, can impose a deceptive sense of assurance in delivery of expertise. As a subject, anatomy has the propensity for perpetuating a mentality that once learned the knowledge is good forever. In the current climate, students, scientists, public domains no longer depend on professors for information strengthening the notion that “everyone is an expert.” This sense of confidence while empowering for many outside the profession of anatomy, may at the same time be foreboding to its scientific and academic rigor. Within the profession, it is no longer sufficient to be satisfied with status quo, nor is it progressive to foster an erroneous sense of identity that if left unchallenged, can promote a reign of self-imposed mediocrity or a sense of all knowing and self-importance. The current professional environment however continues to prove time and time again that anatomy no longer exists as a predetermined science (Eizenberg, 2015). In the study and application of anatomy, audience, emphasis, curricular placement, and expertise required to interpret its content continues to transform, keeping the bar for required expertise in constant flux. In reality, the very progressive spirit of 21st century thinking appears to have circumvented the invaluable role that deliberate practice, critical analysis and reflection have to play in establishing expertise. Simultaneously, the “commodification” of science and the ability to harness large research grants sometimes undermines pedagogic rigor through a different metric but by its very nature, the field of anatomical sciences is built through mentorship and hands on experience underpinned by a commitment to continued learning and improvement of knowledge and skills. This is further fostered by interactional expertise (Collins and Evans, 2002), which can be acquired by “deeper immersion in the linguistic discourse” of the applicable scientific field (e.g., medicine, forensic science, surgery, biomedical sciences). In the academic environment difficulty in securing experts who not only are able to competently deliver a demanding subject, but also provide context to the clinical and scientific application of the subject material is a tangible impediment (McCuskey et al., 2005; Doss and Brooks, 2016). While not academically desirable, it is no longer uncommon for new anatomy graduates to be prematurely catapulted to levels of expert roles that may require greater skill sets and knowledge at which the level of proficiency may not provide. At the same time, the consistently evolving teaching and learning environment and generational shift in student cohort and associated expectations challenges existing anatomy professoriate to rethink, adapt, and innovate (Schaefer et al., 2019). Nonetheless, while most have done well through self-driven efforts, in the absence of any recertification/CPD requirements or opportunity to gain accreditation and advance anatomical knowledge, the impetus, and momentum for enhancement of expertise diminishes. The profession of anatomy is starting to see trends toward establishing a set of standards that would govern how individuals reach, establish, and maintain expertise in anatomical content, pedagogy, and education research. More emphasis is directed toward training of future anatomists in education-focused programs where students conduct rigorous evidence-based education research (Brokaw and O’Loughlin, 2015) and by engaging present anatomists in the scholarship of teaching and learning (O’Loughlin et al., 2019). In fact, there is mounting interest and evidence of professional societies commitment in supporting this effort e.g., American Association of Anatomists (AAA), American Association of Clinical Anatomists (AACA), Anatomical Society (AS) in UK, International Federative Association of Anatomists (IFAA) to enable both early and established career members to participate in formal learning sessions and to further develop expertise through collaborative training programs, postgraduate courses, and funded visiting professorships (Fraher and Evans, 2009; O’Loughlin et al., 2019). As a journal, Anatomical Sciences Education unifies these efforts by striving to maintain custodianship of its content through vigorous peer review and editorial oversight. In an effort to provide a platform for self-directed academic enhancement, the journal is purposeful in its selection of manuscripts so as to align global practices and provide opportunity for remote peer teaching, learning, and education research within the professional framework (Pawlina and Drake, 2010). While akin to medical practice in which expertise is built on deliberate practice, expertise in the anatomical sciences may be more appropriately constructed on deliberate performance – an activity defined by the “effort to increase domain expertise while engaging in routine work activity” (Fadde and Klein, 2010; Norman et al., 2018; Stigler and Miller, 2018). Applying features of deliberate practice (i.e., dissection performance, targeted study of core anatomical knowledge and its relevance to practice), deliberate performance (i.e., active teaching, student interaction, content delivery, hands on laboratory instruction) can be enhanced through several targeted approaches including mentorship, scientific avenues, and professional platforms (Streeter, 2014). Generating and enhancing relationships with peers and colleagues will create a diverse network of sponsors eager to help you succeed (Sulaiman et al., 2016). Even for anatomists whose practice may remain behind closed doors where teaching and learning co-partnerships are not accessible, the era of incentivized, media-driven, web- and electronic-based informational platforms, makes access to information empowering. As anatomists, our responsibility lies in service; through the promotion and innovation of teaching and learning, through the advancement of clinical practice, and through the curatorship of its science. To be satisfied with individual status quo is simply not good enough. In the absence of formal expectation, the drive for self-improvement in whatever form it may take is crucial to the maintenance of the collective profession and its science.

Healthcare and health professions education share many of the same problems in decision making. In both cases, there is a finite amount of resources, and so choices need to be made between alternatives. To navigate the options available requires effective decision making. Choosing one option requires consideration of its opportunity cost - the benefit forgone of the other competing options. The purpose of this abridged AMEE guide is to introduce educational decision-makers to the economic concept of cost, and how to read studies about educational costs to inform effective cost-conscious decision-making. This guide leads with a brief review of study designs commonly utilized in this field of research, followed by an overview of how study findings are commonly presented. The tutorial will then offer a four-step model for appraising and considering the results of an economic evaluation. It asks the questions: (1) Can I trust the results? (2) What are the results telling me? (3) Could the results be transferred to my context? (4) Should I change my practice?