I. INTRODUCTION

For safe practice of medicine, proficiency in anatomy is important. Anatomy is mainly taught in the pre-clinical years. Knowledge retention decreases over time and this will affect clinical and practical application during clinical years (Jurjus et al., 2014; Zumwalt et al., 2007). Literature shows that integrating relevant anatomy with clinical teaching will reinforce the basic concepts and fill these knowledge gaps. Rajan et al. (2016) in their study show that integrating neuroanatomy refresher sessions to clinical neurological case discussions was effective in building relevant knowledge.

Monash University practices a vertically integrated curriculum to promote meaningful learning. In a vertically integrated curriculum, clinical and basic sciences are integrated throughout the program, to provide relevance to basic sciences for clinical practice (Malik & Malik, 2010; Wijnen-Meijer et al., 2020).

As part of the clinical skills development, the Women’s Health (WH) team at Monash university Malaysia in 2010 started episiotomy workshops. Episiotomy is a procedural skill, as future doctors working in Malaysia are expected to know. To perform and repair this surgical procedure safely as well as to identify potential complications, an in-depth knowledge of perineal anatomy is essential.

In 2019, the Anatomy and WH team came together to integrate a refresher anatomy component to the ongoing episiotomy workshops. The objective was to reinforce anatomy relevant to the episiotomy procedure to promote meaningful and lifelong learning.

The anatomy component was integrated virtually because the clinical and preclinical campus are located at different sites about 300km apart. The preclinical Sunway campus is located at Bandar Sunway and the Clinical School Johor Bharu (CSJB) campus is located at Johor Bahru.

Our aim was to see if this approach of virtually integrating refresher anatomy components with the episiotomy workshops will be relevant and beneficial to student learning.

II. METHODS

This cross-campus, blended learning approach, a combination of online (anatomy review session) and face-to-face (episiotomy workshops) sessions, was started in 2019 before the COVID-19 pandemic. These integrated sessions were conducted for year 5 medical students during their O&G rotation with each group attending the session only once. The anatomy sessions were remotely conducted by the anatomy team. All practical hands-on training workshops were conducted in the clinical skills lab (CSJB campus) by the WH team for the students attending onsite. The two sites were connected via a web conferencing platform/ application (Zoom).

Before the pandemic, the online anatomy sessions and the hand-on workshops were conducted synchronously. The anatomy session was in the form of a 30-minute lecture demo-presentation using various models, cadaveric plastinated specimens and images. This lecture-demo was broadcast virtually from the Monash Anatomy and Pathology e-Learning (MAPEL) Lab in Sunway campus to the clinical skills lab at CSJB. This was followed by the practical training on performing and repairing episiotomy on mannequins supervised by the WH team (see Appendix A).

During the COVID-19 pandemic, we altered the delivery format of the anatomy component due to the restrictions. The real time virtual anatomy demo-presentation was replaced by a pre-recorded video lecture uploaded to a Moodle learning management system for students to view asynchronously, before attending the workshop. During the workshop, a knowledge assessment quiz (using online polling application) was remotely conducted by the anatomy team. Each question was discussed in detail with explanation and feedback provided by both teams. This was followed by the practical, hands-on training for students attending onsite in the clinical skills lab at CSJB (see Appendix A).

At the end of the sessions, students responded to a voluntary, anonymised online survey questionnaire. The questionnaire consisted of both quantitative questions based on 5-point Likert scale and qualitative open-ended questions.

III. RESULTS

In 2021, we conducted seven integrated workshops, with a total of 59 students attending. Thirty-two students (54%) responded to the survey questionnaire, out of whom the majority (87.5%) had either observed or assisted an episiotomy procedure on real patients. Based on their feedback, most students had viewed the pre-recorded video lectures and found them useful.

As shown in Figure 1 below, 96% agreed that organization and content of pre-learning materials were effective in achieving the learning outcomes, 96% agreed that this approach refreshed their anatomy knowledge, 91% felt that the anatomy sessions were relevant to the episiotomy workshop, 96% agreed that this approach of integrating anatomy was beneficial and 93% found that this approach was effective in their understanding and application in real time practice.