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Logo of bmcmeduBioMed Centralsearchsubmit a manuscriptregisterthis articleBMC Medical Education
BMC Med Educ. 2012; 12: 85.
Published online Sep 9, 2012. doi:  10.1186/1472-6920-12-85
PMCID: PMC3473305
Arthroscopy or ultrasound in undergraduate anatomy education: a randomized cross-over controlled trial
Matthias Knobe,corresponding author1 John Bennet Carow,1 Miriam Ruesseler,2 Benjamin Moritz Leu,1 Melanie Simon,3 Stefan K Beckers,4 Alireza Ghassemi,5 Tolga T Sönmez,5 and Hans-Christoph Pape1
1Department of Orthopaedic Trauma, Medical Faculty, RWTH Aachen University, 30 Pauwelsstreet, Aachen 52074, Germany
2Department of Trauma Surgery, Medical Faculty, Johann Wolfgang Goethe Hospital, Frankfurt University, 7 Theodor Stern Kai, Frankfurt am Main 60590, Germany
3Dean' office for study affairs, Medical Faculty, RWTH Aachen University, 30 Pauwelsstreet, Aachen 52074, Germany
4AIXTRA – Aix-la-Chapelle Centre for Interdisciplinary Training in Medical Education, RWTH Aachen University, 30 Pauwelsstreet, Aachen 52074, Germany
5Department of Oral and Maxillofacial and Plastic Facial Surgery, Medical Faculty, RWTH Aachen University, 30 Pauwelsstreet, Aachen 52074, Germany
corresponding authorCorresponding author.
Matthias Knobe: mknobe/at/; John Bennet Carow: bennet.carow/at/; Miriam Ruesseler: miriam.ruesseler/at/; Benjamin Moritz Leu: Benjamin.leu/at/; Melanie Simon: msimon/at/; Stefan K Beckers: sbeckers/at/; Alireza Ghassemi: aghassemi/at/; Tolga T Sönmez: ttahas/at/; Hans-Christoph Pape: hpape/at/
Received April 30, 2012; Accepted September 6, 2012.
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 randomized controlled trial investigates whether musculoskeletal ultrasound (MSUS) or arthroscopic methods can increase the anatomical knowledge uptake.
Second-year medical students were randomly allocated to three groups. In addition to the compulsory dissection course, the ultrasound group (MSUS) was taught by eight, didactically and professionally trained, experienced student-teachers 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 (75 minutes each, 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.
The ASK-group (n = 70, age 23.4 (20–36) yrs.) performed moderately better in the anatomical MC exam 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). After an additional arthroscopy teaching 1% of students failed the MC exam, in contrast to 10% in the MSUS- or CON-group, respectively. The benefit of the ASK module was limited to the shoulder area (p < 0.001). 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).
The additional implementation of arthroscopy tutorials to the dissection course during the undergraduate anatomy training is profitable and attractive to students with respect to complex joint anatomy. Simultaneous teaching of basic-skills in 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. Although arthroscopy and ultrasound teaching do not have a major effect on learning joint anatomy, they have the potency to raise the interest in surgery.
Keywords: Arthroscopy, Education, Anatomic competence, Randomized controlled trial, Knee joint, Shoulder joint, Students, Medical, Musculoskeletal ultrasound
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