The Medical Expert Role is the central CanMEDS Role that encompasses a physician’s scope of practice, incorporating their clinical knowledge and skills.¹ Thirty-one studies were identified with this Role. Some addressed the Role of anatomy as part of students core knowledge, while others used the anatomy laboratory as a foundation for developing other clinical skills.

Three studies examined the structure of a school’s anatomy curriculum in relation to student performance on examinations and assessments. Generally, these studies determined that students performed similarly on assessments, regardless of modifications in the delivery of anatomy education. Bergman and colleagues looked at anatomy knowledge in medical students across 8 Dutch medical schools and found no correlation between the school’s approach to anatomy teaching and the student’s objective anatomical knowledge.¹² Granger & Calleson and Marshak and colleagues tried to quantify the impact of cadaveric dissection on anatomy learning outcomes. Both describe the effects of a rotational dissection system, in which groups of students alternate between traditional cadaveric dissections and other methods of learning anatomy (e.g. video tutorials, anatomy texts).^11,13 For both, there were limited, if any, differences in academic performance of those actively participated in dissection versus those that did not (i.e. learned that anatomy by alternative methods). These results are reasonably convincing, given the design of the studies, which compared cohorts and two randomized groups respectively. It must be noted that the latter study by Marshak and colleagues was limited by small medical student participant sizes (12 students in total).

The majority of studies relating to the Medical Expert Role (24 of 31) address the contribution of anatomy education to the development of related clinical knowledge or skills, including clinical reasoning and physical examination skills, surgical skills and ultrasound techniques (8, 7 and 6 studies respectively). One study specifically described the use of lightly embalmed cadavers to teach the Lachman test in conjunction with learning knee anatomy.⁹ The group randomly selected to learn on the cadavers showed both improved competence and confidence when performing the tests, though both groups had prior hands-on teaching. Three additional papers demonstrated that the integration of clinical skills, ranging from abdominal palpation to chest auscultation to musculoskeletal exams, into anatomy laboratories improved the learning of anatomical knowledge.^14-16 Theses studies also make use of comparison groups, either cohorts or randomized, which adds to the strength of the evidence.

Seven studies described benefits related to the integration of surgical skills into the undergraduate medical anatomy laboratory. The surgical skills explored by the students varied from basic surgical skills, like knot tying, suturing, use of surgical instruments and cautery to working with laparoscopic instruments to even performing a full shoulder arthroplasty on a cadaver.^18-24 Of these, all reported subjective benefits. Students’ perceived that the exercises were useful for their learning and development, and enjoyed the experience. Three studies looking at more objective benefits of surgically oriented skills had conflicting results.^19,23,24 Nematollahi and colleagues showed an improvement in both clinical knowledge and technical skills after participation in a 2 hour, fresh cadaver-based emergency surgical skills laboratory.¹⁹ This was similarly demonstrated by Schoeb and colleagues over a semester-long course.²⁴ In contrast, there were no differences found on assessments between a control group and a group that took a dissection course incorporating surgically oriented procedures on cadavers.²³ Of note, only the latter study provided a comparison between students taking and not taking the course.²³

Six studies described the introduction of ultrasound (US) into anatomy education, with varying effects on knowledge.^25-30 Five applied US to in vivo models to complement anatomy teaching and introduce US to students.^25-27,29,30 Of these, four brought US into the anatomy laboratory, in correlation with dissection topics, whereas the other held separate sessions outside of the lab that taught anatomy exclusively with US. The fourth study used US with cadavers to teach the anatomy and technique of several clinical procedures, including line insertion and pericardiocentesis.²⁷ All of these studies described subjective benefits self-reported by students. Three studies also evaluated objective outcomes. In the study by Miller and colleagues, students’ knowledge improved throughout the course and the majority (83%) were able to obtain acceptable images.³⁰ Dreher and colleagues similarly described increased student ability to identify key structures using US.²⁷ Interestingly, Sweetman and colleagues reported a small but significant decrease in the performance of the US-instructed cohort on a relevant clinical assessment compared to the cohort that had not received US-guided teaching.²⁶ Together, these studies show the potential for the successful implementation of US into the undergraduate anatomy curriculum in a variety of different ways, but consensus on their effectiveness is lacking.

The essence of the Collaborator Role is the ability of physicians to work effectively with other healthcare professionals, with the unifying goal of providing the best possible care to patients.¹ Twelve studies identified examined the effect of integrating medical students with students from other health professions around mutually relevant anatomy topics. The majority reported only survey results detailing students’ impression of the exercise. One study also included the observations of the session facilitators.³¹ Two other papers reported results across a semester long course and so was able to use grades as objective assessment of the impact of a multidisciplinary learning environment.^32,41 There was uniform agreement on the benefits of this multidisciplinary approach across students from medicine, nursing, physiotherapy, radiography and biomedical science.

The results of the other studies generally support interdisciplinary activities as valuable experiences for medical students.^33-42 Common themes that emerged include better understanding of the scope of other health care professions and enhanced mutual respect. Fernandes and colleagues even reported a positive benefit to the students’ professional identity, as individuals.³⁴ Another group reported that having dental students involving in craniofacial anatomy actually improved the medical students’ motivation to learn and enhanced their perception of the importance of the subject matter in clinical practice.³⁷ Only Krause and colleagues reported partially negative student perceptions of interprofessional anatomy education.³¹ They found the session involving 1st year medical and physiotherapy students were more collaborative, whereas the session involving 2nd year students took a more competitive tone. Furthermore, while both years valued and expressed appreciation for the session, the 2nd year medical students also voiced frustrations, feeling their knowledge of musculoskeletal anatomy and examination was inferior.

The majority (9 of 12) of interprofessional activities had students from different disciplines learning together. Two studies had the students from other health professions participating in the teaching, while McBride & Drake reported the results of an interprofessional activity that had medical students taking on the teaching Role with physician assistant students.^36-38 Overall, these studies attest to the feasibility of integrating students of different healthcare professions in the anatomy laboratory, though further studies are warranted to assess their efficacy.

The Scholar Role emphasizes skills related to either research or teaching.¹ The 11 studies identified here all relate to the development of teaching skills amongst medical students. In 10 of the 11 studies, this was achieved by giving students the opportunity to teach fellow medical students at (peer) or below (near-peer) their level. One study described medical students participating in continuing medical education for paramedics.⁴³ All of the studies reported positive self-perceived benefits, with only one study reporting objective outcomes. Nnodim found that students participating in a peer-teaching program performed significantly better on their practical exam compared to a control group.⁹ A second study found similar academic benefits between groups of non-randomly selected students.⁵²

Several studies focused on survey results from the students being taught.^44-46 Duran and colleagues found no significant difference between student ratings of medical students and professors on dimensions of motivation, communication and performance.⁴⁴ Similarly, Hall and colleagues found no significant difference in the quality of anatomy sessions taught by junior doctors compared to senior medical students, with students even reporting that they preferred the “delivery of the teaching” and experienced greater “enjoyment” in sessions given by medical students.⁴⁶

Five studies reported the perspectives of the student-teachers.^47-51 These papers presented a common theme of improved communication skills. Erie and colleagues showed further that students perceived development of competencies across several additional teaching domains, including course development and organization and student coaching and assessment.⁵⁰ This study, conducted years after their participation in the student-teacher program, allowed these students to reflect on how it prepared them for the teaching demands of residency.⁵⁰

Together, these studies demonstrate the feasibility of introducing medical students into the teaching role, with the anatomy lab as a backdrop. Though, this area of research would certainly benefit from studies to further elucidate the benefit of these exercises (i.e. whether students improve in their capacity as teachers).

The physician’s Role as a Professional is to maintain certain standards of ethics and behaviour in providing care to patients, as well as being accountable for that care.1 Of the eleven studies identified, three describe the impact on students of interacting with family members of cadaver donors.^53-55 The other studies looked at the ways in which the anatomy laboratory itself could contribute to the development of student professionalism.^56-63

Talarico  described a program that promotes the view of the cadaver as the students’ “first patient”.⁵⁵ They learn about the medical history of a body donor and their motivations for body donation, even receiving the cadaver from the funeral home and having to opportunity to meet with surviving family members afterwards. Student responses from the reflective component of the course report, among other things, that the increased interaction helped them better understand the emotions of the donor and their family, as well as develop a greater sense of compassion towards the cadaver. Kostas and colleagues and Crow and colleagues describe less intensive programs that similarly have students learning more about the cadaver they are dissecting through interactions with their families, also with positive results.^53,54 Interestingly, Cahill & Ettarh found that students’ interest in donating their own bodies decreased from 31.5% to 19.6% after participating in a 9-week dissection course, with a similar decrease in having their family members donate from 31.7% to 14.7%.⁵⁷

As to whether the gross anatomy laboratory itself contributes to the development of professional qualities, Pearson & Hoagland report an increase in altruism over a gross anatomy course.⁶⁰ Other professional attitudes, including accountability, duty, excellence, integrity and respect, did not improve, but at least remained stable. Pawlina and colleagues found a positive correlation between personal qualities of integrity and responsibility and written and practical exam marks.⁵⁶ Another study by Kuranakaran and colleagues served to highlight the role for anatomy educators in reinforcing professional behaviours and attitudes, including humanism, accountability and honesty.⁶³ Two interesting studies propose interventions to develop students’ professionalism within the anatomy lab. One, by Shiozawa and colleagues, describe a professionalism seminar that ran concurrently with the anatomy course.⁶¹ A second, by Kissler and colleagues, introduced written reflections on professional themes as part of the anatomy course.⁶² Overall, these studies provide some evidence that the anatomy laboratory experience contributes to the development of professional attitudes.

Physicians as communicators are expected to develop the ability to share health information with patients.1 Of the five studies identified as relevant to developing Communicator competencies, only Evan directly links anatomy education with patient communication.⁶⁵ This study had students design a leaflet on birth defects for patients, as part of a developmental anatomy course. Evaluations of the leaflets indicated a high degree of readability and accessibility to a wide patient audience. The others each employed techniques within the setting of the anatomy lab to utilize and/or develop student communication skills.^66-69 Each describe a different method of engaging students, including oral examination, reflective essay writing, practicing patient handoffs and interacting on social media. They all reported positive student responses, with Hennessey and colleagues noting an effect on exam marks as well.⁶⁹ While these studies do not provide strong evidence for any particular technique, they do demonstrate the feasibility of these initiatives and offer hypotheses for further research.

The Royal College identifies Leaders as those who can “contribute to a vision of a high quality health care system” by engaging others and taking responsibility for delivering quality patient care.¹ Few studies have identified leadership competencies being enhanced in anatomy education. Of the three studies identified, two were also identified being relevant to competencies in other Roles. Krych and colleagues mentioned the development of leadership skills in their description of a reciprocal peer teaching exercise (described under the Scholar Role).⁴⁸ Pawlina and colleagues did look at different leadership styles amongst medical students in the context of small groups within a gross anatomy (in addition to characteristics related to professionalism).⁵⁶ They did not look at a relationship between anatomy and leadership, but were able to identify styles of leadership best suited to small group anatomy learning. One report described a project where medical students in a gross anatomy course construct a case from a given diagnosis for written and oral presentation.⁶⁴ The authors claimed that this approach developed teamwork and leadership skills, but these skills were not formally assessed. There is certainly room for further exploration in this area, but it is perhaps best done in conjunction with other Roles.

Physicians as health advocates are expected to use their expertise and influence to address the needs of a particular group.¹ In our search, no studies were found that connected anatomy education with competencies of this Role.

The authors declare that they have no conflict of interest.