title: Arthroscopy or ultrasound in undergraduate anatomy education: a randomized cross-over controlled trial.
abstract: BACKGROUND
  The exponential growth of image-based diagnostic and minimally invasive interventions requires a detailed three-dimensional anatomical knowledge and increases the demand towards the undergraduate anatomical curriculum. This randomized controlled trial investigates whether musculoskeletal ultrasound (MSUS) or arthroscopic methods can increase the anatomical knowledge uptake.
  
  
  METHODS
  Second-year medical students were randomly allocated to three groups. 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.
  
  
  RESULTS
  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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Orthopaedic Trauma, Medical Faculty, RWTH Aachen University, 30 Pauwelsstreet, Aachen 52074, Germany. mknobe@ukaachen.de
authors.forename: Matthias
authors.initials: M
authors.lastname: Knobe
authors.forename: John Bennet
authors.initials: JB
authors.lastname: Carow
authors.forename: Miriam
authors.initials: M
authors.lastname: Ruesseler
authors.forename: Benjamin Moritz
authors.initials: BM
authors.lastname: Leu
authors.forename: Melanie
authors.initials: M
authors.lastname: Simon
authors.forename: Stefan K
authors.initials: SK
authors.lastname: Beckers
authors.forename: Alireza
authors.initials: A
authors.lastname: Ghassemi
authors.forename: Tolga T
authors.initials: TT
authors.lastname: Sönmez
authors.forename: Hans-Christoph
authors.initials: HC
authors.lastname: Pape
mesh_terms: D000328:Adult; D000715:Anatomy / Q000193:education*; D001182:Arthroscopy / Q000193:education*; D002983:Clinical Competence; D018592:Cross-Over Studies; D003479:Curriculum; D003867:Depth Perception; D004210:Dissection / Q000193:education; D004504:Education, Medical, Undergraduate / Q000379:methods*; D004521:Educational Measurement; D005260:Female; D005858:Germany; D006801:Humans; D008297:Male; D008875:Middle Aged; D017145:Models, Educational; D009141:Musculoskeletal System / Q000033:anatomy & histology / Q000601:surgery; D009985:Orthopedics / Q000193:education; D013663:Teaching; D014463:Ultrasonography; D014947:Wounds and Injuries / Q000601:surgery; D055815:Young Adult