Needs Assessment of Essential Anatomy: A Perspective from Anesthesiology, Emergency Medicine, ObGyn and Orthopedics Resident

INTRODUCTION: Curricular development begins with identifying a problem, followed by a needs assessment of curricular components. Changes in pedagogical approaches and reductions in curricular time for gross anatomy have been identified as problems in undergraduate medical education. The objective of this study was to conduct a needs assessment of the most essential anatomy for residents in Anesthesiology (AN), Emergency Medicine (EM), Ob/Gyn (OB), and Orthopedics (OR) at Beaumont Health in Royal Oak, MI (the teaching hospital for Oakland Univ. William Beaumont School of Medicine). METHODS: Residents completed a survey to assess the clinical importance of 907 anatomical structures for the back, upper limb (UL), lower limb (LL), thorax (Thx), abdomen (Abd), pelvis and perineum (P&P), and head and neck (H&N) on a 1-4 Likert-scale (1=not important; 4=essential). Kruskal-Wallis analyses with a Bonferroni correction (p<0.007) were used to assess differences of top-level items for each region between residency groups. The 3 and 4 rating response frequencies for each structure formed a basis for classifications of importance: structures rated 3 or 4 by ≥75.0% were essential, 50.0-74.9% more important, 25.0-49.9% less important, 0.0-24.9% not important. RESULTS: Fifty-five residents (AN, N=6; EM, N=l5; OB, N=13; OR, N=21) completed the survey. Ratings by OR residents were significantly higher for the limbs than AN, ER, and OB, and higher for the back than EM and OB. Ratings by OB residents were significantly higher for P&P than by AN and ER residents. No ratings differences were found for Thx, Abd, or H&N. Classifications of essential and more important for all structures across body regions were: AN, 71.8%; EM, 64.5%, OB: 52.0%, OR: 99.9%. Individual regions with ≥70% of structures essential or more important were: AN (Back, Thx, Abd, H&N), EM (UL, Thx, H&N), OB (Abd, P&P), OR (all regions). Regions with ≥20% of structures as not important were: AN (UL, P&P), EM (Back), OB (UL). With few exceptions, the following were classified as essential or more important: surface anatomy, meninges, heart, great vessels, respiratory tract, thoracic skeleton, peritoneum, diaphragm, abdominal veins, skull, cervical fascial spaces, cranial nerves, thyroid and parathyroid glands, and the lumbar and brachial plexuses. CONCLUSIONS: This study conducted a needs assessment of anatomy curricular content solely from the perspective of selected non-primary care residents at a single clinical site. Significant differences in ratings were found between residents for body regions in which residents would be expected to focus their clinical (surgical) activity (notably, OR and OB). SIGNIFICANCE: This data provides insight into the importance that non-primary care residents placed on specific anatomical structures. The authors suggest that the classifications of importance for specific anatomy by these residents were informed by their clinical perspective, and can serve as a guide for curricular development in the context of reduced contact hours, new pedagogies, and vertical integration.