European Journal of Cardiovascular Medicine

The human musculoskeletal system is fundamental to the structure and function of the body, playing a critical role in movement, stability, and overall physical health. An in-depth understanding of musculoskeletal anatomy is essential for medical students as it forms the foundation for diagnosing and managing a broad range of clinical conditions, including orthopedic, neurological, and rheumatological disorders. Despite its significance, research indicates that the knowledge and awareness of musculoskeletal anatomy among medical students often fall short of the expectations required for competent clinical practice. This discrepancy may lead to diagnostic errors, inadequate patient management, and overall diminished clinical efficacy, emphasizing the need for a more rigorous and comprehensive approach to anatomy education in medical curricula.^1-5

The traditional model of anatomy education has typically relied on cadaveric dissections, didactic lectures, and textbook-based learning. However, these methods face challenges such as limited time allocation within increasingly condensed curricula, reduced accessibility to cadaveric resources, and a lack of emphasis on practical and applied anatomical knowledge. As medical education evolves, there is a growing shift towards incorporating innovative teaching modalities, such as digital simulations, virtual dissections, and integrated clinical experiences, to bridge these gaps. Yet, the effectiveness of these modern educational approaches and the extent to which they have improved medical students' knowledge of musculoskeletal anatomy remain underexplored.^6-11

A comprehensive assessment of medical students’ knowledge and awareness of human musculoskeletal anatomy across multiple institutions provides an opportunity to evaluate current educational practices, identify gaps, and propose evidence-based strategies for improvement. This study aims to analyze the current state of knowledge among medical students from diverse institutions, examining both the strengths and weaknesses of existing anatomy education. By employing a multi-institutional approach, the study captures a broader and more representative sample of medical students, enabling a more accurate and generalizable understanding of their anatomical competencies.

In doing so, this research seeks to identify key factors influencing the proficiency of medical students in musculoskeletal anatomy, including variations in teaching methods, institutional resources, and curriculum structure. Ultimately, the findings from this study will provide valuable insights into optimizing anatomy education to better prepare future healthcare professionals for clinical practice, ensuring that they possess the necessary skills to deliver high-quality patient care.

Study Design

This multi-institutional, cross-sectional study was designed to comprehensively assess the knowledge and awareness of human musculoskeletal anatomy among medical students across multiple medical schools. The study was conducted over a six-month period, involving students from various years of study in different institutions to capture a broad spectrum of learning experiences and anatomical proficiency. The research was approved by the Institutional Review Boards (IRBs) of all participating institutions, and informed consent was obtained from all participants prior to their involvement.

Study Population

The study population consisted of medical students from three academic levels: pre-clinical (years 1 and 2), clinical (years 3 and 4), and postgraduate (interns and residents in their first year). Students were selected from five medical schools across different regions to ensure a diverse representation of curricula, teaching methodologies, and institutional resources. Participation was voluntary, and students were recruited through email invitations, online platforms, and in-class announcements. To minimize selection bias, all students who expressed interest in participating were included.

Sample Size

A sample size of 500 students was targeted, with 100 students from each participating institution. This sample size was calculated based on a margin of error of 5% and a confidence interval of 95%, ensuring adequate statistical power to detect significant differences in knowledge and awareness of musculoskeletal anatomy across different educational levels and institutions.

Data Collection

Survey Instrument

A validated, structured questionnaire was developed to assess students' knowledge and awareness of human musculoskeletal anatomy. The survey instrument was designed in two parts:

1. Knowledge Assessment: A 50-item multiple-choice question (MCQ) test was used to evaluate students’ factual and applied knowledge of musculoskeletal anatomy, including topics such as the anatomy of bones, joints, muscles, and related neurovascular structures. Questions were mapped to specific learning outcomes from standard anatomy textbooks and curriculum guidelines to ensure relevance.
2. Awareness and Perception Survey: A Likert scale-based section evaluated students’ self-perception of their proficiency, confidence in applying anatomical knowledge in clinical settings, and their opinions on the adequacy of their anatomy education. This section also gathered information on the teaching methods they were exposed to (e.g., cadaveric dissection, digital resources, clinical integration).

Data Collection Procedure

The questionnaire was distributed online through a secure survey platform to ensure anonymity and convenience for participants. Each student was allocated 60 minutes to complete the MCQ section and 15 minutes for the awareness and perception survey. To ensure consistency, the same version of the survey was used across all participating institutions. The survey was open for two weeks, and multiple reminder emails were sent to encourage participation.

Data Analysis

Scoring and Evaluation

The knowledge section was scored out of 50 points, with one point awarded for each correct answer. The total scores were categorized into three levels of proficiency: low (0-24 points), moderate (25-39 points), and high (40-50 points). Descriptive statistics, including mean scores, standard deviations, and frequency distributions, were calculated for each group of students (pre-clinical, clinical, and postgraduate) to evaluate trends in knowledge across academic levels.

Statistical Analysis

Data were analyzed using SPSS version 26.0. Chi-square tests were used to compare categorical variables, such as teaching methods and self-perceived confidence levels, across institutions. A one-way ANOVA was conducted to compare mean knowledge scores across the three academic levels and the different institutions. A post-hoc Tukey test was performed for pairwise comparisons where significant differences were found. Pearson correlation was used to evaluate the relationship between students' perceived confidence and their actual performance on the knowledge assessment. A p-value of <0.05 was considered statistically significant for all analyses.

Ethical Considerations

The study adhered to the ethical principles outlined in the Declaration of Helsinki. Ethical approval was obtained from the IRBs of all participating institutions. Participation was voluntary, and participants had the option to withdraw at any time without any academic repercussions. The survey was anonymized, and data were stored securely to ensure confidentiality.

Limitations

Potential limitations of the study include self-reported bias in the perception survey, as students may overestimate or underestimate their knowledge and confidence. Additionally, the use of an online survey may have limited participation to students with better internet access, potentially skewing the sample. Lastly, while the sample was diverse in terms of geography and institution, findings may not be generalizable to all medical schools globally.

Socioeconomic status was assessed by the Kuppuswami Scale, (table no.). Subjects were classified in upper, upper middle, lower middle, upper lower and lower socioeconomic status, based on parameters like education, occupation and family income.

By using a multi-institutional approach and diverse student population, this study aims to provide a comprehensive overview of medical students' knowledge and awareness of human musculoskeletal anatomy, offering insights into the effectiveness of current teaching methodologies and areas for improvement.

The results from Table 1 demonstrate a well-distributed demographic profile of participants across pre-clinical, clinical, and postgraduate levels, ensuring a representative sample from all stages of medical education. The gender distribution is relatively balanced, with males making up approximately 57% and females 43%. The representation from the five institutions is also balanced, with each institution contributing around 20% of the total participants. This diversity in the sample allows for a comprehensive assessment of knowledge and perceptions across different educational environments, ensuring that findings are applicable across various medical schools.

Table 1: Demographic Distribution of Participants (N = 500)

Table 2 presents the knowledge assessment scores across academic levels, revealing a progressive increase in mean scores from pre-clinical (24.7) to clinical (33.3) and postgraduate levels (38.6). The standard deviation values indicate moderate variability within groups, with postgraduate students showing the highest consistency. Notably, 44% of postgraduate students achieved high proficiency levels compared to only 13% of pre-clinical students, highlighting the impact of clinical exposure and advanced training on knowledge acquisition. The majority of students fall into the moderate proficiency category, but a significant portion of pre-clinical students remain in the low proficiency bracket, indicating room for improvement in early anatomical education.

Table 2: Knowledge Assessment Scores Across Academic Levels

Table 3 explores the variation in knowledge assessment scores by institution. Institution A achieved the highest mean score (33.4) and the highest proportion of students in the high proficiency category (31%), while Institution B had the lowest mean score (30.3) and the highest percentage of low proficiency students (26%). The remaining institutions showed intermediate performance, with similar distributions in the moderate and high proficiency categories. These differences suggest that variations in curricula, resources, and teaching methodologies across institutions significantly impact student knowledge, highlighting the importance of standardized and effective educational strategies across medical schools.

Table 3: Knowledge Assessment Scores by Institution

Table 4 outlines the self-perceived confidence levels among students at different academic levels. Confidence increases as students progress through their training, with 34% of postgraduate students reporting high confidence compared to just 11% of pre-clinical students. Conversely, 45% of pre-clinical students report low confidence levels, suggesting that foundational courses may not adequately prepare students for clinical application. Overall, while half of the respondents across all levels express moderate confidence, the trend shows that clinical and postgraduate exposure positively influences self-perception, although further support may be needed in the early stages of medical education to build confidence.

Table 4: Self-Perceived Confidence Levels in Musculoskeletal Anatomy (All Participants)

Table 5 examines the impact of different teaching methodologies on knowledge scores. The data indicates that mixed methods, which combine cadaveric dissection, digital simulations, and clinical sessions, produce the highest mean score (37.2). In contrast, institutions relying solely on cadaveric dissection or digital simulations show lower mean scores (29.3 and 32.6, respectively). Integrated clinical sessions alone also performed well (34.1), though not as effectively as the comprehensive mixed approach. These findings suggest that an integrative, multi-modal teaching approach is most effective for enhancing student understanding of musculoskeletal anatomy, providing a well-rounded and applied educational experience.

Table 5: Impact of Teaching Methodologies on Knowledge Scores

Table 6 shows a positive correlation between self-perceived confidence and actual knowledge scores, with the correlation coefficient (r) increasing from 0.46 in pre-clinical students to 0.61 in postgraduate students. This relationship, statistically significant across all levels (p < 0.01), indicates that as students progress and gain more clinical exposure, their confidence levels more accurately reflect their actual knowledge. The overall correlation coefficient of 0.54 suggests a moderate to strong relationship between confidence and knowledge across the entire cohort, reinforcing the idea that educational experiences and clinical exposure enhance both self-assessment accuracy and anatomical competence.

Table 6: Correlation Between Self-Perceived Confidence and Knowledge Scores

The findings of this multi-institutional study highlight critical insights into the knowledge and awareness of human musculoskeletal anatomy among medical students, emphasizing the impact of different educational approaches and the progression of anatomical understanding throughout various stages of medical education. These results underscore the need for an optimized, evidence-based curriculum that effectively supports students in acquiring the anatomical knowledge essential for clinical practice.

The demographic distribution, as seen in Table 1, confirms the representativeness of the sample, encompassing diverse academic levels and institutions, thereby increasing the generalizability of our findings. The balanced gender distribution and institutional representation further enhance the robustness of the data, ensuring that our conclusions are applicable across different educational environments and not limited to a specific demographic or academic structure. This diversity allows for a thorough understanding of how anatomy education varies across institutions and how this impacts the proficiency and confidence levels of medical students.

The progressive increase in knowledge scores across academic levels, as highlighted in Table 2, demonstrates the anticipated learning trajectory from pre-clinical to clinical and postgraduate stages. The highest scores observed among postgraduate students align with expectations, as these individuals have had the most clinical exposure and opportunities to integrate theoretical knowledge with practical experience. However, the relatively low mean score (24.7) among pre-clinical students and the substantial percentage (38%) of low proficiency students within this group indicate a significant gap in early anatomy education. These findings are consistent with previous literature suggesting that pre-clinical students often struggle to retain detailed anatomical information due to the lack of practical application during early training stages. This gap could be addressed by revising the pre-clinical curriculum to incorporate more interactive and application-based learning opportunities, such as simulations and clinical shadowing.^11-14

The variations in knowledge assessment scores between institutions, as depicted in Table 3, suggest that the quality and structure of anatomy education differ significantly across medical schools. Institution A, which had the highest mean score (33.4) and the most students in the high proficiency category (31%), may benefit from a more integrated and interactive anatomy curriculum. In contrast, Institution B’s lower scores (mean score of 30.3) and higher percentage of students in the low proficiency category (26%) indicate that its current approach may not be as effective. These discrepancies emphasize the need for institutions to adopt a standardized curriculum that integrates best practices, such as combining traditional cadaveric dissection with modern technology and clinical experiences. By aligning curriculum standards across institutions, educational disparities can be minimized, allowing all students to receive a consistent and high-quality anatomy education.^8-12

Table 4’s analysis of self-perceived confidence levels reveals an encouraging trend, with confidence levels rising alongside academic progression. However, the fact that nearly half (45%) of pre-clinical students report low confidence in their musculoskeletal knowledge is concerning. This may reflect the inadequacies in foundational anatomy education, which is often theory-heavy and lacks opportunities for hands-on learning. It also suggests that students at this stage may not fully appreciate or grasp the clinical relevance of anatomy, contributing to their lack of confidence. To address this issue, integrating anatomy teaching with early clinical exposure, such as case-based learning or early patient interactions, could help bridge the gap between theory and practice, thereby enhancing both confidence and retention of anatomical knowledge.^15-19

The impact of different teaching methodologies on knowledge scores, as illustrated in Table 5, provides clear evidence of the benefits of a mixed-methods approach. The highest overall mean score (37.2) among students exposed to a combination of cadaveric dissection, digital simulations, and clinical integration suggests that a comprehensive and diverse educational approach is most effective. This finding aligns with contemporary educational theories advocating for multi-modal learning strategies that cater to various learning styles and promote deeper understanding. In contrast, institutions relying solely on cadaveric dissection or digital simulations exhibited lower mean scores (29.3 and 32.6, respectively), highlighting the limitations of single-method approaches. This suggests that while traditional and digital resources each offer unique advantages, their greatest potential is realized when used in conjunction with one another and supplemented with clinical practice.^13,15,17,18

The correlation analysis in Table 6 reinforces the relationship between confidence and actual anatomical knowledge. The increasing correlation coefficient from pre-clinical (0.46) to postgraduate levels (0.61) indicates that, as students gain more clinical experience, their self-assessment becomes more aligned with their actual competencies. This positive trend suggests that clinical exposure and practical application not only enhance knowledge but also improve students’ ability to accurately evaluate their proficiency, which is critical for developing competent and self-aware healthcare professionals. The overall correlation coefficient (0.54) across all levels reflects a moderate to strong relationship between perceived and actual knowledge, underscoring the importance of providing students with opportunities to test and apply their skills in real-world or simulated clinical settings to boost both confidence and competence.

Despite these insightful findings, there are several limitations to consider. The reliance on self-reported data in the perception survey may introduce bias, as students might overestimate or underestimate their abilities. Furthermore, the use of an online survey could have limited participation to those with reliable internet access, potentially affecting the sample's representativeness. Additionally, while the sample included diverse institutions, the findings may not be fully generalizable to medical schools worldwide. Future studies could address these limitations by including a larger, more geographically diverse sample and incorporating observational and performance-based assessments to validate self-reported confidence levels and knowledge.

This study highlights the critical need for a multi-modal, integrative approach to anatomy education that incorporates traditional, digital, and clinical learning experiences to optimize students' understanding of musculoskeletal anatomy. Our findings demonstrate that enhancing anatomy education early in medical training and ensuring consistency across institutions are essential for developing confident, competent future clinicians. The insights gained from this study can inform evidence-based curriculum development aimed at improving anatomical education and, consequently, clinical outcomes in medical practice.

This multi-institutional study reveals significant insights into medical students' knowledge and awareness of human musculoskeletal anatomy, highlighting gaps in early anatomy education and variations across institutions. While knowledge levels improve from pre-clinical to postgraduate stages, the findings suggest the need for curriculum reforms that incorporate interactive, application-based learning methods early in training. Standardizing anatomy education across institutions, using a multi-modal approach that combines traditional, digital, and clinical experiences, is essential for enhancing proficiency. The positive correlation between confidence and knowledge emphasizes the importance of practical application opportunities. Overall, these results provide crucial guidance for optimizing anatomy curricula to better prepare medical students for clinical practice.

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