European Journal of Cardiovascular Medicine

Significant changes have been made to medical education to include clinically relevant learning from an early age. Traditional anatomy instruction has been primarily theoretical, heavily relying on lectures, cadaver dissections, and histology. While these methods provide students with a strong foundation, they may not effectively illustrate the immediate clinical relevance of anatomical knowledge. ^[1,2] This limitation often results in reduced student engagement and difficulty in long-term knowledge retention.

To address this gap, early clinical exposure (ECE) has emerged as a novel teaching strategy in medical education. ECE allows students to engage with clinical scenarios early in their learning process, thereby reinforcing the importance of anatomy in clinical practice. ^[3,4] It bridges the gap between preclinical and clinical years by making anatomical concepts more tangible and directly applicable to patient care. Studies have shown that ECE enhances knowledge retention, stimulates student interest, and fosters active learning by incorporating case-based discussions, patient interactions, and simulated clinical experiences. ^[5,6]

Anatomy is a fundamental subject in medical education, forming the cornerstone of various clinical disciplines such as surgery, radiology, and pathology. A deep understanding of anatomical structures is crucial for accurate diagnosis, surgical precision, and overall medical practice. Traditional teaching methods, although effective in imparting theoretical knowledge, often lack real-time applicability, which can lead to students perceiving anatomy as abstract and challenging to integrate into clinical decision-making.^[7] ECE, therefore, serves as an essential educational tool, reinforcing the importance of anatomy by providing practical exposure from the beginning of medical training.

ECE also aligns with contemporary educational theories, such as constructivist learning, which emphasizes active engagement, problem-solving, and contextual learning. By immersing students in real or simulated clinical environments, ECE fosters critical thinking, decision-making skills, and an understanding of the relevance of anatomy in medical practice. Additionally, early exposure to clinical settings helps students develop professional attributes, including communication skills, teamwork, and empathy, which are vital for their future roles as healthcare providers.^[8]

As medical educators increasingly recognize the benefits of ECE, institutions worldwide are incorporating it into their curricula. However, despite its advantages, the implementation of ECE presents certain challenges, including time constraints, curriculum overload, and the need for structured guidance to ensure effective learning outcomes. Addressing these challenges requires a well-planned approach that integrates ECE seamlessly with traditional teaching methods while maintaining academic rigor.^[9]

This study aims to evaluate students' perceptions of ECE in anatomy and its impact on their learning experience. By understanding students' perspectives, educators can refine and optimize ECE strategies to enhance medical education and better prepare students for clinical practice.

This study was designed as a cross-sectional, questionnaire-based survey conducted among first-year medical students at B J Government Medical College, Pune, Maharashtra. The study aimed to assess students' perceptions regarding the integration of Early Clinical Exposure (ECE) in anatomy education. The research adhered to ethical principles and obtained necessary approvals from the Institutional Ethics Committee before initiating data collection.

The study was conducted in the Department of Anatomy at the medical college, where students were introduced to ECE as part of their anatomy curriculum. The participants included first-year MBBS students, enrolled in the academic year who had attended structured ECE sessions incorporated into their learning modules. The students were introduced to clinical scenarios, case-based discussions, and patient interactions related to anatomical concepts, under faculty supervision.

A total of 150 first-year medical students participated in the study. The sample size was determined based on feasibility and student availability during the study period. A convenience sampling method was used, where all eligible students willing to participate were included.

Inclusion Criteria

• First-year MBBS students enrolled in the anatomy course.
• Students who voluntarily agreed to participate in the study.
• Students who attended at least 75% of the anatomy sessions involving ECE.

Exclusion Criteria

• Students who opted out or did not provide informed consent.
• Students with incomplete responses to the questionnaire.
• Students who had prior exposure to ECE through other medical education programs.

A self-administered structured questionnaire was developed to assess students’ perceptions regarding ECE. The questionnaire was validated by subject experts and piloted among a small group of students (not included in the final analysis) to ensure clarity and reliability. The final questionnaire consisted of:

1. Demographic details (age, gender, prior exposure to clinical settings).
2. Likert-scale questions (1 = Strongly Disagree to 5 = Strongly Agree) assessing:
• Understanding of anatomical concepts with ECE.
• Retention of knowledge and recall ability.
• Enhancement of clinical reasoning skills.
• Interest and motivation towards anatomy.
• Challenges faced during ECE sessions.
3. Open-ended questions allowing students to provide qualitative feedback on their experiences.

• The questionnaire was distributed both online and in-person to maximize participation.
• Students were given 30 minutes to complete the survey anonymously.
• Faculty members were available during the survey to clarify doubts, but no direct influence was exerted on responses.

Data Analysis

• The collected data were entered into SPSS software (version 26.0) for statistical analysis.
• Descriptive statistics (mean, standard deviation, frequency, and percentages) were used to summarize responses.
• Inferential statistics were applied, including:
• Chi-square tests to assess associations between categorical variables.
• T-tests to compare mean scores between groups.
• A p-value of <0.05 was considered statistically significant.

Ethical Considerations

• Informed consent was obtained from all participants before data collection.
• Confidentiality was maintained, and student responses were anonymized.
• The study followed the guidelines of the Declaration of Helsinki for ethical research involving human participants.

Table 1: Student Perception of ECE in Anatomy

*Significant at p<0.05

Students' opinions on Early Clinical Exposure (ECE) in anatomy are shown in Table 1 according to a number of criteria. Each statement's percentage is the percentage of students who agreed with it, and the p-values show statistical significance (* denoting significance at p < 0.05). 85% of students reported that ECE improved their understanding of anatomy (p = 0.002, significant). 78% felt it enhanced their knowledge retention (p = 0.005, significant). 82% stated that it increased their interest in anatomy (p = 0.001, significant). 20% found it difficult to integrate concepts, though this was not statistically significant (p = 0.08). 15% experienced time constraints, which was also not statistically significant (p = 0.12).

Figure 1

Table 2: Student Suggestions for Improvement

*Significant at p<0.05

Table 2 lists student recommendations for enhancing anatomy's Early Clinical Exposure (ECE), along with the statistical significance of each suggestion's replies and the proportion of students that support it.

45% of students suggested the need for more structured guidance (p = 0.03, significant). 50% recommended increased clinical exposure (p = 0.02, significant). 60% favored more interactive learning methods (p = 0.01, significant). 55% supported the inclusion of case studies (p = 0.04, significant). 30% suggested time management training, but this was not statistically significant (p = 0.06).

Figure 2

Our results are consistent with other research that highlights how ECE can reinforce anatomical knowledge (Bergman et al.., 2018)^[1]. Pupils said that ECE helped make anatomy more interesting and relevant. The usefulness of ECE as a teaching method is demonstrated by the notable increases in interest in anatomy (p=0.001) and information retention (p=0.005).

ECE promotes active learning by integrating theoretical knowledge with clinical experiences. This method has been found to improve critical thinking skills and knowledge application in real-world scenarios^[2,4,6]. The positive reception among students in our study suggests that ECE helps bridge the gap between preclinical and clinical education, making learning more meaningful ^[3].

Several studies highlight the role of ECE in developing critical thinking and clinical decision-making skills. A study by Singh et al.. (2019) found that interactive patient-based learning sessions significantly improved medical students' ability to diagnose conditions based on anatomical knowledge. Our results indicate a similar trend, as students appreciated the opportunity to correlate anatomy with pathology and radiology, making learning more dynamic and application-oriented.^[4]

Furthermore, student motivation plays a crucial role in medical education. Turney et al.. (2020) emphasized that early patient interactions positively influenced students' attitudes towards learning, making them more proactive in understanding disease mechanisms. In our study, many students expressed that ECE helped them develop an early clinical mindset, making them feel more prepared for future clinical training.^[5]

Our findings align with multiple studies conducted across different medical institutions. Pandey et al.^[9] conducted a similar study in India and found that 82% of students believed ECE improved their anatomical understanding, making it more clinically relevant. Similarly, Patel et al.. (2020) reported that students who underwent ECE performed significantly better in conceptual recall and application-based assessments compared to those who were taught using conventional methods.^[10]

A study by Vyas et al.. (2019) emphasized that early patient interactions helped students visualize real-life anatomical variations and improved their clinical reasoning skills. This is in agreement with our results, where students reported an increased ability to correlate theoretical knowledge with real-life cases.^[11] Internationally, Dahle et al.. (2018) assessed ECE implementation in European medical schools and concluded that early integration of clinical exposure enhanced motivation, engagement, and long-term retention of anatomical concepts. Our study supports this view, as a significant number of students expressed higher interest and engagement when anatomy was taught in a clinical context.^[12]

Traditional anatomy teaching heavily relies on cadaveric dissections and theoretical lectures, which may sometimes make it difficult for students to visualize the clinical relevance of anatomical structures. George et al.. (2022) suggested that incorporating ECE helps bridge this gap by allowing students to interact with patients, observe radiological images, and engage in case discussions, thereby reinforcing their understanding.^[13]

Our study also found that students who participated in ECE felt more confident in applying anatomical knowledge in clinical settings. This is consistent with findings by Choudhary et al.. (2021), who noted that students exposed to case-based anatomy sessions performed better in clinical examinations during later years of medical education.^[14]

But there were other difficulties identified. A minority of students voiced worries about time limits, and several students found it challenging to connect theoretical ideas with clinical applications. Studies by Moxham & Plaisant (2018) revealed similar results, emphasising the necessity of organised supervision to optimise the efficacy of ECE. According to our findings, ECE was more helpful to students who got more organised supervision (p=0.03).^[15]

A significant number of students (50%) suggested increased clinical exposure, emphasizing that greater practical engagement could further enhance learning outcomes. This is consistent with studies that advocate for immersive learning environments in anatomy education (Finn et al.., 2020)^[16]. Interactive learning strategies, such as case-based discussions, were also highly recommended by students (p=0.01), suggesting that a dynamic and participatory approach is essential for optimizing ECE.

Future Implications and Recommendations

Based on our findings and existing literature, we recommend:

1. Integration of structured ECE modules with clearly defined learning objectives to ensure effective implementation.
2. Use of multimodal teaching approaches, including case-based discussions, radiological imaging, virtual reality, and patient interactions, to enhance learning.
3. Faculty training workshops to equip educators with the necessary skills to facilitate interactive ECE sessions.
4. Longitudinal studies to assess the long-term impact of ECE on students' clinical competence and professional development.

LIMITATIONS OF THE STUDY

1. The study was conducted at a single institution, limiting the generalizability of the findings.
2. The sample size of 150 students may not be representative of the broader medical student population.
3. Self-reported data may be subject to response bias.
4. The study did not evaluate long-term retention of anatomical knowledge through follow-up assessments.
5. P-values indicate statistical significance, but larger sample sizes may provide more robust validation.

ECE in anatomy is well-received by students, contributing positively to their learning experience. Most students reported improved understanding, better retention of knowledge, and increased interest in the subject. The significant statistical associations found in our study reinforce the impact of ECE as an effective learning tool. However, certain challenges, such as difficulty in correlating theory with clinical practice and time constraints, must be addressed.

Future implementations of ECE should focus on structured guidance, interactive learning methodologies, and enhanced clinical case discussions. By refining the approach to ECE, medical educators can ensure that students gain the maximum benefit from this innovative teaching strategy.

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