Embryology in Medical Education: a Mixed Methods Study And
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EMBRYOLOGY IN MEDICAL EDUCATION: A MIXED METHODS STUDY AND PHENOMENOLOGY OF FACULTY AND FIRST YEAR MEDICAL STUDENTS Keely Marie Cassidy Submitted to the faculty of the University Graduate School in partial fulfillment of the requirements for the degree Doctor of Philosophy in the Department of Anatomy and Cell Biology, Indiana University June 2016 Accepted by the Graduate Faculty, Indiana University, in partial fulfillment of the requirements for the degree of Doctor of Philosophy. ______________________________________ Valerie Dean O’Loughlin, PhD, Chair Doctoral Committee ______________________________________ James Brokaw, PhD December 14, 2015 ______________________________________ David Flinders, PhD ______________________________________ Polly Husmann, PhD ______________________________________ Katherine Kearns, PhD ii © 2016 Keely Marie Cassidy iii DEDICATION This dissertation is dedicated to my teachers and mentors – past and present, near and far, formal or informal – whose support and guidance helped to nurture within me an indefatigable curiosity, steadfast motivation, and joyous enthusiasm for learning. iv ACKNOWLEDGEMENTS I would like to give a deep and heartfelt thank you to my partner Brian, whose level-headed problem solving abilities and patience never ceases to amaze me. He supports my academic, professional, and personal decisions, and is always ready to make me laugh. Also thank you to The Roodles, Sky and Gunner, my study buddies and stress relievers. There is no love like that of a dog, and these two provide endless opportunities to both run around and take in the fresh air or to just sit back and enjoy life. I would also like to thank my parents and sisters (two-thirds of the Cassidy Sister Trifecta) for the years of encouragement and support. I am so blessed to have them as role models, sounding boards, and lifelong supports. My research committee – Drs. Valerie Dean O’Loughlin, James Brokaw, David Flinders, Katie Kearns, and Polly Husmann – gave valuable comments and thoughtful advice during the development of this dissertation research. Each member provided an invaluable perspective to my education, research, and professional development, and they truly deserve the moniker of my Doctoral Dream Team. It is with deep gratitude that I also thank Dr. Valerie Dean O’Loughlin for serving as my advisor and mentor at Indiana University for the past five years. I can’t begin to express how instrumental she was in helping me to develop as an educator, researcher, professional, and enthusiastic proponent of the anatomical sciences. She has the ability to know exactly when I need humor, professional advice, a sympathetic ear, or a situation- specific meme. Valerie is the best, and I look forward to many more years of learning and laughter. v Also, I would like to express to Dr. Katie Kearns how deeply I appreciated her as my supervisor for my position as the graduate assistant for the past three years at the Indiana University Center for Innovative Teaching and Learning (CITL). I have learned so much about the scholarship of teaching ad learning in disciplines both close to and far outside of the anatomical sciences. Katie has taught me how to work effectively, efficiently, and enthusiastically in all areas of life, and I am constantly impressed by her. There are many individuals and groups of people to whom I want to extend my thanks for the camaraderie, lessons, humor, and professional and personal growth I experienced during our interactions. These include fellow graduate students, especially in the Hotroom and at Table 4; Medical Sciences faculty and staff, particularly Jackie Cullison for her assistance in interview transcription; Past students and co-instructors; CITL coworkers; Learning communities and formal and informal writing groups; Fellow dog park and daycare friends; and my professional organizations, particularly the American Association of Anatomists and the Human Anatomy and Physiology Society. And finally, a reverent thank you to the individuals who choose to donate their bodies to medical education. Your practicality and altruistic actions towards bettering our understanding of anatomy and improving the education of future healthcare professionals never ceases to amaze me. May your gift serve to inspire others to do the same. vi Keely Marie Cassidy EMBRYOLOGY IN MEDICAL EDUCATION: A MIXED METHODS STUDY AND PHENOMENOLOGY OF FACULTY AND FIRST YEAR MEDICAL STUDENTS The anatomical sciences are experiencing a notable decrease in the time and resources devoted to embryology in North American medical education. With more changes assured, it is necessary to investigate the current trends in curriculum, pedagogy, and related experiences of embryology teachers and learners. To address these concerns, the researcher developed two online mixed methods surveys: one for current anatomy and embryology faculty and another for first year medical students. The faculty survey was followed by interviews with volunteers from that cohort. The researcher used a grounded theory methodology to analyze the qualitative components of the surveys, and descriptive statistics to analyze the quantitative components of the surveys. Both the faculty and student surveys illuminated the vast differences between the explicit, implicit, and null curricular components found in the numerous medical education programs represented. A combined grounded theory methodology and phenomenological approach was used to analyze the interviews with faculty. This generated a lived experience narrative of the phenomenon of teaching embryological content to medical students in the modern world, which led to a better understanding of the needs and challenges that face this subject matter and those who teach it. In this fluid era of medical education reform and integration, the perceptions and experiences of anatomy and embryology faculty and first year medical students are invaluable to assessing the curriculum and pedagogy of vii this foundational anatomical science and formulating evidence-based recommendations for the future. Valerie Dean O’Loughlin, PhD, Chair viii TABLE OF CONTENTS LIST OF TABLES .............................................................................................................xv LIST OF FIGURES ........................................................................................................ xvii LIST OF ABBREVIATIONS .......................................................................................... xix CHAPTER 1: INTRODUCTION .......................................................................................1 Curriculum Definitions and Theoretical Framework .....................................................7 Research Purpose and Questions ...................................................................................9 Overview of Research Methodology ...........................................................................10 Organization of the Dissertation ..................................................................................11 CHAPTER 2: REVIEW OF THE LITERATURE ...........................................................13 Medical Education Reform ..........................................................................................14 Change without difference .....................................................................................14 Reports on medical education curricular reform ...................................................16 Medical education governing bodies .....................................................................18 Recognition of the history of UME reform is necessary for successful future reforms ...................................................................................................................18 History of Medical Education in the U.S. and Canada ................................................19 The apprenticeship model of medical education ...................................................21 The first medical school in the U.S. and Canada .............................................21 Proprietary medical schools .............................................................................22 Entrance requirements of proprietary medical schools ..............................22 Curricula of proprietary medical schools ...................................................23 Professional medical education organizations instigate reform (1850-present) ..................................................................................................24 Reform, not revolution .....................................................................................25 Medical instructors as trained educators versus practicing physicians ......26 Medical textbook development ..................................................................26 Four preeminent U.S. medical schools led medical education reform efforts ...............................................................................................................27 Development of the discipline-based model of medical education .......................28 Academic medicine rises in the 20th century ...................................................29 ix A call for intensive curricular research ............................................................29 Flexner’s background and reputation .........................................................30 Flexner identifies his standards for medical education ..............................31 The Flexner Report ....................................................................................32