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 Table of Contents  
ORIGINAL ARTICLE
Year : 2019  |  Volume : 14  |  Issue : 1  |  Page : 16-21

Impact of Living (Surface) Anatomy module as continuous professional development program for practicing physiotherapists


1 Department of Anatomy, Melaka Manipal Medical College (Manipal Campus), Manipal Academy of Higher Education, Manipal, Karnataka, India
2 Department of Physiotherapy, School of Allied Health Sciences (Bangalore Campus), Manipal Academy of Higher Education, Manipal, Karnataka, India

Date of Web Publication21-May-2019

Correspondence Address:
Dr. Satheesha B Nayak
Department of Anatomy, Melaka Manipal Medical College (Manipal Campus), Manipal Academy of Higher Education, Manipal - 576 104, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jdmimsu.jdmimsu_16_19

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  Abstract 


Background: It is often presumed that physiotherapists need to be thorough in their knowledge in gross anatomy prior to learning new skills or therapeutic techniques. We implemented a Living (Surface) Anatomy module for physiotherapists, prior to the teaching of therapeutic techniques, in one of the continuous professional development (CPD) programs as a supportive venture for their clinical practice. The present study intended to evaluate the impact of a CPD program on reinforcing practicing physiotherapists' knowledge, skills, and attitude for their clinical practice. Methods: A 1-day workshop was conducted on living (surface) anatomy for practicing physiotherapists (n = 27) through a CPD program. This training included manual muscle testing and body painting of selected muscles of trunk and limbs. Pre- and post-tests were conducted to analyze the impact of the module on improvement in participants' knowledge and skills. In addition, participants were requested to respond to a questionnaire (15 items) on a 5-point Likert scale. Results: Analysis of the pre- and post-test scores revealed a significant increase (34.6%) in surface anatomy knowledge. Majority of the participants opined that the workshop was organized effectively (100%) and the modules helped them to become aware of the lacunae in their knowledge (100%). They also echoed that they realized the need for continuous self-directed learning (100%) and responded that they would attempt to apply whatever they learned through the workshop in their clinical practice (96%). The overall satisfaction score reported by the participants was 9, on a rating scale ranging from 1 to 10 (1 = very poor; 10 = excellent). Conclusion: The CPD was well received by the participants, as evident from their feedback. The present study results demonstrated that the CPD had a positive impact on the participants' knowledge, skills, and attitude.

Keywords: Body painting, continuous professional development, living anatomy, manual muscle testing


How to cite this article:
George BM, Nayak SB, Venketesan P, Marpalli S, Rao MK. Impact of Living (Surface) Anatomy module as continuous professional development program for practicing physiotherapists. J Datta Meghe Inst Med Sci Univ 2019;14:16-21

How to cite this URL:
George BM, Nayak SB, Venketesan P, Marpalli S, Rao MK. Impact of Living (Surface) Anatomy module as continuous professional development program for practicing physiotherapists. J Datta Meghe Inst Med Sci Univ [serial online] 2019 [cited 2019 Dec 11];14:16-21. Available from: http://www.journaldmims.com/text.asp?2019/14/1/16/258656




  Introduction Top


Physiotherapists are health-care professionals who use techniques to evaluate and treat patients through direct bodily contact. The art of touching a patient's body by a physiotherapist will be greatly influenced by his or her anatomy knowledge.[1] Continuous professional development program (CPD) for physiotherapists has undergone enormous metamorphosis in the last two decades. Recent innovations, especially in the field of therapeutic techniques for pain management and rehabilitation, are considered to be responsible for this change. As physiotherapy is an art that requires manual skills, the Living (Surface) Anatomy module offers unique possibility to learn and practice manual skills required for analytical and therapeutic purposes for the physiotherapists.[2]

Previous studies have shown that anatomical knowledge is to be considered fundamental or very relevant in orthopedic, neurology, medical, and surgical specializations.[3],[4] Although there are no studies on the usefulness of anatomy knowledge for physiotherapists, they are also dealing with manual/electronic therapeutic techniques to the same or similar cases faced by the above mentioned specialties. It is often presumed that the physiotherapists need to be thorough in their knowledge of gross anatomy prior to learning new skills or therapeutic techniques. In India, the physiotherapy students learn anatomy in the 1st year of their bachelor course (Bachelors of Physiotherapy) through theory and practical classes. In practical classes, either the human body is dissected in front of them or already dissected specimens are demonstrated to them by the teachers. Anatomy models and  Atlas More Detailses are also being used in imparting anatomy knowledge to them. Although Living (Surface) Anatomy is very much important to them, it is not included in their curriculum. We implemented a living (surface) anatomy module for physiotherapists, prior to the teaching of therapeutic techniques, in one of the CPD programs as a supportive venture for their clinical practice.

The important areas for evaluating the impact of anatomy in an educational environment include teaching and learning methods, assessment methods, class atmosphere, and teachers' and students' study skills.[5] Our attempt in the current study was to evaluate the impact of Surface Anatomy module on physiotherapists who underwent training with us.[6] The learning styles of any learner have an important relationship with the learning outcomes. As per previous studies, there are three different ways in which a student learns: (1) Visual method – in which the student learns through something that can be seen such as diagrams and models; (2) auditory method – in which a student learns by hearing sounds and spoken words such as listening to a lecture or audiotape; and (3) kinesthetic method – in which students learn through the use of sensing element such as touch, like in doing dissections.[7] Studies have proven that these methods assist in long-term retention of information for many learners.[8] The method we chose was the Living (Surface) Anatomy module, which involved visual, auditory, and kinesthetic elements of learning. Living (surface) anatomy forms obvious connection between basic gross anatomy and clinical practice as it is the basis of physical examination. Hence, we tried to implement this Surface Anatomy module and test its impact on the physiotherapists in the current study.


  Methods Top


A 1-day CPD program on living (surface) human anatomy was conducted for practicing physiotherapists (n = 27). The program involved manual muscle testing (MMT), palpation, and body painting of selected muscles of trunk and limbs. The first author (anatomist with 14 years of experience in teaching anatomy) with the help of a physiotherapist (with 15 years of experience in teaching and clinical experience in physiotherapy) designed and facilitated the course. The study design was prepared by a medical educationalist. Pre- and post-tests were prepared by the facilitator and were validated by two professors in anatomy. The participation in the workshop was voluntary, and informed consent was obtained from every participant regarding the usage of pre- and post-tests' data for publication. Volunteers among the participants were the subject models for MMT and body painting. Special consent for using the data and pictures was obtained from the subject models before starting the module. The participants were reassured that nonparticipation or withdrawal from test, questionnaire filling, or performance as a subject model would not invite any negative consequences. Data collections were anonymous. Pre- and post-tests, with questions pertaining to the knowledge of anatomy, were conducted to analyze the impact of the module on improvement in participants' knowledge and skills. In addition, participants were requested to respond to a questionnaire (15 items) on a 5-point Likert scale. The participants were also asked to answer three other open-ended questions regarding their expectations, favorable and unfavorable factors, and learning experience during the CPD program. The study design is depicted in [Figure 1].
Figure 1: Outline of the study design

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Test structure

Pre- and post-tests delivered in this study consisted of 12 gross anatomy questions. Out of which eight were on muscles, two were on arteries, and two were on nerves. The questions demanded drawing of the muscles and arteries. A picture with anterior and posterior view of a visible human with skeleton was given with all the above-mentioned 12 questions printed below it. The participants were asked to draw the muscles/arteries as they appear in the human body. The question paper and the answer key were prepared by the first investigator and were validated by two other anatomy professors. The maximum score of the test was set as 34.

Intervention

Following pretest, all participants were assigned to an initial didactic lecture using PowerPoint presentations (PPTs) to refresh their anatomy knowledge. Attachments, nerve supply, actions, and important relations of the selected muscles were included in the PPT. Following this, MMT and surface anatomy practical sessions were conducted by the first investigator on a volunteer. For MMT, protocol recommended by earlier researchers was followed strictly.[9] The method used was “subject initiated MMT,” where concentric to isometric testing was done from the recommended starting position. Correlating both theory and MMT knowledge, the outlines of the selected muscles were drawn on the volunteers' body. The first author facilitated all the sessions of intervention.

The participants were divided into five groups of six or seven members in each group to practice the same in different subject models. Among them, one volunteer from each group consented to take part as subject model. All group members learned MMT and surface anatomy in this manner. [Figure 2], [Figure 3], [Figure 4] show the hands-on experience of the participants.
Figure 2: Participants practicing surface anatomy drawings on subject models

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Figure 3: A subject model with surface anatomy drawings of some scapular muscles

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Figure 4: Participants learning living (surface) anatomy by manual muscle testing and palpation

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  Results Top


The opinion regarding how participating in the CPD program might help them in their future physiotherapy practice was collected through a questionnaire. The responses are shown in [Table 1], [Table 2], [Table 3], [Table 4].
Table 1: Frequency analysis of responses with number and percentage of respondents (n=27)

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Table 2: Mean scores of the test items

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Table 3: Participant's opinions regarding how participation in this program might help in professional development

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Table 4: Participants' feedback regarding the knowledge, skill, and attitudes they learned through the continuous professional development program

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Analysis of the pre- and post-test scores revealed a significant increase (34.6%) in surface anatomy knowledge. Majority of the participants opined that the workshop was organized effectively (100%) and the modules helped them to become aware of the lacunae in their knowledge (100%). They also echoed that they realized the need for continuous self-directed learning (100%) and responded that they would attempt to apply whatever they learned through the workshop in their clinical practice (96%) [Table 1]. The overall satisfaction score reported by the participants was 9, on a rating scale ranging from 1 to 10 (1 = very poor; 10 = excellent) [Table 1]. The self-written words of feedback of the participants regarding the conduct of the workshop and its usefulness in improving their knowledge, skills, and attitude are given in [Table 2], [Table 3], [Table 4].


  Discussion Top


The modules of MMT and surface anatomy can offer a different learning experience to each student. We strongly believe that it is not necessary that all the achievements of the participants have to be reflected in their test scores, but the participants do learn some core skills such as learning the appropriate method of muscle testing and to touch and feel the underlying anatomical structures over the skin through this workshop. The living models assist the participants greatly in the learning of structure, functions, surface anatomy, and bodily variation, whereas learning methods with the usage of cadavers and clay/resin models may act as more passive ways for students to practice their anatomical knowledge. Thus, the living models are considered to be superior since they act as active participants in CPDs.[8]

Body painting is regarded as a very effective learning tool for living (surface) anatomy.[10],[11] It has got many positive factors. It provides conducive medium for enhancing peer communication skills, group activity, and a positive learning atmosphere.[12],[13] It is relatively an inexpensive form of learning with lot of enthusiasm and motivation among participants. This relatively new method of leaning was first reported in the year 2002.[14],[15] The body painting is considered as an effective method when it is adequately supplemented with traditional teaching of gross anatomy and clinical skill training.[10],[13]

The perception of touch involved in this method is regarded as one of the most important methods for clinical practice.[16] MMT is the most commonly used method for documenting the muscle strength. The reliability and validity of different methods to do MMT has been studied by many researchers.[17] The pioneers in MMT opine that the examiners' hand is the most sensitive and fine-tuned instrument.[18]

Physical examination in clinical setup can be considered as the clinical application of surface anatomy.[19] Living anatomy sessions with body painting, palpation, and MMT can definitely facilitate the learning of the spatial orientation of body structures, their variations among different subjects, and functional anatomy, which is necessary to learn for clinical practice.[8]

“Anatomy” is often referred to as an old-fashioned subject which is incapable to adapt to modern educational methods.[20] In the present scenario with less opportunity to conduct prosection or dissection training for allied health professionals, anatomy needs to be reinvented as a subject. This can be accomplished by moving toward functionally and clinically relevant courses in anatomy.[21] As MMT requires proper anatomical and physiological knowledge about a muscle, the Surface Anatomy module can give a good idea to the participants about the MMT procedure.


  Conclusion Top


The CPD was well received by the participants, as evident from their feedback. The present study results demonstrated that the CPD had a positive impact on the participants. Since the subject models were qualified physiotherapists, they were able to assist their peers with their communication skills. As living (surface) anatomy can be taught in any training setup with very minimal cost, the participants can get maximum benefit of the professional development program. It is true that all of them had studied anatomy as a subject in their undergraduate course, but a CPD program like this can surely improve their usage of anatomy knowledge in therapeutic techniques.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Khan MS, ul Ain Q, Hussan SI, Basher S, Iram H, Umar B, et al. Opinion of Pakistani physiotherapists/students about anatomy as a subject and method of teaching anatomy: A cross sectional survey. J Pak Med Assoc 2015;65:153-5.  Back to cited text no. 1
    
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Adam K, Peters S, Chipchase L. Knowledge, skills and professional behaviours required by occupational therapist and physiotherapist beginning practitioners in work-related practice: A systematic review. Aust Occup Ther J 2013;60:76-84.  Back to cited text no. 2
    
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Mompeo B, Pérez L. Relevance of gross human anatomy in health primary care and in clinical disciplines of medical studies. Educ Med 2003;6:41-51.  Back to cited text no. 3
    
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5.
Hadie SN, Hassan A, Ismail ZI, Asari MA, Khan AA, Kasim F, et al. Developing constructs of anatomy education environment measurement: A Delphi study. Proc Soc Behav Sci 2014;116:4219-23.  Back to cited text no. 5
    
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Tanasi CM, Tanase VI, Harsovescua T. Modern methods used in the study of human anatomy Tanasia. Proc Soc Behav Sci 2014;127:676-80.  Back to cited text no. 6
    
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Felder RM. Learning and teaching styles in engineering education. Eng Educ J 2002;7:674-81.  Back to cited text no. 7
    
8.
Collett T, Kirvell D, Nakorn A, McLachlan JC. The role of living models in the teaching of surface anatomy: Some experiences from a UK medical school. Med Teach 2009;31:e90-6.  Back to cited text no. 8
    
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Daniels L, Worthingham K. Muscle Testing – Techniques of Manual Examination. 7th ed. Philadelphia, PA: W.B. Saunders Co.; 2002.  Back to cited text no. 9
    
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Finn GM, McLachlan JC. A qualitative study of student responses to body painting. Anat Sci Educ 2010;3:33-8.  Back to cited text no. 11
    
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Finn GM. Twelve tips for running a successful body painting teaching session. Med Teach 2010;32:887-90.  Back to cited text no. 12
    
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Azer SA. Learning surface anatomy: Which learning approach is effective in an integrated PBL curriculum? Med Teach 2011;33:78-80.  Back to cited text no. 13
    
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Cody J. Painting anatomy on anatomy. J Biocommun 1995;22:14-7.  Back to cited text no. 14
    
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Op Den Akker JW, Bohnen A, Oudegeest WJ, Hillen B. Giving color to a new curriculum: Bodypaint as a tool in medical education. Clin Anat 2002;15:356-62.  Back to cited text no. 15
    
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Fager PJ, von Wowern P. The use of haptics in medical applications. Int J Med Robot 2004;1:36-42.  Back to cited text no. 16
    
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Cuthbert SC, Goodheart GJ Jr. On the reliability and validity of manual muscle testing: A literature review. Chiropr Osteopat 2007;15:4.  Back to cited text no. 17
    
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Walther DS. Applied Kinesiology, Synopsis. 2nd ed. Pueblo, CO: Systems DC; 2000.  Back to cited text no. 18
    
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Bowsher D. What should be taught in anatomy? Med Educ 1976;10:132-4.  Back to cited text no. 19
    
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Turney BW. Anatomy in a modern medical curriculum. Ann R Coll Surg Engl 2007;89:104-7.  Back to cited text no. 20
    
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Lempp HK. Perceptions of dissection by students in one medical school: Beyond learning about anatomy. A qualitative study. Med Educ 2005;39:318-25.  Back to cited text no. 21
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]
 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4]



 

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