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Year : 2012  |  Volume : 7  |  Issue : 3  |  Page : 145-148
The use of thoracoscopy to enhance medical students' interest and understanding of thoracic anatomy

1 Department of Surgery, King Saud University, Riyadh, Saudi Arabia
2 Department of Surgery, University of British Columbia, Vancouver, Canada

Date of Submission31-Dec-2011
Date of Acceptance30-Mar-2012
Date of Web Publication21-Jul-2012

Correspondence Address:
Sami A AlNassar
Division of Thoracic Surgery, Department of Surgery (37), College of Medicine, King Saud University, P.O. Box 7805, Riyadh 11427
Saudi Arabia
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Source of Support: College of Medicine Research Center, Deanship of Scientific Research, King Saud University, Riyadh, Saudi Arabia, Conflict of Interest: None

DOI: 10.4103/1817-1737.98847

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Aim: To develop a video-based educational tool designed for teaching thoracic anatomy and to examine whether this tool would increase students' stimulation and motivation for learning anatomy.
Methods: Our video-based tool was developed by recording different thoracoscopic procedures focusing on intraoperative live thoracic anatomy. The tool was then integrated into a pre-existing program for first year medical students (n = 150), and included cadaver dissection of the thorax and review of clinical problem scenarios of the respiratory system. Students were guided through a viewing of the videotape that demonstrated live anatomy of the thorax (15 minutes) and then asked to complete a 5-point Likert-type questionnaire assessing the video's usefulness. Apart from this, a small group of entirely different set of students was divided into two groups, one group to view the 15-minute video presentation of thoracoscopy and chest anatomy and the other group to attend a 15-minute lecture of chest anatomy using radiological images. Both groups took a 10-item pretest and post-test multiple choice questions examination to assess short-term knowledge gained.
Results: Of 150 medical students, 119 completed the questionnaires, 88.6% were satisfied with the thoracoscopic video as a teaching tool, 86.4% were satisfied with the quality of the images, 69.2% perceived it to be beneficial in learning anatomy, 96.2% increased their interest in learning anatomy, and 88.5% wanted this new teaching tool to be implemented to the curriculum. Majority (80.7%) of the students increased their interest in surgery as a future career. Post-test scores were significantly higher in the thoracoscopy group (P = 0.0175).
Conclusion: Incorporating live surgery using thoracoscopic video presentation in the gross anatomy teaching curriculum had high acceptance and satisfaction scores from first year medical students. The video increased students' interest in learning, in clinically applying anatomic fact, and in surgery as a future career.

Keywords: Medical students, thoracic anatomy, thoracoscopy

How to cite this article:
AlNassar SA, Hajjar W, Rahal S, Clifton J, Finley R, Sidhu R. The use of thoracoscopy to enhance medical students' interest and understanding of thoracic anatomy. Ann Thorac Med 2012;7:145-8

How to cite this URL:
AlNassar SA, Hajjar W, Rahal S, Clifton J, Finley R, Sidhu R. The use of thoracoscopy to enhance medical students' interest and understanding of thoracic anatomy. Ann Thorac Med [serial online] 2012 [cited 2023 Apr 1];7:145-8. Available from:

Over the last 15 years, teaching anatomy has faced many challenges. The component of anatomy in the undergraduate medical curricula decreased, and less emphasis is placed on teaching anatomy via dissection. [1] Since 2001, there has been a decline in the use of cadavers for anatomical dissection studies because of health and safety issues, [2] high cost of maintaining specimens, [2],[3] and employing trained staff. [3]

The development and use of computers, 3D medical visualization, and interactive multi-media have allowed the development of computer-based applications. [4],[5] Computers offered the potential for anatomy to be organized in a more compact and logical way. Nowadays, the study of living anatomy includes medical imaging technologies, such as X-ray, computerized tomography (CT), magnetic resonance imaging, and ultrasound. [6] These new systems make broad-based training experiences available for medical students at all levels. Medical students acquire proficiency and gain confidence in the ability to perform a wide variety of techniques long before they need to use them clinically. They also allow students to rehearse and refine basic operative procedures, using an unlimited pool of virtual patients manifesting a wide range of anatomic and pathologic variations.

Minimal Invasive Surgery (MIS), a procedure involving internal inspection of the abdominal and pleural cavity, has become very increasingly popular since the early 1980's because of its direct visualization of the body cavity including laparoscopy for exploring abdominal anatomy and thoracoscopy for chest anatomy. [7] MIS, together with CT with 3-dimensional reconstructions showed great potential in improving both healthcare and medical education. [8] If this is so, then MIS thoracoscopy can be a useful teaching tool. It can offer a link between clinical medicine and basic science by offering students to view and review chest wall, pleural space, pulmonary and mediastinal anatomy in a living person. However, the magnitude on how MIS thoracoscopy can be a useful teaching tool is yet to be known and published. This study aimed to develop a new video-based educational tool designed for learning anatomy based on thoracoscopic video segments captured during live surgery and determine if this new teaching tool increase students' knowledge and/or motivate them to learn anatomy, much more take surgery as their future career.

   Methods Top

The study was of two parts; Part 1 - Development of a new video-based teaching tool, and Part II - Evaluation of the new video-based teaching tool.

The development of the new video-based teaching tool involved several stages.

  1. Pre-production stage - which started with thorough research of available literatures and materials need to develop this new teaching tool. This stage also involved the formulation of the storyboard, script, shooting schedule, acquiring permissions, length of video needed, and securing the location where the shooting was conducted.
  2. Shooting stage - the actual shoot was conducted on 15 different thoracic surgeries in the operating room. With every thoracic surgery performed, we used a small video camera that was introduced to the patient's chest through a 5-mm fiberoptic scope at 30-degrees angle of visualization. Thoracic surgeries included biopsies for the diagnosis of pulmonary, pleural, or mediastinal pathology, decortications for empyema, pleurodesis for pleural effusions and pneumothorax, wedge resections of lung masses, resections of mediastinal or pleural masses and lung cancer.
  3. Post-production - Rushes from each 30-minute recordings from the 15 thoracic surgeries were assembled and edited one by one. Recordings were supplemented with anatomical landmark segments in order to produce a 30- to 45-minute video covering the essentials of thoracic anatomy. A panel comprising two thoracic surgeons, two surgical educators, an anatomist, and an undergraduate medical students' educator was formed to review the content of the video with regards to appropriateness and clarity of the video for teaching. To test the visual and anatomical quality of the finished product, we approached a small group of naïve subjects comprised of educators and surgeons after final editing.
To evaluate the satisfaction, motivation of students and usefulness of the newly developed video teaching tool, we sent emails to 119 first year medical students during their respiratory block for viewing of the video, which demonstrated live anatomy of the thorax for 15 minutes. A surgeon was present to guide and explain the different steps of the procedure showing the participants the important anatomical landmarks of the chest and the thorax. At the end of the presentation, participants were asked to fill up a 6-item Likert-type survey questionnaire with questions related to their experience with the presentation on thoracic anatomy. Scores on the individual items of the Likert questionnaire were summarized with descriptive statistics using percentages for each score and mean ± standard deviation for the average score of the whole group.

To evaluate gain in knowledge with the use of the newly developed video-based teaching tool, we invited a different set of students for a pretest - post-test recall system. Twenty-six medical students (who were not part of the video demonstration/Likert survey) were divided into two groups randomly (first in line and all odd-numbered position in one group, and 2 nd and all even-numbered position in the other group). Both groups were given a 10-item multiple choice questions (MCQ) on chest and thorax anatomy. After the pretest, one group was guided by a thoracic surgeon through viewing of the newly developed video-based teaching tool (thoracoscopic video) for 15 minutes and the other group was guided by a radiologist through viewing of a reconstructed 3-diemsional CT image of the chest and thorax anatomy. After the presentations, a post-test which consisted of the same questions as the pretest was given to all students of both groups. For testing short-term knowledge of chest anatomy, results from both groups were compared to see if this new teaching modality has improved short-term knowledge of chest anatomy. MCQ scores (Pretest vs Post-test) were compared in between the two groups (Radiology vs the MIS thoracoscopy group) using t-test. A P value of <0.05 was considered statistically significant.

   Results Top

One hundred nineteen first year medical students aged 21 to 22 years participated in the survey. All were males. [Table 1] shows that 88.6% of the participants were satisfied with the teaching session using thoracoscopic video presentation as a tool to teach thoracic anatomy, 3.8% remained neutral, and 7.7% were dissatisfied of the session. The thoracoscopic video presentation was thought to be beneficial in 69.2% of respondents, 23.1% remained undecided, and 7.7% perceived no benefits to their understanding of anatomy. Most of the participants (88.5%) were satisfied with the presentation and they wanted this tool to be implemented to the anatomy curriculum, whereas 7.7% remained neutral in their decision, and 3.8% would not recommend this tool to be part of the curriculum. Majority of the participants (96.2%) agreed that the presentation increased their interest in learning anatomy, whereas 3.8% were dissatisfied. Many participants (84.6%) were satisfied with the overall quality of the images used in the presentation, 3.7% remained undecided, and 11.6% were dissatisfied with the quality of the images. [Figure 1] shows a screenshot from the MIS thoracoscopic video. When participants were asked about whether thoracoscopy increased their interest in surgery as future career, 80.7% thought that this new teaching tool increased their interest in surgery as future career, whereas 11.6% remained undecided, and 7.7% strongly disagreed.
Figure 1: A screenshot taken from the MIS thoracoscopic video showing the intercostal veins and the azygous vein

Click here to view

[Table 2] shows the short-term knowledge gained among the 26 randomized participants. The mean pre-test scores between the MIS thoracoscopy group (6.33 ± 1.63, 95% confidence interval (CI) of ±0.89 with range of 5.44 to 7.22) was not significantly different (P = 0.6964) from the radiology group (6.09 ± 1.38, 95% CI of ±0.75 and range of 5.34 to 6.84). Mean post-test scores were also not significantly different (P = 0.1511) between both groups (6.40 ± 1.59 and 5.55 ± 1.21, respectively). Mean post-test scores decreased in the Radiology group (6.09 ± 1.38, 95% CI of ±0.75 pretest to 5.55 ± 1.21, 95% CI of ±0.66 post-test, P = 0.3408). On the other hand, the mean post-test score of the MIS thoracoscopy group increased from 6.33 ± 1.63, 95% CI of ±0.89 pre-test to a post-test mean of 6.40 ± 1.59, 95% CI of ±0.86. (P = 0.9061).

The Radiology group showed a mean decrease in the overall MCQ scores by 8.96 ± 11.75%, 95% CI ±6.39, whereas the MIS group showed a mean increase in the overall MCQ scores by 1.05 ± 2.35%, 95% CI ±1.28. There was a significant difference in the overall mean changes in the MCQ scores between the two groups (P = 0.0175) [Figure 2].
Figure 2: Changes in the MCQ scores (pretest to post-test)

Click here to view

   Discussion Top

Our results showed 88.6% satisfaction with the teaching session using MIS thoracoscopy as a new tool to teach thoracic anatomy. This satisfaction rate is high. In fact, not only were the students satisfied with MIS thoracoscopy, but 69.2% perceived benefit from the presentation. The rate for success if MIS thoracoscopy will be implemented as a teaching tool will be very high considering 88.5% of the students responded positively toward the implementation of this new teaching tool into the medical curriculum. The high quality of images further increased the satisfaction rate and interest of the students. Heightened interest plus good quality of images equals better retention and better recall. Although some of our participants were dissatisfied with the overall quality of the images, these issues can be easily resolved though enhancement using the most advanced digital technologies. Quality of images will significantly improve in the future.

Based on the short-term knowledge testing that we have obtained from the 26 participants, though were not significant, there were improvements in the test scores, particularly those who attended the MIS thoracoscopy session. Although the observation was conducted in a very short gap of time, we were able to observe and show relative differences in the pretest and post-test scores. In fact, students who had viewing of the MIS thoracoscopy showed increase in test scores by a mean of 1.05, by far better to students of the radiology session, whose scores decreased significantly by 8.96 [Figure 2]. This could be attributed mainly to the lack of interest of students to learn based on how the presentation was done and the lack of a stimulating factor which a video presentation possesses.

Another important aspect of this study that we have so far disclosed is the increase in the students' interest to take surgery as a future career. We have shown that the implementation of this new teaching tool has significantly increased the students' interest to take surgery as a future career. In both parts of our study, students are interested to take surgery as a future career.

Therefore, to incorporate this into a PBL curriculum, we agree with prior studies that imaging techniques have great potentials in both healthcare and medical education. [5],[6],[7] We have shown that the development of technically advanced videos from thoracoscopic procedures will further enhance learning of the thoracic anatomy through positive stimulation, enhancement of students' interest, and acquisition and retention of knowledge even more than just radiological images. The use of live surgery via thoracoscopic video presentation in the gross anatomy teaching curriculum was well perceived by medical students and students expressed high satisfaction scores. The video increased student's interest in learning, in clinically applying anatomic fact, and in selecting surgery as a future career. However, we think this new teaching tool will supplement rather than replacing the existing standard method of teaching anatomy such as cadaver dissection. Such teaching tool is an area for future research to evaluate and assess its usefulness in teaching and learning thoracic anatomy.

   Acknowledgment Top

This work was funded by College of Medicine Research Center, Deanship of Scientific Research, King Saud University, Riyadh, Saudi Arabia.

   References Top

1.Needham C, Wilkinson C, Soames R. Virtual reality haptic human dissection. Stud Health Technol Inform 2011;163:397-9.  Back to cited text no. 1
2.Gogalniceanu P, Madani H, Paraskeva PA, Darzi A. A minimally invasive approach to undergraduate anatomy teaching. Anat Sci Educ 2008;1:46-7.  Back to cited text no. 2
3.Turney BW. Anatomy in a modern medical curriculum. Ann R Coll Surg Engl 2007;89:104-7.  Back to cited text no. 3
4.Höhne KH, Pommert A, Riemer M, Schiemann T, Schubert R, Tiede U, et al. New kinds of 3-dimensional atlases of the anatomy and function of the human body. Z Arztl Fortbild (Jena) 1995;89:430-5.  Back to cited text no. 4
5.Cahill DR, Leonard RJ, Marks SC Jr. A comment on recent teaching of human anatomy in the United States. Surg radiol Anat 2000;22:69- 71.  Back to cited text no. 5
6.Kaspar M, Dech F, Parsad NM, Silverstein JC. Web-based stereoscopic visualization for the global anatomy classroom. Stud Health Technol Inform 2010;163:264-70.  Back to cited text no. 6
7.Jimenez AM, Aguilar JF. Laparoscopy: Learning a new surgical anatomy? Anat Sci Edu 2009;2:81-3.  Back to cited text no. 7
8.Snow RE, Gardner H, Salomon G. Interaction of Media, Cognition and Learning (paperback). Hillsdale, New Jersey: Lawrence Erlbaum Associates (Publisher); 1994.  Back to cited text no. 8


  [Figure 1], [Figure 2]

  [Table 1], [Table 2]

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