Teaching Methodologies of Gross Anatomy Education for Undergraduate Physiotherapy Students: An Updated Scoping Review

Abstract

Gross anatomy provides essential knowledge about the structure and function of the human body. Understanding human anatomy requires specific skills from physiotherapy students to comprehend and memorize the location and relationships of anatomical structures. This review aims to summarize the current evidence on teaching methodologies in anatomy education for undergraduate physiotherapy students. A scoping review was conducted consulting the PubMed, EBSCO, SCOPUS, and Web of Science databases. By analyzing ten studies involving over 1380 students, we identified four primary pedagogical approaches: the use of technological tools, combined traditional methods (such as dissections and radiological imaging), interprofessional education, and the innovative use of animal dissections. The findings highlight that hands-on, practical activities, especially those integrating technology (e.g., virtual reality and interactive quizzes), significantly enhance student engagement and knowledge retention. Collaborative learning through interprofessional education was found to foster a deeper understanding of anatomical concepts and improve teamwork skills, which are crucial for clinical practice. Additionally, the inclusion of traditional methods like dissections and radiological imaging, when paired with modern tools, offers a comprehensive approach that bridges theoretical knowledge with practical application. The use of animal dissections also emerged as an innovative strategy to enhance anatomical comprehension. In conclusion, the literature underscores the importance of adopting diverse and innovative teaching strategies in gross anatomy education for physiotherapy students. Such approaches not only enrich the learning experience but also ensure that students are well prepared for the demands of professional practice.

1. Introduction

Human anatomy is a fundamental branch of biological sciences that focuses on the structural organization of living organisms, particularly humans. This discipline is divided into several subfields, each concentrating on different aspects of bodily structures. Gross anatomy, or macroscopic anatomy, deals with the study of anatomical features visible to the naked eye, such as organs and tissues. In contrast, microscopic anatomy delves into structures requiring magnification, including cells and tissues. Developmental anatomy examines the morphological changes from conception through maturity, while clinical anatomy applies anatomical knowledge to clinical practice, enhancing diagnostic and therapeutic capabilities [1].

In most of the university degree programs of physiotherapy, the general objective of human anatomy training is to provide an in-depth understanding of the human musculoskeletal system’s morphological and functional aspects. This includes studying muscular, joint, neural, and vascular structures [2]. For instance, at Complutense University of Madrid, the curriculum for the Physiotherapy degree includes a Human Anatomy course, divided into Human Anatomy I and II, comprising a total of 12 ECTS (European Credit Transfer System) credits. Theoretical knowledge is imparted through lectures, while practical sessions are conducted at the Body Donation Center and Dissection Rooms, utilizing plastinated prosection models and imaging techniques such as ultrasound, X-ray, or magnetic resonance imaging. Digital platforms such as Anatomy Learning© or Clinical Key Student©, along with recommended anatomy coloring books, are also integrated into the curriculum [3].

The evolution of the physiotherapy profession from a technical training program to a recognized university degree has necessitated a reevaluation and enhancement of teaching and learning strategies. This evolution aims to improve students’ abilities to recognize and understand the complex anatomical structures of the musculoskeletal system. The integration of new teaching methodologies allows students to analyze the morphofunctional implications of these structures, compare and identify their actions in physiotherapeutic contexts, and develop essential skills for evaluating their morphology and functionality [2,3].

Anatomical knowledge is crucial for establishing diagnostic criteria and informing clinical practice [4]. Hence, the anatomy curriculum for physiotherapy students must be oriented toward clinical applicability, emphasizing anatomical data pertinent to disease understanding, patient examination, and treatment planning. Clinical anatomy is effectively taught when students can identify anatomical structures during physical examinations, distinguish between physiological and pathological features in radiographs, and explain the implications of injuries to specific anatomical components [1].

The mastery of human anatomy necessitates that students develop skills to comprehend and memorize the spatial relationships of anatomical structures. Additionally, they must cultivate appropriate spatial orientation and communicate using precise technical language [5]. To achieve these competencies, physiotherapy students must thoroughly understand the musculoskeletal components and the influence of neuroanatomy on their function [6]. This foundational knowledge is essential for performing accurate functional and clinical evaluations and successful treatment applications [7].

In the context of gross anatomy education, various methodologies are employed in health science-related university degrees. These include student-performed anatomical dissections, the use of prosections, plastinated models, digital tools, and imaging techniques like magnetic resonance imaging and ultrasound [8]. Among these resources, dissection and prosection have been the most extensively used and are considered the most effective methods for achieving educational objectives, as indicated by studies involving medical students [9,10,11].

The utilization of cadaveric material in anatomical education dates back to the Middle Ages and the early Renaissance and remains a cornerstone of the Human Anatomy course curriculum, despite the declining rates of body donations [9]. Dissection as a primary teaching method offers students a tangible understanding of the three-dimensional relationships of anatomical structures, reinforcing the theoretical knowledge acquired through lectures [12,13].

Digital resources represent one of the most innovative teaching methodologies in anatomical education. While some reviews suggest that students favor traditional methods, digital approaches provide an autonomous and cost-effective alternative for active learning. These methods have been shown to yield anatomical knowledge acquisition comparable to traditional dissection and prosection methods but at a reduced cost in terms of human and material resources for universities [14,15,16]. Examples of digital tools include 3D anatomical atlases, virtual reality, and augmented reality [8]. These methodologies, along with complementary imaging techniques, have been positively received by students in both the short and long term [17].

Balancing knowledge acquisition, skill development, and learning outcomes is a complex challenge that requires continuous professional development for educators to enhance the quality of their teaching [5]. Addressing this issue within the university community is crucial, given the increasing demand from students to enhance their clinical proficiency and adapt to technology-oriented study programs.

According to the statutes of the professional association of physiotherapists and the law, physiotherapists are responsible for prevention, health promotion, research, teaching, and management tasks within the physiotherapy unit and as part of the multidisciplinary team [18]. From a teaching perspective, instructional approaches are particularly relevant. Therefore, synthesizing information from research reports on educational innovation is necessary to develop strategies for long-term knowledge retention, professional competence, and effective transfer to clinical practice [19,20]. The COVID-19 pandemic, along with cultural and religious considerations, has also impacted the availability and handling of cadavers in anatomical education, presenting additional challenges [6,21].

Considering the importance of employing attractive and effective teaching methodologies for learning human anatomy, the objective of this study is to synthesize current evidence on the teaching methodologies employed in anatomy education for undergraduate physiotherapy students.

2. Materials and Methods

2.1. Study Design

Given that the current guidelines recommend consulting a minimum of 3 databases to adequately conduct a literature review [22], a search was conducted in the PubMed, EBSCO, SCOPUS, and Web of Science databases. To improve the quality, this report followed the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Scoping Reviews) guidelines [23]. The review protocol was prospectively registered (Open Science Framework https://doi.org/10.17605/OSF.IO/WZBJR (accessed on 25 August 2024)).

2.2. Data Sources

The literature search was conducted using a sequence of MeSH (Medical Subject Headings) terms and free terms, combined with Boolean operators AND (for the inclusion of two elements), OR (for the inclusion of one of the two elements), and NOT (for the inclusion of one element but excluding those containing the other). The search strategy used in PubMed, EBSCO, and Web of Science was (Education [Mesh] OR learn* OR teach* OR exam* OR test OR e-learn* OR online OR course OR pedagogy) AND ((Gross OR morphology*) AND anatomy) AND (Undergraduate OR pre-graduate OR student OR trainee) AND (physiotherapy OR physical therapy OR physiotherapist OR physiotherapists OR physical therapists OR physical therapist).

For Scopus, the same search equation was used as in the other databases, except for the addition of the Boolean operator “AND NOT” to exclude terms from the search that were not related to the topic of the work. Therefore, the search equation used was (education OR learn* OR teach* OR exam* OR test OR e-learn* OR online OR course OR pedagogy) AND (gross AND anatomy OR morphology* AND anatomy) AND (undergraduate OR pre-graduate OR student OR trainee) AND (physical AND therapy OR physiotherapy OR physiotherapist OR physiotherapists OR physical AND therapist OR physical AND therapists) AND NOT (nursing OR dentistry OR occupational AND therapy).

2.3. Study Eligibility Criteria

To be included in the data synthesis, the articles had to be published (1) from 2019 to 2024 (to analyze the latest resources and methodologies and update the last scoping review published in this context [6]), (2) either in English or Spanish, and (3) articles published in full-text form. Additionally, the studies had to analyze specific gross anatomy teaching methodologies, specifically targeting physiotherapy undergraduate students. Conversely, review studies, abstracts, and proceeding designs, as well as those studies targeting students from other health-related disciplines or involving postgraduate students, were systematically excluded.

2.4. Resources

Mendeley Desktop v.2.110.2 software for Windows (Glyph & Cog, LLC, Petaluma, CA, USA 2008) was used to collect the search results from the databases. First, duplicates were removed. Second, the titles/abstracts of the articles were examined by two authors (one with +10 years of experience in review designs and one with 1 year of experience) to determine their possible eligibility. Finally, each author analyzed the full article to decide if the study could be definitively included or not. Both reviewers had to achieve consensus on the articles’ inclusion or exclusion. In case of a discrepancy, a third researcher (with +10 years of expertise in review designs) was consulted.

To synthesize the information from the selected articles, a standardized data extraction form was used containing questions about the characteristics of the study population, the teaching methodology applied, the study variables, and the results, according to the STARLITE guide [24].

3. Results

3.1. Article Selection

In the initial literature search, a total of 122 articles were identified (PubMed: 48, Scopus: 5, EBSCO: 65, and Web of Science: 4). Thirty-six duplicate studies were deleted. Subsequently, the remaining 86 documents were subjected to the selected inclusion and exclusion criteria, abstracts were examined, and articles unrelated to the study topic were discarded. Finally, after evaluating the resulting 14 full-text articles, 4 were discarded for exclusionary reasons, leaving a total of 10 studies that met the inclusion criteria.

The results of the search and selection process (identification, screening, eligibility, and analysis) of the 122 studies identified in the search to the 10 studies included in the review [7,25,26,27,28,29,30,31,32,33] are described in the flowchart shown in Figure 1.

3.2. Data Synthesis

The geographical distribution of the studies mainly covered European countries, with more than one study conducted in Spain (n = 2), followed by Germany, Sweden, and Malta, each with one study included. From North America, one study from the United States of America (USA) and one study from Canada were included; from the Asian continent, one study from Turkey; from Oceania, one study from Australia; and finally, from the African continent, one study from South Africa.

The total number of participants in the analyzed articles was 1383 individuals. The ratio of male to female participants was recorded in only five of the studies. In these studies, fewer men were reported in the samples, apart from the study by Ortega et al. [25]. The number of female participants in the studies where the gender of the sample was identified was 212, while the number of male participants was 126. The age of the participants was recorded in only four studies, where it was calculated that the age range was between 18 and 28 years.

An assessment of whether the samples consisted solely of physiotherapy students or were composed of mixed disciplines revealed that six studies (60%) included only physiotherapy students or physiotherapy personnel in anatomy programs exclusively in the sample, and four studies (40%) included mixed disciplines of students. In mixed disciplines, most non-physiotherapy students were medical students, followed by occupational therapy students, nursing students, and exercise science/physiology students.

The qualitative synthesis of the results is available in

Table 1. Qualitative data synthesis of results from the articles included in the review.

Study Information	Objective	Methodology	Outcomes Assessed	Key Findings
Blum et al. 2020 [7] Germany n = 148	Implementation of an interprofessional course teaching functional anatomy, clinical examination, and evaluation of the lower spine and hip to medical and physiotherapy students.	-Participants were divided into two groups attending three 40-min workshops. -Workshops included clinical practices, identification/palpation of anatomical structures, and demonstrations of anatomical prosections. -Randomized grouping of medical and physiotherapy students to facilitate interprofessional communication.	-Pre- and post-assessment using an 18-question questionnaire on anatomical knowledge and clinical evaluation techniques. -Questions rated on a five-point Likert scale. -Additional sub-questions on interprofessional learning experiences from peers and instructors.	-Significant improvements in post-workshop scores (p < 0.001) across all groups. -Physiotherapy students had a 9.1% improvement, while medical students showed higher improvements of 17.6% and 19.9% in two groups. -Medical students benefited more from live anatomy and clinical assessment exercises compared to physiotherapy students
Cuschieri & Narnaware 2023 [26] Malta n = 26	Explore the enhancement of anatomy learning through gamification using the online quiz-based platform “Kahoot!” and assess short-term knowledge retention.	-Use of the Kahoot! platform for multiple-choice quizzes based on gross anatomy topics. -Quizzes conducted after classes on the abdomen and pelvis over four sessions (one per week). -Students compared experiences between traditional classes and those with Kahoot!. Final session included an anonymous survey on the learning experience using a Likert scale.	-Repetitive exposure to anatomical knowledge. -Impact of interactive tools on learning. -Student engagement and knowledge retention.	-Positive short-term knowledge retention observed with increased scores in Kahoot! quizzes. -Students reported a better learning experience after using Kahoot!, with all agreeing it improved their short-term retention. -Kahoot! created a competitive yet non-threatening environment, motivating participation and making the learning process enjoyable.
Fournier & Groh 2020 [27] Canada n = 128	Investigate physiotherapy students’ perceptions of a cadaveric anatomy course and the impact of different practical exam formats.	-Students worked in groups of 4–6 per cadaver in dissection rooms, using weekly worksheets, prosections, plastinated samples, and other resources. -Two assessment formats were compared: 2016–2017 had timed oral exams, while 2017–2018 used “bell ringer” exams. -The oral exam involved answering three progressively complex questions in 8 min. -The “bell ringer” exam required students to rotate through 30 stations, answering two questions per station in 1 min.	-Physiotherapy students’ perceptions of the course and the learning environment, including preparation difficulty, time adequacy, and perceived exam effectiveness.	-“Bell ringer” cohort found the exam more difficult to prepare for compared to the oral exam cohort (p < 0.05). -Oral exam cohort felt they had enough time to answer questions and that the exam tested their ability to apply anatomical knowledge (p = 0.09). -Both cohorts agreed that practical exams were motivating, confidence-boosting, and effective assessments, inspiring problem-solving and teamwork.
Kinirons et al. 2019 [28] United States n = 57	Evaluate the effectiveness of alternating dissection and peer teaching versus prosection demonstrations in teaching macroscopic anatomy to physiotherapy and occupational therapy students.	-Six cadavers were used by 6 laboratory groups (9–10 students each), which were further divided into two subgroups (A & B). -Course divided into four blocks based on anatomical regions. -Peer teaching sessions were alternated with dissections and prosection demonstrations by faculty. -Practical exams in block 4 included questions reflecting the learning experience of each subgroup (A-Dissection, B-Dissection, A-Demonstration, B-Demonstration).	-Influence of alternating dissection and peer teaching on academic outcomes. -Impact of prosection demonstrations on academic outcomes.	-Subgroup A performed better on practical exams related to structures they dissected, while Subgroup B performed better on those they learned through peer teaching. -No significant differences were found between subgroups in the impact of faculty-led prosection demonstrations on academic performance. -Alternating between dissection and peer teaching is a viable approach when cadaver resources are limited, with no clear advantage of one method over the other.
Kurul et al. 2020 [29] Turkey N = 72	Investigate the effects of manipulative anatomy training using an immersive virtual reality (VR) system on physiotherapy students’ learning outcomes compared to traditional lecture-based classes.	-Students divided into VR group (n = 36) and control group (n = 36). -Both groups received 30 min of anatomy training focused on the head and neck region; the VR group used 3D VR devices (Oculus Rift®), while the control group attended a traditional lecture. -A 15-question questionnaire was administered before and after the sessions to evaluate learning outcomes. -Students’ perceptions of the VR training were assessed using a five-point Likert scale.	-Change in questionnaire scores between pre-test and post-test for each group. -Students’ perceptions of the VR experience.	-Significant improvement in post-test scores for both groups, with the VR group showing a greater increase (107%) compared to the control group (26%). -88.8% of VR group students agreed or strongly agreed that they enjoyed studying anatomy with VR. -83.3% of VR group students agreed or strongly agreed that it was easy to understand the location of structures using VR. -The study demonstrated the effectiveness of immersive VR in improving learning outcomes in anatomical education.
McDonald et al. 2021 [30] Australia N = 711	Compare the effect of introducing team-taught practical classes (versus individual teaching) by analyzing student evaluation results and participation in a macroscopic anatomy course.	-The study involved a second-year anatomy course delivered in a blended format at two campuses. -In 2018, team-teaching was implemented at the metropolitan campus, while individual teaching continued at the regional campus. -The 2018 cohort’s results were compared with the 2017 cohort’s baseline data (individual teaching at both campuses). -The course covered regional anatomy of the spine, lower limbs, and thorax over 12 weeks. The primary activity was a weekly two-hour practical class using prosected cadaveric specimens, radiographs, plastinated sections, and models. -The team-teaching format included a lead demonstrator, a clinical demonstrator, and a peer demonstrator. The lead teacher delivered the class and led group discussions, while all demonstrators interacted equally with students.	-Learning outcomes were measured using grades from semester assessments, the final exam, and overall grades. -Student engagement was measured by the proportion of online videos accessed and the number of views and posts on discussion forums.	-Final grades increased across all cohorts in 2018. -For physiotherapy students, there was a slight grade increase at both campuses, while for the exercise science/physiology cohort, grades improved at the metropolitan campus (team-taught) but slightly decreased at the regional campus (individually taught). -Semester grades also improved across all cohorts.-No significant differences were found in online video access between the cohorts. -Forum activity slightly decreased overall between 2017 and 2018, with a decrease in forum views at the metropolitan campus and an increase at the regional campus. - The study concluded that team teaching in practical anatomy classes improved learning outcomes.
Ortega et al. 2023 [25] Spain N = 45	Implement a teaching strategy for the Human Anatomy course in the Physiotherapy Degree, using dissection of fresh porcine hip and knee pieces to enhance learning of these regions through manipulation.	-The study involved first-year physiotherapy students enrolled in the Human Anatomy course during the 2021–2022 academic year. -The dissection activity was conducted as a complement to lectures. Knowledge assessments were administered before and after the dissection. The assessments contained different but equally difficult questions to avoid bias. -After the activity, students completed an anonymous and voluntary survey with 24 items. -The workshop lasted 120 min and took place in the University School’s Simulation Unit. -The dissection involved fresh pig joints (hip and knee) obtained the previous day, stored in a refrigerator, and dissected in two parts: one led by the teacher and one by students in groups of 2–3.	-Student self-perception of knowledge acquisition was assessed on a scale from 1 to 5 (1 = Strongly Disagree to 5 = Strongly Agree). -Correct perception of the physical characteristics of the structures was evaluated (1 = low to 5 = high). -Student satisfaction was measured based on organization, experience, and instructor evaluation.	-The average evaluation score before the activity was 3.73 out of 10, and after the activity, it increased to 7.31, a statistically significant improvement. -Descriptive statistics indicated a high level of student satisfaction with the strategy, organization, and instructor competence. -95.5% of students expressed interest in repeating dissections with other anatomical parts or in higher courses. -Only 18% of students reported unpleasant sensations from handling animal structures, lower than what is typically reported in cadaveric dissections.-The dissection of porcine joints improved students’ understanding of the structures relevant to their future practice and increased their academic performance and motivation.
Pettersson et al. 2023 [31] Sweden n = 16	To study how students perceive the human body using 3D digital images and to observe students’ actions and interactions with visualization tables.	-The study involved 16 students from three different programs: 6 physiotherapy students, 2 nursing students, and 10 medical students. -The students ranged from first to tenth semester. They worked in pairs using a Sectra table (model F18) with a 65” 4K resolution monitor, which displayed 3D images of the human body rendered through CT and MRI scans of real patients. -The images were linked to a fictitious clinical case. Students were observed during the sessions, recorded, and interviewed about their experiences. -The sessions lasted approximately two hours, and students were supported by an experienced anatomy tutor who played a passive role, only assisting with questions about the table. Students were instructed to explore the images and think aloud.	-Patterns of action that occurred while the students used the visualization table to explore anatomy images.	-Seven qualitative action patterns emerged from the data analysis: 1. Decoding the image: Students’ attempts to understand critical features like colors, shadows, or shapes. 2. Positioning the body in space: Orienting themselves to the displayed image and its relation to the whole body. 3. Purposeful searching: Goal-oriented actions, often linked to a hypothesis about what to find. 4. Using knowledge and experience: Applying prior knowledge or clinical experiences to discern the images. 5. Making use of and creating variation: Actively manipulating the images, rotating them, and viewing from different angles to understand anatomy. 6. Aimless exploration: Randomly scrolling, changing images, or zooming without clear direction. 7. Reaching moments of understanding: Significant moments of insight into the anatomy. - The study provides insights into how students build an understanding of anatomy using 3D visualization tools, revealing the diverse ways they interact with and interpret anatomical images.
Shead et al. 2019 [32] South Africa N = 32	To establish what content and pedagogy physiotherapists in the Gauteng province, South Africa, consider necessary for a gross anatomy curriculum for South African physiotherapy students.	-Participants included physiotherapists in public or private practice and physiotherapy lecturers from the University of Witwatersrand (WITS). -Data were collected through semi-structured interviews using open-ended questions. The questions were adapted continuously based on the direction of the discussion and ongoing data analysis. -The interviews began with the question, “Please tell us about the way you were taught gross anatomy when you were a physiotherapy student,” and were modified according to the flow of conversation. -Field notes and reflective “personal notes” were used to complement the data collected.	-Open-ended questions about the most suitable teaching methodology for undergraduate physiotherapy students.	-Seven themes emerged from the analysis: 1. The “skeleton” of anatomy: Core anatomical knowledge required. 2. Anatomy: “A touching experience”: The importance of hands-on experience in learning anatomy. 3. “Personnel matters” in anatomy: The need for properly trained instructors, preferably physiotherapists, to enhance the clinical relevance of anatomy education. 4. “Student embodiment” in anatomy education: Considering the emotional burden on students. 5. Gross anatomy classes: The structure and delivery of anatomy education. 6. “Time is of the essence”: Addressing time constraints in teaching anatomy. 7. “Knowing how to do anatomy” for physiotherapy practice: Practical application of anatomy knowledge. -The findings suggest that while dissection remains the preferred method for teaching anatomy, time constraints may necessitate the use of prosection or digital tools. However, digital tools were not favored as the primary teaching method. -Surface anatomy knowledge was highlighted as crucial for clinical competence, indicating its importance in the curriculum. -The study emphasizes the need to adapt the anatomy curriculum to address time constraints and ensure the emotional and educational needs of students are met, with a strong preference for hands-on and clinically relevant instruction.
Valera-Calero et al. 2023 [33] Spain N = 148	To analyze students’ opinions on the inclusion of cross-sectional and radiological images in traditional teaching methodologies, aiming to evaluate whether these resources enhance their ability to identify musculoskeletal structures in radiological images and understand the neurovascular and visceral structures related to specific muscles to avoid during invasive procedures.	-The study was conducted during the first semester of two consecutive academic years. -Traditional teaching methods were used during weeks 1–8, including lectures, basic radiological imaging concepts, and a 3D anatomy atlas (via the Visible Body app). -Weeks 9–15 focused on cross-sectional images and the identification of musculoskeletal structures in radiological images. The Visible Body app, along with various cross-sectional images and ultrasound (US) images, were used for teaching. -Students completed a six-item survey and two tests with open-ended responses: one after the traditional methods (week 9) and another after completing the full methodology (week 14).	-Students’ perceptions of the usefulness of cross-sectional and ultrasound images as complementary resources to traditional anatomical education based on 3D applications and lectures. -Students’ ability to correctly identify musculoskeletal structures in radiological images. -Students’ ability to consider the visceral and neurovascular structures representing potential risks during dry needling procedures.	-Test scores significantly improved after the introduction of cross-sectional and radiological images, especially in MRI and US images (p < 0.001). Students showed better accuracy in identifying structures in MRI than US images. -Students demonstrated a significantly better understanding of anatomical risks after studying with cross-sectional images in the chest, neck, lower limb, and upper limb locations (p < 0.001). -The majority of students (81.8%) found cross-sectional images useful for learning anatomy, 91.7% believed these images improved their understanding of anatomical relationships, and 93.9% felt they helped in understanding radiological images. -Despite the positive feedback, 30.3% of students found cross-sectional and radiological images to be unappealing resources for learning anatomy. -The study concluded that cross-sectional images are effective in improving students’ ability to correctly identify musculoskeletal structures and better understand the high-risk neurovascular and visceral structures, which is crucial for guiding invasive procedures in clinical practice.

. The examined studies evaluated four different pedagogical approaches in anatomy teaching: the use of technological resources (n = 4); the combined use of prosections, dissections, x-ray images, and plastinated specimens (n = 3); teaching methods through interprofessional education (n = 2); and the implementation of animal joint dissections (n = 1).

The methods of evaluation and measurement of the implemented methodologies in the studies were mostly characterized by questionnaires administered before and after the interventions, followed by the use of a “bell ringer” exam format (a technique for rapid and brief assessment) compared to an oral exam format, evaluation of the final course grades, study and interpretation of student actions and interactions when performing the intervention through recordings, and finally, interviews and discussions conducted with open-ended questions.

4. Discussion

4.1. Overview of Current Trends in Anatomy Education for Physiotherapy Students

This review responds to the need to update the available evidence (as the last review was conducted many years ago [6]) in the field of education applied to physiotherapy, providing a comprehensive analysis of the current teaching methodologies in anatomy for undergraduate physiotherapy students. In summary, four types of methodologies applied to the teaching of gross anatomy for physiotherapy degree students were found, involving both theoretical techniques combined with practices [25,27,28,29,30,32,33], as well as purely theoretical [26] or practical [7,31] sessions.

Teaching through interprofessional education highlights the importance of knowledge exchange between different student and professional groups. This approach promotes collaboration and interdisciplinary understanding, preparing students for diverse clinical environments and promoting a more comprehensive understanding of anatomy and its practical application.

On the other hand, this review emphasizes the benefits of both dissection and peer teaching in learning anatomy. Alternating between these methods not only improves students’ academic performance but also provides valuable practical and cognitive skills for their future professional practice.

The use of technological resources, such as interactive games and virtual reality, offers new perspectives on how technology can enhance knowledge retention and motivate students. However, it is crucial to consider potential challenges, such as “cyber sickness”, to ensure the effectiveness and safety of these tools.

Finally, the use of animal specimens for teaching human anatomy provides students with a deeper and more tangible understanding of anatomical structures, better preparing them for clinical practice. Ultimately, the combination of various methodologies provides a comprehensive and effective approach to teaching and learning anatomy in physiotherapy students. By adapting and combining these methods according to students’ needs and preferences, their educational experience can be optimized, better preparing them for their future professional careers.

4.2. Technological Resources in Anatomy Education

Four studies tested this methodology in Malta [26], Sweden [31], Spain [33], and Turkey [29]. The methodologies across the four studies on anatomy education share some commonalities but also differ in their approach to integrating technology into learning environments. Kurul et al. [29] and Pettersson et al. [31] both focused on leveraging advanced digital technologies to enhance the learning experience. Kurul et al. utilized immersive virtual reality (IVR) to create an engaging and interactive environment for students, allowing them to explore anatomical structures in a three-dimensional space. Similarly, Pettersson et al. investigated how students discern anatomical structures using digital 3D models, focusing on the effectiveness of these models in improving spatial understanding and identification skills.

In contrast, Valera-Calero et al. [33] and Cuschieri et al. [26] employed more traditional resources alongside digital tools. Valera-Calero et al. integrated cross-sectional and radiological images into the curriculum, aiming to enhance students’ ability to relate clinical images to anatomical structures. Cuschieri et al. blended the use of clinical cases and cadaveric specimens with digital enhancements to improve the anatomy learning experience. This approach retained a strong emphasis on traditional dissection and clinical applications, supplemented by digital tools to bridge gaps in understanding.

Despite these differences, a common thread across all studies is the incorporation of digital technology to some degree, whether through IVR, 3D models, or radiological imaging, reflecting a broader trend in anatomy education towards hybrid learning environments. However, the level of technological integration varied, with Kurul et al. and Pettersson et al. focusing more heavily on digital immersion, while Valera-Calero et al. and Cuschieri et al. emphasized the augmentation of traditional methods with digital tools.

The outcomes of these studies collectively indicate that the integration of digital tools, whether in immersive environments or as supplemental resources, generally enhances the learning experience in anatomical education. Kurul et al. [29] found that immersive VR significantly improved students’ engagement and understanding of complex anatomical relationships, making the learning process more interactive and effective. Similarly, Pettersson et al. [31] reported that digital 3D models helped students better visualize and understand anatomical structures, particularly in terms of spatial relationships, which are often challenging to grasp through traditional methods alone.

Valera-Calero et al. [33] observed that the inclusion of cross-sectional and radiological images helped students develop a more integrated understanding of anatomy, especially in clinical contexts, by bridging the gap between theoretical knowledge and practical application. Cuschieri et al. [26] found that the combination of digital tools with traditional methods, such as cadaveric dissection and clinical case discussions, led to improved short-term retention and a more comprehensive learning experience.

The findings across these studies suggest that, while digital tools are valuable in enhancing anatomical education, their effectiveness is maximized when integrated thoughtfully with traditional teaching methods. Immersive technologies like VR and 3D models offer significant benefits in terms of engagement and spatial understanding, but they are most effective when used alongside established practices like dissection and radiological interpretation. This integration allows students to benefit from the strengths of both digital and traditional approaches, leading to a more well-rounded and effective learning experience in anatomy. Overall, the studies advocate for a hybrid approach that combines the best aspects of digital innovation with the proven effectiveness of traditional methods in anatomy education [34,35,36,37]. However, while technological resources provide substantial benefits, they are not without limitations. The cost of implementing advanced technologies like VR can be prohibitive for some institutions, potentially leading to disparities in educational quality. Moreover, the studies have shown that, while digital tools are effective, they should be used in conjunction with traditional methods such as dissection to offer a comprehensive learning experience. Therefore, the successful integration of technology in anatomy education requires a balanced approach, combining the strengths of both digital and traditional methods to optimize learning outcomes.

4.3. Human Dissections and Prosections

The combined use of prosections, dissections, radiographic images, and plastinated samples was identified in a study conducted in Canada [27], one in Australia [30], and the last one in South Africa [32].

Fournier and Groh [27] conducted a pilot study on the impact of a cadaveric anatomy course for physical therapy students, focusing on how cadaver dissection affects students’ understanding of anatomy and their ability to apply this knowledge clinically. This study utilized a hands-on approach with cadaveric specimens, emphasizing the importance of tactile learning and real-life anatomical variations in educational outcomes. In contrast, McDonald et al. [30] investigated the effectiveness of team-taught anatomy courses, where students were taught by multiple instructors rather than a single instructor. The methodology included a comparative analysis of student performances in courses with different teaching formats, aiming to identify whether team teaching leads to better academic results and a deeper understanding of the material. The third study, published by Shead et al. [32], examined the impact of integrating clinical scenarios into anatomy teaching, where students were exposed to anatomy in a contextualized manner, closely related to clinical cases. This approach was designed to improve students’ ability to apply anatomical knowledge in clinical settings, emphasizing a problem-based learning methodology that bridges theoretical knowledge with practical application.

Commonalities among these studies include a focus on improving the practical application of anatomical knowledge and enhancing students’ understanding through innovative teaching methodologies. However, the differences lie in the specific techniques used: Fournier et al. emphasized hands-on dissection, McDonald et al. explored team-based teaching formats, and the South African study focused on the integration of clinical scenarios into anatomy education.

The outcomes from these studies suggest that varying approaches to anatomy education can significantly impact students’ learning experiences and outcomes. Fournier and Groh [27] found that cadaveric dissection provided physical therapy students with a deeper understanding of anatomical structures and a greater ability to translate this knowledge into clinical practice. This hands-on experience was seen as irreplaceable in helping students grasp the three-dimensional complexity and variability of the human body. McDonald et al. [30] reported that team-taught courses led to better academic performance and a more comprehensive understanding of anatomical concepts. The presence of multiple instructors provided diverse perspectives and expertise, which enriched the learning environment and helped students to develop a more rounded understanding of the subject matter. Finally, Shead et al. [32] demonstrated that integrating clinical scenarios into anatomy teaching enhanced students’ ability to connect theoretical knowledge with practical application. Students were better able to visualize how anatomical knowledge is applied in real-life clinical situations, leading to improved retention and comprehension of complex concepts.

The integrated findings from these studies underscore the value of diverse teaching methodologies in anatomy education. The hands-on experience of cadaveric dissection, as highlighted by Fournier and Groh [27], remains a cornerstone of anatomical learning, providing irreplaceable insights into human anatomy that are difficult to achieve through other methods. However, the benefits of team teaching, as shown by McDonald et al. [30], suggest that diverse instructional approaches can enhance understanding by exposing students to a broader range of expertise and perspectives. The integration of clinical scenarios further supports the idea that contextualized learning, where students are encouraged to apply their knowledge to real-world problems, is crucial for developing practical skills and deep comprehension. These studies collectively advocate for a blended approach to anatomy education, where traditional methods like cadaveric dissection are supplemented with innovative instructional strategies such as team teaching and problem-based learning [32]. This approach can lead to more effective and holistic learning outcomes, preparing students not only for academic success but also for practical application in clinical settings.

4.4. Animal Dissections and Prosections

The use of an innovative technique such as the use of porcine pieces for teaching human anatomy, through a manipulative teaching strategy, was described by Ortega et al. [25]. The findings of this study showed that the academic results of the students after the teaching strategy improved statistically significantly. More than 95% of the students agreed quite well or very much with the improvement experienced in orientation, perception of consistency, training in anatomy, and understanding of pathology. In summary, practical experience with animal joints allowed students to identify important physical characteristics that will be fundamental in their future professional practice. For example, by disarticulating the hip, they were able to appreciate its high congruence, which is crucial for understanding common fractures and dislocations in this area. When exploring the knee, they observed the real shape of the structures, especially the three-dimensional shape of the cruciate ligaments and the orientation of their numerous fibers, which helped them understand tension absorption during rotational movements.

4.5. Interprofessional Education and Collaborative Learning

Two studies were found, one conducted in Germany [7] and another in the USA [28]. Blum et al. [7] conducted a study to assess the educational value of whole-body dissection compared to other methods such as prosection and digital learning tools. Their research involved comparing groups of students who participated in different types of anatomy teaching methodologies. The study was extensive, incorporating quantitative assessments of students’ performance in anatomy, as well as qualitative feedback regarding their experiences and preferences. The results indicated that students who engaged in whole-body dissection demonstrated superior spatial understanding and retention of anatomical knowledge compared to those who only participated in prosection or used digital tools. The study concluded that whole-body dissection remains a critical component of anatomy education, especially for enhancing the deep understanding and long-term retention of anatomical knowledge.

On the other hand, Kinirons et al. [28] focused on a blended approach, where students alternated between dissection, peer teaching, and faculty-prosected demonstrations. This study was conducted among physical therapy and occupational therapy students, aiming to explore how these alternating methods influenced students’ understanding, engagement, and confidence in learning anatomy. The study employed a mixed-methods approach, utilizing both quantitative tests to measure academic performance and qualitative surveys to capture student experiences. The findings suggested that the combination of peer teaching and faculty demonstrations, along with hands-on dissection, provided a more dynamic and effective learning environment. Students reported higher engagement and confidence, attributing their positive experiences to the varied teaching methods that allowed them to approach the material from different angles.

Important methodological differences and similarities between both studies need to be discussed. While Blum et al. [7] focused on comparing whole-body dissection with other teaching methods (prosection and digital tools) in a more controlled environment, primarily using quantitative assessments to measure the effectiveness of each method, Kinirons et al. [28] used a more integrative and blended approach, alternating between different teaching methods within the same cohort of students. They combined quantitative performance data with qualitative feedback, providing a more holistic view of the educational experience.

A key commonality between the two studies is their emphasis on hands-on learning as a critical component of anatomy education. Both studies found that direct interaction with cadavers, whether through dissection or prosected demonstrations, significantly enhanced students’ understanding and retention of anatomical knowledge. However, the differences lie in the specific teaching strategies. Blum et al. focused on the effectiveness of whole-body dissection versus other methods, suggesting that dissection offers unique advantages in spatial understanding. Kinirons et al. [28], on the other hand, emphasized the benefits of a mixed-methods approach, highlighting how alternating between different methods can cater to diverse learning styles and improve overall engagement.

Integrating the findings from these studies suggests that, while whole-body dissection is highly effective for in-depth understanding and retention, incorporating a variety of teaching methods, as suggested by Kinirons et al. [28], could address different learning needs and preferences, potentially leading to a more well-rounded educational experience. Both studies underscored the importance of active, hands-on learning but proposed different strategies to maximize its benefits. A synthesized view indicates that a comprehensive anatomy education program might benefit from including whole-body dissection as a core component while also integrating other teaching methods, such as peer teaching and prosected demonstrations, to enhance engagement and accommodate various learning styles.

4.6. Recommendations for Future Research and Practice

Based on the findings of this review, several recommendations can be made for future research and practice in anatomy education for physiotherapy students. First, educators should consider adopting a hybrid approach that combines the strengths of both technological and traditional methods. This approach could include using VR to introduce complex concepts, followed by dissections or prosections to reinforce this knowledge through hands-on experience.

Second, there is a need for more research on the long-term retention of knowledge gained through different educational methods. Most studies focus on short-term outcomes, but understanding how well students retain and apply this knowledge in clinical settings is crucial for evaluating the true effectiveness of these methods.

Finally, the role of interprofessional education in anatomy learning should be further explored. While the initial findings are promising, more research is needed to determine the best ways to integrate interprofessional education into anatomy curricula and to assess its impact on students’ collaborative skills and clinical performance.

4.7. Limitations

The current review presents some limitations that need to be recognized. The most important limitations are that we included only articles written in Spanish and English and excluded unpublished studies, so some relevant information might have been missed. In addition, because of the methodological variability of the statistical calculations, methodologies, and outcomes assessed, a systematic review with quantitative analyses could not be conducted.

5. Conclusions

This review of gross anatomy education within undergraduate physiotherapy programs underscores the significance of adopting a multifaceted approach to teaching. The traditional use of cadaveric dissection remains a cornerstone in anatomical education, offering invaluable hands-on experience and an unparalleled understanding of human anatomy’s spatial relationships. Despite the rise in digital and interactive tools, which bring added engagement and flexibility to learning, cadaveric dissection continues to provide essential tactile and visual experiences that are critical for the deep comprehension of anatomical structures.

The integration of innovative technological tools, such as virtual reality, 3D models, and online interactive platforms, has been shown to enhance student engagement and comprehension when used in conjunction with traditional methods. These tools offer dynamic and accessible ways for students to visualize complex anatomical structures, thus supplementing the more classical approaches. However, the review suggests that these technological advancements should complement, rather than replace, hands-on experiences, which are vital for fostering a comprehensive understanding of anatomy.

The diverse educational strategies explored in this review also highlight the importance of active learning methodologies. Peer teaching, for example, has emerged as a valuable approach, promoting deeper learning and retention by allowing students to reinforce their knowledge through teaching. This method not only aids in solidifying students’ understanding of anatomy but also helps in developing communication and teaching skills, which are essential in clinical practice.

Moreover, the review emphasizes the potential of interprofessional education, where students from different healthcare disciplines learn together. Such an approach not only enhances anatomical knowledge but also prepares students for the collaborative nature of real-world healthcare settings, fostering teamwork and communication skills that are crucial in professional practice.

In conclusion, the optimal strategy for gross anatomy education in undergraduate physiotherapy programs lies in the balanced integration of traditional and modern teaching methods. While cadaveric dissection remains an irreplaceable component, the strategic use of technological tools and active learning methods can significantly enhance the educational experience. These approaches, when used together, prepare students more effectively for the complexities of clinical practice, ensuring a well-rounded and deeply ingrained understanding of human anatomy.