Introduction

Cadaver dissection is an irreplaceable part of anatomy education that enriches the student experience through a close encounter with human mortality [1–3]. Hands-on dissection is necessary for appreciating the complexity and multidimensionality of the human body, for demonstrating the breadth of anatomical variation, and for learning the basic language of medicine [1–4]. Cadaver dissection not only provides opportunities for hands-on learning, but also offers a forum for students to engage in content rich discussions and to assist in each other’s learning [5]. Nevertheless, dissection has become a lengthy and tedious activity in which much of the time is spent watching somebody else dissect [6]. In this respect, cadaver dissection is in need of a change in the teaching and learning method and peer-assisted learning may be an effective alternative.

As a form of cooperative learning, peer-assisted learning promotes more active engagement by students in the learning process and prevents them from leaving the course [7]. Peer tutoring enhances cognitive processing of the tutors by increasing attention to and motivation for learning [7]. Peer tutors acquire positive attitudes toward learning, become more confident in their ability to teach and communicate content, and experience the satisfaction of helping others [8]. The tutees also benefit from peer-assisted learning. The students who are taught by similar social groups perceive the freedom to express opinions and the ownership of the learning process [7, 9].

Several reports have compared the effect of peer-assisted versus faculty-led learning, and indicated that students’ academic achievement after peer-assisted learning was as effective as that of faculty-led learning in clinical skills training and problem-based curricula in health sciences or law [9–11]. However, there have been inconclusive results to show whether students in a peer-assisted dissection model perform better when considering objective measurements than those in faculty-led dissection [12–15]. We implemented peer-assisted learning to encourage the medical students’ participation and interactive learning in the dissection. We hypothesized that peer-assisted cadaver dissection would be as effective as faculty-led dissection in terms of students’ perceptions and retention of anatomical knowledge.

Materials and Methods

Results

The general characteristics of all participants are presented in Table 1. The two groups did not differ significantly with regard to gender or age.

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Table 1. General characteristics of study participants.

https://doi.org/10.1371/journal.pone.0142988.t001

The self-assessment scores on all but one item of the 12-item questionnaire addressing upper-limb learning objectives were significantly higher in experimental group, which performed peer-assisted dissection, than in control group, which performed faculty-led dissection. With the exception of the ability to describe the position and function of the retinacula of the wrist and the tendon sheaths of the wrist and hand, students in experimental group perceived themselves as having a better understanding of the major structures and their courses and functions than did those in control group (Table 2).

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Table 2. Comparison of self-assessment scores regarding the upper-limb learning objectives between groups.

https://doi.org/10.1371/journal.pone.0142988.t002

The total self-assessment scores were also higher in experimental group than in control group. Additionally, experimental group achieved significantly higher academic scores than did control group (Table 3).

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Table 3. Comparison of self-assessment and academic achievement scores between groups.

https://doi.org/10.1371/journal.pone.0142988.t003

Discussion

Peer-assisted learning in a dissection course enhanced medical students’ assessment in their understanding of the multidimensional structure of the human body and led to better academic results compared with faculty-led dissection. Specifically, peer tutoring experiences increase students’ understanding of course content and their retention of the information they taught to their peers [18].

The stereotype of anatomy as endless memorization can cause students to approach dissection with a negative attitude [19]. However, students with high levels of motivation and positive attitudes toward dissection tend to devote more time to and engage more actively in this task [20]. Peer-assisted learning is thought to enhance students’ attention to and motivation for the dissection and encourages them perceive their experience as more active and interesting [7]. Hendelman et al. [21] reported that most students believed that they learned more about, developed better attitudes toward, and acquired better skills including communication and self-study skills in anatomy via peer-assisted than via faculty-led learning. Additionally, we postulated that academic achievement would also be superior following peer-assisted than faculty-led learning.

This effect of peer-assisted learning was predictable insofar as this approach allows more time for the tutors to responsibly prepare, improve their teaching and communication skills, and to become more confident in self-directed learning [18]. In contrast, some tutees worried about the competence of peer tutors or their dependence on tutors. Other studies have found similar results regarding students’ complaints about peer-assisted learning [7, 14, 15, 21, 22]. However, even less-capable tutors functioned well in this role, doing their best and treating the tutees with empathy [8]. Equally, the tutees guided by students tutors tend to spend more time on self-study to compensate for their tutors lack of expertise [9, 15]. Students felt more relaxed during discussions with peer tutors than during those with faculty members, rating the immediate feedback they received from the peers more favorably than that received from the faculty [23, 24]. Eventually, the tutees viewed the dissection course as more interactive and as promoting greater ownership of the learning process [7]. The negative comments about peer-assisted learning seem to be caused by concerns about what might happen rather than by actual experiences [12]. Additionally, the negative comments may have resulted from the intentionally random assignment of students to the dissection group, which separated them from their customary and favorite study partners [22].

This study compared the learning effect of peer-assisted and faculty-led dissection, but it was limited in its ability to perform direct comparisons. First, we used different subjects at different times, so it might have had additional effects on the results. Although it was not available to compare the medical college admission tests or other parameters between two groups, the groups did not significantly differ with respect to basic characteristics; all entered the same medical school with similar levels of competence. Upper-limb anatomy education was investigated as the area of this research, which was presented by the same teacher in the unchanged curriculum from 2008 to 2012 and its outcomes were available for the evaluation in the same way between different time periods. Second, the assessment as an outcome measure was restricted to knowledge-based examinations. This study did not assess student performance such as individual dissection skills and peer group interactions. Another limitation was that student tutors had different levels of competence and were not prepared for peer tutoring through extra-education. As Cloward suggested, tutors do not have to be highly trained or excellent students [25]. Since student tutors are typically more cognitively congruent than a faculty, they tend to understand the problems their peers face and explain difficult concepts at their peers’ level of knowledge [9].

Despite these limitations, our results are still meaningful, as we used objective measures rather than merely students’ perceptions to compare the academic results of peer-assisted and faculty-led dissection. The learning outcome of peer-assisted dissection compared favorably with that of faculty-led dissection. Our study suggests several far-reaching benefits of peer-assisted learning. First, it can encourage students to participate more actively in the dissection process. Second, it is one of the effective learning methods to promote students’ academic achievement. Last, it should be an attractive alternative for the institution to alleviate the lack of faculty compared to the number of students as well.

Conclusions

The students in peer-assisted learning perceived themselves as having a better understanding of course content and achieved better academic results. Students who serve as tutors are better able to acquire knowledge by teaching and tutees are encouraged to actively participate rather than act as bystanders. Institutions should offer programs that help students understand the meaning of peer-assisted learning, to learn how to become effective tutors, and to provide constructive feedback to peers.

Supporting Information

Acknowledgments

The authors are gratefully thankful to Sun-Hee Han who assisted with cadaver preparation, data collection and data entry.