A scoping review of undergraduate anatomy and physiology education: approaches to evaluating student outcomes in the United States

ABSTRACT

Studies document difficulties undergraduate pre-nursing and allied health students face when learning human anatomy and physiology (A&P) course content. A comprehensive synthesis exploring the teaching practices within the course and how those practices are evaluated is warranted. This scoping literature review identified 78 journal articles investigating teaching practices, and we charted their research methods, student outcomes, and institutional contexts. Content analysis found the teaching practices described most frequently in A&P education research literature involved multiple aligned changes across the curriculum, including student activities, course delivery, and assessments. Critical appraisal of study methodologies revealed that most studies in undergraduate A&P were longitudinal, included comparison groups, and used simple inferential statistics. In contrast, few studies listed limitations of their research, collected data from multiple institutions, or reported student demographic data. We believe these factors pose notable limitations to the interpretation of A&P education studies across institutional contexts. The results of this review identify future lines of inquiry to enrich existing evidence about pedagogical interventions in A&P courses.

INTRODUCTION

Human anatomy and physiology (A&P) courses lay the foundation for health sciences education. Students aspiring for health science careers, including medicine, pharmacy, dentistry, nursing, and allied health (1), all must take this coursework during their education. In this scoping review, A&P courses refer specifically to undergraduate introductory-level (i.e., 100 or 200 level in course catalogs) biology courses covering human biology topics for pre-nursing and pre-allied health majors. These courses are usually taught as service courses in biology departments to fulfill catalog requirements for nursing and allied health education programs, while advanced human biology or physiology courses fulfilling catalog requirements for biology majors are separate courses. A&P courses traditionally have high failure rates (2), leading to a high repeat enrollments (3, 4). Evaluating the pedagogical and curricular practices in A&P courses is vital to supporting students along this path.

Education research is critical in generating evidence for efficacy and generalizability of teaching practices (5). Current trends in education research emphasize understanding why pedagogical interventions work, incorporate robust statistical methods, and assess the validity of each data set (6, 7). A compilation and synthesis of pedagogical practices in A&P courses can inform the future design of these challenging undergraduate courses.

Health science education research in other contexts (e.g., medical school and nursing education) utilizes analytic reviews to summarize evidence about teaching practices. For example, existing reviews summarize evidence about concept mapping in medical school (8), curricular approaches to teaching surface anatomy in medical curricula (9), problem-based learning in medical education (10), and nursing school curricula (11). However, research investigating training in physician or nursing practice may not translate to undergraduate A&P settings. The resources, strategies, and outcomes may differ substantially in A&P courses within medical schools, professional schools, and upper-level undergraduate health science coursework. Thus, a synthesis of education research in these allied health-focused undergraduate courses is needed to summarize the practices being evaluated and the context and methodologies used (12).

Research questions

The goals of scoping reviews are to outline key concepts and types of evidence present in the literature to illuminate gaps in research (13, 14); thus, the present review aims to present the scope of evidence generated about A&P education practices. Our research questions were as follows:

Q1: What are the institutional settings and participant attributes in studies of nursing and pre-allied health-focused A&P education research in the United States?

Q2: What teaching practices are evaluated in these studies?

Q3: What student outcome metrics are used to evaluate A&P interventions?

Q4: What methodologies are reported in A&P education studies investigating quantitative learning outcomes?

[This research was conducted in partial fulfillment of the requirements for a Ph.D. from the University of Northern Colorado by E. A. Royse (15).]

METHODS

Scoping review methodology

Scoping review methodology synthesizes types of evidence about a given topic, using rigorous methods to search and vet the resulting compiled literature to meet specific inclusion criteria (13, 16). The protocol for this review included the development of inclusion and exclusion criteria, search process, data collection and synthesis, and critical appraisal (17). This review followed recommended reporting guidelines for scoping reviews [PRISMA-ScR; (14)].

Database searches

First, the search-and-screen process aimed to identify peer-reviewed research that used student data to evaluate pedagogical or curricular components of A&P courses in US contexts. We systematically searched six databases for peer-reviewed education research conducted in undergraduate A&P courses (Table 1). Search terms captured potential descriptors of teaching practices in A&P courses from Titles and Abstracts that met the inclusion criteria (Table 1). Eligible articles for inclusion were peer-reviewed, empirical studies about undergraduate A&P courses for nursing, allied health, or non-biology majors published prior to 31 December 2018. Included A&P courses could be described as lecture, laboratory, or a combination of lecture and laboratory components in which the course was described as an anatomy and physiology course; other biology courses having human anatomical or physiological topics as part of the curriculum were not sufficient for inclusion. Exclusion criteria, utilized in the screening stages, eliminated studies not reporting data relevant to the data charting phase (i.e., student data or teaching practice description; Table 1). Due to the comprehensive scope of this study, no starting date bound was specified in the search criteria; thus, the starting date bound was limited by the coverage of the databases searched. Additionally, all articles published in the HAPS Educator journal volumes 2016–2018 were manually added to the search results, as they were not otherwise databased. The date bounds of the HAPS Educator reflect the journal’s shift to peer-review publication process in 2016.

TABLE 1.

A priori criteria and search terms for the systematic search and screening of articles

Category	Description
Search terms	[(“anatomy and physiology” OR “human anatomy”) AND (educat* OR “education research” OR curricul* OR pedagog* OR “allied health” OR instruct* OR activit* OR teach* OR “teaching methods”)] OR [(“homeostasis”) AND (educat* OR “education research” OR curricul* OR pedagog* OR “allied health” OR instruct* OR teach* OR “teaching methods”)]
Inclusion criteria	Research included must meet all of the following: Conducted in undergraduate A&P courses or course sequences at 4-year or 2-year institutions Students identified as allied health, nursing, or non-biology majors Published in academic journals Peer reviewed Empirical (including quasi-experimental, qualitative, quantitative, and mixed methods research) or descriptive methodologies utilized
Exclusion criteria	Research meeting any one of the following criteria was excluded: Student data not systematically collected and reported Does not describe a pedagogical or curricular component of the course context
Databases searched	PsycInfo (American Psychological Association, Washington, DC) ProQuest (ProQuest LLC, Ann Arbor, MI) PubMed (U.S. National Library of Medicine, Bethesda, MD) Medline (U.S. National Library of Medicine, Bethesda, MD) CINAHL (Cumulative Index of Nursing and Allied Health Literature; EBSCO Industries Inc., Birmingham, AL) Web of Science (Clarivate Analytics, Philadelphia, PA)
Database filters selected	In each database, the following filters were used when running the search: Search fields: Title and Abstract Dates: research published prior to 31 December 2018 Languages: English Resource characteristics: Peer reviewed

Study screening and selection

After compiling the search results, duplicate citations and retracted articles were manually removed (Fig. 1). The remaining articles were uploaded into Covidence, an online software tool to facilitate analytic review processes (18). Within Covidence, researchers removed additional duplicates and completed the screening, data extraction and charting, and critical appraisal tasks. One researcher (E.A.R.) screened titles and abstracts, removing articles unrelated to undergraduate A&P contexts. Two members of the research team (E.A.R. and A.C.) independently conducted full-text screening of all articles that passed the previous phase to remove articles that did not meet all inclusion criteria or met one or more of the exclusion criteria (Table 1). For disagreements during the full-text screening phase, a third member of the research team (N.A.P. or E.A.H.) acted as a tiebreaker.

Fig 1.

Tiered screening process flowchart. Schematic to illustrate the number of articles removed or progressing through screening, data charting, and critical appraisal phases of the scoping review process, in alignment with the preferred reporting items for systematic reviews and meta-analyses—extension for scoping reviews (14).

Data charting

The data charting step of the analysis aimed to address Q1-3 and was completed by one researcher (E.A.R.). We captured details about the setting in which the research was conducted, the teaching practices described, and the types of student data (e.g., exam scores or surveys) researchers collected to evaluate the teaching practice effectiveness (Table 2). First, information from the finalized set of studies was extracted to describe the study context, including institution type and demographic data of student participants (Q1). Second, data from the finalized set of studies were extracted to summarize the pedagogical practices assessed in A&P education research (Q2). Content analysis was used to organize articles by types of teaching practices described. These deductive categories were grounded in recommendations from the Vision and Change Report [i.e., learning objectives, assessments, and instruction; (19)], as these standards describe evidence-based practices in undergraduate biology courses. The types of student outcomes collected in A&P education research to provide evidence for efficacy of pedagogical practices were also charted [Q3; (20)].

TABLE 2.

Data charting categories and code definitions

Research question	Data charted	Description and subcategories
Study context (Q1a)	Institution type	Four-year private/public/unspecified, community college, not described
	Sample size
	Student demographics	Major, race, ethnicity, gender, first-generation student status
Pedagogical tools (Q1b)	Learning objectives	Describes development or evaluation of learning objectives (i.e., student content knowledge)
	Assessment	Implementation of formative or summative assessments, both inside and outside of class meeting times
	Assignment	Learning activities assigned for students to complete outside of class meeting times, either individually or in groups
	In-class activity	Learning activities completed during class meeting times, either individually or in groups
	Course design	Pedagogical innovations impacting multiple instances of course delivery, organization, or assessment
	Resource	Intervention based on non-compulsory tools to aid in student learning
	Supplemental instruction	Interventions taking place as instruction given outside of class meeting times
Types of evidence (Q1c)	Learning outcomes	The research instruments used to measure those outcomes (e.g., examination grades, final grades, validated psychometrics) were also identified and coded Learning outcomes were defined as outcomes relating to A&P content skills or knowledge
	Satisfaction outcomes	Satisfaction outcomes were related to students’ enjoyment, interest, or perceived utility of the course
	Other outcomes	Perceived learning, student engagement (e.g., study behaviors or attendance), and other cognitive constructs (e.g., test anxiety)
	Study design	Qualitative, quantitative, or mixed methods

Critical appraisal of methodologies

The critical appraisal phase of the scoping review aimed to assess the methodologies used in the included articles to examine potential generalizability of the evidence provided by the research presented (21, 22). Only studies reporting learning outcomes were evaluated as part of the critical appraisal stage of this review. The research methods (qualitative, quantitative, or mixed methods) were coded for each article along with various indicators of research generalizability from both an objectivist and a subjectivist perspective [e.g., author discussion of limitations and bias present in the study from a subjectivist perspective, or the robustness of the statistical analyses from an objectivist perspective; (22)].

We adapted Martin and colleagues’ (23) rubric outlining methodological attributes in quantitative research for this phase (Table 3). The criteria include markers of quantitative generalizability, such as sampling robustness, statistical modeling techniques used to relate independent and dependent variables, and statement of limitations. However, we caution against interpreting studies that meet multiple criteria from the critical appraisal rubric as “better”; instead, meeting these criteria indicates the methodology used promoted generalizability beyond the sampled population. One member of the research team (E.A.R.) completed the critical appraisal for all included articles, and 20% of appraised studies were checked for agreement by another member of the research team (E.A.H.).

TABLE 3.

Number of studies meeting criteria for generalizability markers [adapted from reference (23) with permission of the publisher (copyright 2018 Wiley Periodicals, Inc)]

Generalizability marker	Criteria	Response	Number of studies meeting criteria
Sampling robustness	What was the institutional setting?	Statewide or multiple institutions	3
		One institution	59
	What was the sample size?	Sample size equal or above 300 participants	18
		Sample size below 300 participants	44
	Was there a comparison group?	Comparison group	49
		No comparison group	13
	Was the study a longitudinal design (i.e., data at multiple times for at least one cohort of students)?	Yes, it was a longitudinal study	59
		No, it was not a longitudinal study	3
	Was the study multiple cohorts?	Yes, it was multiple cohorts	51
		No, it was not multiple cohorts	11
Modeling technique	What method(s) were used to test relationship(s) between learning outcomes and independent variables?	Regression	4
		Correlation	2
		t-Test, ANOVA, or chi-square analysis	47
		Descriptive analysis	9
Limitations stated	Did author describe the limitations of the study’s findings or methods?	Yes	30
		No	32

RESULTS

Q1: Characteristics of A&P education research

As illustrated in Fig. 1, 78 articles met our inclusion criteria and were included in the data extraction and charting phase (Supplemental Materials). The greatest proportion of articles was found in HAPS Educator (n = 16), Advances in Physiology Education (n = 14), and Anatomical Sciences Education (n = 11). The most common institutional setting was public 4-year institutions (n = 34, either exclusively or as one of the contexts), followed by community colleges (n = 14), unspecified 4-year institutions (n = 8), and private 4-year institutions (n = 11).

All papers reported the majors or career objectives of the students of their population of interest, but most did not quantify the distribution of students per major in their sample (n = 51). Additionally, few articles reported race and/or ethnic identity (n = 3) or first-generation student status (n = 2) of students in their sample. Of the three articles reporting race and/or ethnic identity data, the samples of two of the studies were composed primarily of white students. The samples of both studies reporting first-generation student status were primarily continuing generation students. However, 18 of the research articles in the sample reported gender distribution of their participants. In every instance where gender was reported, the majority of students in the sample were identified as female or women, with the proportion reported ranging from 58.4% to 91.7% women.

Q2: Salient pedagogies in undergraduate anatomy and physiology

The teaching practice codes (Table 2) were numerous, aligning with the goal of scoping reviews to explore the potentially expansive key concepts present in the investigated field (14). Studies investigating learning objectives were not present in the sample of A&P education research articles, thus are not analyzed further. The two most common teaching practices in the sample were Course Design (n = 25) and In-Class Activity (n = 17), followed by Assessment (n = 12), Resource (n = 8), Assignment (n = 9), and Supplemental Instruction (n = 7).

Curricular structures in A&P

While studies coded as Course Design described many types of interventions, all described approaches to instruction impacting multiple facets of course delivery and activities. The Course Design categories included diverse A&P teaching practices, primarily focused on laboratory components. Unlike in medical and other professional schools, cadaver dissection is often unavailable to teach gross anatomy to introductory undergraduate students. Instead, anatomy teaching tools described in the sample included cadaveric prosection demonstrations (24–26), clay modeling and animal dissections (27–31), or use of plastic models (32). Inquiry-focused laboratory curricula were also described in the sample, especially as approaches for teaching physiological concepts (33, 34). Examples of how the Course Design code appeared in A&P lecture settings included flipped classroom interventions and hybrid instruction (35–38).

Studies examining activities occurring during class meetings without changes to other teaching practices were coded as In-Class Activities instead of Course Design. In-Class Activities in the sample included writing exercises (39, 40), discussion exercises (41–43), diagraming and modeling activities (44, 45), and specific, short-term laboratory activities unconnected from assessment [e.g., spirometry; (46)].

Examples of using clinical cases to support student learning and interest in A&P were found under both the Course Design and Assignment codes. Course Design examples were embedded within collaborative inquiry curriculum, such as process-oriented guided-inquiry learning, in which students in groups address questions of different levels of complexity to explore the underlying structure of a discipline (47). Assignments reflected activities students completed outside of class. The two most common types of assignments were centered around either case studies or evaluating scientific research. Case studies of clinical scenarios were often implemented to activate student interest through realistic health applications (48–50), and research-oriented projects were designed to increase familiarity and confidence in scientific literature (51, 52).

An important trend included incorporating formative assessments, which are low-stake assessments designed to provide feedback to help students self-monitor their learning (53) in the course. The Assessment code captured non-compulsory online quizzes (54) and required quizzes (55, 56). Polling questions delivered in-class were also a frequently coded form of Assessment (57–59).

Supplemental supports for A&P

The studies coded into Resources and Supplemental Instruction described supports to student learning that were supplemental to in-class instruction. Studies coded into Resources described several digital and analog tools made available to students. Digital resources included the use of digital anatomy atlases (60) and class websites (61). Studies investigating textbooks and supplements to textbooks were also coded as resources and included commercially available (62) and instructor-authored texts (63–65). The Supplemental Instruction code in the sample referred to structured peer-learning and tutoring sessions (66, 67) and instructor-led non-compulsory instruction conducted outside of class (68). This code was also used for studies describing concurrent courses and pre-semester workshops, which were designed for remediating students or students identified as benefiting from additional supports (69, 70).

Q3: Student outcomes to evaluate pedagogical practice

Most studies in the sample were quantitative (n = 64), followed by mixed methods studies (n = 11), and studies that were strictly qualitative (n = 3; Supplementary Materials). Of these studies, 65 reported learning outcomes (quantitative = 54, mixed methods = 11). The qualitative research and the qualitative data collected in most mixed methods studies (n = 9) focused on student perceptions and not student learning outcomes, precluding their analysis. Examples of how qualitative data in mixed methods studies could be used as a learning outcome were assessments of students’ drawing accuracy [e.g., references (45, 71)].

In our sample, 19 studies reported student data in the form of learning outcomes only, 8 reported satisfaction outcomes only, 5 reported outcomes other than learning and satisfaction exclusively, and 46 reported a mix of both learning and other outcomes. Most studies included at least one learning outcome in their analysis (n = 65), most commonly in the form of examination, quiz, or assignment scores (n = 42); final grades (n = 18); or non-validated questionnaires (n = 16). Satisfaction outcomes included multiple attitudes about the class that were not necessarily defined in the articles as a specific construct, including enjoyment, interest, perceived helpfulness, perceived relevance, or usability (see Table 4 for example questionnaire items for each attitude). Of the 47 studies reporting satisfaction outcomes, 45 measured the outcomes using non-validated questionnaires, and the other 2 used qualitative methods (e.g., analysis of interviews or student writing). Other outcomes represented in the sample included perceived learning (n = 3), test anxiety (n = 1), confidence (n = 1), and self-reported study behaviors (n = 6).

TABLE 4.

Sample items measuring facets of satisfaction

Satisfaction attitude	Sample questionnaire item
Enjoyment	“Did you enjoy the clay modeling?” (31)
Interest	“I was able to find a topic that was interesting to me personally.” (50)
Perceptions of helpfulness	“The interactive nature of the activity facilitated my learning of the content area.” (43)
Perceptions of relevance	“Learning human anatomy from a plastic anatomical model is as beneficial as learning from dissected human cadavers.” (26)
Usability	“It was easy to identify specimens under the microscope with the use of my smartphone and the microscope adapter.” (72)

Q4: Critical appraisal of methodologies

The prevalence of non-validated measures assessing student outcomes in these articles presents one challenge for interpreting the psychometric generalizability of their findings. Additionally, the methods and criteria for the efficacy of the evaluated teaching practices varied widely, from simple descriptive statistics to regression analyses, making comparisons between studies challenging. Other indicators of generalizability we captured included the number of discrete campuses from which data were collected, the number of participants, the presence of a comparison group, the collection of longitudinal data, the collection of data from multiple cohorts, the complexity of analysis, and the discussion of limitations (Table 3).

Sixty-two studies satisfied the criteria for the critical appraisal (i.e., used the learning outcome to evaluate a pedagogical or curricular component of the course). In these papers, statistical analysis was most often a comparison of means or frequencies (e.g., t-test, ANOVA, or chi-square test; n = 47), followed by descriptive comparisons (n = 9), correlation (n = 2), or regression (n = 4). Most studies in the critical appraisal were longitudinal studies (n = 59), included multiple cohorts of students (n = 51), and had a comparison group included in the study design (n = 49), indicating that even though the statistics used were relatively simple, the design of the studies was set up to capture changes in student learning. However, fewer than half of the studies included a “Limitations” section that considered potential methodological limitations to the presented work (n = 30).

DISCUSSION

The aims of this scoping review were to identify key instructional components evaluated in undergraduate nursing and pre-health A&P education in the United States, describe the methodologies of such research, and identify topics warranting future investigation. The articles included in the sample described diverse teaching practices and used a range of metrics to evaluate the efficacy of those practices in undergraduate A&P courses.

Teaching practices in A&P

Common approaches to A&P curriculum described in our sample are rooted in students constructing understanding through the use of teaching practices that promote student inquiry, clinical case studies, and modeling exercises. Clinical case studies and curricula based on such cases (e.g., problem-based learning curricula) can introduce diagnostic competencies earlier in the pre-nursing and pre-allied health curriculum [e.g., references (73, 74)], providing conceptual frameworks that students can construct further understanding from in later health science courses. Students using and constructing anatomical models, such as clay anatomical models (27, 30), indicate that while human cadavers are not commonly accessible in these introductory courses, modeling exercises can be an accessible approach in this context.

We posit that the efficacy of supplemental instruction warrants further investigation, as these interventions were unique in the sample because they often directly addressed the problems of remediation in A&P. As high failure, withdrawal, and remediation rates are endemic in A&P contexts (2–4), interventions focused on addressing barriers are critical for equitable and successful outcomes in A&P courses.

Learning outcomes to assess practices

Previous reviews of education research in health sciences suggest this research is limited by the lack of learning outcomes reported (12, 75). In contrast, our findings indicate that studies about A&P courses did report student learning outcomes, most often as examination grades or final grades. We caution that examination and final grades can be unreliable data about student learning due to documented equity issues with multiple-choice examinations (76) and the subjective nature of what contributes to a final grade based on instructor practices (77, 78). Assessment of learning could be improved by more explicit alignment with learning objectives and use of concept inventories, which undergo more extensive validity and reliability testing than standard examinations [e.g., references (79, 80)]. While we have not found learning objectives for introductory anatomy and physiology to be peer reviewed and publicly available, literature describing the development of physiology objectives (81) and objectives for introductory medical school A&P (82) can serve as exemplars for useful methodologies for such an endeavor. Following the identification of core concepts in anatomy and physiology, the development of aligned concept inventories or other assessments could be useful for assessing the understanding of A&P concepts at scale.

Over half of the works (n = 47) in our investigation included satisfaction as a measured variable used to evaluate A&P instruction. Asking students to rate satisfaction across a single scale, however, may not capture satisfaction accurately (83), and all quantitative studies in our sample used non-validated measures. Student satisfaction reflects alignment of students’ expectations with their assessment of teaching, not necessarily their learning (84). Indeed, the articles in our sample that reported both learning and satisfaction outcomes did not consistently report that satisfaction was related to higher learning outcomes (43, 57, 85–88). Given these discrepancies, we posit that research prioritizing learning-focused outcomes is critical toward evaluating the efficacy of A&P teaching practices.

Recommendations for future A&P education research

Our critical appraisal of studies measuring learning outcomes identified room for methodological growth in future A&P education research. Given the lack of qualitative studies in our sample, the field would be enriched by narrative inquiries about teaching and learning in these key pre-requisite courses. Additionally, key details about student identities and experiences were absent in quantitative studies that might explain variance in the different measures used to evaluate A&P teaching practices. When survey measures are developed by research teams for use in A&P courses, we recommend including methodological details about the validation and reliability of those instruments. Existing recommendations for developing learning assessments for use in research and evaluation emphasize choosing appropriate wording and seeking expert feedback to create valid instruments [e.g., reference (89)]. As the teaching practices used in A&P are diverse, it would be beneficial for future researchers to disclose pre-requisites required in the context of the study (90–92).

Overall, studies in our sample conducted at community colleges were less common than 4-year institutions, mirroring the trend that these contexts are underrepresented in biology education research (93, 94). The only article in our sample that used multiple institutions identified differences in intervention efficacy between institutional settings (95). Testing interventions in multiple contexts with multiple cohorts will help inform the generalizability of pedagogical interventions.

Additionally, the dearth of reported demographic data describing study participants is problematic for describing representation in A&P courses. Further lack of disaggregation perpetuates a dominant identity experience as the “universal” experience (96). Reporting and disaggregation of findings by demographics can help untangle how interventions may be differentially aiding some students and not others (97) and enrich demographic analysis beyond simplified, often inaccurate, panethnic groupings (98). This consideration is especially important when examining educational interventions, as curricular structures affect student groups differently (99), and inequity in A&P grades exist across demographic variables (100). The absence of demographic information reporting in our sample is consistent within historical biology education research (94). Due to the nature of A&P as a pre-requisite course for students pursuing careers in healthcare, collecting and including demographic data about these students are important to understand student diversity throughout the healthcare education pipeline, which in turn can help inform efforts to reduce health disparities through the development of a more diverse healthcare workforce (101–103). Recommendations for collecting data about student demographics and how to use such data responsibly evolve, thus having a theoretical framework to describe which data to collect is necessary for socially just decisions in research design and interpretation [e.g., reference (104)].

Limitations

The risks of bias in analytic reviews can arise from accountability to the search protocol and bias in the primary sources (105). We composed a protocol prior to beginning the review to mitigate this bias. However, only 30 of the 62 studies included in the critical appraisal phase of this review reported any limitations in the manuscript, and so mitigation of bias from primary sources is limited. The final data set is limited by the scope of the search and search terms. Unindexed, non-digital resources, and gray papers relevant to A&P education were not included in the scope of this study, and so some descriptions of innovative A&P teaching practices are not represented in the sample. Additionally, other evidence relevant to the research questions may have been missed due to semantic differences, such as A&P courses with different course titles, or teaching tools and curricula that were not described with the search terms used. Our data charting and findings rely on our coding of the teaching tools described in the articles included in our sample. The teaching practices described in the studies were not always clearly aligned with the coding categories, and so we needed to make decisions when categorization was ambiguous.

Conclusions

Our review’s purpose was to identify the approaches that have been tested in the A&P classroom and characterize the methods and measures to evaluate their efficacy. While the teaching practices identified in this review and evidence about such practices is specific to introductory A&P courses, our recommendations for potential routes of inquiry and methodological considerations for generating evidence-based practices are broadly applicable to biology education research. It is out of the scope of this review to synthesize their findings and assess the strength of the pedagogical interventions. Indeed, the breadth of teaching practices identified by this review and the limitations to generalizability within individual studies impact the validity of such assessments. However, scoping reviews provide a preliminary scaffold for identifying the types of evidence and gaps in the literature that exist on a given topic. Future meta-analyses and systematic reviews about specific practices (e.g., modeling exercises in A&P laboratories) would be especially useful for addressing questions about how to allocate resources in these classes to best support students’ learning across diverse populations. Such analyses could also move beyond asking whether interventions work to investigating the mechanisms behind learning A&P. For example, examinations of retrieval practice [e.g., references (55, 106) could provide insight about how formative assessment timing could support students’ outcomes on summative assessments. Future analytic reviews will need to account for the multiple measures of student outcomes, as they were not equivalent in the sample, and learning objectives were not commonly described as the basis of assessment. To help address the wide-ranging challenges of teaching A&P to nursing and allied health students, further empirical investigations using student learning outcomes to test A&P course practices are needed to identify efficacious intervention strategies at scale.

SUPPLEMENTAL MATERIAL

The following material is available online at https://doi.org/10.1128/jmbe.00011-24.

Supplemental material. jmbe.00011-24-s0001.docx.

Tables S1 and S2 and a list of all studies included as part of the scoping review.

ASM does not own the copyrights to Supplemental Material that may be linked to, or accessed through, an article. The authors have granted ASM a non-exclusive, world-wide license to publish the Supplemental Material files. Please contact the corresponding author directly for reuse.