Skip to main content

On the job training in the dissection room: from physical therapy graduates to junior anatomy instructors



 The training of near-peer (NP) teachers and junior faculty instructors received major attention as a possible solution for the shortage of experienced anatomy instructors in faculties of medicine and health professions. Several studies described the training of NP teachers and junior instructors (≤ 2 years of teaching experience) using various methods. However, few publications include On the Job Training (OJT), which enables reflection and performance evaluation and encourages professionals to cope with their blind spots. Previous publications describing OJT did not include formal observation of the NP teacher or junior instructor. Therefore, this study aimed to present a novel approach to OJT inclusion during prosection laboratories based on the Lewinian experiential model.


 Eight physical therapy (PT) graduates were recruited as junior anatomy instructors into the prosection laboratories. All participated in a unique training program during two consecutive academic years (2017, 2018) and received OJT during the teaching sessions. Two questionnaires were filled out to evaluate the educational impact of the training program. Eighty-three first-year PT students participated in prosection laboratories in anatomy taught by junior instructors, and filled out a questionnaire evaluating the performance of both junior and senior instructors. In addition, we compared the final grades in anatomy obtained by students taught by senior instructors to the grades of those taught by junior instructors.


 Each junior anatomy instructor participated in four OJT sessions. Based on self-reported measures, all professional and didactic aspects of the training program received a median score of 4.5 or higher on a five-point Likert scale. Students obtained similar grades in anatomy when taught by junior instructors compared with senior ones, and were similarly satisfied from the teaching performance of both senior and junior anatomy instructors.


 OJT is applicable in a small-sized PT program facing a shortage of anatomy instructors. Including junior anatomy instructors in prosection laboratories for PT students is a viable solution to the shortage of experienced anatomy instructors. Further study, involving a larger cohort with a longer follow up will strengthen the preliminary results presented here.

Peer Review reports


Gross anatomy courses are considered essential to the education of medical and health professions students [1,2,3,4,5]. Over the past decades, pedagogical concepts of “authentic learning” were adapted to gross anatomy courses, whereby clinical knowledge was integrated into introductory anatomy courses via active learning [6,7,8,9,10].

The integration of problem-based learning and the inclusion of computer-based learning, medical imaging and ultrasound led to a reduction in the number of frontal lectures and dissection laboratory hours and the transition to a multi-modal learning content [1, 11,12,13,14,15,16,17,18,19]. In addition, reduced laboratory hours and limited availability of skilled dissectors were mentioned as possible risks to decreased knowledge in anatomy [18, 20, 21]. Furthermore, a shortage of cadavers, adequate dissection facilities, and experienced anatomy instructors challenge the inclusion of dissection/prosection laboratories in anatomy syllabi [22,23,24]. Nevertheless, even scaled-down dissection or prosection laboratories are considered a fundamental part of all anatomy courses [1, 4, 5, 25,26,27]. In many cases, dissection laboratories were replaced with prosected material, and a shift towards peer and near-peer (NP) teaching, whereby students are taught by students from senior years, has been proposed as a viable solution, enabling NP teachers (NPT) to develop their teaching skills before becoming residents [27,28,29,30,31,32,33,34,35,36,37].

The incorporation of junior faculty into the faculty of medicine after being trained in anatomical science and teaching obligations is another strategy [38, 39]. Thus, a solution to shortage of experienced anatomy instructors is including NPT or junior faculty in the dissection/prosection laboratories [39, 40]. Appropriate training, emphasizing pedagogic, didactic and professional aspects in anatomy instruction, is essential in both cases [39,40,41,42,43,44].

Several authors described training of NPT and junior faculty, incorporating various methods, such as the microteaching method that offers simulations of teaching and reflection on performance, modules of teaching skills, ongoing peer evaluation, and performing a prosection under supervision [44, 45]. Others included training in gross anatomy and neurosciences, and practicum experiences as part of their faculty training [39]. All programs were regarded as beneficial and received high ratings by students, NPT and junior faculty [39, 41, 44, 45].

As gaining anatomical skills is more straightforward than gaining didactic communication skills and proficiency, a formal peer observation process and follow-up programs were recommended to support the NPT or junior faculty in their first steps [41, 44, 46, 47]. On the job training (OJT) is an excellent method for this purpose, allowing fast and efficient changes in the goals of course syllabi and teacher/instructor roles in light of the challenges described above [48, 49].

Initially developed in the field of Economics, OJT has a central role in lifelong learning in medicine and health professions, however the majority focus on describing policies rather than describing the process in depth [50,51,52,53,54,55,56,57]. Interventions on practicing psychomotor skills of surgeons, improving evidence based practice for clinicians and clinical scientists and improving communication skills of residents, emphasize the importance of a structured mentoring process with high availability of the senior instructor to the trainees [54, 55, 57].

Strategies incorporated into OJT include reflection that reveals gaps in knowledge, skills or attitudes, and performance evaluation, which is tailored to encourage professionals to cope with their blind spots [58,59,60,61,62].

Previous publications describing OJT in anatomy education included mentoring, debriefing and providing feedback to the trainees [32, 36, 40]. Most did not include formal observation of the trainee, except Evans and Cuffe, who described an informal observation process. However, they did not describe the process in depth [46].

A key element of the Lewinian experiential model is formal observation of the trainee, followed by structured reflection and feedback [63, 64]. This has not been described previously. Therefore, a novel approach to OJT inclusion during the prosection laboratories, adapted to PT clinical content, is presented here. In this article, we describe a unique training program for junior anatomy instructors (≤ 2 years of teaching experience) tailored to the needs of an undergraduate PT department, established in 2010 in Zefat Academic College (Zefat, Israel). Due to a shortage of skilled anatomy instructors and limited resources, junior instructors were incorporated into the prosection laboratories.

The objectives of the present study were: to describe a new program of training junior anatomy instructors for prosection laboratories, adapted to the needs of PT curricula, to evaluate the training programs’ educational impact, to evaluate junior anatomy instructors’ performance, and finally, to evaluate the academic achievements of PT students taught by the junior anatomy instructors.

Materials and methods

Junior anatomy instructors

Following the approval by Zefat Academic College’s Ethics committee (no. 07/2017) eight PT graduates (six males and two females), between the ages of 24 and 28, participated in a unique training program during two consecutive academic years (2017, 2018). The junior anatomy instructors’ background in anatomy was the gross anatomy course taken during their first academic year in the PT department. Additionally, all served as tutors during their second year and assisted with preparing the prosection laboratories during their third or fourth academic years before participating in the training program. Therefore, their teaching experience was less than two years.

Training program

Based on previous publications [13, 25, 39, 41,42,43,44], a training program was developed to meet the needs of the PT Department at Zefat Academic College.

and implemented during 2017 and 2018.

The objectives of the training program were threefold: (1) to expand the junior instructors' knowledge in anatomy; (2) to provide the junior instructors with didactical and pedagogical skills; and (3) to improve the junior instructors' performance through providing both a supportive environment and continuous feedback. Table 1 includes the expanded learning goals of the training program.

Table 1 Learning goals of the training program (Workshop and On the Job Training)

The training program consisted of two workshops: the first workshop focused on prosection preparation, the second workshop was dedicated to principles in anatomy instruction (32 h each). Following the two workshops, OJT was carried out, whereby the junior instructor received feedback from a senior anatomy instructor prior to, during, and following each teaching session. Self-evaluation of the workshops and OJT was carried out following the workshops and OJT (see Fig. 1 for a flow chart of the methodology).

Fig. 1
figure 1

Flow chart of the training program and methodology. aTwo workshops for junior anatomy instructors,2 years of teaching experience, n = 8, 32 h each. bA prosected body part. cOJT supervised by a senior instructor (≥ 10 years of teaching experience). dProsection laboratories for first-year students during 2017–2018 academic years (n = 85)

The workshop on preparing prosections

This workshop was led by two senior instructors (SP and RPK, ≥ 10 years of teaching experience) and was conducted during the semester break of each year (February–March). A didactical lecture on ethics in the dissection room was delivered during the first session, followed by demonstrations of cutting techniques. The main aspects were: working with the aid of an atlas, working from distal to proximal, working slowly while exposing neurovascular structures, working with scissors vs. working with a Stanley knife based on the size and depth of the structure.

Each junior anatomy instructor was assigned to a specific region, e.g., upper arm, forearm, intrinsic foot muscles, knee joint and ligaments etc. Two senior instructors inspected all prosected materials (SP and RPK) to ensure high quality, e.g., separation between muscles and layers, exposing neurovascular structures, identification of the origin and insertion of the muscles, and distinction of a joint with associated ligaments.

A refining process was carried out in dyads (i.e. SP with each junior instructor) to improve the junior instructors' prosection skills. On special occasions, the whole group was gathered, and the senior instructor emphasized critical points, e.g., identifying and exposing the radial nerve in the axillary region.

Each junior instructor completed eight preparates (a prosected body part, e.g., pelvis and thigh including pelvic and thigh musculature and neurovascular structures) and prosected two regions of a cadaver (e.g., posterior thigh and anterolateral forearm) based on 350 key points/words. A total of eight cadavers were fully prosected, and 32 preparates were prepared as part of the training program, and were later used for the prosection laboratories.

The workshop on principles of anatomy instruction

This workshop was conducted by two senior instructors (SP and AB) during April and May of each year, before the beginning of the prosection laboratories (Supplementary material 1: Workshop on principles in Anatomy instruction). This workshop emphasized pedagogical and didactical aspects and principles of teaching in small groups. In addition, on each day, the junior instructors practiced in dyads on a given topic, while giving and receiving feedback and reflecting on their performance. The beginning and end of each day were dedicated to sharing knowledge and preparing for the next meeting, based on the prosection laboratory syllabus.

Based on Harden and Laidlaw and Wolf et al., we added Situational Awareness (SA) as a didactical goal to this workshop [9, 65]. SA is defined as the junior anatomy instructor being aware of the learners’ focus ability and ability to hear and see demonstrations.


Concepts from the Lewinian experiential model (Fig. 2) were adapted to anatomy instruction and implemented as follows (May–June) [63]: every evening before the actual prosection laboratory the junior instructors simulated the material of their planned instruction in dyads. Additionally, OJT was carried out by one senior instructor (SP) during and following the prosection laboratories.

Fig. 2
figure 2

On the job training for junior anatomy instructors based on the Lewinian experiential model [63]. ajunior anatomy instructors 2 years of experience, bsenior anatomy instructors 10 years of experience

Emphasis was placed on the following [63, 64]:

  • Concrete experience and observation: each junior instructor was observed by a senior instructor while teaching on a given topic during a prosection laboratory.

  • Observation and reflection: after the teaching session, each junior instructor reflected on his/her performance, followed by focused feedback from the senior instructor. The feedback included one positive point for preservation and one suggestion for improvement using examples from the instructors' performance.

  • Conceptualization: detailed written feedback was then given to each junior instructor, allowing for further clarifications if needed.

  • Testing implications of concepts in new situations: based on the above, the junior instructors had an opportunity to improve their performance in subsequent prosection laboratories.

Each junior instructor participated in four OJT sessions, i.e. OJT was provided for each instructor during each of the prosection laboratories. During each prosection laboratory, each junior instructor gave a structured session on an anatomical region. Every session lasted 45 min, after which the groups of students alternated between the instructors. Since there were four groups of students, the junior instructors taught the same session four times. The senior instructor observed each junior instructor during one of the four sessions, and switched to the next junior instructor after the session ended. A 30-min break followed every two sessions. During the break, two junior instructors received feedback from the senior instructor comprising of one point of preservation and one suggestion for improvement. The other two junior instructors received their feedback at the end of the following two sessions. All feedback was given as a group discussion.

Written feedback was sent from the senior instructor to each of the four junior anatomy instructors. The junior instructors were encouraged to respond and ask for clarifications if and when needed.

Prosection laboratories

Eighty-five first year PT students participated in prosection laboratories carried out by junior instructors between 2017–2018. Eighty-one PT students that participated in prosection laboratories and were taught by senior instructors between 2015–2016 served as a control group.

The prosection topics were based on clinically meaningful content for the musculoskeletal anatomy syllabus [67] and adapted to the PT curriculum, as the topics need to be relevant to the PT students’ clinical practice [3]. A list of 350 keywords of possible structures was handed out to the students in advance and served as a learning aid.

Five prosection laboratories, four hours each, took place in May–June each year. The first four laboratories were structured, whereby each junior instructor gave a teaching session on an anatomical region. The class was divided into four groups of students that rotated between the stations every 45 min, with a 30-min break after two sessions (90 min). A ratio of 10:1 between students and instructors was similar to previous years (2015–2016) when the prosection laboratories were taught by the senior instructors.

The fifth prosection laboratory served as a review session with all instructors available to answer questions.

Based on a gradual transition to student-centered learning, the students used activities and content provided by the junior instructors as part of the teaching sessions to support and facilitate the students’ learning process [66, 68].

One senior instructor (SP) supervised the junior anatomy instructors during the prosection laboratories, while the other (AB) coordinated the prosections, i.e., was available to the students’ needs. He also taught one structured session. Both senior instructors taught during the review laboratory, where the students learned independently in dyads or groups of three.


Two questionnaires were used to evaluate the educational impact of the training program, and one questionnaire was used to evaluate the junior anatomy instructors’ performance (Fig. 1) [36]. Before filling out the questionnaire, two statements were presented to the participants, one guaranteeing their anonymity and the second inviting them to volunteer for the research.

All junior instructors completed two questionnaires to self-evaluate their professional improvement following the training program and OJT. These questionnaires were developed based on Shiozawa et al., and adapted to the needs of our program [45]. The first questionnaire (Q1) was administrated at the end of the two workshops (Supplementary material 2), while the second questionnaire (Q2) was administered after the OJT process was completed (Supplementary material 3).

After completing all prosection laboratories, the students completed one questionnaire (Q3) (Supplementary material 4). This questionnaire was developed and validated by the Center for Teaching Advancement of Zefat Academic College and evaluates instruction performance, as well as interaction and atmosphere in the dissection laboratory.

All questionnaires were in the form of a Likert scale of 1–5 for questionnaires one and two, and a scale of 1–7 for the third questionnaire.

Statistical analysis

Descriptive statistics and statistical analyses were carried out using SPSS)IBM SPSS Statistics for windows, Version 22.0, IBM Corp. Armonk NY). Statistical significance was set at α < 0.05.

Students' demography was analysed and compared between the academic years, including age, sex distribution and academic achievements (i.e. final grades in the Anatomy course and average grades of the first year). As data were not normally distributed, the Kruskal–Wallis test was used to examine differences in grades between the academic years and Mann–Whitney test used to determine differences between students taught by junior instructors and those taught by the senior ones (α < 0.05).

The reliability of all questionnaires was assessed by calculating internal consistency. The median scores were calculated for all questionnaires, and for Q3 comparisons between senior and junior instructors were carried out using the Mann–Whitney test (α < 0.05).



A total of 164 first-year PT students participated in the study between the years 2015–2018. There were no significant differences between the academic years regarding age and first-year academic achievements (p = 0.925 and 0.208, respectively, Table 2). The grade in the Anatomy course in 2015 was slightly lower compared to all other years. However, the difference was significant only compared to 2017 and 2018 (p = 0.021, Table 2).

Table 2 Demography of students

Reliability and validity of the questionnaires


Internal consistency of all questionnaires was high (α = 0.817 for Q1 and Q2, α = 0.971 for Q3).


questionnaires Q1 and Q2 possess judgment-based validity, i.e. both have face and consensual validity. The panel, made up of the three senior instructors (SP, RPK and AB), agreed that all the questionnaire items were representative of the original questionnaires.

Self-evaluation of the workshop—Q1

All junior anatomy instructors (8/8) filled out the self-evaluation questionnaire of the workshop. All didactical aspects in the workshop received a median score of 4.5 or higher on a five-point Likert scale (Supplementary material 2).

In the open comment section, the junior instructors emphasized the importance of simulations as part of the workshop. We quote:

Junior instructor 1 (2018): “Simulations were particularly important, especially before our first teaching sessions, when stage fright was high. The simulations offer additional practice in addition to the feedback and are therefore very important. The feedback enabled me to focus better during demonstrations and helped improve my instruction”.

Self-evaluation of OJT during the prosection laboratories—Q2

All junior anatomy instructors (8/8) filled out the self-evaluation questionnaire of the OJT (Supplementary material 3). All didactical aspects of the OJT process received a median score of 4.5 or higher on a five-point Likert scale. Examples of points for preservation and suggestions for improvement are described in Table 3. The main didactical aspects were complementary to the ones taught in the workshop.

Table 3 Examples of the feedback given to junior instructors during OJT: a) points for preservation, and b) suggestions for improvement

Students' evaluation of the anatomy instructors’ performance—Q3

Seventy-eight percent of students in 2017 (32/41) and eighty-two percent of students in 2018 (36/44) filled out this questionnaire (Supplementary material 4). High satisfaction rates were given to the junior and senior anatomy instructors (an average score of 6.4 or higher on a 1–7 Likert scale) (Fig. 3).

Fig. 3
figure 3

Average scores for quality of instruction for junior and senior anatomy instructors. Results of questionnaire 3 filled out by first-year PT students (n = 85). Possible answers were: 1 = very low, 2 = quite low, 3 = low, 4 = moderate, 5 = high, 6 = very high, 7 = extremely high. 78% percent of the students in 2017 (32/41) and 82% of the students in 2018 (36/44) filled out the questionnaire

The students emphasized their understanding and satisfaction with the junior instructors in the open comments. We quote:

Student A: “The fact that the junior anatomy instructors recently graduated allowed them to focus on what was really important and relevant to our learning.”


The current study describes the implementation of a two-stage training program of junior anatomy instructors specifically designed for prosection laboratories. The training program consisted of two workshops and OJT, which was based on the Lewinian experiential model and embedded in the prosection laboratories [63, 64]. Additionally, simulations were included as a preparatory stage and were carried out every evening before each prosection laboratory.

The workshops followed previous publications that focused on dissection laboratories [41, 44]. Shiozawa et al., presented mini-teaching modules of short tasks and the microteaching method of short teaching sessions as key elements of professional and didactical training [41]. These short exercises offered the possibility of simulating a teaching session in a safe environment and individual reflection on one's performance, using videotape analysis. Dickman et al., taught the basics of didactics, pedagogical approaches, and teaching methods via specific modules, with emphasis on providing effective feedback as well as advanced practical skills in cadaveric dissection, without the aid of videotape recording [44]. We adopted this approach with emphasis on a more graded training process, which included preparation of the prosections by the junior instructors, simulation on their peers during the preparatory stage (i.e. the other junior instructors), followed by feedback and an opportunity to implement improvements during their real-time performance. This graded process reduces apprehension, and strengthens the integration between professional and didactical knowledge in a safe environment [69, 70]. In addition, by providing feedback to their peers, the junior instructors improved their communication skills. This important pedagogical goal, termed “dialogic communication", is considered a keystone for a student-centered approach [30, 44].

The second stage of the training program included OJT of the junior instructors, carried out during the prosection laboratories, emphasizing structured feedback, the reflection of the junior instructors on their performance, and implementation of suggestions for improvement during the following sessions.

The novelty of this study is that OJT was an integral part of the training program and corresponds with Hendry and Shiozawa et al., who raised the need for a follow-up program with formative and supervisory elements, appropriate resources allowing [41, 47]. Previous reports included weekly one-hour debriefing sessions facilitated by a core faculty member, in which the junior instructors could reflect on their personal experience, strengths and areas of improvements [36, 40].

Models for organizing and assessing junior instructors in PT programs were presented previously for NPT only [32, 33]. These reports were based on mentoring and an apprenticeship approach [36]. However, the element of individual structured supervision by a senior instructor has not been described in detail so far. Evans and Cuffe reported that the lead faculty member informally observed each NPT during each dissection laboratory, and senior instructors were available to help when any difficulty arose; however, they did not present a detailed description of the process [46].

In the current study, OJT of junior instructors included two aspects of the feedback given by the senior instructor: the first consisted of one point for preservation and one suggestion for improvement (given during the prosection laboratory, after the junior instructors reflected on their performance), the second was a detailed written feedback supported with examples. The first part enabled prompt feedback and reflection, with an immediate opportunity to implement improvement in real-time [71, 72].

This part was carried out as an open discussion and is complementary to the learning process. As was suggested by Nicol and MacFarlane-Dick, increasing discussion and reflection about criteria and standards in class promotes the trainees' performance [73]. Thus, the junior instructors learned from each others' performance and enhanced their skills by identifying performance standards [70, 73]. Therefore, in the current study, all junior instructors could improve their performance in at list one aspect based on the reflection and conceptualization stages carried out [53].

The second part followed the written feedback process described by Dickman et al., and the supervision by a senior instructor briefly described by Evans and Cuffe [44, 46]. As cameras or videotape are not allowed in the dissection room at our disposal, we could not adopt the video analysis component of the microteaching method [41].

In the current study, the senior instructor documented examples of positive performance and suggestions for improvement in writing. In addition, the junior instructors were encouraged to consult with the senior instructor in order to improve their performance [36, 40].

This slower and deeper process helped the junior instructors prepare themselves for the following laboratory, overcoming blind spots which impaired their primary performance [59, 62, 74]. Reflection and conceptualization (the third stage in the lewinian experiential model) improved the junior instructors’ ability to give a multilayered three-dimensional explanation combining the use of a prepatrate and a cadaveric prosected material [53]. For example:

Junior instructor 3 (2018): in response to the feedback I received during the first OJT session, I implemented the suggestion for improvement by adding a defleshed preparate of the wrist in order to clarify the carpal tunnel's bony boundaries. After that, I switched to the fleshed prosection of the carpal tunnel to present the different anatomical structures and how they relate to each other. I found that the combination of both preparates enhanced students' understanding, and I feel that receiving the feedback helped me improve my teaching skills.”

In this sense, we would like to emphasize the importance of providing written feedback as a key element in the junior instructors’ professional development, as it is used as part of their preparation for upcoming teaching sessions, as well as for preparing for sessions in the following academic year.

Based on the self-reported measures of the junior anatomy instructors, all didactic aspects were rated high, indicating the high educational value of the training program. This work is in line with Shiozawa et al., whereby NPT evaluated their performance before and after the training program, and an average increase of more than two points was presented for both technical and didactic aspects [41, 45]. Similar results were reported by Erie and colleagues and by Lachman et al., whereby over 90% of the NPT agreed or strongly agreed that they could effectively communicate complex material and that they were exposed to a variety of teaching techniques after obtaining teaching experience themselves in the anatomy course [36, 40].

The results of the current study showed similar academic achievements of PT students taught by junior instructors compared to those taught by senior ones and are consistent with Kinirons et al. [27]. They reported similar academic achievements of PT and occupational therapy students taught by peer teachers compared to demonstrations taught by senior faculty during dissection laboratories.

The findings from this study were further validated by the students' high evaluation rates for both junior and senior anatomy instructors. This is in agreement with Dickman et al., who reported similar evaluation rates for NPT and senior instructors, and Durán et al., who reported that 90% of students thought that the performance of NPT and professors alike was equal to a score of 8 or higher (on a 1–10 Likert scale) [31, 44]. They concluded that the quality of teaching provided by NPT is comparable to that of associate professors [31].

In the current study, PT graduates were incorporated into the prosection laboratories of a PT undergraduate program with the long-term goal of employing them within the department. During the two consecutive years of OJT, four junior instructors taught the students, one senior instructor served as their tutor and the second served as the laboratory coordinator. Therefore, six instructors were simultaneously present in each prosection laboratory, making the impression that this intervention is time and effort consuming in the short term. However, the great benefit is in the long term, i.e., starting at 2019 academic year the junior instructors conducted the prosection laboratories with only one senior instructor coordinating the laboratories. This is in line with Richardson-Hatcher et al., suggesting that structured OJT can be implemented in training programs focused on junior faculty staff development or in NP teaching programs that are part of the anatomy course in medical or health profession faculties [39].

Limitations and future research

This study is not without limitations. First, our cohort included a small number of participants, primarily males, from a physical therapy department, limiting our results' generalizability. Second, we report on the results of OJT intervention during two consecutive academic years only. Third, we only assessed internal consistency, as it was technically impossible to administer the questionnaires again within the study period. Forth, the participation of different students according to the years may affect our findings. Lastly, we did not assess confounding factors such as self-motivation, or implicit biases that may be related to inclusion of female instructors.

Future research should involve more students and junior instructors with more senior instructors carrying out OJT including quantitative measures, implementing such programs in other health care departments, and utilizing a longer follow up periods to yield more conclusive and generalizable results. Lastly, a test–retest analysis of the questionnaires is warranted.


OJT is applicable in a small-sized PT program facing a shortage of anatomy instructors and on a broader scale, adds an adaptation of the experiential learning model to the needs of a prosection laboratory. Formative and constructive feedback given to the junior instructors and simulations of teaching sessions further enhance the process.

Including junior anatomy instructors in prosection laboratories for PT students is a viable long-term solution, provided that close supervision and structured OJT is carried out.

Availability of data and materials

All data generated or analysed during this study are included in this published article [and its supplementary information files].



On the Job Training


Near Peer


Near peer teacher


Physical Therapy


  1. Drake RL, McBride JM, Lachman N, Pawlina W. Medical education in the anatomical sciences: The winds of change continue to blow. Anat Sci Educ. 2009;2(6):253–9 Available from:

    Article  Google Scholar 

  2. Arráez-Aybar L-A, Sánchez-Montesinos I, Mirapeix R, Mompeo-Corredera B, Sañudo-Tejero J-R. Relevance of human anatomy in daily clinical practice. Ann Anat. 2010;192(6):341–8. Available from:

    Article  Google Scholar 

  3. Latman NS, Lanier R. Gross anatomy course content and teaching methodology in allied health: clinicians’ experiences and recommendations. Clin Anat. 2001;14(2):152–7. Available from:;2-A.

    Article  Google Scholar 

  4. Carroll MA, Lawson K. The intermingled history of occupational therapy and anatomical education: a retrospective exploration. Anat Sci Educ. 2014;7(6):494–500. Available from:

    Article  Google Scholar 

  5. Schofield KA. Anatomy in occupational therapy program curriculum : practitioners’ perspectives. Anat Sci Educ. 2014;106(April):97–106.

  6. Herrington J, Oliver R. An Instructional Design Framework for Authentic Learning Environments. Educ Technol Res Dev. 2000;48(3):23–48. Available from:

    Article  Google Scholar 

  7. Harden RM, Laidlaw JM. Be FAIR to students : four principles that lead to more effective learning y. Med Teach. 2013;35:27–31. Available from:

    Article  Google Scholar 

  8. Harden R, Laidlaw J. The “authentic” currilicum. In: Essential skills for medical teacher: an introduction to teaching and learning in medicine. Second. London: Elsevier; 2017. p. 89–94.

  9. Harden R, Laidlaw J. Learning in small groups. In: Essential skills for medical teacher: an introduction to teaching and learning in medicine. London: Elsevier; 2017. p. 175–82.

    Google Scholar 

  10. Pawlina W, Drake RL. Authentic learning in anatomy: a primer on pragmatism. Anat Sci Educ. 2016;9(January/February):5–7. Available from:

  11. Biassuto SN, Caussa LI, Criado del Río LE. Teaching anatomy: cadavers vs. computers? Ann Anat. 2006;188(2):187–90. Available from:

    Article  Google Scholar 

  12. Brown B, Adhikari S, Marx J, Lander L, Todd GL. Introduction of ultrasound into gross anatomy curriculum: perceptions of medical students. J Emerg Med. 2012;43(6):1098–102. Available from:

    Article  Google Scholar 

  13. May H, Cohen H, Medlej B, Kornreich L, Peled N, Hershkovitz I. Computed tomography-enhanced anatomy course using enterprise visualization. Anat Sci Educ. 2013;6(5):332–41. Available from:

    Article  Google Scholar 

  14. Estai M, Bunt S. Best teaching practices in anatomy education: a critical review. Ann Anat. 2016; Available from:

  15. Heylings DJA. Anatomy 1999–2000: the curriculum, who teaches it and how ? Med Educ. 2002;36(8):702–10. Available from:

    Article  Google Scholar 

  16. Nicholson LL, Reed D, Chan C. An interactive, multi-modal Anatomy workshop improves academic performance in the health sciences : a cohort study. BMC Med Educ. 2016;16(7):1–9. Available from:

    Google Scholar 

  17. Ogard WK. outcomes related to a multimodal human anatomy course with decreased cadaver dissection in a doctor of physical therapy curriculum. J Phys Ther Educ. 2014;28(3):21–6. Available from:

    Article  Google Scholar 

  18. Sugand K, Abrahams P, Khurana A. The Anatomy of Anatomy : a review for its modernization. Anat Sci Educ. 2010;93(April):83–93. Available from:

    Google Scholar 

  19. Youdas JW, Krause DA, Hellyer NJ. teaching anatomy to students in a physical therapy education program. In: Chan LK, Pawlina W, editors. Teaching anatomy: a practical guide. 1st ed. Springer International Publishing; 2015. p. 373–80.

    Google Scholar 

  20. Prince KJAH, Scherpbier AJAA, Van Mameren H, Drukker J, Van Der Vleuten CPM. Do students have sufficient knowledge of clinical anatomy? Med Educ. 2005;39(3):326–32. Available from:

    Article  Google Scholar 

  21. Leveritt S, McKnight G, Edwards K, Pratten M, Merrick D. What anatomy is clinically useful and when should we be teaching it? Anat Sci Educ. 2016;9(5):468–75. Available from:

    Article  Google Scholar 

  22. Mccuskey RS, Carmichael SW, Kirch DG. The importance of anatomy in health professions education and the shortage of qualified educators. Acad Med. 2005;80(4):349–51. Available from:

    Article  Google Scholar 

  23. Turney BW. Anatomy in a modern medical curriculum. Ann R Coll Surg Engl. 2007;89(2):104–7. Available from:

  24. Chen D, Zhang Q, Deng J, Cai Y, Huang J, Li F, et al. A shortage of cadavers: The predicament of regional anatomy education in mainland China. Anat Sci Educ. 2018;11(4):397–402. Available from:

    Article  Google Scholar 

  25. Kawashiro Y, Anahara R, Kohno T, Mori C, Matsuno Y, Science F. Attitudes of healthcare students on gross anatomy laboratory sessions. Anat Sci Educ. 2009;279(December):273–9.

  26. Shead DA, Roos R, Olivier B, Ihunwo AO. Gross anatomy education for South African undergraduate physiotherapy students. Anat Sci Educ. 2018;11(6):554–64. Available from:

    Article  Google Scholar 

  27. Kinirons SA, Reddin VM, Maguffin J. Effects of alternating dissection with peer teaching and faculty prosected cadaver demonstrations in a physical therapy and occupational therapy gross anatomy course. Anat Sci Educ. 2019;12(5):468–77. Available from:

    Article  Google Scholar 

  28. Johnson J. Importance of dissection in learning anatomy : personal dissection versus peer teaching. Clin Anat. 2002;15(1):38–44. Available from:

    Article  Google Scholar 

  29. Nnodim JO. A controlled trial of peer-teaching in practical gross anatomy. Med Educ. 1997;117(92):112–7. Available from:;2-X.

    Google Scholar 

  30. Krych AJ, March CN, Bryan RE, Peake BJ, Pawlina W, Carmichael SW. Reciprocal peer teaching: students teaching students in the gross anatomy laboratory. Clin Anat. 2005;18(4):296–301. Available from:

    Article  Google Scholar 

  31. Durán CEP, Bahena EN, Rodríguez M de los ÁG, Baca GJ, Uresti AS, Elizondo-Omaña RE, et al. Near-peer teaching in an anatomy course with a low faculty-to-student ratio. Anat Sci Educ. 2012;5(May-June):171–6. Available from:

  32. Haladay DE, Miro RM, Hardwick D, Swisher LL, Klein AB. Doctor of physical therapy student perceptions of near- peer teaching in an anatomy educational experience. J Phys Ther Educ. 2020;34(1):67–75. Available from:

    Article  Google Scholar 

  33. Youdas JW, Hoffarth BL, Kohlwey SR, Kramer CM, Petro JL. Peer teaching among physical therapy students during human gross anatomy : perceptions of peer teachers and students. Anat Sci Educ. 2008;1(September):199–206. Available from:

    Article  Google Scholar 

  34. Ten Cate O, Durning S. Dimensions and psychology of peer teaching in medical education. Med Teach. 2007;29:546–52. Available from:

    Article  Google Scholar 

  35. Williams B, Reddy P. Does peer-assisted learning improve academic performance ? A scoping review Nurse Educ Today. 2016;42:23–9. Available from:

    Article  Google Scholar 

  36. Erie AJ, Starkman SJ, Pawlina W, Lachman N. Developing medical students as teachers: an anatomy-based student-as-teacher program with emphasis on core teaching competencies. Anat Sci Educ. 2013;6(6):385–92. Available from:

    Article  Google Scholar 

  37. Dandavino M, Snell L, Wiseman J. Why medical students should learn how to teach. Med Teach. 2007;29(6):558–65.

    Article  Google Scholar 

  38. Brokaw JJ, O’Loughlin VD. Implementation of an education-focused PhD program in anatomy and cell biology at Indiana University: lessons learned and future challenges. Anat Sci Educ. 2015;8(3):258–65.

    Article  Google Scholar 

  39. Richardson-Hatcher A, Macpherson B, Gould D, Brueckner-Collins J. Assessing the impact of the graduate certificate in anatomical sciences instruction : a post-degree survey. Anat Sci Educ. 2018;11(5):516–24. Available from:

    Article  Google Scholar 

  40. Lachman N, Christensen KN, Pawlina W. Anatomy teaching assistants : facilitating teaching skills for medical students through apprenticeship and mentoring. Med Teach. 2013;35(1):e919-25. Available from:

    Article  Google Scholar 

  41. Shiozawa T, Hirt B, Celebi N, Baur F, Weyrich P, Lammerding-Köppel M. Development and implementation of a technical and didactical training program for student tutors in the dissection course. Ann Anat. 2010;192(6):355–60. Available from:

    Article  Google Scholar 

  42. Shiozawa T, Griewatz J, Hirt B, Zipfel S, Lammerding-Koeppel M, Herrmann-Werner A. Development of a seminar on medical professionalism accompanying the dissection course. Ann Anat. 2016;208:208–11. Available from:

    Article  Google Scholar 

  43. Shiozawa T, Hirt B, Lammerding-Koeppel M. The influence of tutor training for peer tutors in the dissection course on the learning behavior of students. Ann Anat. 2016;208:212–6. Available from:

    Article  Google Scholar 

  44. Dickman N, Barash A, Reis S, Karasik D. Students as anatomy near-peer teachers: a double-edged sword for an ancient skill. BMC Med Educ. 2017;17(1):1–5. Available from:

    Article  Google Scholar 

  45. Shiozawa T, Hirt B, Celebi N, Werner A, Weyrich P, Lammerding-Koeppel M. Does a combined technical and didactical training program improve the acceptance of student tutors in the dissection course? A prospective controlled randomized study. Ann Anat. 2010;192(6):361–5. Available from:

    Article  Google Scholar 

  46. Evans DJ, Cuffe T. Near-peer teaching in anatomy : an approach for deeper learning. Anat Sci Educ. 2009;2(September/October):227–33. Available from:

  47. Hendry GD. Problem-based learning tutors’ conceptions of their development as tutors. Med Teach. 2009;31:145–50. Available from:

    Article  Google Scholar 

  48. Sister G, Glass HJ. On the job training. J Natl Med Assoc. 1970;62(5):377–9.

    Google Scholar 

  49. Rouse WB, Johns MME, Pepe KM. Learning in the health care enterprise. Learn Heal Syst. 2017;1(4):e10024. Available from:

  50. Becker GS. Human Capital: A theoretical and empirical analysis, with special reference to education. 3rd ed. Encyclopedia of Career Development. Chicago: The University of Chicago Press; 1993.

    Book  Google Scholar 

  51. Coppus SF, Emparanza JI, Hadley J, Kulier R, Weinbrenner S, Arvanitis TN, et al. A clinically integrated curriculum in Evidence-based Medicine for just-in-time learning through on-the-job training: The EU-EBM project. BMC Med Educ. 2007;7:1–10.

    Article  Google Scholar 

  52. Flentje M, Böhmelt D, Sieg L, Eismann H. Instructors for on-the-job training of advanced paramedics – definition of competencies and development of a quality management tool for a " High Responsibility Organization ". GMS J Med Educ. 2019;36(1):1–18.

    Google Scholar 

  53. Leung EYL, Malick SM, Khan KS. On-the-job evidence-based medicine training for clinician-scientists of the next generation. Clin Biochem Rev. 2013;34(2):93–103.

    Google Scholar 

  54. Kulier R, Coppus SFPJ, Zamora J, Hadley J, Malick S, Das K, et al. The effectiveness of a clinically integrated e-learning course in evidence-based medicine: a cluster randomised controlled trial. BMC Med Educ. 2009;9(1):1–7.

    Article  Google Scholar 

  55. Noordman J, Post B, Van Dartel AAM, Slits JMA, Olde Hartman TC. Training residents in patient-centred communication and empathy: evaluation from patients, observers and residents. BMC Med Educ. 2019;19(1):1–11.

    Article  Google Scholar 

  56. Rouse WB, Johns MME, Pepe KM. Learning in the health care enterprise. Learn Heal Syst. 2016;2017:1–11.

    Google Scholar 

  57. Allum W. Improving surgical training. Surgery. 2020;38(10):596–600.

    Google Scholar 

  58. Sandars J. The use of reflection in medical education: AMEE Guide No. 44. Med Teach. 2009;313:685–95. Available from:

    Article  Google Scholar 

  59. Ribeiro LMC, Mamede S, Moura AS, Brito EM De, Faria RMD De. Effect of reflection on medical students ’ situational interest : an experimental study. Med Educ. 2018;52:488–96. Available from:

  60. Ingham H and Luft J. The Johari Window: a graphic model for interpersonal relations. Los Angeles: Proceedings of the western training laboratory in group development; 1955

  61. Luft J. The Johari Window: a graphic model of awareness in interpersonal relations. Hum Relations Train News. 1961;5(1):6–7.

    Google Scholar 

  62. Argyris C. Teaching smart people how to learn. Harv Bus Rev. 1991;(May-June):99–110.

  63. Kolb DA. Experiential learning : experience as the source of learning and development. Englewood Cliffs, NJ: Prentice Hall; 1984.

    Google Scholar 

  64. Taylor DCM, Hamdy H. Adult learning theories: Implications for learning and teaching in medical education: AMEE Guide No. 83. Med Teach. 2013;35(11):e1561–e1572. Available from:

  65. Wolff CE, Jarodzka H, Boshuizen HPA. Classroom management scripts: a theoretical model contrasting expert and novice teachers’ knowledge and awareness of classroom events. Educ Psychol Rev. 2020; Available from:

  66. Harden R, Laidlaw J. Independent learning. In: Essential skills for medical teacher: an introduction to teaching and learning in medicine. 2nd ed. London: Elsevier; 2017. p. 183–7.

    Google Scholar 

  67. Lisk K, Flannery JF, Loh EY, Richardson D, Agur AMR, Woods NN. Determination of clinically relevant content for a musculoskeletal anatomy curriculum for physical medicine and rehabilitation residents. Anat Sci Educ. 2014;7(2):135–43. Available from:

    Article  Google Scholar 

  68. English MC, Kitsantas A. Supporting student self-regulated learning in problem- and project-based learning. Interdiscip J Probl Learn. 2013;7(2):128–150.

  69. Bandura A. Self-efficacy: the exercise of control. Freeman. New York: Freeman; 1997.

    Google Scholar 

  70. Lachman N. Giving Feedback to Students. In: Pawlina W, Chan LK, editors. Teaching anatomy: a practical guide. Switzerland: Springer International Publishing; 2015. p. 143–53.

    Google Scholar 

  71. Shurtz S, Foster MJ. Developing and using a rubric for evaluating evidence-based medicine point-of-care tools. J Med Libr Assoc. 2011;99(July):247–54. Available from:

    Article  Google Scholar 

  72. Tee DD, Ahmed PK. 360 degree feedback: an integrative framework for learning and assessment. Teach High Educ. 2014;19(6):579–91. Available from:

    Article  Google Scholar 

  73. Nicol D, Macfarlane-Dick D. Formative assessment and self-regulated learning: a model and seven principles of good feedback practice. Stud High Educ. 2006;31(2):199–218. Available from:

    Article  Google Scholar 

  74. Mikkelsen J, Holm HA. Contextual learning to improve health care and patient safety. Educ Heal. 2007;20(3):1–9. Available from:

    Google Scholar 

Download references


The authors thank Mr. Shmuel Har Noy, former Director-General of Zefat Academic College (2010-2019) for supporting the Anatomy project, the Azrieli Faculty of Medicine, Bar-Ilan University, Israel, for permitting access to their dissection room, and Dr. Michal Arnon, Levinsky-Wingate Academic Center (Wingate Campus), Israel for her statistical advice. Finally, we thank Mr. Amit Mani for his active involvement in the planning and implementation of this project. 


No funding was obtained for this research.

Author information

Authors and Affiliations



SP, RPK and AB conceived the concept of the study and participated in its design and implementation. RPK and TY performed the acquisition of the evaluation data and drafted the presentation of the results. YA, SP, RPK and AB participated in the design of the course and study concepts and its realization into teaching practice. All authors were involved in drafting the manuscript. The author(s) read and approved the final manuscript.

Authors information

SMADAR PELEG, BPT, MSc, PhD, is a senior lecturer at Levinsky-Wingate Academic Center, Israel (since 2021). She founded and headed the Department of Physical Therapy at Zefat Academic College in Zefat, Israel between 2010–2019 and acted as coordinator of the gross anatomy course until 2020. She also developed and implemented the anatomy program for physical therapy students in collaboration with Dr. Alon Barash. Her research interests are anatomy and kinesiology.

TOMER YONA, BPT, MSc-PT, is a PhD student in the Department of Biomedical Engineering at the Technion—Israel Institute of Technology in Haifa, Israel. He is a physical therapist and a member of the board of directors of the Israeli Physiotherapy Society. His research interests include knowledge transfer, innovative technologies, and biomechanics.

YUVAL ALMOG, BPT, is a Master of Medicine (pain management) student at the Faculty of Medicine and Health, University of Sydney, Camperdown/Darlington, NSW, Australia. Before and after graduation from Zefat Academic College, he was involved in the planning and implementation of prosection laboratories in anatomy adapted to physical therapy training programs.

ALON BARASH, PhD, is a lecturer at the Azrieli Faculty of Medicine at Bar-Ilan University, Safed, Israel. He is the coordinator of anatomy instruction and teaches gross anatomy and neuroanatomy for first-year medical students. He developed and implemented the anatomy program for physical therapy students, in collaboration with Dr Smadar Peleg, at Zefat Academic College. His research interests are physical anthropology, human anatomy and evolution.

RUTH PELLEG-KALLEVAG, BPT, MSc-PT, is a PhD candidate in the Department of Anatomy and Anthropology at Tel Aviv University, Tel Aviv-Yafo, Israel. She has been a faculty member at the Department of Physical Therapy at Zefat Academic College since 2010, serving as the coordinator of clinical courses. She teaches assessment and treatment of peripheral joints and spine, sports injuries and anatomy prosections. Her research interests are development of the lumbar curvature during growth and rehabilitation of the knee.

Corresponding author

Correspondence to Smadar Peleg.

Ethics declarations

Ethical approval and consent to participate

The project was approved by Zefat Academic College’s Ethics committee (no. 07/2017). The participants provided a written informed consent to participate in the study. All methods were carried out in accordance with relevant guidelines and regulations (declaration of Helsinki).

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interest.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Rights and permissions

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Peleg, S., Yona, T., Almog, Y. et al. On the job training in the dissection room: from physical therapy graduates to junior anatomy instructors. BMC Med Educ 22, 354 (2022).

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI:


  • Anatomy education
  • Physical therapy education
  • Near-peer teaching
  • Lewinian experiential model