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How about an anatomy elective? Making a case for utilizing spaced repetition and longitudinal integration of anatomy in medical curricula

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Azim, Homaira M., Santare, John A., Sprague, Abigail V., Murphy, Robert J., Miller, Luke C., Perrotta, Sophia E., Maddahi, Yaniv N., Record, Matthew J.·2025·BMC Medical Education
DOI 10.1186/s12909-025-07021-0PMC PMC11956444
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Abstract

BACKGROUND: Anatomy can be rapidly forgotten without repetition and retrieval. With an overall decrease in time allotment for teaching discrete subjects, longitudinal integration of anatomy throughout medical curricula is a more effective approach. This study sought to assess the efficacy of spaced repetition in an integrated anatomy elective. METHODS: An advanced anatomy elective course was designed for second-year medical students at one medical school. Spaced repetition was utilized to review gross and radiological anatomy. A total of 21 students participated in 2022 and 2023. Student reflections were collected via an online survey and focus group interviews. Qualitative data was thematically analyzed using an abductive coding scheme. Major themes and subthemes were identified via cross-case analyses. RESULTS: Survey results showed that 95% of students felt better prepared for USMLE Step 1 after taking this elective. Strongest aspects of the course were identified as: 1) reviewing anatomy in the context of medical imaging, 2) revisiting anatomy lab as teaching assistants, 3) reinforcing foundational and multidisciplinary basic science concepts using clinical case questions. Overall findings based on both phases of data analysis indicated that participation in the elective increased student confidence in preparation for Step 1 and helped solidify their understanding of foundational anatomical knowledge while also enhancing metacognition. CONCLUSIONS: An anatomy elective course can serve as an efficient and effective step toward longitudinal integration of anatomy in undergraduate medical curricula. Future research is needed to assess the quantitative impact of this educational intervention on long-term learning and student performance on Step 1.

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  • Researchers utilized high-impact standardized assessments, such as the USMLE Step 1 and institutional final exams, to measure long-term knowledge retention.

    “Researchers utilized high-impact standardized assessments, such as the USMLE Step 1 and institutional final exams, to measure long-term knowledge retention (Azim et al., 2025;Burel et al., 2025;Chang & Wimmers, 2017;Gilbert et al., 2023;Ward & Vengrin, 2024).”

    From Systematic Review of the Effectiveness of Neurodidactic Spaced Learning Strategies in Long-Term Memory (2026) · cites this paper as Azim et al., 2025

    The Results report students’ perceived preparation for USMLE Step 1, not retention measured by exam scores. The Conclusions explicitly say future research is needed to assess long-term retention and USMLE performance quantitatively. The Discussion mentions final-exam scores only when describing other studies. (LLM, conf=0.88)

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  • Strategies including peer tutoring and qualitative student reflections allowed learners to self-regulate their progress and perceive a higher degree of readiness for high-stakes examinations.

    “Additionally, strategies including peer tutoring and qualitative student reflections allowed learners to self-regulate their progress and perceive a higher degree of readiness for high-stakes examinations (Azim et al., 2025;Burel et al., 2025;Ward & Vengrin, 2024).”

    From Systematic Review of the Effectiveness of Neurodidactic Spaced Learning Strategies in Long-Term Memory (2026) · cites this paper as Azim et al., 2025

    The Results sections on metacognition and Step 1 describe students reinforcing knowledge while assisting junior students, identifying knowledge gaps, and feeling more confident about anatomy and radiology before exam preparation (page not available). But the Methods describe qualitative student responses as data collected to evaluate the elective, not as a strategy shown to help learners self-regulate; the reported confidence is also specific to anatomy and radiology rather than overall exam readiness. (LLM, conf=0.86)

    Experimental — accuracy not yet measured

  • The potential efficacy of spaced neurodidactic strategies appears to be mediated by contextual factors such as the quality of feedback, curricular integration, and the socio-emotional conditions of the classroom.

    “Additionally, the potential efficacy of these strategies appears to be mediated by contextual factors such as the quality of feedback, curricular integration, and the socio-emotional conditions of the classroom”

    From Systematic Review of the Effectiveness of Neurodidactic Spaced Learning Strategies in Long-Term Memory (2026) · cites this paper as Azim et al., 2025

    The Background (page unavailable) links longitudinal curricular integration with opportunities for spaced repetition and improved learning. The Results (page unavailable) describe students valuing collaboration and camaraderie, but our copy does not establish that classroom socio-emotional conditions or feedback quality mediate the strategies’ efficacy. (LLM, conf=0.82)

    Experimental — accuracy not yet measured

  • Reliability was reinforced through neurophysiological mapping (such as EEG pattern similarity analysis) and, in studies involving qualitative components, the application of abductive coding and inter-rater reliability checks.

    “Reliability was further reinforced through neurophysiological mapping (such as EEG pattern similarity analysis) (Feng et al., 2019) and, in studies involving qualitative components such as student reflections, the application of abductive coding and inter-rater reliability checks (Azim et al., 2025).”

    From Systematic Review of the Effectiveness of Neurodidactic Spaced Learning Strategies in Long-Term Memory (2026) · cites this paper as Azim et al., 2025

    The Methods > Data analysis section reports abductive coding and independent analyses by multiple researchers, followed by joint review to improve reliability. It does not report inter-rater reliability checks or an agreement measure. The EEG component is attributed to a different citation in the citing sentence, not to Azim et al. (LLM, conf=0.85)

    Experimental — accuracy not yet measured

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Authors
Azim, H. M., Santare, J. A., Sprague, A. V., Murphy, R. J., Miller, L. C., Perrotta, S. E., Maddahi, Y. N., & Record, M. J.
Affiliations
  • Drexel University (US)
  • St. Luke's Hospital (US)
Corresponding author
Azim, Homaira M.
ORCID
Venue
BMC Medical Education
Publisher
Springer Science and Business Media LLC
Published
2025-03-31
Volume
25
Issue
1
Pages
462-462
ISSN
1472-6920 (ISSN-L)
DOI
10.1186/s12909-025-07021-0
PMC
PMC11956444
OpenAlex
W4408991916
Cited by
5
References
7
Citations by year
2026: 3 · 2025: 2
FWCI
1.22
Type
journal article
Language
en
Open access
Licence
Locations
  • BMC Medical Education (publishedVersion, cc-by-nc-nd)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by-nc-nd)
  • PubMed Central (publishedVersion, cc-by-nc-nd)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Topics
  • Physical Sciences › Engineering › Biomedical Engineering › Anatomy and Medical Technology
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Innovations in Medical Education
  • Life Sciences › Neuroscience › Cognitive Neuroscience › Undergraduate Neuroscience Education and Research
Keywords
spaced repetition, anatomy education, medical curriculum, metacognition, diagnostic imaging, clinical case-based learning, student self-confidence
MeSH terms
Anatomy, Curriculum, Education, Medical, Undergraduate, Educational Measurement, Female, Humans, Male, Surveys and Questionnaires, Students, Medical, Focus Groups

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