gms | German Medical Science

Jahrestagung der Gesellschaft für Medizinische Ausbildung (GMA)

27.09. - 29.09.2012, Aachen

Arthroscopy or ultrasound in undergraduate anatomy education: a randomised cross-over controlled trial


  • corresponding author Matthias Knobe - RWTH Aachen, Unfallchirurgie, Aachen, Deutschland
  • Hans-Christoph Pape - RWTH Aachen, Unfallchirurgie, Aachen, Deutschland
  • Stefan Beckers - RWTH Aachen, Anästhesie / AIXTRA, Aachen, Deutschland
  • Felix Hoffmann - RWTH Aachen, Unfallchirurgie, Aachen, Deutschland
  • Sasa Sopka - RWTH Aachen, Anästhesie / AIXTRA, Aachen, Deutschland
  • Melanie Simon - RWTH Aachen, Studiendekanat, Aachen, Deutschland
  • Miriam Rüsseler - Johann Wolfgang Goethe-Universität Frankfurt/M., Unfallchirurgie, Frankfurt, Deutschland
  • John Bennet Carow - RWTH Aachen, Unfallchirurgie, Aachen, Deutschland

Jahrestagung der Gesellschaft für Medizinische Ausbildung (GMA). Aachen, 27.-29.09.2012. Düsseldorf: German Medical Science GMS Publishing House; 2012. DocP113

doi: 10.3205/12gma012, urn:nbn:de:0183-12gma0128

Published: September 18, 2012

© 2012 Knobe et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.



Background: The exponential growth of image-based diagnostic and minimally invasive interventions requires a detailed three-dimensional anatomical knowledge and increases the demand towards the undergraduate anatomical curriculum. This randomised controlled trial investigates whether musculoskeletal ultrasound (MSUS) or arthroscopic methods can increase the anatomical knowledge uptake.

Methods: Second-year medical students were randomly allocated to three groups. Additionally to the compulsory dissection course, the ultrasound group (MSUS) was taught by eight, didactically and professionally trained, experienced student teachers (Fifth-year’s medical students) and the arthroscopy group (ASK) was taught by eight experienced physicians. The control group (CON) acquired the anatomical knowledge only via the dissection course. Exposure (MSUS and ASK) took place in two separate lessons (each of 75 minutes, shoulder and knee joint) and introduced standard scan planes using a 10-MHz ultrasound system as well as arthroscopy tutorials at a simulator combined with video tutorials. The theoretical anatomic learning outcomes were tested using a multiple-choice questionnaire (MCQ), and after cross-over an objective structured clinical examination (OSCE). Differences in student’s perceptions were evaluated using Likert scale-based items.

Results: The ASK-group (n=70, age 23.4 (20-36) yrs.) showed a significantly better anatomical knowledge (MCQ) in general in comparison to the MSUS-group (n=84, age 24.2 (20-53) yrs.) and the CON-group (n=88, 22.8 (20-33) yrs.; p=0.019). There were significant knowledge benefits of the students in the shoulder area after the arthroscopy tutorial (p<0.001), while in the knee area (p=0.317) as well as other anatomic areas (p=0.456) no differences could be detected between any of the three different trial groups. The final examination (OSCE) showed no significant differences between any of the groups with good overall performances. In the evaluation, the students certified the arthroscopic tutorial a greater advantage concerning anatomical skills with higher spatial imagination in comparison to the ultrasound tutorial (p=0.002; p<0.001) (see Figure 1 [Fig. 1]).

Conclusions: The additional implementation of arthroscopy tutorials to the dissection course during the undergraduate anatomy training is, with respect to complex joint anatomy, profitable and attractive to students. An intended simultaneous teaching of basic-skills in the musculoskeletal ultrasound should be performed by medical experts, but seems to be inferior to the arthroscopic 2d-3d-transformation, and is regarded by students as more difficult to learn [1], [2], [3], [4], [5].


Knobe M, Münker R, Sellei RM, Holschen M, Mooij SC, Schmidt-Rohlfing B, Niethard FU, Pape HC. Peer teaching: a randomised controlled trial using student-teachers to teach musculoskeletal ultrasound. Med Educ. 2010;44(2):148-155. DOI: 10.1111/j.1365-2923.2009.03557.x External link
Wright SA, Bell AL. Enhancement of undergraduate rheumatology teaching through the use of musculoskeletal ultrasound. Rheumatology (Oxford). 2008;47(10):1564-1566. DOI: 10.1093/rheumatology/ken324 External link
Knobe M, Sellei RM, Maus U, Mooij S, Gradl G, Sopka S, Niedhard FU, Pape HC. Undergraduate curricular training in musculoskeletal ultrasound: the impact of preexisting anatomic knowledge. Z Orthop Unfall. 2010;148(6):685-690. DOI: 10.1055/s-0030-1250378 External link
Hariri S, Rawn C, Srivastava S, Youngblood P, Ladd A. Evaluation of a surgical simulator for learning clinical anatomy. Med Educ. 2004;38(8):896-902. DOI: 10.1111/j.1365-2929.2004.01897.x External link
Bliss JP, Hanner-Bailey HS, Scerbo MW. Determining the efficacy of an immersive trainer for arthroscopy skills. Stud Health Technol Inform. 2005;111:54-56.