Enjoy Embryology: A Student’s Perspective and Research on Enhancing the Instruction of

Embryology in the MUCOM BMS Program

Carmen McGhee
A capstone paper submitted in partial fulfillment of the requirements for a Master’s degree in
Biomedical Science

Marian University
College of Osteopathic Medicine
Indianapolis, IN

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 Table of Contents

Abstract............................................................................................................................................3
Introduction......................................................................................................................................3
Part I: Defining Embryology and Exploring its Relevance in Medical Training and Beyond........4
Part II: Methods for teaching embryology – Areas for Improvement and Limitations...................6
Part III: My Study and Results........................................................................................................7
References......................................................................................................................................12

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Abstract

Many students struggle to grasp the concepts presented when learning embryology. The

vocabulary of embryology is unique to embryology, words like syncytiotrophoblast do not exist

outside of the discipline. Prior to a graduate-level program, most students are not exposed to

such terminologies. The perceived isolation of the topic makes it difficult for students to connect

it to other topics or find its relevance among their other medical studies. The visual language is

also a challenge, as the early embryo does not have a face or other helpful structures that are

recognizably human. Leaning into my own concerns with the limitations of the material

available, I sought to make a resource that would help my fellow students understand and enjoy

learning embryology. A survey from former students of the Marian University BMS program

helped me tailor my resource, in the hopes that their feedback could help future cohorts.

Introduction

Historically embryology has challenged pre-medical and medical students alike. In an

undergraduate degree the topic is lightly touched on, but master’s and doctorate level

embryology require a more in-depth look. Many methods are used to help students master the

material. Engaging students to find relevance and interest in embryology is a persistent endeavor

on the part of academic administrators and instructors alike. Some question its importance and

place in medical education. While others find that it is an integral part of a holistic medical

education and is critical to a successful career in clinical medicine. It is important to engage

students under a variety of teaching methods paired with accurate and consistent resources to

guide them in their studies.

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Part I: Defining Embryology and Exploring its Relevance in Medical Training and Beyond

Embryology is defined as the branch of medicine and biology concerned with the study

of embryos and their development. Embryology is a discipline studied across species, but human

embryology is of special interest to anyone pursing a medical degree. It is taught alongside

anatomy and physiology as the two topics relate and are relevant to the understanding of both.

Learning embryology alongside anatomy and physiology is beneficial for identifying clinical

manifestations of developmental abnormalities. For example, esophageal atresia or EA is a rare

birth defect occurring in 1 out of every 4,100 babies. During development of the esophagus, the

lower portion of the tube may fuse with the trachea referred to as tracheoesophageal fistula or

TEF. This causes the esophagus to stop short and prevents food from entering the stomach. A

combination of symptoms may present such as difficulty breathing, choking, or coughing during

feedings and not being able to keep any food down. Although rare and treatable through surgery,

without proper diagnosis TEF and EA can be a death sentence for the infant. EA/TEF is one of

the most frequently missed congenital anomalies prenatally. Without proper exposure to

embryology as a medical student, this common misdiagnosis may persist.

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Figure 1. Esophageal atresia with tracheoesophageal fistula or TEF in infant. From CDC website.

Although the importance of embryology may seem apparent, there has been debate over

the years about its relevance in medical training. A recent study surveyed medical students on

their attitude towards the clinical importance of embryology (Moxham, 2015, p.147). The study

included a vast number of students from several countries all over Europe, with one common

conclusion: medical students did not see the clinical relevance for learning embryology early on

in their training. An encouraging finding was that most of the students had not yet been exposed

to embryological content, thus leaving space for future understanding of its importance. Many

critical questions have been raised about the best way to teach embryology. Should it be

sprinkled throughout the anatomy and physiology course, or should it have its own time to shine

in a separate stand-alone course? How much time should be devoted to embryology? One study

claimed that a single 2-hour course which covered eight body systems was enough to give first

year medical students more confidence and increased a benign view of embryology (Kazzazi,

Bartlett, 2017, p.802). But is a 2-hour course for all of embryology on a graduate level enough?

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Presentation of the material in a clear and consistent way along with the exploration of a variety

of teaching methods may be the key to making embryology more accessible.

Part II: Methods for teaching embryology – Areas for Improvement and Limitations

Embryological instruction presents unique challenges due to the lack of directional cues

early in development. For example, during the “pre-embryonic” phase – the blastocyst is formed

and has three basic structures – the trophoblast, the blastocystic cavity and the embryoblast. As

the blastocyst develops further and becomes the embryo, these same structures change in name

and shape. In the embryonic stage another challenge is that it is important to show the dorsal and

transverse view of the embryo because it looks different depending on what structure is being

depicted. A quick google search yields thousands of inconsistent images, which can be dizzying

for students. Taking such a complex three-dimensional arrangement of different cell types, etc

and putting them on the paper as an illustration is a very tough task.

Many teaching methods can be employed to help students manage the complexity and

volume of embryological content. Although traditionally, passive learning methods have

dominated the classrooms of medical trainees. The passive learning method involves the

transmission of information from the instructor to the student without active engagement on the

student’s part. Even with this method being the most popular and most likely the most time-

efficient – it doesn’t always lead to the best outcomes as far as retention of the material. Active

methodologies are fast becoming a new and ‘radical’ approach for teaching embryology and

other related topics to medical students (Guedert et al., 2022). Six active learning methodologies

were outlined by Guedert and colleagues in their paper about the importance of these teaching

styles for embryology instruction in particular:

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Team-based learning of TBL - was found to give students ‘instant feedback’ which gave them a
real-time look at what they knew and what they needed to review.

Blended learning - mixed online and in-person learning and allowed students and instructors to
individualize schedules and encouraged self-directed study.

Sandwich method – a technique where students practice topics they know and topics they need to
learn in an alternating fashion. That way the students in the class can go at their own pace. This
method can also include phases of learning collectively and individually.

Group teaching – this method can use a monitor or tutor or be self-directed. Group study or
teaching has been shown to intensify interest in the subject and has an over-all positive effect on
learning.

Playful teaching – using materials such as model clay to present embryological topics have been
shown to increase student engagement and retention of the material. The cost of materials is low
and thus this technique is economically sound.

e-Learning – considered to be the ‘future of learning’ students and teachers alike must stay in
touch with the current apps and programs available on the internet. Apps such as Kahoot have
been shown to have a positive impact on learning.

A revision of embryological instruction is timely, especially because all of these methods can be
employed at little to no cost. All have shown in several studies to improve cognitive
development, student engagement, and retention of the material.

Part III: My Study and Results

My own experience with learning embryology was a whirlwind. It was my first in-depth

exposure to the topic and my head was spinning after just the first lecture. Learning embryology

includes orienting yourself not only visually but learning the language of embryology. Even with

being introduced to the subject in undergrad Anatomy and Physiology, I still had a lot of new

terminologies to learn that I had not seen prior to my graduate studies. I found the illustrations

from the textbook to be confusing and I didn’t know what I was looking at a lot of the time. It

wasn’t until I started to draw structures out myself that I understood better. I have the advantage

of being an illustrator, so it was enjoyable to me, but I know several of my cohort were less
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enthusiastic. It got me thinking that I could probably help a lot of people by making an illustrated

guide to our program’s embryological content specifically. There are several resources available,

but they are all different and not tailored to BMS-521-MM01 (AnP I) and BMS-522-MM01

(AnP II) at Marian. As I started to create the resource it became apparent how important the

resource would be. Several of the images I found from a google search were inaccurate, which

was alarming. Even a few illustrations from our textbook Before We Are Born raised questions

for me as far as anatomical accuracy.

Figure 2. Example of internet illustration with the connecting stalk in the incorrect position.

Found from googling “primitive streak.”

To begin making my resource I thought of all the things I would have wanted while

taking embryology. I think having all the embryology sprinkled throughout the course was fine,

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but I kept wanting something where all the embryology was together so I could make

connections throughout the year and refer quickly to past lectures. I also wanted something

where all the illustrations were by the same artist, so I could see the progression of development

in a consistent way. Lastly, I wanted illustrations that helped me visualize a 3D structure on

paper. After deciding the most important things to me, I went a step further and created a survey

to capture the needs of my fellow classmates. The survey was five questions – made short to

encourage participation – with three multiple choice and two short answer. The goal of the

survey was to understand any frustrations among BMS students while learning embryology.

Fifteen former Marian BMS students participated. Results from the survey are illustrated below.

1. Which Topic(s) in Embryology Were The Most Chal-

lenging To You?
I don't remember
Reproductive
Digestive
Embryology Topic

Lymphatic
Urinary
Blood Vessel
Respiratory
Cardiovascular
Peipheral Nervous System
Nervous System
Muscle
Weeks 3-4
Weeks 1-2
0 2 4 6 8 10 12 14
Number of Student Responses

Figure 3. The first question from the BMS student survey.

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 For the first question, I wanted to get a sense of which topics were the hardest for

students. I knew for myself that week’s 1-4 were very challenging, so I was amused to see that

those were the hardest for others as well.

2. What Resources Helped You The Most For

Embryology?
Other

Office Hours
Resources

Lecture Material

Youtube Videos

Draw It to Know It

0 1 2 3 4 5 6 7 8 9 10
Number of Student Responses

Figure 4. The second question from the BMS student survey.

The second question in the survey – what resources helped you the most for embryology?

– was asked to get an understanding of what students leaned on most heavily to study and

understand material. The lecture material was rated as the most helpful, while YouTube videos

were voted as the second most helpful. I found it interesting that DITKI had no votes, since it

has videos and guided lectures to draw along with.

The third prompt in the survey – Please state any of the ways in which illustrated

resources could be better for embryology – was a fill in the blank. A response that popped up

more than once was that the illustrations weren’t consistent throughout lecture material making it

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harder to grasp certain concepts. One participant noted that better images with more “broken-

down steps” would have helped them. Another suggested 3D models as a teaching tool for

embryology, and another mentioned that including models with “colored skin” would have made

the illustrations better and more inclusive.

For the fourth prompt, I asked students to share their outcome in embryology. Not with a

grade, but rather with a feeling. A couple examples of the multiple-choice answers included, “I

felt very confident” or “I struggled throughout the course to stay on top of embryology material.”

Most people chose, “I struggled in the beginning but felt more confident with the material as the

course progressed.” To me this suggests that there is a big learning curve with embryology,

because much of the terminology is brand new to learners. The language of embryology must be

learned first. Not only the verbal or written language, but the visual language as well.

For the fifth and final question, I asked students to write a short answer to the prompt:

“What I wish I knew about embryology before taking the course, and what I would tell future

cohorts before they begin” Many participants suggested drawing concepts out to help. Others

suggested studying early and staying consistent.

It would have been ideal to have had more participants included in the survey over the

course of several cohorts. If I were to further this research, I would work to secure more data.

The most impactful thing for me when I was in the BMS program was learning from the medical

students. I benefitted so much from our office hours together. Getting their perspective and

wisdom was imperative to my success. In all of this, getting the survey out and making the

resource, I wanted to give back and help future students feel a little bit more comfort while

studying embryology. The resource I made ended up being 155 pages broken into four parts. I

was very intentional about how I drew concepts to help students visualize topics better. The next

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phase of this research would be to have students use the resource and see if it helps them. Future

plans also include 3D models and videos. Learning embryology along with the massive amounts

of other information can be daunting. I wanted to break it down to smaller pieces, and show

students how fascinating the topic is, so they too can enjoy embryology.

References

1. “Facts about Esophageal Atresia.” Centers for Disease Control and Prevention, 28 June 2023,
www.cdc.gov/ncbddd/birthdefects/esophagealatresia.html.

2. Ferlauto, H. R., Fleming, T. L., Drysdale, N. D., Gilmore, B. F., & Migaly, J. (2021). A Novel
Model for a Student-Led Surgical Anatomy Seminar. J Surg Educ, 78(2), 382-385.
https://doi.org/10.1016/j.jsurg.2020.07.029

3. Formation of the Primitive Streak,

embryology.ch/en/embryogenese/embryonic-disk/trilaminar-germ-disk/primitive-
streak.html. Accessed 8 Sept. 2023.

4. Guilherme Guedert, D., de Lima, P., Souza, E. S. R., & Cláudia Carneiro Girão Carmona, V.
(2022). The use of active methodologies for the teaching of human embryology: A
systematic review. Anat Histol Embryol, 51(3), 332-338.
https://doi.org/10.1111/ahe.12803

5. Kassif, E., Weissbach, T., Kushnir, A., Shust-Barequet, S., Elkan-Miller, T., Mazkereth, R.,
Weissmann-Brenner, A., Achiron, R., & Weisz, B. (2021). Esophageal atresia and
tracheoesophageal fistula: prenatal sonographic manifestation from early to late
pregnancy. Ultrasound Obstet Gynecol, 58(1), 92-98. https://doi.org/10.1002/uog.22050

6. Kazzazi, F., & Bartlett, J. (2017). Condensing embryology teaching for medical students: can
it be taught in 2 hours? Adv Med Educ Pract, 8, 797-806.
https://doi.org/10.2147/amep.S151880

7. Moraes, S. G., & Pereira, L. A. (2010). A multimedia approach for teaching human
embryology: Development and evaluation of a methodology. Ann Anat, 192(6), 388-395.
https://doi.org/10.1016/j.aanat.2010.05.005

8. Moro, C., Štromberga, Z., Raikos, A., & Stirling, A. (2017). The effectiveness of virtual and
augmented reality in health sciences and medical anatomy. Anat Sci Educ, 10(6), 549-
559. https://doi.org/10.1002/ase.1696

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9. Moxham, B. J., Emmanouil-Nikoloussi, E., Standley, H., Brenner, E., Plaisant, O., Brichova,
H., Pais, D., Stabile, I., Borg, J., & Chirculescu, A. (2016). The attitudes of medical
students in Europe toward the clinical importance of embryology. Clin Anat, 29(2), 144-
150. https://doi.org/10.1002/ca.22667

10. Patel, S. T., Dodhia, S., & Parekh, K. P. (2018). Condensing embryology teaching: a medical
student perspective. Adv Med Educ Pract, 9, 187-190.
https://doi.org/10.2147/amep.S160475

11. Scott, K. M., Charles, A. R., & Holland, A. J. (2013). Clinical embryology teaching: is it
relevant anymore? ANZ J Surg, 83(10), 709-712. https://doi.org/10.1111/ans.12213

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