Relevancy of Embryology in Modern Medical Curriculum

Abstract

Traditionally, embryology is considered a valuable part of the medical curriculum. Over the last few decades, the time allocated for anatomy teaching has reduced significantly with embryology suffering the most compared to other disciplines of anatomy. Consequently, some medical schools around the world have excluded embryology from their curriculum. In this commentary, we evaluate the relevance of embryology in the current medical curriculum including exploring the current state of embryology teaching and learning as well as student perceptions towards embryology.

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 Malaysian Association of Education in Medicine and Health Sciences and
Penerbit Universiti Sains Malaysia. 2023
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COMMENTARY
Volume 15 Issue 4 2023
DOI: 10.21315/eimj2023.15.4.10
ARTICLE INFO
Received: 31-01-2023
Accepted: 16-05-2023
Online: 29-12-2023
CORRESPONDING AUTHOR Mohd Asnizam Asari, Department of Anatomy, School of Medical Sciences, Health
Campus, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia
Email: asnizam@usm.my
INTRODUCTION
Embryology, normally considered a part
of anatomy, is a science concerned with
processes and mechanisms associated
with normal human development from
the moment of fertilisation until birth (1,
2). Through embryology, we get to know
how our body is rst formed and what
changes occur throughout our intrauterine
development (3). Traditionally, embryology
has long been regarded as an important
component of preclinical basic medical
science in medical curricula throughout the
world. However, over the past few decades,
for some reason, embryology has lost its
allure within medical education, and could
possibly be excluded from the medical
curriculum (4–6). In fact, some medical
schools in the US and Canada have already
removed embryology from their curriculum
(4, 7, 8). In this short commentary, we
discuss the current state of embryology
teaching from evidence available in the
literature and explore student perceptions
and the relevance of embryology in medical
curricula.
To cite this article: Mukhtar SF, Asari MA, Kasim F, Mohd Ismail ZI, Hadie SNH, Mohd Yusof
NA, et al. Relevancy of embryology in modern medical curriculum. Education in Medicine Journal.
2023;15(4):133–137. https://doi.org/10.21315/eimj2023.15.4.10
To link to this article: https://doi.org/10.21315/eimj2023.15.4.10
ABSTRACT
Traditionally, embryology is considered a valuable part of the medical curriculum. Over the last few
decades, the time allocated for anatomy teaching has reduced signicantly with embryology suffering
the most compared to other disciplines of anatomy. Consequently, some medical schools around the
world have excluded embryology from their curriculum. In this commentary, we evaluate the relevance
of embryology in the current medical curriculum including exploring the current state of embryology
teaching and learning as well as student perceptions towards embryology.
Keywords: Embryology, Anatomy, Medical education, Medical curriculum
Relevancy of Embryology in Modern Medical
Curriculum
Siti Fatimah Mukhtar, Mohd Asnizam Asari, Fazlina Kasim, Zul Izhar
Mohd Ismail, Siti Nurma Hanim Hadie, Nurul Aiman Mohd Yusof,
Shamsi Amalina Shamsuddin, Anna Alicia Simok, Mohamad Syabil
Ikhwan Mohd Amin
Department of Anatomy, School of Medical Sciences, Universiti Sains
Malaysia, Kelantan, MALAYSIA

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Education in Medicine Journal 2023; 15(4): 133–137
https://eduimed.usm.my
regarded as an important component of
medical curricula and many medical schools
want to maintain it in their curriculum.
Firstly, a clear understanding of embryology
provides insight regarding human creation
and intrauterine development. Good
knowledge of embryology enables students
to appreciate human beginnings, including
their own, from fusion of two reproductive
cells (sperm and ovum) which undergo
tremendous transformation to form a
complex multicellular, multisystem entity
(4). This understanding may instil a sense
of humility into a student’s conscience
which would produce empathic and
responsible future health practitioners. The
second reason is that embryology provides
an understanding regarding the sacred
interaction between the embryo and its
mother during intrauterine development.
This includes the role of the mother in
providing nutrients and protection to the
developing embryo during pregnancy.
Thirdly, studying embryology provides a
basis for understanding the mechanism
and processes of birth defect. Congenital
conditions and birth defects are sadly not
uncommon in the community, and it is
estimated that up to 6% of infants are born
with congenital conditions worldwide,
resulting in over 295,000 deaths per
annum (13). Finally, students should
also be educated and aware of factors
such as endogenous genetic or external
environmental elements that may inuence
or increase the incidence of various
congenital malformations.
What is the perception of students towards
embryology? It is often assumed that
medical students regard embryology as
a boring, not easy to learn and low-yield
subject which can be neglected. It is also
often assumed that students would be
happy if embryology were to be removed
from the medical curriculum. However,
the available evidence from the literature
suggests otherwise. Perhaps surprisingly, a
majority of students would like embryology
to remain within the medical curriculum.
A study by Hamilton and Carachi (5)
on 146 British medical students revealed
How is embryology taught in medical
schools throughout the world? Available
evidence shows that the teaching of
embryology not only varies considerably
between countries but also between different
universities within the same country (9).
In the US, according to the most recent
available survey, embryology is taught
in an integrated curriculum in 92% of
medical schools there, with the remaining
8% as a stand-alone course (7). A survey
in Canada revealed that almost 100% of
medical schools taught embryology in
integrated curriculum (8). In addition, there
is variation on how the embryology lectures
are delivered to medical students. Some
medical schools integrated embryology with
gross anatomy, some medical schools taught
embryology in conjunction with histology,
and some taught it as stand-alone lectures
(9, 10). At Universiti Sains Malaysia, and
many other medical schools in Malaysia,
embryology is taught as stand-alone lectures
in fully integrated curriculum.
Data collected in the US indicate that
there has been a signicant decrease in the
time allocated to embryology teaching over
the past century (11, 12). Although such
data do not seem to have been gathered
elsewhere, it is likely that a similar reduction
in the allocated time to embryology teaching
has occurred in other parts of the world. As
for the US, the time devoted to embryology
was reduced by over 75% between 1955
and 2017, that is from approximately
60 hours to 14 hours on average (7, 11,
12). In Canada, a survey conducted during
the 2016/2017 academic year, found only
7 hours on average were dedicated to the
teaching of embryology (8), which is a
signicant reduction in embryology teaching
hours compared to three to four decades
ago.
As mentioned, a few medical schools in the
US and Canada have removed embryology
from their medical curriculum. Despite that,
majority of the medical schools throughout
the world still maintain embryology as a core
subject in their medical curriculum. There
are several reasons why embryology is still

COMMENTARY | Embryology in Medical Curriculum
135
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3D approach permits students to visualise
in greater detail on the spatial relationships
between certain embryonic structures and
their dynamic process of development (17).
The use of multimedia approaches such as
recorded videos and interactive animation
to supplement the existing lectures has
been shown to enhance student’s learning
experience (18). Web-based learning
(e-learning) is increasingly being used
in many medical schools worldwide to
deliver various learning activities via the
internet. This method offers unlimited
access to instructional resources and at the
same time makes the learning exible and
efcient. The use of e-learning has increased
exponentially during the COVID-19
pandemic throughout the world. In fact,
e-learning is the only method available to
engage students in learning especially during
total lockdown to prevent the spread of the
virus in the community (19). E-learning
can be integrated into a curriculum that
turns into a complete stand-alone course
or as a supplement to traditional courses.
Furthermore, a greater focus on clinical
implications during embryology teaching
has been shown to be effective in improving
student interest and understanding of the
subject (16).
CONCLUSION
What is the future of embryology education?
One thing is almost certain; embryology
will continue to be part of the medical
curriculum in many medical schools
throughout the world for the foreseeable
future. Secondly, embryology teaching
time is unlikely to be increased within the
current medical curriculum and this should
be acknowledged and accepted by educators
involved in embryology teaching. In spite
of the time limitation, educators can and
should make appropriate adjustments
in terms of course delivery and teaching
methods so that students acquire the
necessary embryology knowledge for safe
medical practice (16). It has been shown
that well-planned and well-constructed
that despite being unhappy with their
current embryology teaching, the majority
of them (81%) would like embryology to
be retained in the medical curriculum.
A larger study by Moxham et al. (9) on
1,600 medical students across Europe
revealed the same pattern of positive
attitudes among medical students towards
embryology. A recent study in Ethiopia in
2022 showed overall positive perception
among 246 medical students towards
embryology with more than half of the
students (68%) perceived embryology as
the most clinically relevant basic sciences
subject (14). Another study in India shows
that medical students recognised the
importance of embryology knowledge for
their professional career as future medical
practitioners with overall positive perception
towards embryology (15). A similar study
among Australian medical graduates found
overwhelming number of students reported
that embryology knowledge helped them
during their clinical works (16). Therefore,
from these past studies, embryology is still
deemed as relevant to medical students
and majority of them want it in the medical
curriculum.
Therefore, the issue now is not whether
embryology is still relevant in medical
curriculum, but how to deliver the
embryology knowledge to medical students
effectively. The shift from traditional to
integrated curricula has led to the reduction
in time allocation for anatomy teaching,
in which embryology suffered the most
compared to other disciplines of anatomical
sciences. Traditionally, embryology was
taught via a series of lectures with no
laboratory activities (10). Due to current
time constraints, absolute adherence to
traditional teaching methods may no longer
be suitable for embryology. There have been
many innovative approaches introduced
by various researchers to teach embryology
effectively and efciently despite the
restricted allocated time for embryology.
For instance, the use of 3D virtual computer
images and models has been shown to be
superior to the traditional 2D images as

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Education in Medicine Journal 2023; 15(4): 133–137
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8. Rockarts J, Brewer-Deluce D, Shali A,
Mohialdin V, Wainman B. National survey
on Canadian undergraduate medical
programs: the decline of the anatomical
sciences in Canadian medical education.
Anat Sci Educ. 2020;13(3):381–89. https://
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9. Moxham BJ, Emmanouil-Nikoloussi E,
Standley H, Brenner E, Plaisant O, Brichova
H, et al. The attitudes of medical students
in Europe toward the clinical importance of
embryology. Clin Anat. 2016;29(2):144–50.
https://doi.org/10.1002/ca.22667
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neglected part of the medical curriculum. Rev
Argent Anat Clín. 2017;9(2):47–51. https://
doi.org/10.31051/1852.8023.v9.n2.16899
11. Drake RL, Lowrie DJ Jr, Prewitt CM. Survey
of gross anatomy, microscopic anatomy,
neuroscience, and embryology courses in
medical school curricula in the United States.
Anat Rec. 2002;269(2):118–22. https://doi.
org/10.1002/ar.10079
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teaching resources result in a high degree of
satisfaction and condence among students
even within modern time constraints (20).
In conclusion, embryology should be taught
in the context of clinical conditions and to
an appropriate level and depth, which are
topics for future discussion.
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