Qualitative Tehran study links anatomy curriculum perceptions to specialty alignment and safety

An integrated clinical anatomy curriculum shared by General Surgery and Orthopedic Surgery residents was perceived as relevant and, with reservations, acceptable by surgical residents and faculty in a qualitative study at a university-affiliated teaching hospital in Tehran, Iran. Participants identified specialty balance, protected educational time, transparent assessment standards and a learning environment in which knowledge gaps could be voiced as conditions shaping the curriculum’s perceived value. The findings describe experiences and opinions; the study did not measure anatomical knowledge, curriculum effectiveness, assessment validity or patient-safety outcomes.

The curriculum was implemented over one academic year and shared by residents from two specialties. Researchers used a qualitative descriptive design within an interpretivist paradigm, conducting 20 individual semi-structured interviews during the eight weeks following the first full curriculum cycle and its end-of-course objective structured clinical examination, or OSCE. The sample included eight residents—four in General Surgery and four in Orthopedic Surgery, with one resident representing each postgraduate year from PGY1 through PGY4—and 12 faculty members comprising four general surgeons, four orthopedic surgeons and four clinical anatomists. Interviews were conducted in Persian, recorded and transcribed verbatim; reported quotations were translated into English with independent back-translation. The transcripts underwent codebook thematic analysis using a hybrid inductive–deductive orientation. Dataset adequacy was evaluated through information power rather than saturation, and the researchers reported the study in line with the Consolidated Criteria for Reporting Qualitative Research, or COREQ.

Six themes emerged from the interviews. Across the three participant groups, anatomy was regarded as a perceived precondition for safe operative practice. Participants also reported an estimated five- to seven-year interval between their preclinical anatomy instruction and the period in which residents assumed operative responsibility. Access to the integrated curriculum was constrained by post-call fatigue, unprotected academic half-days and travel between hospitals. Residents described these conditions as barriers to participation, while faculty treated them as implementation or delivery problems. Faculty also emphasized the absence of a national reference curriculum for clinical anatomy. These accounts document perceived access and delivery at one institution, rather than the prevalence of similar barriers across other residency programs.

Specialty alignment produced a mixed response. General Surgery residents perceived the shared material as weighted toward orthopedics. Orthopedic residents did not report a reciprocal concern, and requests for deeper coverage of limbs and joints came from orthopedic faculty rather than from orthopedic residents. The most positively described components were cadaveric prosection, case-based Integrated Clinical Morning Report sessions and co-teaching in which surgeons and clinical anatomist worked together. Assessment feedback focused on the OSCE’s perceived clarity, timing and authenticity rather than on measured validity. Because the study did not quantify the examination’s reliability or validity, the favorable comments cannot establish that the OSCE was a valid measure of learning.

Residents and faculty also described hierarchy and embarrassment as barriers to asking elementary anatomy questions. Small-group and case-based settings were perceived as comparatively safer places to acknowledge uncertainty and expose knowledge gaps, giving the curriculum a psychological-safety dimension beyond subject coverage. The study’s defensible conclusion is that perceptions of relevance and acceptability were conditional: specialty balance, scheduling compatible with residency work, clear assessment standards and permission to ask foundational questions shaped how participants experienced the program. Because the qualitative sample was limited to 20 participants at a single center, the results do not demonstrate improved anatomical retention, examination performance, operative safety or patient outcomes. Those questions would require separate outcome-based evaluation, and the reported associations between curriculum conditions and participant perceptions should not be read as measured causal effects.

Subject of Research: Resident and faculty experiences of an integrated clinical anatomy curriculum in general and orthopedic surgery

Article Title: Resident and faculty experiences of an integrated anatomy curriculum in general and orthopedic surgery: a qualitative study of specialty alignment and psychological safety

Article References: Shahrezaee, M., Movahedinia, M., Keshtkari, S., Shahrezaee, M. H., Chamanara, M., Mosaed, R., Rezaee, S. P., Feizi, D., Shishegar, A., Sadeghi, S., Mirsaeid, S. G., & Naseri, A. (2026). Resident and faculty experiences of an integrated anatomy curriculum in general and orthopedic surgery: a qualitative study of specialty alignment and psychological safety. BMC Medical Education. https://doi.org/10.1186/s12909-026-10361-0

Image Credits: AI Generated

DOI: 10.1186/s12909-026-10361-0

Keywords: clinical anatomy, surgical education, medical residents, curriculum integration, psychological safety, OSCE assessment, case-based learning, orthopedic surgery, general surgery, qualitative study, Resident, faculty