Monitoring student meaning-making in human anatomy and physiology: the need for multiple representations and representation construction

Effective teaching and learning in Human Anatomy and Physiology (HAP) requires fostering deep conceptual understanding essential for medical careers. However, traditional instruction often relies heavily on multiple-choice assessments, emphasising memorisation rather than meaningful learning. This study investigates how integrating multiple representations and engaging students in representation construction enhances their meaning-making and provides insights for instructors to better monitor student learning. The Draw-and-Explain Questionnaire (DaEQ) was developed to assess 27 undergraduate HAP students' abilities to express their understanding through drawing and writing tasks. Correlation and demographic analyses revealed performance variations across different forms of representation, showing a significant negative correlation between drawing and written responses (r = -0.503). Demographic variables including high school HAP learning experience (F = 5.04, η2 = 0.17, p < 0.05), university HAP learning experience (F = 0.04; η2 = 0.19, p < 0.05), and university level (F = 4.16; η2 = 0.14, p < 0.05) also influenced student ability to demonstrate meaning-making through text and drawing. These findings highlight that monitoring students' conceptual development necessitates tracking their use of multiple representations. Consequently, instructional practices should intentionally integrate diverse representation strategies, particularly drawing and textual explanations, to effectively support and assess students' deeper meaning-making in HAP education.