Implementation of Ultrasound in Anatomy Education

Comparing the Clinical Orientation Benefits of Endoscopic demonstration on the Nose, Paranasal Sinuses, and Skull Base Versus Cadaveric Dissection for First-Year Medical Undergraduates

The study aims to evaluate the advantages of using endoscopic demonstrations to teach nose, paranasal sinuses, and skull base anatomy compared to traditional cadaveric demonstrations. Traditional dissection methods do not provide an accurate representation of in vivo visualization of these anatomical areas. The goal is to align the teaching approach with the perspective students will have during clinical practice for better clinical orientation. In this study, 100 first-year medical students were split into two groups: Group A and Group B, each with 50 students. Group A received teaching through endoscopic demonstrations, while Group B had cadaveric demonstrations, both focused on nose, paranasal sinuses, and skull base anatomy. To assess comprehension and clinical orientation, both groups completed a questionnaire with clinically relevant questions, and their responses were collected and compared for analysis. Students who received endoscopic training showed better accuracy in addressing clinical queries than those only exposed to cadaveric dissection. Many participants favored incorporating endoscopic instruction, either as a replacement or addition to traditional cadaveric dissection, for the studied topics. The endoscopically trained group performed better in understanding anatomical landmarks, mentally reconstructing 3D images, and conceptualizing surgical approaches for the targeted anatomical areas. Incorporating endoscopic training for the nasal cavity, paranasal sinuses and skull base into the undergraduate medical curriculum would substantially augment students' clinical understanding and provide a more profound grasp of the dynamic anatomy in these areas.

The advantages of utilizing different ultrasound imaging techniques on joints of human cadavers in the teaching of anatomy - A scoping review

BACKGROUND

A common approach to define sonoanatomy is a reciprocal exchange of macroscopic and microscopic information in ultrasound imaging. High-resolution ultrasound has been long established and is crucial as an inexpensive and adaptable tool, not just in clinical settings but also while teaching anatomy. Early application of ultrasonography provides medical students with a couple of benefits: they acquire an improved understanding of anatomy and learn how to use it.

METHODS

A comprehensive literature review has been carried out, with relevant studies discovered in the following databases: MEDLINE, EMBASE, CENTRAL, BIOSIS Previews and Web of Science Core Collection. Gray literature was also considered in two different ways: (1) Regarding grey literature databases: National Gray Literature Collection. (2) For PhD theses and dissertations, the databases EThOS and Open Access Theses and Dissertations were screened for relevant studies by combining the keywords used in the search string. The reference lists of all relevant papers were scanned. Search process was performed on January 3rd, 2023. The search string was developed with the aid of and finally checked by a professional librarian. Only ultrasound studies on human cadavers were included, not animals or phantoms. If the studied subject was a joint, the article was included. Only B-Mode ultrasound was included, whereas Elastosonography, Doppler sonography and quantitative approaches including among others sound speed, backscatter attenuation were excluded. Intravascular, intraosseous, intraarticular, and three-dimensional or four-dimensional ultrasonography were also eliminated from the analysis. All appropriate information comprising articles, PhD theses, dissertations and chapters in textbooks were considered. There were solely English and German studies covered. There was no additional restriction on the publishing year. The included studies' general characteristics and ultrasound techniques were taken from them and examined. Using VOS viewer, a keyword analysis was also carried out.

RESULTS

142 of the 8899 results that were returned by the search satisfied the requirements. With a quarter of the included studies, the knee joint was the most extensively studied joint, followed by the elbow joint (10.6%) and the shoulder joint (9.2%). The methodological analysis includes 125 studies. Both the sample size and the ultrasonographer's qualifications were diverse. The probe position and the ultrasound method were precisely documented so that a reader could duplicate them in about three-quarters of the included studies (72.8%).

CONCLUSION

The current study, in our perspective, is the first scoping review to screen ultrasound studies on human cadaver joints. A heterogeneous field was shown by the methodological investigation. We suggest using a uniform method for conducting and presenting ultrasound examinations in future studies.

A new dimension in medical education: Virtual reality in anatomy during COVID-19 pandemic

Virtual reality technology has been increasingly used in the field of anatomy education, particularly in response to the COVID-19 pandemic. Virtual reality in anatomy (VRA) allows the creation of immersive, three-dimensional environments or experiences that can interact in a seemingly real or physical way. A comprehensive search of electronic databases was conducted to identify relevant studies. The search included studies published between 2020 and June 2023. The use of VRA education has been shown to be effective in improving students' understanding and retention of knowledge, as well as developing practical skills such as surgical techniques. VRA can allow students to visualize and interact with complex structures and systems in a way that is not possible with traditional methods. It can also provide a safe and ethical alternative to cadavers, which may be in short supply or have access restrictions. Additionally, VRA can be used to create customized learning experiences, allowing students to focus on specific areas of anatomy or to repeat certain exercises as needed. However, there are also limitations to the use of VRA education, including cost and the need for specialized equipment and training, as well as concerns about the realism and accuracy of VRA models. To fully utilize the potential of VRA education, it is important for educators to carefully consider the appropriate use of VR and to continuously evaluate its effectiveness. It is important for educators to carefully consider the appropriate use of VRA and to continuously evaluate its effectiveness to fully utilize its potential.

Role of Living Anatomy in Medical Education: A Narrative Review

Introduction

There has been a significant change noticed in the way in how anatomy is taught and learned in last two decades. The use of teaching approaches such as body painting, peer physical examination, medical imaging, and virtual anatomy software in the teaching and learning of living anatomy was made possible by advancements in medical technology. This study focuses on a review of the historical context and contemporary developments in teaching and learning of live and surface anatomy with a special emphasis on its pedagogical elements, some opinions of medical educationists, and undergraduates.

Conclusions

It is suggested that living anatomy be included as a core subject in the curriculum. Learning about living anatomy will be improved in an integrated and pertinent framework with the inclusion and execution of teaching and learning modalities such as body painting, peer physical examination, medical imaging, and virtual anatomy software.

Correlation between Body Composition and Inter-Examiner Errors for Assessing Lumbar Multifidus Muscle Size, Shape and Quality Metrics with Ultrasound Imaging

Ultrasound imaging (US) is widely used in several healthcare disciplines (including physiotherapy) for assessing multiple muscle metrics such as muscle morphology and quality. Since measuring instruments are required to demonstrate their reliability, accuracy, sensitivity, and specificity prior to their use in clinical and research settings, identifying factors affecting their diagnostic accuracy is essential. Since previous studies analyzed the impact of sociodemographic but not body composition characteristics in US errors, this study aimed to assess whether body composition metrics are correlated with ultrasound measurement errors. B-mode images of the lumbar multifidus muscle at the fifth lumbar vertebral level (L5) were acquired and analyzed in 49 healthy volunteers by two examiners (one experienced and one novel). Cross-sectional area, muscle perimeter and mean echo intensity were calculated bilaterally. A multivariate correlation matrix was calculated for assessing the inter-examiner differences with body composition metrics. Results demonstrated excellent reliability (intraclass correlation coefficient, ICC > 0.9) for assessing the muscle cross-sectional area and perimeter, and good reliability for assessing the muscle shape and mean echo intensity (ICC > 0.7). Inter-examiner errors for estimating muscle size were correlated with participants' age (p value, p < 0.01), weight (p < 0.05), total and trunk lean mass (both, p < 0.01) and water volume (p < 0.05). Greater shape descriptors and mean brightness disagreements were correlated with older ages (p < 0.05) and total lean mass (p < 0.05). No correlations between age and body composition metrics were found (p > 0.05). This study found US to be a reliable tool for assessing muscle size, shape and mean brightness. Although aging showed no correlations with body composition changes in this sample, it was the main factor correlated with US measurement errors.

Snapshot of ultrasound imaging in basic anatomy and physiology teaching in the United Kingdom and Republic of Ireland: perceptions, obstacles, and solutions

We have used ultrasound imaging and technology as a tool for nonclinical teaching of basic physiological concepts for several years and are aware anecdotally that only a few others in the United Kingdom and Republic of Ireland (UK/ROI) are also using ultrasound with this intention in physiology and anatomy teaching. To better understand what areas ultrasound is used for by others, along with what barriers might exist to its use, we reached out to colleagues in UK/ROI institutions instructing on anatomy and physiology courses by asking them to complete a survey regarding their experiences. Relatively few institutions (9%) reported using the technology in this way but covered physiology and anatomy teaching in most major body systems. The perception of responding educators overall is that, overwhelmingly, ultrasound offers a useful addition to the teaching of physiology and anatomy and is very popular with students. Barriers to its implementation were identified, including unfamiliarity with equipment and potential uses. Lack of funding for equipment and staff, issues with class sizes, and lack of curriculum time were also identified. Despite these potential impediments, most nonusers were interested in finding out about the uses of ultrasound as a teaching tool. We conclude that the teaching community would benefit from wider dissemination of local practices.NEW & NOTEWORTHY We surveyed UK and Republic of Ireland institutions to establish the extent of ultrasound use in teaching undergraduate modules with significant anatomy or physiology content. Responses indicate that although ultrasound is used for a wide variety of systems, only a small proportion of courses use ultrasound for teaching. There is widespread interest in its use, with the main barriers being unfamiliarity with potential uses and the technology. We endorse further dissemination of this teaching practice.

Has pedagogy, technology, and Covid-19 killed the face-to-face lecture?

The lecture has been around for centuries and has featured as a popular and frequent component in higher education courses across many disciplines including anatomy. In more recent years, there has been a growing shift toward blended learning and related pedagogies that encourage active participation of students in both face-to-face and online learning environments. Unfortunately, in many cases, the lecture, which has typically focused on the transmission of information from educator to student has not been adapted to become a more learner-oriented approach with opportunities for students to actively interact and engage. As a result, the future of whether the lecture should continue has once again become a center of debate. The consequence of the Covid-19 pandemic and its aftermath have added to this with institutions now looking to stop all lectures or offer them in an online format only. This commentary argues that lecture-style components could still feature within face-to-face and online provision, but only if they are used sparingly within a blended curriculum, have a defined use that aligns well to learning outcomes, are assessed as the most effective method pedagogically, and importantly integrate approaches and activities that promote student engagement. Anatomy educators have demonstrated for years that they are able to be at the forefront of pedagogical change and evidenced during the pandemic their agile and innovative ability to adapt and do things differently. Therefore, the fate of the lecture, at least in anatomy, may well be in their hands.

"Fun slipping into the doctor's role"-The relationship between sonoanatomy teaching and professional identity formation before and during the Covid-19 pandemic

The various psychological dimensions of professional identity formation (PIF) are an important aspect of the study course for undergraduate medical students. Anatomical learning environments have been repeatedly shown to play a critical role in forming such an identity; however, relevance of PIF during sonoanatomical training remains underexplored. At the end of their basic anatomy studies, third-semester medical students took part in a four-day block course on anatomy and imaging. Anatomical content was revised in small groups using peer teaching and imaging methods, including one hour of hands-on sonoanatomy sessions each day. On-site sonoanatomy was identified as an excellent format to support students' transition from the pre-clinical to clinical phase as medical experts-to-be. Students enjoyed practical exercises and the clinical input, which increased their interest in the medical profession and their academic studies. This study further examined the effects of the transition into an online-only format, necessitated by the current Covid-19 pandemic. A comparison was made between the quantitative and qualitative evaluation data, and the written results of examinations of several on-site (n = 1096, mean age = 22.4 years ± 2.18), and online-only cohorts (n = 230, mean age = 22.6 years ± 2.21). The online-only transition led to a reduction of all PIF-related variables measured, losing identity-related variables, increasing students' stress levels, and reducing their long-term academic performance. Together, this study demonstrates presence of PIF in undergraduate sonoanatomy teaching, and cautions against the uncritical online-only substitution of hands-on learning environments.

Effectiveness of Ultrasound Cardiovascular Images in Teaching Anatomy: A Pilot Study of an Eight-Hour Training Exposure

The present study aimed to evaluate the students’ progress in evaluating ultrasound (US) and cadaveric cardiac images and long-time retention of information. First-year medical students were invited to participate in four two-hour online lectures during one week voluntarily. The students were trained to recognize cardiovascular anatomical structures on US and cadaveric images during the intervention. The participants’ abilities to identify specific anatomical structures were tested before, immediately after and six months after the training. A group of second-year students without US training participated as a control group and filled the same test once. Ninety-one first-year students agreed to participate, and forty-nine completed all three tests. The performances in the correct identification of cardiovascular structures on the US images significantly improved after the training but significantly decreased after six months. In the intervention group, the accurate identification of cardiovascular structures was significantly higher on cadaveric images (80% vs. 53%, p-value < 0.0001, n = 91 at post-training; 70% vs. 33%, p-value < 0.0001, n = 49 at 6 months after training). The correct answers percentage score in the control group varied from 6.7% to 66.7% for US cardiovascular anatomical without a significant difference than the intervention group (p-value = 0.7651). First-year students’ knowledge of heart US anatomy proved less effective than cadaveric images, significantly improved after training and decreased over time, indicating the need for repetition reinforcement.