Anatomy education in US Medical Schools: before, during, and beyond COVID-19

BACKGROUND

Anatomy education in US medical schools has seen numerous changes since the call for medical education reform in 2010. The purpose of this study was to survey US medical schools to assess recent trends in anatomy education, the impact of the COVID-19 pandemic on anatomy teaching, and future directions of medical school anatomy curricula.

METHODS

We sent a 29-item survey to anatomy course directors of 145 AAMC-associated allopathic medical schools inquiring about their schools' anatomy curricula. The survey contained objective discrete questions concerning the curricula changes preceding COVID-19 and those directly related to COVID-19. We also asked subjective and open-ended questions about the impact of COVID-19 and future directions of anatomy education.

RESULTS

A total of 117/143 course directors (82%) completed the survey. Most schools (60%) reported a major change to their anatomy course within the past five years, including a decrease in total course time (20%), integration of anatomy into other courses (19%), and implementation of a "flipped classroom" (15%) teaching style. Due to COVID-19, there was a decrease in the fraction of course time dedicated to "hands-on" learning (p < 0.01) and teaching of clinical correlates (p = 0.02) and radiology (p < 0.01). Most course directors (79%) reported that COVID-19 had a negative impact on quality of learning due to decreased interactive or in-person (62%) learning and lack of dissection (44%). Incorporation of virtual-reality applications or 3D anatomy software (23%) and a decrease in cadaver dissection (13%) were the most common future anticipated changes.

CONCLUSION

The constraints conferred by COVID-19 highlight the importance of maximizing interactive learning in the discipline of anatomy. In an era of social distancing and decreased emphasis on conventional anatomy dissection, adaptations of new technologies and teaching modalities may allow for traditional educational rigor to be sustained.

Metastatic hypernephroma to the head and neck: unusual case reports and review of the literature

Hypernephroma is one of the most common tumours to spread by extranodal metastases to the head and neck. We herein report on six patients with unusual metastatic hypernephroma to the head and neck area. In two of the six cases, the metastatic tumour in the head and neck was the presenting symptom, and the renal tumour was secondarily detected. Metastatic hypernephroma to the head and neck area has been demonstrated mostly in the paranasal sinuses, parotid gland, and the mandible. Among the six cases presented, four belong to the above-mentioned group, but the other two are rather rare cases, one metastatic to the nasopharynx and soft palate and the other to both lobes of the thyroid gland. Hypernephroma should be sought and excluded whenever a metastatic lesion is encountered in the head and neck area, even if the metastatic lesion is the first clinical presentation. The diagnosis of metastatic hypernephroma should be suspected in any patient with even a remote history of renal cell carcinoma.

[Differential malignant lymphoproliferative syndrome (LPS) diagnosis with flow cytometry: a study of 100 patients]

The clinical utility of flow cytometry in diagnosis of chronic lymphoproliferative disorders (LPD) is well established. Accurate diagnosis of related but still distinct entities is relevant to therapeutic decisions. We report on the immunophenotypic findings of 100 patients with a new diagnosis of LPD established by two-color flow cytometry. A panel of > 15 monoclonal antibodies was regularly applied. The characteristic immunophenotype of B-cell chronic lymphocytic leukemia (CD5+, CD23+, FMC7-) was found in 74 patients including one with Richter's transformation. Hairy cell leukemia (CD5-, CD11c+, CD103+) was diagnosed in 6, and B-cell Non-Hodgkin lymphoma (B-NHL) in 13 patients, respectively. 6 of the B-NHLs belonged to the entity of splenic lymphoma with villous lymphocytes (CD5-, CD23-, FMC7+) and 6 were identified as mantle cell lymphomas (CD5+, CD23-, FMC7+). One B-NHL was typed as follicular center cell lymphoma (CD5-, CD10+, FMC7+). Three B-cell LPDs without a characteristic marker profile were histologically further classifiable. With a total of 4 patients T-cell LPDs were much less frequent. Sézary syndrome (CD4+, CD8-, CD56-) and T gamma lymphoproliferation (CD4-, CD8+, CD16-, CD56-, CD57+) were diagnosed twice. In 17 patients with a characteristic marker profile (1 Richter's transformation, 5 hairy cell leukemias, 3 splenic lymphomas with villous lymphocytes, 4 mantle cell lymphomas, 4 T-cell proliferations) a further histological or molecular investigation confirmed the immunophenotypic diagnosis in all cases. Clinical presentation with lymphadenopathies and B-symptoms was mainly associated with the diagnosis of mantle cell lymphoma, whereas splenomegaly and infection were suggestive of hairy cell leukemia. 94% of the B-CLL patients were diagnosed at an early clinical stage with still conserved hematopoiesis, 32% of the LPDs were diagnosed following a routine hematogramm.

[Diagnosis of thalassemias and hemoglobinopathies by HPLC (high performance liquid chromatography): study of 627 patients]

Red cell haemolysates of 627 patients with mainly microcytic anaemia were subjected to HPLC for diagnosis of thalassaemia (thal) or haemoglobinopathy during 1998. Thalassaemia was diagnosed in 16.3% (95 beta-thal minor, 1 beta-thal major, 2 delta beta-thal heterozygote, 4 alpha-thal1), haemoglobinopathies in 3.5% (10 Hb S including 3 Hb S-alpha-thal, 1 homozygote, 1 Hb SC and 1 Hb SE; 6 Hb E including 3 homozygotes; 3 Hb Lepore heterozygotes; 1 Hb K; 1 Hb O-Arab*; 1 Hb K-Ibadan* [* = confirmed by DNA sequencing]). In 10.7% of patients severe iron-deficiency (ferritin < 7 micrograms/l) was the cause of microcytosis (MCV 72.1 +/- 2.6 fl) and anaemia (Hb 97.2 +/- 9.8 g/l). The beta-thal minor group showed prominent microcytosis (MCV 66.9 +/- 2.6 fl) but only mild anaemia (Hb 114.1 +/- 12.9 g/l). Variant Hb K-Ibadan und Hb O-Arab were found during quantification of HbA1c. Patients with beta-thal minor or severe iron-deficiency anaemia were identified with equal frequency in adult females, children and adolescents of both sexes; however, in adult males beta-thal minor was the most frequent aetiology (> 90%) of microcytic anaemia. Our results demonstrate the diagnostic value of red cell lysate HPLC and ferritin determination when evaluating unclear microcytic anaemia. This approach, together with die HbA1c-quantification by HPLC, will render possible detailed diagnosis of thalassaemia and haemoglobinopathies.

Internal jugular vein patency after functional neck dissection: venous duplex imaging

We present a retrospective study performed to determine jugular patency after functional neck dissection (FND). Twenty-six patients, 16 females and 10 males, ranging in age from 16 to 78 were examined. These patients underwent either unilateral FND or bilateral FND for cervical lymph node metastases. Cervical duplex and pulsed Doppler imaging were chosen to determine internal jugular vein (IJV) patency. The examination was performed after a minimum postoperative period of 2 months and a maximum one of 22 years. Thirty-one IJVs were examined. All but 4 IJVs examined were found patent postoperatively. The preservation rate of patency of the IJV in FND was found to be high (27 of 31 or 87%). These results favor the use of FND for IJV preservation, particularly in bilateral neck dissection.

[Hairy cell leukemia: diagnosis using monoclonal antibodies in flow cytometry]

A prospective study was performed on peripheral EDTA blood samples mailed for screening purposes to a hematology laboratory. Twenty-one samples which were suspicious for hairy cell leukemia (H 6000, Technicon Co. or STKS, Coulter Co.), were evaluated using three diagnostic tests: Microscopic morphology (Giemsa stain); Microscopic controlled inhibition of lymphocyte acid phosphatase by tartrate; Flow-cytometric immunophenotyping with monoclonal antibodies (Epics Profile, Coulter Co.). A characteristic immunophenotype was found on all typical hairy cell leukemias (except two) by positivity of CD11c, CD19, CD22, and CD25. The above-mentioned immunophenotype on peripheral lymphocytes, which can moreover be supported by demonstrating positivity for FMC7, is diagnostic for hairy cell leukemia. It therefore represents a rather straightforward tool to the bone-marrow diagnosis.

Interleukin-3 immunoassay in systemic lupus erythematosus patients: preliminary data

Systemic lupus erythematosus (SLE) may be associated with thrombocytopenia on one hand and lymphoma on the other. Interleukin-3 (IL-3) may contribute to both conditions. IL-3 is a pleotrophic growth factor affecting the proliferation and differentiation of stem cells to committed progenitors of several hematopoietic lineages including megakaryocytes and lymphocytes. The serum level of IL-3 determined by ELISA was found to be higher in a cohort of 16 patients with SLE in comparison to health controls. The IL-3 levels were highest in 2 patients with SLE and lymphoma. Interestingly, low serum levels were detected in SLE patients with thrombocytopenia. Our preliminary results may point to the role of IL-3 in the hematopoietic changes observed in SLE.

[Effects of neuropeptide Y on rat body temperature in normal conditions and after ethanol administration]

It was shown that intracerebroventricular (icv) administration of 2 micrograms neuropeptide Y (NPY) increased the rectal temperature in rats 2.5 hours postinjection. During 5 days we analysed dynamics of the effect of NPY on alcohol-induced hypothermia in this particular interval. 2 micrograms of NPY were given daily 30 min prior to 25% solution of ethanol (3 g/kg weight rat) intraperitoneal injection. It was found that NPY can prevent the attenuation of alcohol hypothermia on the 3-d and 4-th injection day. It was supposed that the inhibitory effect of NPY on the development of alcohol tolerance may be due to the capacity of NPY to increase food behavior. So it's known that activation of other competitor motivation may inhibit the development of alcoholism.

[Effects of neuropeptide Y on behavior and noradrenaline level in the brain]

The administration of neuropeptide Y in lower doses (1 and 100 ng/rat) into the lateral ventricle of the brain gave rise to the inhibition of locomotor activity, weakening of the orienting-exploratory behaviour, increase in the period of rest in animals. Feeding and drinking behaviour after the administration of neuropeptide was not observed. Alterations of behaviour in rats were followed by a dose-depended increase in noradrenaline in hypothalamus. No changes were observed in the content of noradrenaline in the frontal cortex and septum. Some variations in the level of noradrenaline were found in amygdala and hippocamp. It may be assumed that behavioural effects, aroused by the central administration of neuropeptide Y, is connected with the activation of catecholaminergic systems of hypothalamus.