Integrated Case-Based Learning Session for Breast and Upper Limb Anatomy

Introduction

Medical students are frequently introduced to medical school curricula through anatomy coursework, which often includes histology and embryology content. As medical education has increasingly emphasized integration of content areas, use of activities such as case-based learning (CBL) sessions has grown. Little published work has demonstrated the effectiveness of CBL sessions in integrating anatomy, embryology, and histology on first-year medical students' ability to improve content mastery and adapt their study techniques.

Methods

We developed a CBL session that included anatomy, embryology, and histology content covering the upper extremity and breast pathology that was taught to incoming first-year medical students (N = 51) during a prematriculation program in the summers of 2022 and 2023. The session involved completion of an individual pre- and postsession quiz; group completion of clinical cases involving image interpretation, matching exercises, and construction of diagrams, flowcharts, or tables; and a postsession survey with Likert-style and free-response questions about preparation and session effectiveness.

Results

Postsession quiz scores significantly improved (p < .001). On the postsession survey (response rate: 59%), students commented that they enjoyed the real-life application and integration of the cases and that the sessions improved their understanding of the connections between content areas. Other comments demonstrated that students were evaluating and adapting their study approach in preparation for the sessions, often using techniques introduced and practiced in the sessions.

Discussion

CBL sessions can provide opportunities to incoming first-year medical students to practice, adapt, and evaluate study techniques while delivering integrated content.

Use of Clinically Oriented Laboratory Manuals in a Prosection Gross Anatomy Laboratory during COVID-19

Gross anatomy is a critical course for the development of a variety of skills such as anatomical knowledge and spatial, critical, and clinical reasoning. There have been few attempts to integrate clinical applications in gross anatomy, with the majority of these being in the lecture hall and not in the laboratory. Clinical cases and guided questions were added to a laboratory manual (Clinically Oriented Laboratory Manuals (COLMs)) in a first-year medical gross anatomy prosection course during COVID-19. The effectiveness of the COLMs was analyzed using in-laboratory assessments between treatment and control groups, as well as student perceptions. There was no significant difference between in-lab assessment scores between students with or without the COLMs in 2020 (t1304.735= 0.647, p ;= 0.518). Student perceptions demonstrated that 61.6% strongly agreed or agreed that the COLMs were a good way to learn anatomy and 32.0% desired more COLMs in the lab. Overall, COLMs did not increase student knowledge by the end of a session. Students thought the COLMs were a good tool to learn anatomy because they helped become more clinically aware; however, students desired better implementation of the COLMs. The addition of COLMs in the laboratory is a potential method to address the need for clinical applications within the gross anatomy laboratory.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40670-023-01970-1.

Learning Head and Neck Anatomy Through a Radiological Imaging Platform

INTRODUCTION

Head and neck anatomy is complex for students to learn and educators to teach. Instructing students on anatomy using radiological imaging can aid comprehension and prepare them for future clinical practice. Computer-aided anatomy instruction is accessible to diverse learners and avoids barriers identified with face-to-face teaching.

METHODS

We designed a self-guided PowerPoint tutorial with multiple medical imaging modalities, clinical correlations, and self-review questions incorporated throughout. The tutorial was evaluated with a group of 178 Australian preclinical medical students who had prior teaching related to head and neck anatomy. Student participants were divided into experimental and control groups. Participants completed two knowledge assessments: experimental group before and after tutorial engagement and control group before tutorial engagement. All participants were invited to provide feedback on their experiences with the tutorial via questionnaires.

RESULTS

Engagement with the tutorial improved overall head and neck anatomy knowledge (p < .001). Knowledge outcomes were maintained across question group type (e.g., multiple-choice questions, identification, and short-answer questions; p < .05), with participants reporting 96% overall positive feedback related to the tutorial experience.

DISCUSSION

Given the improved outcomes following tutorial exposure, our results suggest that this tutorial is efficacious when used in concert with existing anatomy curricula. Participants' perceived value of the tutorial additionally suggests that it would be taken up well by medical students and is an effective addition to the existing tutorial series. Further research is needed to assess the tutorial's use as a stand-alone addition to the anatomy curriculum.

Expect the unexpected: The course of the inferior alveolar artery - Preliminary results and clinical implications

INTRODUCTION

The anatomical position of the inferior alveolar artery (IAA) within the mandibular canal and in relation to the substructures of the neurovascular mandibular bundle has been sparsely described to date. More detailed information on the exact IAA position would be beneficial for both dental and maxillofacial surgical procedures to minimize complications such as bleeding, nerve compression hematoma, and sensory deficiency.

MATERIAL AND METHODS

In 31 Thiel-preserved and fresh-frozen cadaver hemimandibles the position of the IAA in relation to the structures of the inferior alveolar neurovascular bundle and the mandible borders was analyzed anatomically and histologically.

RESULTS

In 77.4% of the cases, rotation of the IAA around the mental nerve was apparent, resulting in a typical site-dependent IAA position. While the IAA was situated buccally within the pterygomandibular space, buccal-inferior in the mandibular foramen, superior in the molar region, and lingually in the premolar region. In 12.9% of the cases, a persistent lingual position of the IAA was observed for the entire mandibular canal. In one case, an additional mandibular canal and an accessory IAA were identified.

DISCUSSION

This study provides new and encompassing information on the complete course and position of the IAA. This course is of practical use for oral implantology and various surgical procedures in dental- and maxillofacial surgery. Variations in the typical IAA course and site-dependent positional changes may be referred to as mandible growth and functional adaption to occlusion anomalies. This report helps enhance the morphological and functional understanding of IAA relationship during mandible development.

A Multimedia Educational Module for Teaching Early Medical Neuroanatomy

INTRODUCTION

As the global burden of neurological disorders continues to rise, physicians' need for a solid understanding of neuroanatomy is becoming more important. Traditional neuroanatomy curricula offer a limited approach to educating a diverse profile of learning styles. In an attempt to incorporate recent literature addressing diverse learning formats, we developed and evaluated two new image-based resources for the neuroscience curriculum.

METHODS

We created narrated videos demonstrating the brain dissections that students were to perform in the laboratory and quiz-style, postdissection review slides for later self-guided study. These were offered as optional study aids to two classes of preclerkship medical students at the Uniformed Services University of the Health Sciences F. Edward Hébert School of Medicine. Effectiveness was evaluated through examination questions, and a survey was administered to one of the classes to assess usage of and satisfaction with the materials.

RESULTS

Mean scores on the practical examination questions were 83% and 89% for the two classes of students given the resources. Notably, 100% of respondents used the review slides after the laboratory, and more than 99% found them very helpful or extremely helpful for learning relevant concepts.

DISCUSSION

Our results support the usefulness of these resources as learning tools for neuroanatomy. These resources were meant to augment various traditional resources (textbooks, lecture) to provide a broad range of study options in line with current research. Our experience suggests that similar tools could be developed for application in other visually based content areas of the preclerkship curriculum.

The Clinical Anatomy and Imaging Laboratory: Vertical Integration in the Preclerkship Curriculum

INTRODUCTION

As medical schools implement integrated curricula, anatomy education especially has experienced increased pressure to make foundational content clinically relevant. We designed a novel type of integrative anatomy laboratory experience where students could use foundational anatomy concepts in concert with modern imaging/diagnostic techniques to enhance important clinical concepts.

METHODS

We selected a process called Lesson Study to develop the multidisciplinary Clinical Anatomy and Imaging Laboratory (CAIL) in the cardiovascular and gastrointestinal systems. We utilized soft-embalmed cadavers extensively for their highly realistic tissue appearance and texture, which allowed instructors and students to perform a wide array of procedures in case-based scenarios similar to practicing clinicians. We conducted field observations of participating students, focus-group discussions, and knowledge-based exams to examine efficacy of the CAIL.

RESULTS

Approximately 150 first- and second-year students participated in each of the CAIL activities on an annual basis. Most focus-group participants felt the CAIL was a great learning experience. They commented on how the lab provided relevance to anatomy knowledge and helped integrate prior classroom learning more deeply. Instructors noted that students asked more advanced, clinically relevant questions than in a typical anatomy lab. Knowledge improved significantly after the CAIL, although it is unclear if this translates to summative exams.

DISCUSSION

The CAIL creates a unique learning experience where students use prior foundational anatomy knowledge in conjunction with modern imaging and diagnostic techniques to reinforce important clinical concepts. We have continued to integrate CAIL experiences into more clinical systems in our medical school curriculum.

A Case of Pancreatic Cancer: Abdominal Anatomy Team-Based Learning Module for Medical Students

Introduction

Team-based learning (TBL) is an instructional method utilized by the University of Alabama School of Medicine to facilitate collaboration and integration of concepts introduced in undergraduate medical training. This TBL was created for the Gastrointestinal module and facilitates understanding of anatomy of the retroperitoneal space, posterior abdominal wall, and neurovasculature of the abdomen. This module integrates topics from abdominal anatomy, radiology, and clinical decision-making for medical students.

Methods

Prior to the TBL, students were provided with a set of learning objectives and three instructional video podcasts. During the in-class portion of the activity, learners completed the readiness assurance phase, which consisted of individual and team assessments. During the application phase, teams of five to six students collaborated on multiple-choice questions centered on the presentation, diagnosis, surgical intervention, and palliation of a patient with pancreatic cancer. TBL sessions were cofacilitated by an anatomist and a physician.

Results

Since the TBL's institution in 2014, medical students have consistently performed better on the readiness assurance test in teams rather than individually. On a 5-point Likert scale, over 90% of students in the 2016 (M = 4.12) and 2017 (M = 4.20) Gastrointestinal modules agreed or strongly agreed on an end-of-course evaluation that the TBL activity was effectual for learning.

Discussion

In a medical climate that continues to rely heavily on cross-sectional imaging, early integration of gross anatomy and cross-sectional anatomy is essential and can facilitate acclimation to the clinical years. This TBL would be a valuable addition to other undergraduate medical programs.

Study of the normal heart size in Northwest part of Iranian population: a cadaveric study

Introduction: The heart is in a muscular organ in the middle mediastinum. According to our knowledge, there is no standard data about the anthropologic parameters of normal Iranian hearts. Hence, the aim of the present study was to investigate the normal heart size in Iranian cadavers.

Methods: In a cross-sectional study, 550 cadavers (104 female/446 male) from June 2014 to July 2015 in the Razavi Khorasan province of Iran were included in the study. After approval of the Ethical Committee, cadavers were divided into 10 groups based on age groups. Length, width, weight, chordae tendineae, papillary muscles, and heart valves were measured using vernier caliper. Finally, data were analyzed using SPSS software.

Results: The mean values of the demographic data were as follows: age= 42.12 ± 21.34 years; weight = 60.38 ± 15.32 kg; height = 158.14 ± 23.77 cm; and BMI = 24.66 ± 17.60 kg/m². The mean values of the heart length, width, chordae tendineae, pupillary muscles, weight, and index of the heart were 11.41 ± 2.15 cm, 8.21 ± 4.38 cm, 19.41 ± 6.70, 5.74 ± 1.96, 247.78 ± 62.27 grams, and 5.74 ± 1.96, respectively. In addition, the circumference of the tricuspid valve, circumference of the mitral valves, and tricuspid and mitral areas were 8.80 ± 1.11 cm, 9.43 ± 1.44 cm, 4.11 ± 0.71 cm², and 4.50 ± 0.90 cm², respectively.

Conclusion: Mean values of the heart’s length and width was similar to previous reports from western population. The circumference of the tricuspid valve was less than the textbook’s data, while circumference of the mitral valves was more than it. The study findings provide valuable information about standard data of the heart in the Iranian population, which is useful for surgeons as well as anthropologists. However, multi-center studies with a larger sample size are required to complete data about anatomical characteristics of normal hearts.