Anja Böckers

Rat embryonic fibroblasts improve reprogramming of human keratinocytes into induced pluripotent stem cells.

Patient-specific human induced pluripotent stem (hiPS) cells not only provide a promising tool for cellular disease models in general, but also open up the opportunity to establish cell-type-specific systems for personalized medicine. One of the crucial prerequisites for these strategies, however, is a fast and efficient reprogramming strategy from easy accessible somatic cell populations. Keratinocytes from plucked human hair had been introduced as a superior cell source for reprogramming purposes compared with the widely used skin fibroblasts. The starting cell population is, however, limited and thereby further optimization in terms of time, efficiency, and quality is inevitable. Here we show that rat embryonic fibroblasts (REFs) should replace mouse embryonic fibroblasts as feeder cells in the reprogramming process. REFs enable a significantly more efficient reprogramming procedure as shown by colony number and total amount of SSEA4-positive cells. We successfully produced keratinocyte-derived hiPS (k-hiPS) cells from various donors. The arising k-hiPS cells display the hallmarks of pluripotency such as expression of stem cell markers and differentiation into all 3 germ layers. The increased reprogramming efficiency using REFs as a feeder layer occurred independent of the proliferation rate in the parental keratinocytes and acts, at least in part, in a non-cell autonomous way by secreting factors known to facilitate pluripotency such as Tgfb1, Inhba and Grem1. Hence, we provide an easy to use and highly efficient reprogramming system that could be very useful for a broad application to generate human iPS cells.

Does learning in clinical context in anatomical sciences improve examination results, learning motivation, or learning orientation?

The preclinical compulsory elective course “Ready for the Operating Room (OR)!?” [in German]: “Fit für den OP (FOP)”] was implemented for students in their second year, who were simultaneously enrolled in the gross anatomy course. The objective of the study was to determine whether the direct practical application of anatomical knowledge within the surgical context of the course led to any improvement in learning motivation, learning orientation, and ultimately examination results in the gross anatomy course, as compared with a control group. Within the scope of five teaching sessions, the students learned surgical hand disinfection, suturing techniques, and the identification of commonly used surgical instruments. In addition, the students attended five surgical demonstrations performed by surgical colleagues on cadavers. Successful learning of these basic skills was then assessed based on an Objectively Structured Practical Examination. Learning motivation and learning orientation in both subgroups was determined using the SELLMO‐ST motivation test and the Approaches and Study Skills Inventory test. While a significant increase in work avoidance was identified in the control group, this was not the case for FOP participants. Similarly, an increase in the “deep approach” to learning, as well as a decrease in the “surface approach,” was able to be documented among the FOP participants following completion of the course. The results suggest that students enrolled in the gross anatomy course, who were simultaneously provided with the opportunity to learn in clinical context, were more likely to be successful at maintaining learning motivation and learning orientation required for the learning process, than students who attended the gross anatomy course alone. Anat Sci Educ. 7: 3–11.

Reduction of mental distress in the dissection course by introducing the body donor experience through anatomical demonstrations of organ systems

The practice of dissection teaches students not only the foundations of anatomical knowledge but also encourages the development of professional competencies. Yet, the dissection of cadavers in the gross anatomy course can be a stress factor for medical students. There are a minor proportion of students who demonstrate strong emotional reactions in anticipation of being confronted with a cadaver. Therefore, in 2008, the authors implemented a voluntary course entitled, “Anatomical demonstrations of organ systems” (AD‐OS) in advance of the dissection course to ease this psychological burden. The question of whether attendees of AD‐OS showed less mental distress at the start of the dissection course compared with those that had not or only infrequently visited AD‐OS was addressed. AD‐OS attendees assessed their expected mental distress using a five‐point Likert scale before starting the dissection course and a second time at the end of their first day, after they had been confronted with a cadaver. AD‐OS was evaluated as excellent and the majority of students participated actively during teaching sessions. Overall, female students showed higher levels of mental distress. AD‐OS attendees assessed themselves as being less burdened by mental distress than members of the control group. Longitudinal analysis revealed that students who visited AD‐OS showed a marked decrease of their mental distress level, comparing prospective and retrospective ratings. This was significantly (P < 0.001; Z = −6.061) different from nonattendees or those who visited AD‐OS only infrequently. AD‐OS satisfied its intended teaching goals and proved that a step‐by‐step introduction of dissection through anatomical demonstrations helped to reduce the mental distress of students. Future studies are planned to measure mental distress with objective instruments. Anat Sci Educ

Evaluating differently tutored groups in problem-based learning in a German dental curriculum: a mixed methods study

BackgroundIt is still unclear to what extent the PBL tutor affects learning in PBL-sessions. This mixed-methods study (Part 1 and 2) evaluated the effects of facilitative (f) versus non-facilitative (nf) tutoring roles on knowledge-gain and group functioning in the field of endodontics.MethodsPart 1 was a quantitative assessment of tutor effectiveness within a prospective, experimental, single-blind, stratified, randomized, two-group intervention study. Participants attended PBL in the context of a hybrid curriculum. A validated questionnaire was used and knowledge assessments were conducted before and after the intervention. External observers rated tutor performance. Part 2 was a qualitative assessment of tutor effectiveness and consisted of semi-structured expert interviews with tutors and focus group discussions with students.ResultsPart 1: f tutors obtained significantly higher scores than nf tutors with respect to learning motivation and tutor effectiveness (p ≤ 0.05). nf tuition resulted in a slightly larger knowledge gain (p = 0.08). External observers documented a significantly higher activity among facilitative tutors compared to non-facilitative tutors.Part 2: Tutors found the f role easier although this led to a less autonomous working climate. The students rated f tutoring as positive in all cases.ConclusionsWith respect to PBL-group performance, students felt that groups guided in a non-facilitative fashion exhibited a higher level of independence and autonomy, especially with increasing PBL experience. In addition, students reported that more preparation was necessary for sessions guided by a non-facilitative tutor. Tutors were able to modify their role and influence group processes in a controlled manner. Results are useful for future “Train-the-Teacher” sessions.

Ready for the OR? - Clinical anatomy and basic surgical skills for students in their preclinical education.

Medical students’ first experience in the operating theatre often takes place during their electives and is therefore separated from the university’s medical curriculum. In the winter term 2009/10, the Institute of Anatomy and Cell Biology at the University of Ulm implemented an elective called “Ready for the OR” for 2nd year medical students participating in the dissection course. We attempted to improve learning motivation and examination results by transferring anatomical knowledge into a surgical setting and teaching basic surgical skills in preparation of the students’ first participation in the OR. Out of 69 online applicants, 50 students were randomly assigned to the Intervention Group (FOP) or the Control Group. In 5 teaching session students learned skills like scrubbing, stitching or the identification of frequently used surgical instruments. Furthermore, students visited five surgical interventions which were demonstrated by surgical colleagues on donated bodies that have been embalmed using the Thiel technique. The teaching sessions took place in the institute’s newly built “Theatrum Anatomicum” for an ideal simulation of a surgical setting. The learning outcomes were verified by OSPE. In a pilot study, an intervention group and a control group were compared concerning their examination results in the dissection course and their learning motivation through standardized SELLMO-test for students. Participants gained OSPE results between 60.5 and 92% of the maximum score. “Ready for the OR” was successfully implemented and judged an excellent add-on to anatomy teaching by the participants. However, we could not prove a significant difference in learning motivation or examination results. Future studies should focus on the learning orientation, the course’s long-term learning effects and the participants’ behavior in a real surgery setting.

Anatomie der Tuba Eustachii

The auditory tube is part of a complex anatomical functional system, which even today is not completely explained. It plays a crucial role in the understanding of the pathogenesis of chronic middle ear infections and possible therapeutic interventions--particularly in infants. This paper summarizes the current knowledge of eustachian tube gross anatomy and histology, its peritubular structures and its topographic relationship to the internal carotid artery in adults. Anatomical aspects specific to infancy are related to their possible influence on tube function.

Quality management of eLearning for medical education: current situation and outlook.

Introduction: In 2008, the German Council of Science had advised universities to establish a quality management system (QMS) that conforms to international standards. The system was to be implemented within 5 years, i.e., until 2014 at the latest. The aim of the present study was to determine whether a QMS suitable for electronic learning (eLearning) domain of medical education to be used across Germany has meanwhile been identified. Methods: We approached all medical universities in Germany (n=35), using an anonymous questionnaire (8 domains, 50 items). Results: Our results (response rate 46.3%) indicated very reluctant application of QMS in eLearning and a major information deficit at the various institutions. Conclusions: Authors conclude that under the limitations of this study there seems to be a considerable need to improve the current knowledge on QMS for eLearning, and that clear guidelines and standards for their implementation should be further defined.

Preparing Students Emotionally for the Human Dissection Experience

The process of dissecting human bodies as well as the reflection of this process inherently bears the potential for emotional stress. This emotional stress impedes the students’ adequate learning process and prevents them from developing medical competencies such as professional empathy for the students’ first and future patients. Fortunately, students—in particular females ones—experience strongest emotions in anticipating the dissection. Shortly after the first contact with the cadaver, a habituation process starts in most students and their fears decrease significantly. Different strategies such as intellectualization or distancing have been described and show how students might handle the challenge of mental distress in the dissection course. Fear and emotional reactions due to dissection are reduced significantly if the students feel well prepared to enter the course. Therefore, mental distress in the dissection course demands anatomists’ attention and requires their efforts to support the initial habituation process. Dissection is structured differently in different medical curricula: The dissection course might be placed in the first or the second year of training, it might be run modularly or continuously, it might be based on functional body systems or on topographic body regions and finally, it might be founded on prosection rather than on dissection. We summarize precourse interventions, describe procedures that help students to work through their emotions at the time of dissection and come to terms with their emotional experiences at the end of the course. Our suggestions on how and when students should be prepared and guided need to be modified according to how dissection is structured in the curriculum.