Brenda J. Klement

Anatomy as the Backbone of an Integrated First Year Medical Curriculum: Design and Implementation

Morehouse School of Medicine chose to restructure its first year medical curriculum in 2005. The anatomy faculty had prior experience in integrating courses, stemming from the successful integration of individual anatomical sciences courses into a single course called Human Morphology. The integration process was expanded to include the other first year basic science courses (Biochemistry, Physiology, and Neurobiology) as we progressed toward an integrated curriculum. A team, consisting of the course directors, a curriculum coordinator, and the Associate Dean for Educational and Faculty Affairs, was assembled to build the new curriculum. For the initial phase, the original course titles were retained but the lecture order was reorganized around the Human Morphology topic sequence. The material from all four courses was organized into four sequential units. Other curricular changes included placing laboratories and lectures more consistently in the daily routine, reducing lecture time from 120 to 90 minute blocks, eliminating unnecessary duplication of content, and increasing the amount of independent study time. Examinations were constructed to include questions from all courses on a single test, reducing the number of examination days in each block from three to one. The entire restructuring process took two years to complete, and the revised curriculum was implemented for the students entering in 2007. The outcomes of the restructured curriculum include a reduction in the number of contact hours by 28%, higher or equivalent subject examination average scores, enhanced student satisfaction, and a first year curriculum team better prepared to move forward with future integration. Anat Sci Educ 4:157–169, 2011.

Cross-linking density alters early metabolic activities in chondrocytes encapsulated in poly(ethylene glycol) hydrogels and cultured in the rotating wall vessel.

In designing a tissue engineering strategy for cartilage repair, selection of both the bioreactor, and scaffold is important to the development of a mechanically functional tissue. The hydrodynamic environment associated with many bioreactors enhances nutrient transport, but also introduces fluid shear stress, which may influence cellular response. This study examined the combined effects of hydrogel cross‐linking and the hydrodynamic environment on early chondrocyte response. Specifically, chondrocytes were encapsulated in poly(ethylene glycol) (PEG) hydrogels having two different cross‐linked structures, corresponding to a low and high cross‐linking density. Both cross‐linked gels yielded high water contents (92% and 79%, respectively) and mesh sizes of 150 and 60 Å respectively. Cell‐laden PEG hydrogels were cultured in rotating wall vessels (RWV) or under static cultures for up to 5 days. Rotating cultures yielded low fluid shear stresses (≤0.11 Pa) at the hydrogel periphery indicating a laminar hydrodynamic environment. Chondrocyte response was measured through total DNA content, total nitric oxide (NO) production, and matrix deposition for glycosaminoglycans (GAG). In static cultures, gel cross‐linking had no effect on DNA content, NO production, or GAG production; although GAG production increased with culture time for both cross‐linked gels. In rotating cultures, DNA content increased, NO production decreased, and overall GAG production decreased when compared to static controls for the low cross‐linked gels. For the high cross‐linked gels, the hydrodynamic environment had no effect on DNA content, but exhibited similar results to the low cross‐linked gel for NO production, and matrix production. Our findings demonstrated that at early culture times, when there is limited matrix production, the hydrodynamic environment dramatically influences cell response in a manner dependent on the gel cross‐linking, which may impact long‐term tissue development. Biotechnol. Bioeng. 2009;102: 1242–1250.

Endochondral Bone Formation in Embryonic Mouse Pre-metatarsals

Long term exposure to a reduced gravitational environment has a deleterious effect on bone. The developmental events which occur prior to initial bone deposition will provide insight into the regulation of mature bone physiology. We have characterized a system in which the events preceding bone formation take place in an isolated in vitro organ culture environment. We show that cultured pre-metatarsal tissue parallels development of pre-metatarsal tissue in the embryo. Both undergo mesenchyme differentiation and morphogenesis to form a cartilage rod, which resembles the future bone, followed by terminal chondrocyte differentiation in a definite morphogenetic pattern. These sequential steps occur prior to osteoblast maturation and bone matrix deposition in the developing organism. Alkaline phosphatase (ALP) activity is a distinctive enzymatic marker for mineralizing tissues. We have measured this activity throughout pre-metatarsal development and show (a) where in the tissue it is predominantly found, and (b) that this is indeed the mineralizing isoform of the enzyme.

Implementation and modification of an anatomy-based integrated curriculum

Morehouse School of Medicine elected to restructure its first‐year medical curriculum by transitioning from a discipline‐based to an integrated program. The anatomy course, with regional dissection at its core, served as the backbone for this integration by weaving the content from prior traditional courses into the curriculum around the anatomy topics. There were four primary goals for this restructuring process. Goal 1: develop new integrated courses. Course boundaries were established at locations where logical breaks in anatomy content occurred. Four new courses were created, each containing integrated subject content. Goal 2: establish a curriculum management team. The team consisted of course directors, subject specialists, and a curriculum director. This team worked together to efficiently manage the new curriculum. Goal 3: launch contemporary examination and question banking methods. An electronic system, in which images could be included, was implemented for examinations and quizzes, and for storing and refining questions. Goal 4: ensure equitable distribution of standardized examinations and course grading systems among all courses. Assessments included quizzes, in‐course examinations, and National Board of Medical Examiners® (NBME®) Subject Examinations. A standard plan assigned the contribution of each to the final course grade. Significant improvement was seen on subject examinations. Once the obstacles and challenges of integration were overcome, a robust and efficient education program was developed. The curriculum is expected to continue evolving and improving, while retaining full regional dissection as a core element. Anat Sci Educ 10: 262–275.

Assessment of three types of spaceflight hardware for tissue culture studies: Comparison of skeletal tissue growth and differentiation

Three different types of spaceflight hardware, the BioProcessing Module (BPM), the Materials Dispersion Apparatus (MDA), and the Fluid Processing Apparatus (FPA), were assessed for their ability to support pre-metatarsal growth and differentiation in experiments conducted on five space shuttle flights. BPM-cultured pre-metatarsal tissue showed no difference in flight and ground control lengths. Flight and ground controls cultured in the MDA grew 135 μm and 141 μm, respectively, in an 11 day experiment. Only five control rods and three flight rods mineralized. In another MDA experiment, pre-metatarsals were cultured at 4 °C (277K) or 20 °C (293K) for the 16 day mission, then cultured an additional 16 days in laboratory dishes at 37 °C (310K). The 20 °C (293K) cultures died post-flight. The 4 °C (277K) flight pre-metatarsals grew 417 μm more than the 4 °C (277K) ground controls post-flight. In 5 and 6 day experiments done in FPAs, flight rods grew longer than ground control rods. In a 14 day experiment, gro...

Clinical Correlations as a Tool in Basic Science Medical Education

Clinical correlations are tools to assist students in associating basic science concepts with a medical application or disease. There are many forms of clinical correlations and many ways to use them in the classroom. Five types of clinical correlations that may be embedded within basic science courses have been identified and described. (1) Correlated examples consist of superficial clinical information or stories accompanying basic science concepts to make the information more interesting and relevant. (2) Interactive learning and demonstrations provide hands-on experiences or the demonstration of a clinical topic. (3) Specialized workshops have an application-based focus, are more specialized than typical laboratory sessions, and range in complexity from basic to advanced. (4) Small-group activities require groups of students, guided by faculty, to solve simple problems that relate basic science information to clinical topics. (5) Course-centered problem solving is a more advanced correlation activity than the others and focuses on recognition and treatment of clinical problems to promote clinical reasoning skills. Diverse teaching activities are used in basic science medical education, and those that include clinical relevance promote interest, communication, and collaboration, enhance knowledge retention, and help develop clinical reasoning skills.

Role of Anatomists in Building an Integrated Medical Curriculum

The anatomical sciences have traditionally included a range of related disciplines and variety of approaches to instruction. Together, they provide a unique opportunity for laying the groundwork for medical curricular integration. Finding a place for regional dissection in a systems-based curriculum-integration scheme has been challenging. However, incorporating regional human dissection into systems-based approaches to histology and embryology can provide a foundation for an integrated basic-science curriculum that preserves medical student exposure to the team-based learning and discovery, and the lessons in professionalism, that traditionally accompany human dissection. This chapter describes steps in curricular development and integration that have led to a unique blend of regional anatomy and organ system structure and function that provides a foundation for the effective practice of medicine from physical examination through diagnosis and medical or surgical treatment. The approach described was initiated by anatomy faculty and involved extensive contributions of the teaching faculty from other basic science disciplines throughout the process. It valued faculty contributions to the pre-existing curriculum and provided a framework for ongoing integration and improvement of student performance.

The use of reduced temperatures for reversible developmental arrest of organ cultures prior to spaceflight experimentation and for postflight analyses

One complication of using rapidly growing and developing tissues for spaceflight experimentation is that, due to early turnover and launch delays, the tissues often undergo complete development before orbit is achieved. We conducted a series of studies using three different types of tissue, chick pre-cardiac explants, embryonic mouse lung rudiments and embryonic mouse pre-metatarsal mesenchyme, to examine the use of reduced temperature as an inexpensive means to slow growth and development, before the experiment begins. Pre-cardiac explants could be held at 4 °C (277K), 13 °C (286K), or 22 °C (295K) for up to 48 hours and still begin normal beating within 24 hours of culture at 37 °C (310K). Lung explants could be held at 5 °C (278K), 15 °C (288K), and 24 °C (297K) for 3–6 days without clefts changing in appearance, but would resume branching morphogenesis and growth after being placed at 37 °C (310K). Pre-metatarsal cultures could be held at 15 °C (288K), 22 °C (295K) and 24 °C (297K) for 6 days with ver...