George Ramsey-Stewart

Team-based learning methods in teaching topographical anatomy by dissection

Background:  While the effectiveness of teaching human topographical anatomy by groups of medical students carrying out embalmed cadaver dissections has been recognized for centuries, the mechanisms by which this teaching is so effective have not been well described.

Diffusion tensor imaging to aid subgenual cingulum target selection for deep brain stimulation in depression.

Background: The most investigated target for deep brain stimulation in depression is the subgenual cingulate gyrus (Cg25) which has been shown to be a critical hub for signalling in the condition. Diffusion tensor imaging (DTI) is a form of MR sequence that can visualise white matter connections and potentially aid target selection. Objectives: To assess whether targets selected using DTI to find the area of maximal tract crossover (maximal isotropy) underlying the subgenual cingulum differ significantly in location from those selected using standard T2 sequences. Methods: Fifty-nine non-depressed adult volunteers underwent MR imaging using T1, T2 and DTI sequences of the brain. Each patient had targets selected for both hemispheres using both T2 and DTI sequences. The significance of the differences in coordinates in all three dimensions was tested using the paired t test. Results: There was a significant difference in the mediolateral (x) and dorsoventral (z) coordinates of DTI targets when compared with T2 targets (p < 0.001). Conclusions: Targets within Cg25 selected using DTI are significantly different in location from those selected using T2 sequences and have the potential to enhance treatment outcome by reducing the impact of interindividual variability.

Elective anatomy by whole body dissection course: what motivates students?

BackgroundStudents’ motivation provides a powerful tool to maximise learning. The reasons for motivation can be articulated in view of self-determination theory (SDT). This theory proposes that for students to be motivated and hence benefit educationally and professionally from courses, three key elements are needed: autonomy, competence, and relatedness. In this paper we apply SDT theory to consider medical students’ motivation to participate throughout a 2014 optional summer intensive eight week elective anatomy by whole body dissection course. The course was designed and facilitated by surgeons, and required small group, active learning.MethodsAt the end of the course, data were collected from all (24/24) students by means of an open ended survey questionnaire. Framework analysis was used to code and categorise data into themes.ResultsUtilising self-determination theory as a theoretical framework, students’ motivation and experiences of participation in the course were explored. Elements that facilitated students’ motivation included the enthusiasm and expertise of the surgeons, the sense of collegiality and community within the course, the challenges of group activities, and sense of achievement through frequent assessments.ConclusionThe team learning course design, and facilitation by surgeons, provided an enriched learning environment, motivating students to build on their knowledge and apply a surgical context to their learning.

Retention of topographical anatomical knowledge following surgeon-facilitated whole-body dissection

Topographical anatomy has been taught to medical students by cadaver‐based dissection for centuries. However, there is a void in the literature assessing the long‐term retention of anatomical knowledge by medical students following teaching by whole‐body dissection. The purpose of this paper was to assess both the acquisition and retention of topographical anatomical knowledge gained by medical students undertaking an elective whole‐body dissection course.

What motivates surgeons to teach dissection anatomy to medical students and surgical trainees

Introduction Although a fading tradition in some institutions, having clinicians teach anatomy by whole-body dissection provides a clinical context to undergraduate and postgraduate medical students, increasing their depth of learning. The reasons for a clinician’s motivation to teach may be articulated in accordance with self-determination theory (SDT). SDT proposes that for individuals to be intrinsically motivated, three key elements are needed: 1) autonomy, 2) competence, and 3) relatedness. Materials and methods Data were collected through semistructured interviews with eight surgeons who were supervisors/facilitators in the anatomy by whole-body dissection course for undergraduate students in the Bachelor of Medicine, Bachelor of Surgery program and postgraduate students in the Master of Surgery program at the University of Sydney. Qualitative analysis methods were used to code and categorize data into themes. Results Our study used SDT as a conceptual framework to explore surgeons’ motivation to supervise students in the anatomy by whole-body dissection courses. Elements that facilitated their desire to teach included satisfaction derived from teaching, a sense of achievement in providing students with a clinical context, a strong sense of community within the dissection courses, and a sense of duty to the medical/surgical profession and to patient welfare. Conclusion The surgeons’ motivation for teaching was largely related to their desire to contribute to the training of the next generation of doctors and surgeons, and ultimately to future patient welfare.

Anatomy teaching: confusion continues. Do surgeons have the answer?

The teaching of clinical anatomy to medical students in the foreshortened modern medical curriculum remains contentious, confused and confusing. There is little unanimity between medical schools on what should be taught, how it should be taught and who should do the teaching. Current variations in these three essential ingredients for an adequate clinical anatomical education are legion. The danger in this state of confusion is that medical graduates may end up with such a perfunctory knowledge of essential clinical anatomy that safe medical practice is imperiled. Furthermore, if such graduates desire to embark on a surgical career, the exacting requirements in anatomy of the Royal Australasian College of Surgeons makes such aspirations at times ‘a bridge too far’ even with extensive postgraduate anatomical studies. There is great disquiet among many medical students from a number of Australian medical schools that this confused state of clinical anatomical education is short changing them for whatever role in medicine they should aspire to. In this number of the journal, Farey et al., three medical students from different medical schools, express this disquiet on behalf of the Australian Medical Students Association and call for national standards and a national syllabus for the teaching of clinical anatomy in Australian medical schools. It is hard to find fault with this suggestion. Such a call for a national core curriculum has been made before. It would certainly be a start and would provide a baseline in rationalizing clinical anatomy teaching in the modern medical curriculum. It could provide a useful standard against which Australian medical schools could measure themselves. It should not be an all-inclusive wish list of anatomical facts (as has been previously produced in North America and the UK) but a practicable scheme capable of implementation. Therefore, this initiative deserves the support of the College and all Fellows. However, two other factors are at least of equal importance in such anatomical education. How should these proposed national standards be taught and who should teach them? How should clinical anatomy be taught? It is perhaps apposite that this continually contentious issue of anatomy teaching and learning should arise yet again this year. 2014 marks the fifth centenary since the birth of the Brabantian scholar Andreas Vesalius, who is generally regarded as the father of modern anatomical knowledge. Vesalius’s masterpiece ‘De Humani Corporis Fabrica’ (About the structure of the human body), published in 1543, while he was Professor of Anatomy and Surgery at the University of Padua, positively transformed the knowledge of human anatomy as well as the way it was studied and taught. Vesalius conclusively demonstrated the efficacy of dissection of the human body in teaching and learning human anatomy. He established anatomical dissection as the traditional way of educating medical students in anatomy, and this has persisted up until recent times. There is no doubt that classical whole-body dissection in the Vesalian tradition provides the ideal for anatomy teaching. It results in the most detailed acquisition of anatomical knowledge with the best retention of this practical knowledge. Dissection students usually acquire a ‘three-dimensional mind map’ of the regions of the human body as well as experiencing tactile gnosis of tissues. However, dissection is very time-consuming and expensive to mount and supervise. It requires considerable physical facilities and expert teachers. Despite being the ideal, it is clearly not feasible for all present day medical students to have this experience. Nevertheless, it has been shown to be possible to mount an elective intense 8-week whole-body dissection course, within the shortened modern curriculum, with good results, for those senior students streaming towards a surgical career. All medical students should, however, have the proposed national standards taught by suitable teachers, utilizing lectures, tutorials and very importantly wet-specimen demonstrations. This should be supported by adequate barrier summative assessments (utilizing wet specimen identifications, spot tests and multiple choice questions) before progress. Sophisticated IT techniques can be of great help here, but they have not been proven effective in replacing the demonstration of well-prosected wet specimens. Only the latter allows three-dimensional relations to be demonstrated. Thus, effective clinical anatomical teaching depends largely on the ready availability of such high-quality prosections so that all regions of the body are covered. Many contend that the demonstration of such prosections should replace lectures. Who should deliver clinical anatomy education to medical students? Anatomical knowledge borders on the infinite. A much smaller volume of anatomical information is of clinical relevance and importance. An even smaller number of anatomical facts are essential for safe medical practice. It is almost impossible for most non-clinicians (even with the best will in the world) to emphasize the teaching of these essential clinical anatomical facts.Yet, this must be done in this time-poor modern medical curriculum to ensure safe clinical practice. There appears to be a wide spectrum of qualifications among those teaching clinical anatomy to medical students. This includes science graduates, biological research scientists, postgraduate science students, senior medical students, physiotherapy and chiropractic graduates, with a sprinkling of medically qualified clinicians, and an even smaller number of active, semi-retired and retired surgeons with extensive clinical expertise. It has been demonstrated that this latter surgical group is capable of teaching essential clinical anatomy effectively in the shortened curriculum. This is not for all surgeons, but for those willing to apply themselves, the rewards are very satisfying. It is then but a short step to teaching surgical anatomy to postgraduate surgical trainees which for surgeons are even more personally gratifying. By recruiting from this surgical group, the shortfall in clinical anatomy teachers can very likely be overcome. However, for this solution to be sustainable, recognition with a suitable academic title and a reasonable emolument must be forthcoming from the responsible tertiary institutions. 800 Editorials

Anatomy by whole body dissection: a new Masters of Surgery course.

In 2012, a new anatomy by whole body dissection‐Masters of Surgery (WBD‐MS) course was introduced as a subject within the MS degree at Sydney Medical School. The purpose of this study, based on two iterations of the course, implemented in 2012 and 2013, was to investigate the participants’ knowledge acquisition of clinical topographical anatomy and perceptions of the course.

Anatomy by whole body dissection: a focus group study of students’ learning experience

Background The social construction of knowledge within medical education is essential for learning. Students’ interactions within groups and associated learning artifacts can meaningfully impact learning. Situated cognition theory poses that knowledge, thinking, and learning are located in experience. In recent years, there has been a reported decline in time spent on anatomy by whole body dissection (AWBD) within medical programs. However, teaching by surgeons in AWBD provides unique opportunities for students, promoting a deeper engagement in learning. In this study, we apply situated cognition theory as a conceptual framework to explore students’ perceptions of their learning experience within the 2014 iteration of an 8-week elective AWBD course. Methods At the end of the course, all students (n=24) were invited to attend one of three focus groups. Framework analysis was used to code and categorize data into themes. Results In total, 20/24 (83%) students participated in focus groups. Utilizing situated cognition theory as a conceptual framework, we illustrate students’ learning experiences within the AWBD course. Students highlighted opportunities to create and reinforce their own knowledge through active participation in authentic dissection tasks; guidance and clinical context provided by surgeons as supervisors; and the provision of an inclusive learning community. Conclusion Situated cognition theory offers a valuable lens through which to view students’ learning experience in the anatomy dissection course. By doing so, the importance of providing clinical relevance to medical teaching is highlighted. Additionally, the value of having surgeons teach AWBD and the experience they share is illustrated. The team learning course design, with varying teaching methods and frequent assessments, prompting student–student and student–teacher interaction, was also beneficial for student learning.

Contemporary teaching of anatomy in Australian medical schools: are we doing enough? (Re: ANZ J. Surg. 2011; 81: 662–3)

A 70-year-old male underwent an optical urethrotomy in 2010 for treatment of a dense 3-cm anastomotic urethral stricture. His history is significant for Gleason 9 T2b prostate cancer treated with an uncomplicated prostatectomy in 1998 and external beam radiotherapy in 2003 secondary to local recurrence. His urethral catheter was removed day 3 post-optical urethrotomy. He developed right groin pain radiating to the inner thigh and had difficulty weight bearing on the right leg over the subsequent days. His symptoms intermittently worsened and he presented 5 weeks post-optical urethrotomy to the emergency department with a fever, right groin pain and inability to walk. His C-reactive protein was elevated at 137 mg/L and a urine culture positive for pseudomonas aeruginosa. A contrast-enhanced computed tomography scan of his abdomen and pelvis revealed a hypoechoic lesion in his obturator externus muscle. An initial bone scan showed no area of increased uptake to suggest osteomyelitis. On day 3 of admission, a magnetic resonance imaging showed an extensive collection within the right obturator externus measuring 3.7 ¥ 2.1 cm as well as osteomyelitis of the pubis (Fig. 1). Ultrasound-guided drainage of the collection aspirated 3 mL of purulent material which grew Pseudomonas aeuroginosa. Optical urethrotomy is considered a safe and effective treatment for urethral strictures. The most common complications are fever, bleeding, urinary tract infection, epididymitis, urinary incontinence, urinary extravasation and recurrence of stricture. We postulate that a disruption of the anatomical planes secondary to radiotherapy resulted in the extravasation of urine, from a breach in the corpus spongiosum at time of urethrotomy, into the superficial perineal space which then tracked deep to Colles’ fascia into the medial compartment of the thigh. Pyomyositis is a rare but possible complication of optical urethrotomy, with patients previously treated with local radiotherapy at particular risk.

Triangle of Marcille: the anatomical gateway to lateral pelvic exenteration

To perform more radical surgery for complex pelvic malignancies and recurrent colorectal cancer, the surgeon must increasingly operate outside the conventional anatomical planes. Published in 1963 the ‘Triangle of Marcille’ (lumbosacral triangle) remained primarily of intellectual interest being found lateral to the traditional operating field. However, with the advancement of complex colorectal and gynaecological surgery it now provides a schema to assist surgeons in becoming acquainted with a complex and poorly understood anatomical region. Additionally, it prepares the surgeon for the extent of lateral dissection required to achieve the ‘holy grail’ for oncological surgery in pelvic malignancy, the complete resection (R0).