Graham Louw

The place of anatomy in medical education: AMEE Guide no 41*

This Guide, a combined work by three authors from different countries, provides perspectives into the history of teaching gross anatomy, briefly, from the earliest of times, through to a detailed examination of curricula in both traditional didactic approaches and Problem-Based Learning (PBL) curricula. The delivery of a module within a curriculum in tertiary education is interplay between the content (knowledge and skills) of a subject, the teaching staff involved, the students and their approaches to learning, and the philosophy underpinning the delivery of the learning material. The work is divided into sections that deal with approaches to learning anatomy from the perspective of students, to delivery of the content of the curriculum by lecturers, including the assessment of knowledge, and itemises the topics that could be considered important for an appropriate anatomy module in an integrated course, delivered in a way that emphasises clinical application. The work concludes by looking to the future, and considering what measures may need to be addressed to ensure the continued development of anatomy as a clinically relevant subject in any medical curriculum.

The reliance on unclaimed cadavers for anatomical teaching by medical schools in Africa

The study of gross Anatomy through the use of cadaveric dissections in medical schools is an essential part of the comprehensive learning of human Anatomy, and unsurprisingly, 90% of the surveyed medical schools in Africa used cadaveric dissections. Donated cadavers now make up 80% of the total cadavers in North American medical schools and all the cadavers used for dissection in the United Kingdom are donated. Because the sources of cadavers used in Africa are not clearly known, a questionnaire to gather information on cadavers used at medical schools was designed from the relevant literature and was sent by electronic mail to 123 Anatomy lecturers in 23 African countries (48 medical schools). Fourteen lecturers from 14 medical schools in ten countries responded to the questionnaires. The results indicate that, in most countries, the cadavers are unclaimed bodies from the hospitals and prisons, and the bodies of dead bandits. In South Africa and Zimbabwe, the donations are mostly from the white community, and medical school in the Islamic country of Libya is importing cadavers from India. The lack of knowledge about body donation programes and firmly held cultural and religious burial traditions may explain the lack of bequests from black communities. The use of unclaimed bodies may disproportionally affect people who were homeless and poor, criminals, people with fewer social links, and social outcasts. The Anatomy lecturers felt that there should be broader national awareness programes for body donations, although the benefits of this could take decades to materialize. Anat Sci Educ, 2010.

Who donates their body to science? An international, multicenter, prospective study

The altruistic act of body donation provides a precious resource for both teaching and researching human anatomy. However, relatively little is known about individuals who donate their bodies to science (donors), and in particular whether donors in different geographical locations share similar characteristics. A multicenter prospective survey of donors registering during 2010 in three different geographical locations, New Zealand, Ireland, and the Republic of South Africa, was conducted to identify donor characteristics. The 28‐question survey included sections on body donation program awareness, reasons for donating, giving tendency, education, ethnicity, relationship status, occupation, religion, and political preference. Two hundred surveys (81%) were returned [New Zealand 123 (85% response rate), Republic of South Africa 41 (67%), and Ireland 36 (92%)]. Results indicate that donors share certain characteristics including reason for donating (80% cited a desire to aid medical science as the main reason for wishing to donate their body); family structure (most donors are or have been in long‐term partnerships and ≥85% have siblings); and a higher proportion with no religious affiliation compared to their reference population. Some variations between locations were noted including donor age, the mode of program awareness, occupation, relationship status, political preference, organ donor status and with whom donors had discussed their decision to donate. This information could be important for assisting the identification of potential body donors in new and established bequest programs. Anat Sci Educ.

Cross-sectional Survey of Growth of Urban and Rural ''Cape Coloured'' Schoolchildren: Anthropometry and Functional Tests

The patterns of physical growth (height, weight, length of body segments, circumferences, and widths) and function (grip strength, reflexes, and pulse rates) of “Cape Coloured” schoolchildren were studied. Urban and rural groups were selected with maximum contrasting socioeconomic status (SES). Data were collected between 1986 and 1988 and included 906 males and 1,068 females of high SES between 5 and 20 years in the Cape Town urban area and 834 males and 940 females of low SES between 5 and 19 years in the Little Karoo region. Means and standard deviations of 20 characteristics by age are presented separately for males and females and urban and rural groups. The heights and weights of prepubertal urban children match American reference data, but postpubertally they decline somewhat, whereas these measurements of the rural children consistently lie ∼1 standard deviation below the urban group. Skinfold thicknesses of urban children match or exceed the American reference, implying that their nutritional needs are being met well. Functional indicators of rural children are much poorer than those of urban children. The results of the urban children may provide a target for the improvement in growth status of rural children. Am. J. Hum. Biol. 10:73–85, 1998.

Height and weight differences among South African Urban schoolchildren born in various months of the year

Among 1,165 subjects aged 6–18 years who were examined once cross‐sectionally, a significant variation in body height and weight according to the month of birth of the subjects was found. All subjects belonged to the so‐called Cape Coloured community, were born locally, and their parents belonged to the most affluent sector of the community. Individuals born in February to July were shorter and weighed less (by 13 to 17% of the standard deviation) than those born in August to January. These results are similar to those obtained for Canadian children, who were measured on their birthdays. Since our individuals were measured only once, at the same time of the year, observed differences cannot be ascribed to seasonal fluctuations of growth rates prior to measurement but must constitute a persistent effect of seasonal fluctuation in earlier growth. Immediate environmental conditions (food, temperature, rainfall, and insolation) in the Southern Hemisphere fluctuate seasonally 6 months out of phase from those in the Northern Hemisphere. Thus the similarity of our findings to those from the Northern Hemisphere suggests a factor common for the entire earth, possibly related to the ellipsoid shape of the orbit of the planet.

What is medicine and what is a doctor? Medical students’ perceptions and expectations of their academic and professional career

Background: Research was conducted at the University of Cape Town in South Africa where a new medical curriculum was introduced in 2002. This curriculum is largely problem-based and primary health care (PHC) driven. Aim: To qualitatively explore medical students’ perceptions of medicine and doctors and their expectations of studying medicine and practising as a doctor. Methods: A questionnaire was administered to all first-year students (n = 193) that assessed their perceptions of doctors, and their expectations of studying medicine and practising as a doctor. Interviews and focus groups were conducted with purposively selected first-, second-, third- and fourth-year students. Results: Medical students at the University of Cape Town were found to have generally positive perceptions of medicine and doctors, and depicted the medical profession as one that is very significant because of its influence within society, to the point of being perceived as almost noble. Some of the more challenging and difficult aspects of a career in medicine were mentioned, but these seem to be minor compared to the positive aspects. Some students regarded the medical profession as having a biomedical and curative emphasis, although there seemed to be a strong move towards a more holistic view. However, students expected their degree to concentrate on the biomedical aspects of medicine, and therefore did not expect particular components of their degree, such as the psychosocial component. Conclusions: Unmet expectations regarding their curriculum seem to be a very significant issue for students. It is therefore important for educators who deliver the curriculum to be aware of and to understand medical students’ perceptions and expectations of medicine and doctors, in order to detect and deal with conflict between these perceptions and expectations and what may be an educational institutions ‘hidden curriculum’. Practice points Students have generally positive perceptions of medicine and doctors, and some depict the medical profession as significant and influential. Some of the challenging and difficult aspects of the medical profession were mentioned, but these seemed to be overshadowed by the significance of the profession and its associated status and wealth. Students’ views of the medical profession seem to be moving away from a biomedical and curative view and towards a holistic view of medicine. However, students still expect their medical degree to be mostly biomedical and scientific in content, and did not expect the psychosocial component of their curriculum. Students did not expect the PHC approach to be part of their medical degree or part of their medical career.

The frequency of absence of palmaris longus in a South African population of mixed race

The palmaris longus (PL) is a weak flexor of the wrist that may be harvested as a tendon graft and used in surgical procedures for reconstructive purposes. The PL is congenitally absent in 15% of the worldwide population. However, the frequency of absence varies considerably among different population groups, being as high as 63.9% in the Turkish population and as low as 3% in the black population in the Republic of Congo. In this study, South African persons of mixed race (n = 201) were assessed by two anatomists for the presence of the PL tendon using three clinical tests, namely the Traditional Test, Mishras Test II, and the Gangata Test. The most reliable of the three tests used was determined using Kendalls coefficient of concordance. Of the total number of subjects used, 11.5% had absence (either bilaterally or unilaterally) of the PL tendon. There was a 5.5% bilateral absence of the PL. The study revealed that the PL tendon may present in six different patterns according to the clinical assessment tests applied, the presence or absence of the PL alongside the flexor capi radialis, and the degree of prominence of PL, if present. Using the Kendalls coefficient of concordance, the Mishras Test II, and the Gangata Test, both involving abduction of the thumb, were found to be most effective in revealing the PL. The frequency of absence of the PL in South Africans of mixed race has been determined. Clin. Anat. 23:437–442, 2010.

The contribution of the palmaris longus muscle to the strength of thumb abduction.

The palmaris longus muscle (PLM) is described as a weak flexor of the wrist and a tensor of the palmar aponeurosis, but not a thumb abductor. The PLM is believed to aid thumb abduction through its insertion onto the thenar eminence. Two groups, both right hand dominant, were selected from 1,200 sampled participants. The first group comprised of 38 subjects with unilateral presence of the PLM and was used to determine the strength of thumb abduction. The second group comprised of 30 subjects, with bilateral presence of the PLM, and it was used to calculate the effects of hand dominance. A significant number of subjects with bilateral absence of the PLM were observed and undocumented. Using a dynamometer in subjects with unilateral presence of the PLM, the force of thumb abduction was significantly greater on the hand with a PLM than the one without it (P = 0.014), irrespective of hand dominance. In the second sample with bilateral PLM, thumb abduction on the dominant hand was 10% stronger than on the nondominant hand and was similar to the universally accepted average of 10% increase in grip strength of the dominant hand. Thus, 10% was deducted from all the dominant hands, and the force of thumb abduction remained greater on the hand with PLM than the hand without it (P = 0.049). The results of this study demonstrated the PLM to be involved in thumb abduction, and the authors therefore recommend that this action of the muscle be universally accepted by anatomists and hand surgeons. Clin. Anat. 23:431–436, 2010.

Choosing a Career in Medicine: The Motivations of Medical Students from the University Of Cape Town

The aim of this study was to investigate students’ reasons for studying medicine. The findings presented in this article form part of a broader set of findings for a PhD research study at the University of Cape Town (Cape Town, South Africa) that aimed to qualitatively explore medical students’ attitudes towards and perceptions of the primary healthcare (PHC) approach. Mixed methods were used in the PhD study, but this article will focus on the data gathered from qualitative methods; that is, focus groups and interviews. These were conducted in 2004 and 2005. Participants were purposively selected and included first, second, third and fourth-year students of a problembased and PHC-driven medical curriculum. Students mentioned a range of reasons including an interest in biology, medicine being a good academic choice, family factors, status, financial gain and job security. The dominant reasons seemed to be altruistic. These findings are encouraging considering South Africa’s health situation and the need for South African doctors to draw on their altruistic motivations. Students’ reasons for studying medicine contribute to their mental image of what their Education for Primary Care (2007) 18: 338–45 # 2007 Radcliffe Publishing Limited

Embryological and molecular development of the adrenal glands

In this mini review, the embryological and functional development of the adrenal glands is presented from a molecular perspective. While acknowledging that this is a highly complex series of events, the processes are described in simple and broad strokes in a single text for the reader who is interested in this field but is not an active researcher. The origin of the adrenal glands is in the mesodermal ridge as early as the fourth week of gestation. Between the eighth and ninth weeks of gestation, the adrenal glands are encapsulated and this results in the presence of a distinct organ. There have been great strides in deciphering the very complicated molecular aspects of adrenal gland development in which multiple transcription factors have been identified, directing the adrenogonadal primordium into the adrenal cortex, kidney, or bipotential gonad. Adrenocorticotrophic hormone is critical for early development of the hypothalamic‐pituitary adrenal axis. Several mutations in transcription factors, responsible for normal adrenal gland development have been found to induce the familial syndrome of congenital adrenal hypoplasia or neoplasia. Clin. Anat. 28:235–242, 2015.