James D. Pickering

DHPR activation underlies SR Ca2+ release induced by osmotic stress in isolated rat skeletal muscle fibers

Changes in skeletal muscle volume induce localized sarcoplasmic reticulum (SR) Ca2+ release (LCR) events, which are sustained for many minutes, suggesting a possible signaling role in plasticity or pathology. However, the mechanism by which cell volume influences SR Ca2+ release is uncertain. In the present study, rat flexor digitorum brevis fibers were superfused with isoosmotic Tyrodes solution before exposure to either hyperosmotic (404 mOsm) or hypoosmotic (254 mOsm) solutions, and the effects on cell volume, membrane potential (Em), and intracellular Ca2+ ([Ca2+]i) were determined. To allow comparison with previous studies, solutions were made hyperosmotic by the addition of sugars or divalent cations, or they were made hypoosmotic by reducing [NaCl]o. All hyperosmotic solutions induced a sustained decrease in cell volume, which was accompanied by membrane depolarization (by 14–18 mV; n = 40) and SR Ca2+ release. However, sugar solutions caused a global increase in [Ca2+]i, whereas solutions made hyperosmotic by the addition of divalent cations only induced LCR. Decreasing osmolarity induced an increase in cell volume and a negative shift in Em (by 15.04 ± 1.85 mV; n = 8), whereas [Ca2+]i was unaffected. However, on return to the isoosmotic solution, restoration of cell volume and Em was associated with LCR. Both global and localized SR Ca2+ release were abolished by the dihydropyridine receptor inhibitor nifedipine by sustained depolarization of the sarcolemmal or by the addition of the ryanodine receptor 1 inhibitor tetracaine. Inhibitors of the Na-K-2Cl (NKCC) cotransporter markedly inhibited the depolarization associated with hyperosmotic shrinkage and the associated SR Ca2+ release. These findings suggest (1) that the depolarization that accompanies a decrease in cell volume is the primary event leading to SR Ca2+ release, and (2) that volume-dependent regulation of the NKCC cotransporter contributes to the observed changes in Em. The differing effects of the osmotic agents can be explained by the screening of fixed charges by divalent ions.

Anatomy Drawing Screencasts: Enabling Flexible Learning for Medical Students.

The traditional lecture remains an essential method of disseminating information to medical students. However, due to the constant development of the modern medical curriculum many institutions are embracing novel means for delivering the core anatomy syllabus. Using mobile media devices is one such way, enabling students to access core material at a time and place that suits their specific learning style. This study has examined the effect of five anatomy drawing screencasts that replicate the popular anatomy drawing element of a lecture. These resources were uploaded to the Universitys Virtual Learning Environment for student access. Usage data and an end of module questionnaire were used to assess the impact of the screencasts on student education. The data revealed a high level of usage that varied in both the time of day and day of the week, with the number of downloads dramatically increasing towards the end of the module when the assessment was approaching. The student group found the additional resources extremely useful in consolidating information and revision, with many commenting on their preference to the screencasts compared to the more traditional approaches to learning. Scrutinizing the screencasts in relation to cognitive load theory and the cognitive theory of multimedia learning indicates a high correlation with an evidence‐based approach to designing learning resources. Overall the screencasts have been a well‐received enhancement that supports the student learning and has been shown to promote flexible learning. Anat Sci Educ 8: 249–257.

A holistic model for evaluating the impact of individual technology-enhanced learning resources

Abstract Background: The use of technology within education has now crossed the Rubicon; student expectations, the increasing availability of both hardware and software and the push to fully blended learning environments mean that educational institutions cannot afford to turn their backs on technology-enhanced learning (TEL). The ability to meaningfully evaluate the impact of TEL resources nevertheless remains problematic. Aims: This paper aims to establish a robust means of evaluating individual resources and meaningfully measure their impact upon learning within the context of the program in which they are used. Methods: Based upon the experience of developing and evaluating a range of mobile and desktop based TEL resources, this paper outlines a new four-stage evaluation process, taking into account learner satisfaction, learner gain, and the impact of a resource on both the individual and the institution in which it has been adapted. Results: A new multi-level model of TEL resource evaluation is proposed, which includes a preliminary evaluation of need, learner satisfaction and gain, learner impact and institutional impact. Each of these levels are discussed in detail, and in relation to existing TEL evaluation frameworks. Conclusions: This paper details a holistic, meaningful evaluation model for individual TEL resources within the specific context in which they are used. It is proposed that this model is adopted to ensure that TEL resources are evaluated in a more meaningful and robust manner than is currently undertaken.

Introduction of an anatomy eBook enhances assessment outcomes

relevant formative material with minimal input from staff (a 1-hour session). These data suggest that PeerWise can be a popular resource when targeted appropriately, and that students can find the writing, answering and discussion of questions valuable, particularly for examination preparation. However, some cohorts may fail to engage. In our experience, the nonengaging cohort (Year 2) was more senior and was following a lecture-based curriculum. The cohort that engaged (Year 1) consisted of new students in a small-group and self-directed learning-based curriculum. These factors may have contributed to the degree of engagement. PeerWise is globally available and so this approach to introducing PeerWise can be administered easily and productively at any medical school.

An Anatomy Massive Open Online Course as a Continuing Professional Development Tool for Healthcare Professionals

Massive open online courses (MOOCs) remain a novel and under-evaluated learning tool within anatomical and medical education. This study aimed to provide valuable information by using an anatomy MOOC to investigate the demographic profile, patterns of engagement and self-perceived benefits to healthcare professionals. A 21-item survey aimed at healthcare professionals was embedded into the Exploring Anatomy: The Human Abdomen MOOC, in April 2016. The course attracted 2711 individual learners with 94 of these completing the survey, and 79 of those confirming they worked full- or part-time as healthcare professionals. Variations in use across healthcare profession (allied healthcare professional, nurse or doctor) were explored using a Fisher’s exact test to calculate significance across demographic, motivation and engagement items; one-way ANOVA was used to compare self-perceived benefits. Survey data revealed that 53.2% were allied healthcare professionals, 35.4% nurses and 11.4% doctors. Across all professions, the main motivation for enrolling was to learn new things in relation to their clinical practice, with a majority following the prescribed course pathway and utilising core, and clinically relevant, material. The main benefits were in relation to improving anatomy knowledge, which enabled better support for patients. This exploratory study assessing engagement and self-perceived benefits of an anatomy MOOC has shown a high level of ordered involvement, with some indicators suggesting possible benefits to patients by enhancing the subject knowledge of those enrolled. It is suggested that this type of learning tool should be further explored as an approach to continuing professional, and interprofessional, education.

Medical Student Use of Facebook to Support Preparation for Anatomy Assessments.

The use of Facebook to support students is an emerging area of educational research. This study explored how a Facebook Page could support Year 2 medical (MBChB) students in preparation for summative anatomy assessments and alleviate test anxiety. Overall, Facebook analytics revealed that in total 49 (19.8% of entire cohort) students posted a comment in preparation for either the first (33 students) or second (34) summative anatomy assessments. 18 students commented in preparation for both. In total, 155 comments were posted, with 83 for the first and 72 for the second. Of the 83 comments, 45 related to checking anatomical information, 30 were requiring assessment information and 8 wanted general course information. For the second assessment this was 52, 14 and 6, respectively. Student perceptions on usage, and impact on learning and assessment preparation were obtained via a five‐point Likert‐style questionnaire, with 119 students confirming they accessed the Page. Generally, students believed the Page was an effective way to support their learning, and provided information which supported their preparation with increases in perceived confidence and reductions in anxiety. There was no difference between gender, except for males who appeared to be significantly less likely to ask a question as they may be perceived to lack knowledge (P < 0.05). This study suggests that Facebook can play an important role in supporting students in preparation for anatomy assessments. Anat Sci Educ 10: 205–214.

Preservation of cranial nerves during removal of the brain for an enhanced student experience in neuroanatomy classes.

Neuroanatomy teaching at the University of Leeds includes the examination of isolated brains by students working in small groups. This requires the prosected brains to exhibit all 12 pairs of cranial nerves. Traditional methods of removing the brain from the skull involve elevating the frontal lobes and cutting each cranial nerve as the brain is reflected posteriorly. This can leave a substantial length of each nerve attached to the skull base rather than to the removed brain. We have found a posterior approach more successful. In this study, five adult heads were disarticulated at the level of the thyroid cartilage and placed, prone, in a head stand. A wedge of bone from the occipital region was removed before the cerebellum and brainstem were elevated to visualize the cranial nerves associated with the medulla oblongata, cerebellopontine angle and mesencephalic‐pontine junction prior to cutting them as close to the skull as possible. Five brains were successfully removed from the skull, each having a full complement of cranial nerves of good length attached to them. This approach significantly increases the length and number of cranial nerves remaining attached to the brain, which supports student education. For integration into head and neck dissection courses, careful consideration will be required to ensure the necks are suitably dissected and to decide whether the cranial nerves are best left attached to the skull base or brain. Clin. Anat. 27:20–24, 2014.

Taking human anatomy drawings for teaching outside the classroom

the lecture quality rating increasing from 4.50 in 2011/2012 to 4.95 on a 0–5 Likert scale in 2012/2013. So, how can this method of anatomy teaching be taken away from the classroom? Mobile media devices. After each lecture, which had an anatomy drawing included, the drawing was reproduced on a pen-tablet (Wacom Cintiq) and captured using screen-capture software (Camtasia Studio, Techsmith). These drawings were then converted to .mp4 files and made available to the students via the University’s Virtual Learning Environment for download to the students’ desktop or mobile media device. The success of this development? Student feedback on the resource is extremely positive as highlighted by year 1 medical students:

Twelve tips for developing and delivering a massive open online course in medical education

Abstract Massive open online courses (MOOCs) are a novel mode of online learning. They are typically based on higher education courses and can attract a high number of learners, often in the thousands. They are distinct from on-campus education and deliver the learning objectives through a series of short videos, recommended readings and discussion fora, alongside automated assessments. Within medical education the role of MOOCs remains unclear, with recent proposals including continuing professional development, interprofessional education or integration into campus-based blended learning curricula. In this twelve tips article, we aim to provide a framework for readers to use when developing, delivering and evaluating a MOOC within medical education based on the literature and our own experience. Practical advice is provided on how to design the appropriate curriculum, engage with learners on the platform, select suitable assessments, and comprehensively evaluate the impact of your course.

Measuring learning gain: Comparing anatomy drawing screencasts and paper‐based resources

The use of technology‐enhanced learning (TEL) resources is now a common tool across a variety of healthcare programs. Despite this popular approach to curriculum delivery there remains a paucity in empirical evidence that quantifies the change in learning gain. The aim of the study was to measure the changes in learning gain observed with anatomy drawing screencasts in comparison to a traditional paper‐based resource. Learning gain is a widely used term to describe the tangible changes in learning outcomes that have been achieved after a specific intervention. In regard to this study, a cohort of Year 2 medical students voluntarily participated and were randomly assigned to either a screencast or textbook group to compare changes in learning gain across resource type. Using a pre‐test/post‐test protocol, and a range of statistical analyses, the learning gain was calculated at three test points: immediate post‐test, 1‐week post‐test and 4‐week post‐test. Results at all test points revealed a significant increase in learning gain and large effect sizes for the screencast group compared to the textbook group. Possible reasons behind the difference in learning gain are explored by comparing the instructional design of both resources. Strengths and weaknesses of the study design are also considered. This work adds to the growing area of research that supports the effective design of TEL resources which are complimentary to the cognitive theory of multimedia learning to achieve both an effective and efficient learning resource for anatomical education. Anat Sci Educ 10: 307–316.