Jeremy K. Gregory

Restructuring a basic science course for core competencies: an example from anatomy teaching.

Medical schools revise their curricula in order to develop physicians best skilled to serve the publics needs. To ensure a smooth transition to residency programs, undergraduate medical education is often driven by the six core competencies endorsed by the Accreditation Council for Graduate Medical Education (ACGME): patient care, medical knowledge, practice-based learning, interpersonal skills, professionalism, and systems-based practice. Recent curricular redesign at Mayo Medical School provided an opportunity to restructure anatomy education and integrate radiology with first-year gross and developmental anatomy. The resulting 6-week (120-contact-hour) human structure block provides students with opportunities to learn gross anatomy through dissection, radiologic imaging, and embryologic correlation. We report more than 20 educational interventions from the human structure block that may serve as a model for incorporating the ACGME core competencies into basic science and early medical education. The block emphasizes clinically-oriented anatomy, invites self- and peer-evaluation, provides daily formative feedback through an audience response system, and employs team-based learning. The course includes didactic briefing sessions and roles for students as teachers, leaders, and collaborators. Third-year medical students serve as teaching assistants. With its clinical focus and competency-based design, the human structure block connects basic science with best-practice clinical medicine.

GABAB receptor autoantibody frequency in service serologic evaluation

Objective: Small-cell lung carcinoma (SCLC) and limbic encephalitis are recognized γ-aminobutyric acid-B receptor (GABABR) autoantibody accompaniments. We sought to determine in a diagnostic serology laboratory the frequency and accompaniments (neurologic, oncologic, and serologic) of GABABR–immunoglobulin G (IgG). Methods: We tested stored serum and CSF specimens from 3 patient groups for GABABR-IgG by indirect immunofluorescence on mouse brain tissue and transfected HEK293 cells. Group 1 included 3,989 patients tested for GABABR-IgG in service evaluation for suspected autoimmune encephalopathy. Group 2 included 49 patients with an unclassified CNS synaptic IgG detected (antedating descriptions of GABABR autoantibody). Group 3 included 384 patients in whom ≥1 SCLC-predictive autoantibodies had been detected. Results: GABABR-specific IgG was detected in 17 patients (serum, 14; CSF, 11). N-type calcium channel antibody coexisted with GABABR-IgG in all seropositive patients of groups 1 and 2. In group 1, 7 of 3,989 patients were positive (0.2%). All had limbic encephalitis; 5 had SCLC. Four patients received immunotherapy and improved neurologically. In group 2, 5 of 49 patients were positive (10%). Three had limbic encephalitis, 1 had rapidly progressive encephalomyelopathy, and 1 had cerebellar ataxia. Two patients had SCLC and 1 had multiple myeloma. In group 3, 5 of 384 patients were positive (1.3%); titers were low (detected only by transfected cell assay). The neurologic presentations were diverse and attributable to coexisting T-cell-mediated autoimmunity (indicated by CRMP-5 IgG [2], ANNA-1 [2], and ANNA-3 [2]), rather than to GABABR-IgG. Conclusion: GABABR autoantibody is a marker of an uncommon but treatable paraneoplastic neurologic disorder, usually occurring in the setting of limbic encephalitis and SCLC.

Comparative Efficacy of Group and Individual Feedback in Gross Anatomy for Promoting Medical Student Professionalism.

Professionalism is a core competency of medical training that requires students to develop the skills of providing and receiving feedback. Our study evaluated the effectiveness of delivering feedback in a group setting compared with an individual setting. The first‐year class of Mayo medical students (n = 49) enrolled in gross anatomy (in dissection teams), completed weekly anonymous evaluations of themselves and their teammates regarding seven aspects of professionalism (altruism, compassion, respect, honesty/integrity, responsibility, commitment to excellence, and self‐reflection). Professionalism scores from these surveys were calculated using a six‐point Likert scale. Students were also asked to comment on strengths and possible areas for improvement on each peer. At the midpoint of the course, peer comments and professionalism scores were shared with students in debriefing sessions either individually or with their team. Analysis of preintervention and postintervention professionalism scores indicated that the students receiving feedback in a one‐on‐one setting (student and instructor) were more likely to demonstrate higher scores on subsequent evaluations as compared with those students receiving feedback in a group setting (all team members and one instructor). Our findings suggest that providing feedback to first‐year medical students on an individual basis is the best way to improve professional attitudes and behaviors. Anat Sci Educ 3: 64–72, 2010.

Learning to Lead: Self- and Peer Evaluation of Team Leaders in the Human Structure Didactic Block.

Increasing emphasis on leadership in medical education has created a need for developing accurate evaluations of team leaders. Our study aimed to compare the accuracy of self‐ and peer evaluation of student leaders in the first‐year Human Structure block (integrated gross anatomy, embryology, and radiology). Forty‐nine first‐year medical students at Mayo Medical School were assigned to learning teams of three or four members. Teams worked together on daily laboratory dissection, clinical projects, embryology presentations, and daily group quizzes. Student team leaders were responsible for leading laboratory dissection, reviewing radiographic findings, and organizing group assignments. Weekly electronic surveys were administered to evaluate team leaders on altruism, compassion, respect, integrity, responsibility, commitment to excellence, and self‐reflection. Results demonstrated that team leaders rated themselves lower than their peers rated them in multiple aspects of leadership. Peer evaluation of team leaders was statistically higher than self‐evaluation in all traits measured except respect. Female leaders were rated higher by their peers in the areas of responsibility and self‐reflection compared to male leaders. This study demonstrates the need for increased communication between team leaders and members, along with creation of a mutually respectful environment, to improve leader awareness of their abilities and foster team success. Anat Sci Educ 2:210–217, 2009.

Teaching video neuroimages: reading epilepsy: a seizure in a thousand words (or less).

A 14-year-old right-handed boy developed spells of lip twitching only while reading. With prolonged reading, he occasionally experienced loss of awareness and limb jerking (figure and video on the Neurology® Web site at www.neurology.org). Reading epilepsy is a rare form of reflex seizure in which reading (silently or aloud) may trigger orofacial myoclonus, stammering, aphasia, or generalized convulsions. Onset is typically in early adulthood, with 2:1 male predominance. It occurs in isolation or autosomal dominant fashion.1 Previous reports suggest efficacy of clonazepam, valproate, or levetiracetam.2 Our patient did not tolerate levetiracetam but remains seizure-free on oxcarbazepine. Reading epilepsy should be recognized and promptly treated to avoid unnecessary academic struggles.

Media and Book Reviews: Luria's Legacy in the 21st Century

edited by Anne-Lise Christensen, Elkhonon Goldberg, Dmitri Bougakov 192 pp., Oxford University Press, 2009,

Telling the Patient's Story: using theatre training to improve case presentation skills

49.50 Alexandre Romanovich Luria was an early neuropsychologist in Soviet Russia whose published work spanned more than half a century beginning in the 1920s and whose influence remains strong on the field of psychological assessment and treatment for brain-injured patients. In Lurias …