Maria Amélia Duarte Ferreira

Student perspectives of imaging anatomy in undergraduate medical education

Radiological imaging is gaining relevance in the acquisition of competencies in clinical anatomy. The aim of this study was to evaluate the perceptions of medical students on teaching/learning of imaging anatomy as an integrated part of anatomical education. A questionnaire was designed to evaluate the perceptions of second‐year students participating in a clinical anatomy course over three consecutive academic years. A principal component analysis was used to evaluate the dimensionality of the questionnaire. The variables were summarized using frequencies, mean, median, 25th percentile, 75th percentile, minimum, and maximum. The results demonstrated that students felt the teaching of imaging anatomy influenced learning in the clinical anatomy course (mean = 4.5, median = 5.0) and subsequent clinical courses (mean = 4.4, median = 4.0). Regarding the imaging techniques used in the demonstration of anatomical structures, computed tomography (median = 5.0) and magnetic resonance imaging (median = 5.0) were highly rated. Students suggested the use of additional support material (37.6%) and favored a more practical approach. In conclusion, the results of this work highlight the value of imaging anatomy in learning human anatomy. Students comments pointed out a need to focus teaching/learning programs toward a more practical rather than theoretical approach as well as a need to provide a better fit between sectional anatomy and clinical cases using imaging anatomy. In order to provide an optimal learning environment to students, it also seems important to create improved media material as an additional resource tool. Anat Sci Educ.

Surface anatomical landmarks for the location of posterior sacral foramina in sacral nerve stimulation

AbstractBackgroundnSacral nerve stimulation is a common treatment for various pelvic floor disorders. It consists of the percutaneous introduction of electrodes through the posterior sacral foramina for therapeutic stimulation of the target sacral spinal nerve. The aim of our study was to determine the surface anatomical landmarks of the sacrum to facilitate identification of the posterior sacral foramina.MethodsThis study was conducted on 20 human cadavers. The cadavers were placed in a prone position, and all the soft tissues of the sacral region were removed to allow exposure of the osseous structures. Different measurements were taken in relation to the posterior sacral foramina, the posterior superior iliac spine (PSIS) and the median sacral crest (MSC). A median coefficient of variation (CV) was determined.ResultsThe diameter of the second sacral foramen showed the greatest variability. The distances between each individual foramen and the MSC had an acceptable variability (CVxa0<xa020%). In contrast, the distance between foramina had a high variability. The distance between PSIS and the second posterior sacral foramen was also found to have an acceptable variability (CVxa0<xa020%). However, the angle formed by an horizontal line between PSIS and a line between PSIS and S2 foramina had high variability.ConclusionsWe found that the distance between sacral foramina and MSC is relatively constant while the distance between foramina and the relations between foramina and PSIS is highly variable. Detailed knowledge of the anatomy may facilitate electrode placement and is complementary to the regular use of fluoroscopy.

Sacral malformations: use of imaging to optimise sacral nerve stimulation

IntroductionThe success of sacral nerve stimulation, a common treatment for pelvic floor disorders, depends on correct placement of the electrodes through the sacral foramina. When the bony anatomy and topography of the sacrum and sacral spinal nerves are intact, this is easily achieved; where sacral anomalies exist, it can be challenging. A better understanding of common sacral malformations can improve the success of sacral nerve stimulation (SNS) electrode placement.Material and methodsWe reviewed 998 consecutive MRI scans performed to investigate low back pain in patients who had undergone CT and/or X-ray.ResultsCongenital sacral malformations were found in 24.1xa0%, the most common being sacral meningeal cysts (16xa0%) and spina bifida occulta (9.9xa0%). Others were lumbosacral transitional vertebrae (2.5xa0%), anterior occult meningocele (0.5xa0%), partial sacral agenesis (0.2xa0%) and vertebral dysplasia of S1 (0.2xa0%).ConclusionThis radiologic review uncovered a high incidence of sacral malformations, and most were asymptomatic. All surgeons who perform SNS should have a basic understanding of sacral malformations, their incidence and effect on foraminal anatomy. Imaging will aid procedural planning.

The impact of students and curriculum on self-study during clinical training in medical school: a multilevel approach

BackgroundIn higher education, the focus has shifted from the acquisition of knowledge to learning objectives and skills. This means that, the majority of student learning time is spent independently working outside the classroom. Students take an active role in setting goals, deciding how to achieve them, and planning individual study time. Although extensive research has recognized the importance of curriculum and students’ characteristics in time devoted to self-study, it is still unclear to what extent these variables affect time to study. Due to the growing reliance on self-directed learning in medical education, and in an attempt to elucidate this issue, this research aims to evaluate self-study time during clinical training and assess whether this is more influenced by the student or the curriculum.MethodsA questionnaire was given to 1220 medical students (43.3% of the enrolled students). The students were asked to indicate the average number of study hours per week beyond the time allocated to classes for each clerkship (rotation) attended. Variation and generalizability of students’ self-study were estimated using linear mixed models.ResultsFindings showed that the intrinsic differences within students were a greater source of variation in self-study time than differences within clerkships (56.0% vs. 6.9%). If the amount of self-study dedicated to an individual clerkship is to be determined, at least 32 students are needed to achieve acceptable reliability. However, this data with two clerkships per student can used to retrospectively measure the self-study reported by students in clinical training.ConclusionsThe findings suggest that, both, curriculum and student characteristics influence self-study in undergraduate clinical training. Indeed, students’ characteristics play a significant role in time devoted to study. Further research should be undertaken to investigate students’ characteristics that may predict self-study during undergraduate medical training.

How medical education can contribute towards the reduction of maternal mortality in Angola: the teaching/learning process of Gynecology and Obstetrics

BACKGROUNDnIn Angola the maternal mortality ratio is among the highest in the world. Medical students are an important target for intervention.nnnOBJECTIVESnTo evaluate how students perceive the curricular unit of Gynecology and Obstetrics (G&O) in a public institution of reference in Angola.nnnMETHODSnThe study involved a sample of 147 students of the faculty of Medicine of the University Agostinho Neto, Luanda, Angola, attending the curricular unit of G&O in the 5th and 6th years of the medical course. Data were obtained through surveys of opinion. The information of the scales was summarized through the construction of scores from the original items using the Principal Components Analysis.nnnRESULTSnStudents evaluated positively the curricular unit although emphasizing the lack of human and physical resources. The 5th year scored with higher values Teacher Performance and 6th year Students Performance. Both years considered to have insufficient skills to meet the learning objectives.nnnCONCLUSIONnConstraints were identified in the outcomes of the teaching/learning program. Several points emerged as crucial from this study: widespread the areas of teaching/learning, increase the number and quality of teaching staff, improve the monitoring of students and provide adequate infrastructures and medical equipment to support the teaching/learning program.

Opção pelo curso de Medicina em Angola: o caso da Universidade Agostinho Neto

This study aimed to (i) identify the reasons leading young people to choose to study medicine at the Agostinho Neto University School of Medicine (FMUAN) in Angola; (ii) identify how they perceive the medical profession; and (iii) determine whether socio-demographic characteristics influence the factors identified as determinants in the applicants decision to pursue the medical career. The study involved a sample of 1,815 medical school applicants (96.2%). The data came from a sample obtained through opinion polls. The applicants main reasons for choosing medicine were: altruism (median = 87.5), vocation (median = 81.3), family influence (median = 75.0), social prestige (median = 75.0), scientific interest (median = 68.7), family members in the medical profession (median = 62.5), and work market (median = 50.0). Less important factors were: economic/financial benefit (median = 45.0), success (median = 43.8), and health problems in the family (median = 37.5). The study concludes that medical school applicants in Angola are characterized by dedication and commitment to others, with vocation and altruism as the key drivers in their career choice.

Tools and resources for neuroanatomy education: a systematic review

BackgroundThe aim of this review was to identify studies exploring neuroanatomy teaching tools and their impact in learning, as a basis towards the implementation of a neuroanatomy program in the context of a curricular reform in medical education.MethodsComputer-assisted searches were conducted through March 2017 in the PubMed, Web of Science, Medline, Current Contents Connect, KCI and Scielo Citation Index databases. Four sets of keywords were used, combining “neuroanatomy” with “education”, “teaching”, “learning” and “student*”. Studies were reviewed independently by two readers, and data collected were confirmed by a third reader.ResultsOf the 214 studies identified, 29 studies reported data on the impact of using specific neuroanatomy teaching tools. Most of them (83%) were published in the last 8xa0years and were conducted in the United States of America (65.52%). Regarding the participants, medical students were the most studied sample (37.93%) and the majority of the studies (65.52%) had less than 100 participants. Approximately half of the studies included in this review used digital teaching tools (e.g., 3D computer neuroanatomy models), whereas the remaining used non-digital learning tools (e.g., 3D physical models).ConclusionsOur work highlight the progressive interest in the study of neuroanatomy teaching tools over the last years, as evidenced from the number of publications and highlight the need to consider new tools, coping with technological development in medical education.

Call to Publish in an Undergraduate Medical Course: Dissemination of the Final-Year Research Project

ABSTRACT Problem: Todays medical doctors must not only have the clinical skills to treat patients effectively but also keep current with new advances in medicine and critically analyze evidence to choose the best treatments and explain the risks and benefits of different options. In this article, we aim to share the approach taken at a Portuguese medical school to promote a close connection between research and learning. Intervention: In a blended-learning approach, students studied research and scientific methods and undertook one of three faculty-supervised research and dissemination projects. To support immediate application of new research knowledge, students were offered optional short lectures and problem sets. All course information was featured on a website that also supported a discussion forum. We analyzed 1,350 theses leading to the medical degree, defended in six consecutive academic years (2007–2013). Our aim was to estimate the publication rates and factors associated with publication of the final-year undergraduate research projects. Context: The present research curriculum was developed at the University of Porto Faculty of Medicine as part of the Bologna process curriculum implemented in the 2007–2008 academic year. From May to June 2014 we looked for corresponding articles published over the period of September 2007 to April 2014. We searched PubMed, Scielo, Scopus, and IndexRMP databases to locate publications resulting from student theses. Outcomes: Over 6 years, the diffusion of knowledge produced by medical students, who engaged in clinical practice concurrently with research projects, was fairly low (10.4%). Program modifications that increased student accountability and engagement allowed for an increased rate of publication from 1.0% to 23.9%. Factors associated with publication were research area, publication as a performance assessment criterion, and publication language. Lessons Learned: The results of this study suggest that it is helpful to provide research opportunities that allow aspiring future medical doctors to begin their research careers. Further research is needed to understand difficulties students and supervisors face in project development and to achieve greater balance in topic coverage among projects and, consequently, in departmental involvement in the program.