Santos Guzmán López

Morphometry of Pedicle and Vertebral Body in a Mexican Population by CT and Fluroscopy

Es necesario tener un conocimiento anatomico preciso de la morfologia de los pediculos en la region lumbar para la colocacion segura de tornillos intrapediculares. No existen reportes de la morfometria de los pediculos lumbares en la poblacion Mexicana. Se desarrollo un estudio descriptivo, observacional y transversal en 60 cadaveres en el laboratorio del Departamento de Anatomia Humana de la Facultad de Medicina. El objetivo del estudio fue determinr las caracteristicas morfometricas de los pediculos de la region lumbar en una muestra de poblacion Mexicana. Se evaluaron las regiones lumbares (L1-L5) de un total de 60 cadaveres por fluroscopia y TC en un rango de edad entre 40 y 78 anos. Cada pediculo fue medido en los planos axial, sagital y coronal. La evaluacion por TC muestra un aumento progresivo y gradual de la anchura de los pediculos de L1 (7,81 ±1,30 mm) a L5 (14,36 ±14,36 mm). Tambien se observo una disminucion gradul de la longitud del pediculo de L1 (14,36 ±14,36 mm) a L5 (17,23 ±1,35 mm). Al realizar las mediciones por fluroscopia se observaron las mismas condiciones, pero los valores fueron proporcionalmente mayores que los obtenidos por TC. La anchura y longitud pedicular fueron ligeramente mayores en hombres que en mujeres, pero no revelan significancia estadistica (p<0,05). Los datos obtenidos del estudio indican que los tornillos intrapediculares (5,5- 6,5mm) pueden ser utilizados en la region lumbar.

The Development of Clinical Reasoning Skills: A Major Objective of the Anatomy Course.

Traditional medical school curricula have made a clear demarcation between the basic biomedical sciences and the clinical years. It is our view that a comprehensive medical education necessarily involves an increased correlation between basic science knowledge and its clinical applications. A basic anatomy course should have two main objectives: for the student to successfully gain a solid knowledge base of human anatomy and to develop and hone clinical reasoning skills. In a basic anatomy course, clinical case discussions based on underlying anatomic anomalies or abnormalities are the major means to teach students clinical reasoning skills. By identifying, classifying, and analyzing the clinical data given, a student learns to methodically approach a clinical case and formulate plausible diagnoses. Practicing and perfecting clinical problem‐solving skills should be a major objective of the anatomy curriculum. Such clinical reasoning skills are indeed crucial for the successful and expert practice of medicine. Anat Sci Ed 1:267–268, 2008.

Morphometric Study of Cervical Vertebrae C3-C7 in a Population from Northeastern Mexico

Las mediciones de los elementos vertebrales son importantes para la instrumentacion de columna cervical. Se han reportado variaciones etnicas en estas medidas y en la actualidad no existen estudios morfometricos en la poblacion mexicana. Se realizo un estudio morfometrico en 150 vertebras cervicales (C3-C7) para determinar las medidas de los cuerpos, pediculos, laminas, procesos espinosos y articulares superiores e inferiores. No se encontraron diferencias significativas (p<0.05) en las medidas tomadas entre ambos lados. Las dimensiones de los cuerpos vertebrales se incrementan en niveles mas bajos. Los pediculos de la vertebra C3 son mayores en todas sus dimensiones. La mayor altura de las laminas se observo en C7 y la mayor longitud transversal en C5. Las dimensiones del cuerpo, procesos espinosos y laminas se incrementan de C3-C7, mientras las dimensiones de los pediculos, altura de procesos articulares superiores e inferiores disminuyen en los niveles cervicales mas bajos.

A Morphometric Study of the Extraocular Muscles

Los musculos extraoculares son importantes en la cirugia de estrabismo y en la colocacion de dispositivos intraorbitarios. Analizamos la morfometria de los musculos extraoculares y las posibles variaciones anatomicas en 20 orbitas. No encontramos variantes en longitud, anchura y sitios de insercion. Los musculos rectos superior y lateral son los mas largos; la diferencia en longitud entre los musculos rectos superior e inferior es mayor a la diferencia en longitud entre los musculos rectos medial y lateral. El musculo oblicuo superior es mas pequeno en calibre que el musculo oblicuo inferior, lo que coincide con otros estudios anatomicos. El conocimiento detallado de la morfologia de los musculos extraoculares es fundamental en la cirugia de estrabismo y representa un factor clave para la innovacion de tecnicas quirurgicas y procedimientos en la cavidad orbitaria.

Estudio Morfométrico de la Arteria Radial y su Implicación en la Cirugía de Revascularización Miocárdica

La arteria radial (AR) es utilizada en la practica medica para la realizacion de diversos procedimientos quirurgicos, entre los que destaca la cirugia de revascularizacion miocardica. En la literatura actual hay poca informacion acerca de la compatibilidad de esta arteria con otros conductos vasculares. El objetivo fue determinar las caracteristicas anatomicas, morfometricas y distribucion de la arteria radial en el antebrazo. Se diseco la arteria radial de 10 antebrazos de cadaveres embalsamados; se identificaron y registraron los ramos musculares y vasa nervorum emitidos por la arteria, se midio la longitud total y obtuvieron tres muestras (proximal, media y distal) de cada una para ser procesadas mediante tecnicas histologicas y se determinaron los grosores de la tunica media y los diametros. Se observaron modas de 8 ramos arteriales para el musculo braquiorradial, 4 para los musculos flexor superficial de los dedos y flexor radial del carpo, un ramo arterial unico para el musculo pronador cuadrado y una moda de 1 vasa nervorum para el ramo superficial del nervio radial. La longitud total de la arteria fue de 21,94 cm (±3,34). Los grosores encontrados fueron de 196,16 µm (±72,35), 148,25 µm (±40,40) y 158,96 µm (±45,74) en los segmentos proximal, medio y distal respectivamente. Los diametros luminales mostraron una media de 1,48 mm (±0,70) en la region proximal, 1,01mm (±0,35) en la media y 1,43 mm (±0,47) en la distal. Considerando las caracteristicas morfometricas, la arteria radial es una opcion que satisface los criterios de longitud, diametro luminal y grosor para ser utilizada como injerto.

Students helping students: Five years of experience

Peer teaching can be defined as the transmission of knowledge between colleagues from the same or similar stages of academic training. Near peer teaching (NPT) is a similar variant, in which higher level students (tutors typically 2–5 years ahead of the tutee in the academic program) mentor their junior classmates (tutees) by temporarily assuming the role of the instructor. This method has been utilized in many university and medical school settings (Evans and Cuffe, 2009; Jackson and Evans, 2012; Cantwell et al., 2015; Riddell and King, 2016). In the United Kingdom, the General Medical Council’s guidelines, Tomorrow’s Doctors: Recommendations on Undergraduate Medical Education, states that a medical graduate must “function effectively as a mentor and teacher” (GMC, 2009). Therefore, implementing an NPT program within an undergraduate curriculum stands to prepare medical students for their future role as educators. We have read with great interest the recent article published in ASE by Bruno et al. (2016), and we applaud their work; however, as the authors mentioned, there were several limitations. We agree that the sample size and the number of sessions involved were too small to draw any longstanding conclusions. We would like to bring to attention another important limitation. With regards to the analysis of student perceptions regarding the program, the authors based their findings on comments from the majority of students (74.3%) who attended a single session of the peer teaching program in human anatomy (Bruno et al., 2016). In our opinion, every student must complete at least 80% of the course in order to have a valid perception of the entire program. Five years ago we designed and implemented a human anatomy course in our medical school at Autonomous University of Nuevo Leon in Monterrey, Mexico, integrating NPT. We were faced with several obstacles: curriculum reform, an increase in student enrollment, low faculty-to-student ratios, and an insufficient number of cadavers for gross anatomy laboratory practical sessions. The course was reformatted to last 18 weeks and was divided into four learning modules: theory, clinical hours, anatomy imaging, and laboratory modules (Dur an et al., 2012). The theory module consisted of lectures that lasted one hour daily, five days a week, and were carried out in a traditional manner (one professor with 50 students). The laboratory section (three hours per week) was based on clinical reasoning activities guided by near-peer instructors who were previously trained by professors with regards to the subject matter (Dur an et al., 2012). When we first implemented this program in 2011, a total of 700 first-year students were enrolled in the human anatomy course. At the end of the semester more than 500 had agreed to answer a survey we designed to collect and analyze their opinions on the course design. We analysed qualitative aspects of the NPT program (i.e., communication skills, motivation, and performance) and found that the majority of students rated all of these aspects as eight or higher on a ten-point Likert scale. The mean student perception score regarding the course was 9.21. This survey is now applied at the end of each semester and thus far, all of the results have been satisfactory. In 2014, we began applying a survey to 120 near peer-teachers that were involved as instructors in our human anatomy course in order to obtain their views regarding their roles in the NPT program. Overall, instructors perceived that their participation benefited both themselves and the tutees. Most instructors agreed that they felt comfortable in their role and believed that all medical students should learn how to teach through NPT, or a similar program (Reyes-Hern andez et al., 2015). In our five years of experience, we have analyzed the responses from over 5,000 students and more than 200 near peer teachers, with a generally positive perspective regarding our program. Our method is constantly evolving and adapting to the new challenges we have faced each year. We have developed a monitoring system for training sessions and tutors, and we apply specific rubrics to evaluate the NPT implementation process, among other quality rubrics. In conclusion, we are certain NPT is a useful and dynamic method for teaching human anatomy in which both tutors and tutees are benefited. It is important to develop tools to assess the implementation of the teaching method, to ensure quality and satisfaction, while achieving the goals of the course.

The influence of histology and embryology courses on student achievement in gross human anatomy courses

experiences in order to develop simulated patient programmes that provide learners with the best opportunities in which to develop a whole range of professional skills. We believe the success of our simulated patient programme is based on adherence to principles of adult learning (Knowles, 1990), thinking creatively about ways to support health care professional training and a team approach that whenever possible includes students, actors, clinicians, psychologists and educationalists at all stages of programme development, implementation and evaluation. Debra Nestel, Senior Lecturer in Clinical Communication Department of Biosurgery and Technology, Imperial College London, Paterson Centre Charing Cross Hospital, St Dunstan’s Road, Room 9L04 London W6 8RF, UK. Email: d.nestel@imperial.ac.uk Roger Kneebone, Senior Lecturer in Surgical Education Steve Black, Clinical Research Fellow Norma Jones, Simulated Patient Emma Horrocks, Medical Student Rachael Harrison, Medical Student Cordula Wetzel, PhD Student