Wojciech Pawlina

Medical education in the anatomical sciences: The winds of change continue to blow

At most institutions, education in the anatomical sciences has undergone several changes over the last decade. To identify the changes that have occurred in gross anatomy, microscopic anatomy, neuroscience/neuroanatomy, and embryology courses, directors of these courses were asked to respond to a survey with questions pertaining to total course hours, hours of lecture, and hours of laboratory, whether the course was part of an integrated program or existed as a stand‐alone course, and what type of laboratory experience occurred in the course. These data were compared to data obtained from a similar survey in 2002. Comparison between the data sets suggests several key points some of which include: decreased total hours in gross anatomy and neuroscience/neuroanatomy courses, increased use of virtual microscopy in microscopic anatomy courses, and decreased laboratory hours in embryology courses. Anat Sci Educ 2: 253–259, 2009.

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.

Anatomical basis of chronic pelvic pain syndrome: the ischial spine and pudendal nerve entrapment

Chronic pelvic pain syndrome is a conundrum that may be explained partly by pudendal nerve entrapment (PNE), which causes neuropathic pain. In men with PNE, aberrant development and subsequent malpositioning of the ischial spine appear to be associated with athletic activities during their youth. The changes occur during the period of development and ossification of the spinous process of the ischium.

An update on the status of anatomical sciences education in United States medical schools

Curricular changes continue at United States medical schools and directors of gross anatomy, microscopic anatomy, neuroscience/neuroanatomy, and embryology courses continue to adjust and modify their offerings. Developing and supplying data related to current trends in anatomical sciences education is important if informed decisions are going to be made in a time of curricular and course revision. Thus, a survey was sent to course directors during the 2012–2013 academic years to gather information on total course hours, lecture and laboratory hours, the type of laboratory experiences, testing and competency evaluation, and the type of curricular approach used at their institution. The data gathered were compared to information obtained from previous surveys and conclusions reached were that only small or no change was observed in total course, lecture and laboratory hours in all four courses; more gross anatomy courses were part of an integrated curriculum since the previous survey; virtual microscopy with and without microscopes was the primary laboratory activity in microscopic anatomy courses; and neuroscience/neuroanatomy and embryology courses were unchanged. Anat Sci Educ 7: 321–325.

Accuracy of Ultrasound-Guided Versus Palpation-Guided Acromioclavicular Joint Injections: A Cadaveric Study

To describe a technique for sonographically guided acromioclavicular joint (ACJ) injections and compare its accuracy to palpation‐guided injections in a cadaveric model.

Animated PowerPoint as a tool to teach anatomy.

Anatomy is a visual science. For centuries, anatomic information has been conveyed through drawings that have been presented to students through every available medium. The projection of animated images from a computer is a medium that offers great promise in effecting improved communication of anatomic information. Using Microsoft PowerPoint® software, we have developed animated presentations for all of our lectures in Gross and Developmental Anatomy. As a starting point, we scan pen‐and‐ink drawings to create a digital image. The image may be edited and manipulated in an image processing program. Next, the image is imported into a PowerPoint slide where it is labeled and otherwise enhanced (arteries overlaid with red color, veins in blue, etc.) and the enhancements are animated, as we describe here step by step. For the lecture, the file is loaded on a server that is accessible through a network from a computer in the lecture hall. The output is directed to a video projector and the PowerPoint presentation is projected in the “Slide Show” mode. We use a wireless mouse that allows us to control the presentation from anywhere in the room. Before the lecture, students are provided with the same unlabeled drawings as handouts, and during the lecture the students are actively engaged in labeling the drawings and making related notes. After the lecture, the file is saved in HTML format and posted on our course web site where students can access the slides. Evaluation by the students at the end of the course demonstrated that this style of presentation was very favorably received. Anat Rec (New Anat) 261:83–88, 2000.

Ultrasound-guided versus nonguided tibiotalar joint and sinus tarsi injections: a cadaveric study.

To compare the relative accuracy rates of ultrasound (US)‐guided versus nonguided ankle (tibiotalar) joint and sinus tarsi injections in a cadaveric model.

An explorative learning approach to teaching clinical anatomy using student generated content.

Translating basic sciences into a clinical framework has been approached through the implementation of various teaching techniques aimed at using a patient case scenario to facilitate learning. These techniques present students with a specific patient case and lead the students to discuss physiological processes through analysis of provided data supported by independent learning and research. However, no literature exists that describes a reverse teaching methodology in which students are given disease diagnosis and then asked to construct a patient case. This article discusses an explorative learning approach introduced in the gross anatomy course in which students were asked to use clinical skills and reasoning to create a patient case. The online knowledge‐sharing portal utilizing MediaWiki provided a necessary base for students in completing their task. Teams were given 4 weeks to complete their written online project with weekly feedback provided by 3rd year teaching assistants using the Wiki discussion page. A survey was performed to assess competence regarding a patient write up and oral presentation. Skills that the teams acquired through the completion of this project will benefit future patient interactions. This project also emphasized and reinforced the importance of effective communication, leadership, and teamwork. This study shows that a clinical anatomy project that incorporates explorative learning can be an effective way of introducing students to the skills needed for patient write ups and oral presentations. Furthermore this approach to learning allows students to excel during their clinical years and to correlate anatomy to clinical diagnoses. Anat Sci Ed 1:106–110, 2008.

Robotic extraperitoneal aortic lymphadenectomy: Development of a technique

OBJECTIVES To develop a robotic technique for extraperitoneal aortic lymphadenectomy in cadavers followed by application in a patient with advanced cervical cancer. METHODS Two fresh frozen female torso cadavers were used to develop the correct placement of the robotic column and trocars, respectively, to allow for a safe and adequate performance of aortic lymphadenectomy using the da Vinci S system. The resulting technique was applied to a patient with cervical cancer Stage IB2 presenting with enlarged aortic nodes. RESULTS Appropriate sites for trocar and robotic column placement were identified in the female cadavers. In the patient, the operating, docking, and console times were 103, 3.5, and 49 minutes, respectively. The blood loss was 30 ml. Selective removal of 5 enlarged aortic nodes revealed no evidence of metastases. CONCLUSION Robotic extraperitoneal aortic lymphadenectomy is feasible provided there is proper robotic trocar and column placement. The operating time and number of aortic nodes selectively removed by robotics in this patient are within the range of those reported with an extraperitoneal systematic aortic lymphadenectomy by laparoscopy.

Developing medical students as teachers: An anatomy‐based student‐as‐teacher program with emphasis on core teaching competencies

Teaching is an increasingly recognized responsibility of the resident physician. Residents, however, often assume teaching responsibilities without adequate preparation. Consequently, many medical schools have implemented student‐as‐teacher (SAT) programs that provide near‐peer teaching opportunities to senior medical students. Near‐peer teaching is widely regarded as an effective teaching modality; however, whether near‐peer teaching experiences in medical school prepare students for the teaching demands of residency is less understood. We explored whether the anatomy‐based SAT program through the Human Structure didactic block at Mayo Medical School addressed the core teaching competencies of a medical educator and prepared its participants for further teaching roles in their medical careers. A web‐based survey was sent to all teaching assistants in the anatomy‐based SAT program over the past five years (2007–2011). Survey questions were constructed based on previously published competencies in seven teaching domains – course development, course organization, teaching execution, student coaching, student assessment, teacher evaluation, and scholarship. Results of the survey indicate that participants in the anatomy‐based SAT program achieved core competencies of a medical educator and felt prepared for the teaching demands of residency. Anat Sci Educ 6: 385–392.