Integrating gross anatomy into a clinical oncology curriculum: the oncoanatomy course at Duke University School of Medicine

University of Toronto's redesigned ophthalmology curriculum and eye dissection lab

OBJECTIVE

To present a multifaceted approach to ophthalmology undergraduate medical education and to assess the efficacy of an eye dissection laboratory in enhancing medical student learning.

DESIGN

Curriculum review, validation, and student feedback evaluations.

PARTICIPANTS

Year 2 medical students enrolled in the University of Toronto's Doctor of Medicine Program.

METHODS

Student feedback evaluations were compiled from the University of Toronto undergraduate medical education student surveys before 2012-2016 and following introduction of the redesigned foundations ophthalmology curriculum at the University of Toronto (2017-2018). Students who participated in the Eye Dissection Lab as part of the newly designed curriculum completed the pre- and postsession satisfaction and overall interest in ophthalmology questionnaires and a knowledge-based test.

RESULTS

Analysis of 1640 student evaluations demonstrated an increase in ophthalmology curriculum rating following the launch of the foundations ophthalmology curriculum (p = 0.015). Among the 335 students who completed the eye dissection lab, there was a significant increase in the average scores for the satisfaction questionnaire, knowledge-based test, and level of interest in the field of ophthalmology from before and after the session, with improvements in scores noted in 91%, 42%, and 36% of the educational parameters of the participants, respectively (p < 0.001).

CONCLUSIONS

The newly designed foundations ophthalmology curriculum and the eye dissection lab at the University of Toronto serve as effective means for enhancing ophthalmology teaching in medical schools across Canada.

A Scoping Review of Radiation Oncology Educational and Career-Planning Interventions in Undergraduate Medical Education

Radiation oncology (RO) teaching in undergraduate medical education (UME) is lacking worldwide with potentially detrimental effects on medical student career choices and patient care. The objective of this scoping review is to examine the extent of published literature describing RO educational and career-planning interventions in UME. Online databases were searched from respective dates of inception to June 2020 for articles that reported outcomes from RO educational and career-planning interventions in UME. Two independent reviewers screened entries for inclusion. Following full-text reviews, 25 articles were analyzed. Most interventions were a single session, involved clinical medical students, and were based in North America. Didactic teaching was most commonly used, though a majority included interactive learning in addition to or in place of didactic teaching. As expected, there was a heterogeneity of outcomes reported, and most studies collected data using surveys alone. Recurring topics included the multidisciplinary nature of oncology and psychosocial oncology. There was a paucity of studies reporting on formal mentorship programs and research programs. The data collated in this study can help develop new initiatives based on what has succeeded in the past. Areas that may benefit from future studies include mentorship programs, research programs, and interventions from outside North America.

Successful integration of radiation oncology in preclinical medical education : Experiences with an interdisciplinary training project

PURPOSE

Modern impartation of both anatomic and radiation oncology (RO) knowledge in medical education enables a transfer of preclinical knowledge to clinical practice, which may be addressed by multidisciplinary concepts. The faculty's "Anatomy and imaging" course attempts to integrate RO, radiology and nuclear medicine into the preclinical curriculum. The present analysis focuses on the description of the course concept and discusses the potential didactic impact of the implementation of RO.

METHODS

In total 5 semester cohorts have undertaken the course since the introduction of RO in the winter semester of 2015/2016 with 682 students participating. It is designed as a small group circuit training with a teaching content of 8 h daily. Course evaluation was performed on a 100-item Likert scale.

RESULTS

General evaluation showed an average of 9.3-12.7 on a Likert scale (0 being the best, 100 being the worst grade). Use of media, relevance for medical training, gain of interest in medicine in general and overall satisfaction with the course received excellent mean values. For RO, there was a high degree of consent with the following statements: "the course was well organized", "subjects and presentation were well-structured", "topics were well chosen", "the time for exercises was sufficient" and "teaching by student tutors and physicians was adequate".

CONCLUSION

The present evaluation demonstrates the feasibility of introducing RO in the preclinical part of medical education. The course concept shows excellent results in evaluation and may help in broadening RO knowledge and in recruiting new doctoral candidates and residents.

Out of the Basement and Into the Classroom: Pathways for Expanding the Role of Radiation Oncologists in Medical Student Education

PURPOSE

To characterize radiation oncologist involvement in undergraduate medical education at US academic medical centers and to incorporate these findings into practical pathways for greater and broader integration of radiation oncology (RO) into medical curricula.

METHODS

Chairpersons and residency program directors at RO departments directly affiliated with a medical school were asked to describe all the ways in which radiation oncologists in their department are involved in medical student education, excluding their elective clerkship.

RESULTS

Of 75 eligible departments, 49 responded (response rate 65.3%). Twenty departments (40.8%) reported that at least one faculty member participates in a curricular educational session on an oncology-related topic. Twelve (24.5%) of these sessions were focused specifically on RO. Twenty-one departments (42.9%) had faculty involved with organized clinical shadowing or preceptorship programs for first- and second-year medical students. Twelve departments (24.5%) described no involvement in the formal curricula at their local or affiliated medical school. Thirteen departments (44.8%) described participation in a medical school-organized residency fair, and 12 departments (41.4%) sponsor an RO interest group. Reported novel approaches to teaching included development of multidisciplinary clerkships or educational sessions that include RO concepts, guest lectures on RO during a required clerkship, organized extracurricular experiences such as an oncology seminar series, participation in special medical student enrichment programs, and sponsorship or initiation of an RO interest group.

CONCLUSION

The minority of RO departments are involved in formal teaching of the medical student body at large. The approaches described herein should facilitate more robust involvement of radiation oncologists in all areas of undergraduate medical education.

A Nationwide Medical Student Assessment of Oncology Education

Cancer is the second leading cause of death in the USA, but there is minimal data on how oncology is taught to medical students. The purpose of this study is to characterize oncology education at US medical schools. An electronic survey was sent between December 2014 and February 2015 to a convenience sample of medical students who either attended the American Society for Radiation Oncology annual meeting or serve as delegates to the American Association of Medical Colleges. Information on various aspects of oncology instruction at participants' medical schools was collected. Seventy-six responses from students in 28 states were received. Among the six most common causes of death in the USA, cancer reportedly received the fourth most curricular time. During the first, second, and third years of medical school, participants most commonly reported 6-10, 16-20, and 6-10 h of oncology teaching, respectively. Participants were less confident in their understanding of cancer treatment than workup/diagnosis or basic science/natural history of cancer (p < 0.01). During the preclinical years, pathologists, scientists/Ph.D.'s, and medical oncologists reportedly performed the majority of teaching, whereas during the clinical clerkships, medical and surgical oncologists reportedly performed the majority of teaching. Radiation oncologists were significantly less involved during both periods (p < 0.01). Most schools did not require any oncology-oriented clerkship. During each mandatory rotation, <20 % of patients had a primary diagnosis of cancer. Oncology education is often underemphasized and fragmented with wide variability in content and structure between medical schools, suggesting a need for reform.

Integrating anatomy training into radiation oncology residency: considerations for developing a multidisciplinary, interactive learning module for adult learners

Radiation oncologists require an in-depth understanding of anatomical relationships for modern clinical practice, although most do not receive formal anatomy training during residency. To fulfill the need for instruction in relevant anatomy, a series of four multidisciplinary, interactive learning modules were developed for a cohort of radiation oncology and medical physics residents. Instructional design was based on established learning theories, with the intent of integrating knowledge of specific anatomical regions with radiology and radiation oncology practice. Each session included presentations by a radiologist and a radiation oncologist, as well as hands-on exploration of anatomical specimens with guidance from anatomists. Pre- and post-tests distributed during each session showed significant short-term knowledge retention. According to qualitative surveys and exit interviews, participants felt more comfort' with delineating structures, gross anatomy, and radiograph interpretation at the end of each session. Overall participant experience was positive, and the modules were considered effective for learning radiologic anatomy. Suggestions for future interventions include more time, increased clinical application, additional contouring practice and feedback, and improved coordination between each of the three disciplines. Results and conclusions from this study will be used to inform the design of a future multi-day national workshop for Canadian radiation oncology residents.

Evaluating the impact of a Canadian national anatomy and radiology contouring boot camp for radiation oncology residents

BACKGROUND

Radiation therapy treatment planning has advanced over the past 2 decades, with increased emphasis on 3-dimensional imaging for target and organ-at-risk (OAR) delineation. Recent studies suggest a need for improved resident instruction in this area. We developed and evaluated an intensive national educational course ("boot camp") designed to provide dedicated instruction in site-specific anatomy, radiology, and contouring using a multidisciplinary (MDT) approach.

METHODS

The anatomy and radiology contouring (ARC) boot camp was modeled after prior single-institution pilot studies and a needs-assessment survey. The boot camp incorporated joint lectures from radiation oncologists, anatomists, radiologists, and surgeons, with hands-on contouring instruction and small group interactive seminars using cadaveric prosections and correlative axial radiographs. Outcomes were evaluated using pretesting and posttesting, including anatomy/radiology multiple-choice questions (MCQ), timed contouring sessions (evaluated relative to a gold standard using Dice similarity metrics), and qualitative questions on satisfaction and perceived effectiveness. Analyses of pretest versus posttest scores were performed using nonparametric paired testing.

RESULTS

Twenty-nine radiation oncology residents from 10 Canadian universities participated. As part of their current training, 29%, 75%, and 21% receive anatomy, radiology, and contouring instruction, respectively. On posttest scores, the MCQ knowledge scores improved significantly (pretest mean 60% vs posttest mean 80%, P<.001). Across all contoured structures, there was a 0.20 median improvement in students' average Dice score (P<.001). For individual structures, significant Dice improvements occurred in 10 structures. Residents self-reported an improved ability to contour OARs and interpret radiographs in all anatomic sites, 92% of students found the MDT format effective for their learning, and 93% found the boot camp more effective than educational sessions at their own institutions. All of the residents (100%) would recommend this course to others.

CONCLUSIONS

The ARC boot camp is an effective intervention for improving radiation oncology residents' knowledge and understanding of anatomy and radiology in addition to enhancing their confidence and accuracy in contouring.

Physician opinions about an anatomy core curriculum: a case for medical imaging and vertical integration

Pre-clinical anatomy curricula must provide medical students with the knowledge needed in a variety of medical and surgical specialties. But do physicians within specialties agree about what anatomical knowledge is most important in their practices? And, what is the common core of anatomical knowledge deemed essential by physicians in different specialties? Answers to these questions would be useful in designing pre-clinical anatomy courses. The primary aim of this study was to assess the importance of a human gross anatomy course by soliciting the opinions of physicians from a range of specialties. We surveyed 93 physicians to determine the importance of specific anatomical topics in their own practices. Their responses were analyzed to assess variation in intra- and inter-departmental attitudes toward the importance of anatomy. Nearly all of the topics taught in the course were deemed important by the clinicians as a group, but respondents showed little agreement on the rank order of importance of anatomical topics. Overall, only medical imaging received high importance by nearly all respondents, and lower importance was attached to embryology and lymphatic anatomy. Our survey data, however, also suggested distinct hierarchies in the importance assigned to anatomical topics within specialties. Given that physicians view the importance of anatomy differently, we suggest that students revisit anatomy through a vertically integrated curriculum tailored to provide specialty-specific anatomical training to advanced students based on their areas of clinical interest. Integration of medical imaging into pre-clinical anatomy courses, already underway in many medical schools, is of high clinical relevance.

Evaluating the impact of an integrated multidisciplinary head & neck competency-based anatomy & radiology teaching approach in radiation oncology: a prospective cohort study

BACKGROUND

Modern radiation oncology demands a thorough understanding of gross and cross-sectional anatomy for diagnostic and therapeutic applications. Complex anatomic sites present challenges for learners and are not well-addressed in traditional postgraduate curricula. A multidisciplinary team (MDT) based head-and-neck gross and radiologic anatomy program for radiation oncology trainees was developed, piloted, and empirically assessed for efficacy and learning outcomes.

METHODS

Four site-specific MDT head-and-neck seminars were implemented, each involving a MDT delivering didactic and case-based instruction, supplemented by cadaveric presentations. There was no dedicated contouring instruction. Pre- and post-testing were performed to assess knowledge, and ability to apply knowledge to the clinical setting as defined by accuracy of contouring. Paired analyses of knowledge pretests and posttests were performed by Wilcoxon matched-pair signed-rank test.

RESULTS

Fifteen post-graduate trainees participated. A statistically significant (p < 0.001) mean absolute improvement of 4.6 points (17.03%) was observed between knowledge pretest and posttest scores. Contouring accuracy was analyzed quantitatively by comparing spatial overlap of participants' pretest and posttest contours with a gold standard through the dice similarity coefficient. A statistically significant improvement in contouring accuracy was observed for 3 out of 20 anatomical structures. Qualitative and quantitative feedback revealed that participants were more confident at contouring and were enthusiastic towards the seminars.

CONCLUSIONS

MDT seminars were associated with improved knowledge scores and resident satisfaction; however, increased gross and cross-sectional anatomic knowledge did not translate into improvements in contouring accuracy. Further research should evaluate the impact of hands-on contouring sessions in addition to dedicated instructional sessions to develop competencies.

Beyond the standard curriculum: a review of available opportunities for medical students to prepare for a career in radiation oncology

PURPOSE

To review currently available opportunities for medical students to supplement their standard medical education to prepare for a career in radiation oncology.

METHODS AND MATERIALS

Google and PubMed were used to identify existing clinical, health policy, and research programs for medical students in radiation oncology. In addition, results publicly available by the National Resident Matching Program were used to explore opportunities that successful radiation oncology applicants pursued during their medical education, including obtaining additional graduate degrees.

RESULTS

Medical students can pursue a wide variety of opportunities before entering radiation oncology. Several national specialty societies, such as the American Society for Radiation Oncology and the Radiological Society of North America, offer summer internships for medical students interested in radiation oncology. In 2011, 30% of allopathic senior medical students in the United States who matched into radiation oncology had an additional graduate degree, including PhD, MPH, MBA, and MA degrees. Some medical schools are beginning to further integrate dedicated education in radiation oncology into the standard 4-year medical curriculum.

CONCLUSIONS

To the authors' knowledge, this is the first comprehensive review of available opportunities for medical students interested in radiation oncology. Early exposure to radiation oncology and additional educational training beyond the standard medical curriculum have the potential to create more successful radiation oncology applicants and practicing radiation oncologists while also promoting the growth of the field. We hope this review can serve as guide to radiation oncology applicants and mentors as well as encourage discussion regarding initiatives in radiation oncology opportunities for medical students.

Fostering creativity: how the Duke Graduate Medical Education Quasi-Endowment encourages innovation in GME

The Duke Medicine Graduate Medical Education Quasi-Endowment, established in 2006, provides infrastructure support and encourages educational innovation. The authors describe Duke's experience with the "grassroots innovation" part of the fund, the Duke Innovation Fund, and discuss the Innovation Fund's processes for application, review, and implementation, and also outcomes, impact, and intended and unintended consequences.In the five years of the Innovation Fund described (2007-2011), 105 projects have been submitted, and 78 have been funded. Thirty-seven projects have been completed. Approved funding ranged from $2,363 to $348,750, with an average award of $66,391. This represents 42% of funding originally requested. Funding could be requested for a period of 6 months to 3 years. The average duration of projects was 27 months, with a range from 6 months to 36 months. Eighty percent of projects were completed on time. Two projects were closed because of lack of progress and failure to adhere to reporting requirements. Thirty-nine are ongoing.Program directors report great success in meeting project outcomes and concrete impacts on resident and faculty attitudes and performance. Ninety-two percent report that their projects would have never been accomplished without this funding. Projects have resulted in at least 68 posters, abstracts, and peer-reviewed presentations. At least 12 peer-reviewed manuscripts were published.There has been tremendous diversity of projects; all 13 clinical departments have been represented. Interdepartmental and intradepartmental program cooperation has increased. This modest seed money has resulted in demonstrable sustainable impacts on teaching and learning, and increased morale and scholarly recognition.

The LINDSAY Virtual Human Project: an immersive approach to anatomy and physiology

The increasing number of digital anatomy teaching software packages challenges anatomy educators on how to best integrate these tools for teaching and learning. Realistically, there exists a complex interplay of design, implementation, politics, and learning needs in the development and integration of software for education, each of which may be further amplified by the somewhat siloed roles of programmers, faculty, and students. LINDSAY Presenter is newly designed software that permits faculty and students to model and manipulate three-dimensional anatomy presentations and images, while including embedded quizzes, links, and text-based content. A validated tool measuring impact across pedagogy, resources, interactivity, freedom, granularity, and factors outside the immediate learning event was used in conjunction with observation, field notes, and focus groups to critically examine the impact of attitudes and perceptions of all stakeholders in the early implementation of LINDSAY Presenter before and after a three-week trial period with the software. Results demonstrate that external, personal media usage, along with students' awareness of the need to apply anatomy to clinical professional situations drove expectations of LINDSAY Presenter. A focus on the software over learning, which can be expected during initial orientation, surprisingly remained after three weeks of use. The time-intensive investment required to create learning content is a detractor from user-generated content and may reflect the consumption nature of other forms of digital learning. Early excitement over new technologies needs to be tempered with clear understanding of what learning is afforded, and how these constructively support future application and integration into professional practice.

Assessing the value of an optional radiation oncology clinical rotation during the core clerkships in medical school

PURPOSE

Few medical students are given proper clinical training in oncology, much less radiation oncology. We attempted to assess the value of adding a radiation oncology clinical rotation to the medical school curriculum.

METHODS AND MATERIALS

In July 2010, Jefferson Medical College began to offer a 3-week radiation oncology rotation as an elective course for third-year medical students during the core surgical clerkship. During 2010 to 2012, 52 medical students chose to enroll in this rotation. The rotation included outpatient clinics, inpatient consults, didactic sessions, and case-based presentations by the students. Tests of students' knowledge of radiation oncology were administered anonymously before and after the rotation to evaluate the educational effectiveness of the rotation. Students and radiation oncology faculty were given surveys to assess feedback about the rotation.

RESULTS

The students' prerotation test scores had an average of 64% (95% confidence interval [CI], 61-66%). The postrotation test scores improved to an average of 82% (95% CI, 80-83%; 18% absolute improvement). In examination question analysis, scores improved in clinical oncology from 63% to 79%, in radiobiology from 70% to 77%, and in medical physics from 62% to 88%. Improvements in all sections but radiobiology were statistically significant. Students rated the usefulness of the rotation as 8.1 (scale 1-9; 95% CI, 7.3-9.0), their understanding of radiation oncology as a result of the rotation as 8.8 (95% CI, 8.5-9.1), and their recommendation of the rotation to a classmate as 8.2 (95% CI, 7.6-9.0).

CONCLUSIONS

Integrating a radiation oncology clinical rotation into the medical school curriculum improves student knowledge of radiation oncology, including aspects of clinical oncology, radiobiology, and medical physics. The rotation is appreciated by both students and faculty.

Relationships between family physicians' referral for palliative radiotherapy, knowledge of indications for radiotherapy, and prior training: a survey of rural and urban family physicians

BACKGROUND

The primary objective of this research was to assess the relationship between FPs' knowledge of palliative radiotherapy (RT) and referral for palliative RT.

METHODS

1001 surveys were sent to FPs who work in urban, suburban, and rural practices. Respondents were tested on their knowledge of palliative radiotherapy effectiveness and asked to report their self-assessed knowledge.

RESULTS

The response rate was 33%. FPs mean score testing their knowledge of palliative radiotherapy effectiveness was 68% (SD = 26%). The majority of FPs correctly identified that painful bone metastases (91%), airway obstruction (77%), painful local disease (85%), brain metastases (76%) and spinal cord compression (79%) can be effectively treated with RT, though few were aware that hemoptysis (42%) and hematuria (31%) can be effectively treated. There was a linear relationship between increasing involvement in palliative care and both self-assessed (p < 0.001) and tested (p = 0.02) knowledge. FPs had higher mean knowledge scores if they received post-MD training in palliative care (12% higher; p < 0.001) or radiotherapy (15% higher; p = 0.002). There was a strong relationship between FPs referral for palliative radiotherapy and both self-assessed knowledge (p < 0.001) and tested knowledge (p = 0.01).

CONCLUSIONS

Self-assessed and tested knowledge of palliative RT is positively associated with referral for palliative RT. Since palliative RT is underutilized, further research is needed to assess whether family physician educational interventions improve palliative RT referrals. The current study suggests that studies could target family physicians already in practice, with educational interventions focusing on hemostatic and other less commonly known indications for palliative RT.

Cancer education for medical students in developing countries: where do we stand and how to improve?

BACKGROUND

This article is a review of the literature regarding the state of oncology education for medical students in developing countries, and possible solutions to the problems at hand.

METHODS

Ovid MEDLINE, PubMed, ERIC, The Cochrane CENTRAL Register of Controlled Trials (CENTRAL) and Google Scholar were searched using the terms oncology, undergraduate, cancer, education and teaching.

RESULTS

The search resulted in 40 relevant articles in total. Ten articles showed that there is a lack of adequate knowledge in the scientific, clinical and psychological aspects of oncology and palliative care amongst students and physicians in developing countries. Eight articles describe the relevance and usefulness of summer schools, workshops and trainings. The rest of them discuss possible methods of addressing the issue, the most important of which is the inclusion of a clinical oncology rotation in the undergraduate syllabus.

CONCLUSION

Graduated physicians and medical students are a long way from reaching the standard knowledge and skills required in oncology. Thus, there is a pressing need to reform the undergraduate medical curricula in developing countries in order to increase cancer awareness for better graduated future physicians.

Mentoring medical students in radiation oncology

Mentoring in academic medicine has been described on a multitude of levels in medical literature, but seldom with respect to medical students. In fact, although some fields have addressed mentoring in the context of medical student education, radiation oncology has yet to do so in a comprehensive fashion. Furthermore, the projected domestic and worldwide epidemiologic trends in cancer cases, coupled with the frequent use of radiation-based cancer treatment regimens, make this an opportune moment to initiate such a discussion. Herein, the authors consider mentoring in the context of radiation oncology and related fields from the perspective of a medical student. They present a paradigm for promoting mentorship through traditional classroom-based and nontraditional socially and research-based initiatives. It is the authors' hope that both radiation oncology and other specialties will benefit from the initiation of this discussion, as well as build on the suggestions detailed here as we prepare the next generation of radiation oncologists.

Design, implementation, and evaluation of an innovative anatomy course

Starting in 2004, a medical school gross anatomy course faced with a 30% cut in hours went through an extensive redesign, which transformed a traditional dissection course into a course with a clinical focus, learning societies, and extensive on-line learning support. Built into the redesign process was an extensive and ongoing assessment process, which included student focus groups, faculty development, surveys, and examinations. These assessments were used formatively, to enhance the course from year to year, and summatively, to determine how well the course was meeting the new learning objectives. The assessments from focus groups and faculty development prompted changes in support structures provided to students and the training and preparation of faculty. Survey results showed that, after student satisfaction declined the first year, satisfaction increased steadily through the fourth iteration as the course gained acceptance by students and faculty alike. There was a corresponding increase in the performance of students on course examinations. An additional examination given to students one and a half and three years after their anatomy course ended demonstrated the redesigned course's long-term effectiveness for retaining anatomical knowledge and applying it to clinical cases. Compared to students who took the original course, students who took the shorter, more clinical course performed as well, or better, on each section of the examination. We attribute these positive results to the innovative course design and to the changes made based on our formative assessment program.

Radiation oncology in undergraduate medical education: a literature review

PURPOSE

To review the published literature pertaining to radiation oncology in undergraduate medical education.

METHODS AND MATERIALS

Ovid MEDLINE, Ovid MEDLINE Daily Update and EMBASE databases were searched for the 11-year period of January 1, 1998, through the last week of March 2009. A medical librarian used an extensive list of indexed subject headings and text words.

RESULTS

The search returned 640 article references, but only seven contained significant information pertaining to teaching radiation oncology to medical undergraduates. One article described a comprehensive oncology curriculum including recommended radiation oncology teaching objectives and sample student evaluations, two described integrating radiation oncology teaching into a radiology rotation, two described multidisciplinary anatomy-based courses intended to reinforce principles of tumor biology and radiotherapy planning, one described an exercise designed to test clinical reasoning skills within radiation oncology cases, and one described a Web-based curriculum involving oncologic physics.

CONCLUSIONS

To the authors' knowledge, this is the first review of the literature pertaining to teaching radiation oncology to medical undergraduates, and it demonstrates the paucity of published work in this area of medical education. Teaching radiation oncology should begin early in the undergraduate process, should be mandatory for all students, and should impart knowledge relevant to future general practitioners rather than detailed information relevant only to oncologists. Educators should make use of available model curricula and should integrate radiation oncology teaching into existing curricula or construct stand-alone oncology rotations where the principles of radiation oncology can be conveyed. Assessments of student knowledge and curriculum effectiveness are critical.

An interactive method for teaching anatomy of the human eye for medical students in ophthalmology clinical rotations

Much research has shown the benefits of additional anatomical learning and dissection beyond the first year of medical school human gross anatomy, all the way through postgraduate medical training. We have developed an interactive method for teaching eye and orbit anatomy to medical students in their ophthalmology rotation at Duke University School of Medicine. We provide review lectures on the detailed anatomy of the adult human eye and orbit as well as the developmental anatomy of the eye. These lectures are followed by a demonstration of the anatomy of the orbit using conventional frontal and superior exposures on a prosected human cadaver. The anatomy is projected onto a large LCD screen using a mounted overhead camera. Following a brief lecture on clinically relevant anatomy, each student then dissects a fresh porcine (pig) eye under low magnification using a dissecting microscope. These dissections serve to identify structures extrinsic to the eyeball, including extraocular muscle attachments, small vessels, optic nerve stalk, and fascial sheath of the eyeball (Tenon's fascia). Dissection then shifts to the internal anatomy of the eyeball. The size and anatomy of the porcine eye is comparable with that of the human and the dissection provides students with a valuable hands-on learning opportunity that is otherwise not available in embalmed human cadavers. Students and clinical faculty feedback reveal high levels of satisfaction with the presentation of anatomy and its scheduling early during the ophthalmology clerkship.

An experience in surgical anatomy to provide first-year medical students with an early exposure to general surgery: a pilot study

INTRODUCTION

The level of interest expressed by medical students toward the field of general surgery has decreased. The aims of this study were to (1) describe an educational scheme in surgical anatomy that increases interaction between practicing surgeons and first-year medical students and (2) garner feedback and opinions of these medical students from a pilot study of this educational experience.

MATERIALS AND METHODS

A faculty member from the Department of Surgery provided a review of pancreatic malignancies and its management to first-year medical students during their anatomy course. Then, using a cadaver, the clinically relevant anatomy was detailed, and a pancreaticoduodenectomy was performed with the help of student volunteers. A 7-question survey using the 5-point Likert response scale ranging from "strongly agree" to "strongly disagree" was used to obtain feedback from the students.

RESULTS

A total of 145 responses (of 205) were collected for a response rate of 70.38%. Most students (99%) felt that this type of surgical demonstration during the anatomy course was extremely beneficial. The students also felt that this approach improved their understanding of the relevant anatomy and its clinical importance. The survey also demonstrated that most students would like these surgical demonstrations to be repeated in future. Less than 1% of the students did not find these demonstrations beneficial.

CONCLUSIONS

The results of this study demonstrate the benefit of surgical demonstrations by surgical faculty to first-year medical students. These findings have led to the incorporation of this educational scheme into the medical school anatomy curriculum on a regular basis at our University.

Age modulates attitudes to whole body donation among medical students

Managing a whole body donor program is necessary for facilitating a traditional dissection-based anatomy curriculum in medicine and health sciences. Factors which influence body donations to medical science can therefore affect dissection-based anatomy teaching. In order to determine whether age influences the attitudes of medical students to donations, this study surveyed, by Likert-type questionnaires, first-year graduate-entry medical students attending a dissection-based anatomy course. In contrast to attitudes among younger traditional-entry medical students, initial support for whole body donation by an unrelated stranger (83.8%), a family member (43.2%) or by the respondent (40.5%) did not decrease among graduate-entry medical students after exposure to dissection although there was a significant shift in strength of support for donation by stranger. This suggests that older medical students do not readily modify their pre-established attitudes to the idea of whole body donation after exposure and experience with dissection. Initial ambivalence among respondents to the idea of donation by family member was followed by opposition to this type of donation. These findings demonstrate that age modulates the influences on a priori attitudes to whole body donation that exposure to dissection causes in younger medical students.

An increase in medical student knowledge of radiation oncology: a pre-post examination analysis of the oncology education initiative

PURPOSE

The Oncology Education Initiative was created to advance oncology and radiation oncology education by integrating structured didactics into the existing core radiology clerkship. We set out to determine whether the addition of structured didactics could lead to a significant increase in overall medical student knowledge about radiation oncology.

METHODS AND MATERIALS

We conducted a pre- and posttest examining concepts in general radiation oncology, breast cancer, and prostate cancer. The 15-question, multiple-choice exam was administered before and after a 1.5-hour didactic lecture by an attending physician in radiation oncology. Individual question changes, overall student changes, and overall categorical changes were analyzed. All hypothesis tests were two-tailed (significance level 0.05).

RESULTS

Of the 153 fourth-year students, 137 (90%) took the pre- and posttest and were present for the didactic lecture. The average test grade improved from 59% to 70% (p = 0.011). Improvement was seen in all questions except clinical vignettes involving correct identification of TNM staging. Statistically significant improvement (p <or= 0.03) was seen in the questions regarding acute and late side effects of radiation, brachytherapy for prostate cancer, delivery of radiation treatment, and management of early-stage breast cancer.

CONCLUSIONS

Addition of didactics in radiation oncology significantly improves medical students' knowledge of the topic. Despite perceived difficulty in teaching radiation oncology and the assumption that it is beyond the scope of reasonable knowledge for medical students, we have shown that even with one dedicated lecture, students can learn and absorb general principles regarding radiation oncology.