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Crosby B, Gell-Levey IM, Monroe J, Streed CG, Siegel J, Carter EE, Mulkey N, Zumwalt AC. Comparison of faculty and student perceptions of sexual and gender minority content in a preclerkship medical curriculum. BMC Med Educ 2023; 23:973. [PMID: 38115000 PMCID: PMC10731801 DOI: 10.1186/s12909-023-04925-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Accepted: 12/01/2023] [Indexed: 12/21/2023]
Abstract
BACKGROUND Sexual and gender minority (SGM) persons experience stark health disparities. Efforts to mitigate disparities through medical education have met some success. However, evaluations have largely focused on subjective perspectives rather than objective measures. This study aimed to quantify Boston University School of Medicine's sexual and gender minority (SGM) education through surveys of course directors (CDs) and medical students regarding where SGM topics were taught in the preclerkship medical curriculum. Responses were compared to identify concordance between faculty intention and student perceptions regarding SGM education. METHODS A cross-sectional survey was distributed to preclerkship CDs and current medical students in Spring 2019 and 2021, respectively, regarding where in the mandatory preclerkship curriculum CDs deliberately taught and where first- and second-year students recalled having learned 10 SGM topic domains. RESULTS 64.3% of CDs (n = 18), 47.0% of the first-year class (n = 71), and 67.3% of the second-year class (n = 101) responded to the surveys. Results indicate that, as anticipated, deliberate SGM teaching correlates with greater student recall as students recalled topics that were reported by CDs as intentionally taught at a significantly higher rate compared to those not intentionally taught (32.0% vs. 15.3%; p < 0.01). Students most commonly recalled learning SGM-related language and terminology, which is likely partly but not entirely attributed to curricular modifications and faculty development made between distribution of the faculty and student surveys, indicating the importance of all faculty being trained in appropriate SGM terminology and concepts. Discordance between faculty intention and student recall of when topics were taught reveals opportunities to enhance the intentionality and impact of SGM teaching. CONCLUSIONS Students perceive and recall SGM content that is not listed as learning objectives, and all faculty who utilize this material in their teachings should receive foundational training and be thoughtful about how information is framed. Faculty who intentionally teach SGM topics should be explicit and direct about the conclusions they intend students to draw from their curricular content.
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Affiliation(s)
- Benjamin Crosby
- Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA.
| | - Isabelle M Gell-Levey
- Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Departments of Pediatrics & Child Neurology, Barrow Neurological Institute at Phoenix Children's Hospital, Phoenix, AZ, USA
| | - Janet Monroe
- Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Carl G Streed
- Center for Transgender Medicine and Surgery, Boston Medical Center, Boston, MA, USA
| | - Jennifer Siegel
- Center for Transgender Medicine and Surgery, Boston Medical Center, Boston, MA, USA
- Transgender Health Program, Massachusetts General Hospital, Boston, MA, USA
| | - Erin E Carter
- Division of Urology, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Nat Mulkey
- Department of Psychiatry, The University of Vermont Medical Center, Burlington, VT, USA
| | - Ann C Zumwalt
- Department of Anatomy & Neurobiology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
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2
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Keim SA, Harmon DJ, Martindale JR, Lopez EN, Sanky C, Brooks WS, Cotter MM, Davies DL, Doroudi M, Fahl JC, Farias A, Granite G, Harrell KM, Kar R, Kramer KL, Jackson J, Jones S, Lackey-Cornelison W, Laitman JT, Latacha K, Lewis SR, Lovejoy Mork A, Marzban H, McNary TG, McWhorter DL, Merchant A, Mussell JC, Quinn MM, Reidenberg JS, Royer D, Sakaguchi A, Sawyer FK, Topping DB, Wainman B, Wineski LE, Zumwalt AC, Hankin MH. Essential anatomy for core clerkships: A clinical perspective. Anat Sci Educ 2023; 16:943-957. [PMID: 36929575 DOI: 10.1002/ase.2272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Revised: 03/12/2023] [Accepted: 03/13/2023] [Indexed: 06/18/2023]
Abstract
Clerkships are defining experiences for medical students in which students integrate basic science knowledge with clinical information as they gain experience in diagnosing and treating patients in a variety of clinical settings. Among the basic sciences, there is broad agreement that anatomy is foundational for medical practice. Unfortunately, there are longstanding concerns that student knowledge of anatomy is below the expectations of clerkship directors and clinical faculty. Most allopathic medical schools require eight "core" clerkships: internal medicine (IM), pediatrics (PD), general surgery (GS), obstetrics and gynecology (OB), psychiatry (PS), family medicine (FM), neurology (NU), and emergency medicine (EM). A targeted needs assessment was conducted to determine the anatomy considered important for each core clerkship based on the perspective of clinicians teaching in those clerkships. A total of 525 clinical faculty were surveyed at 24 United States allopathic medical schools. Participants rated 97 anatomical structure groups across all body regions on a 1-4 Likert-type scale (1 = not important, 4 = essential). Non-parametric ANOVAs determined if differences existed between clerkships. Combining all responses, 91% of anatomical structure groups were classified as essential or more important. Clinicians in FM, EM, and GS rated anatomical structures in most body regions significantly higher than at least one other clerkship (p = 0.006). This study provides an evidence-base of anatomy content that should be considered important for each core clerkship and may assist in the development and/or revision of preclinical curricula to support the clinical training of medical students.
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Affiliation(s)
- Sarah A Keim
- Department of Surgery, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Derek J Harmon
- Department of Biomedical Education and Anatomy, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - James R Martindale
- Office of Medical Education, University of Virginia School of Medicine, Charlottesville, Virginia, USA
| | - Elisabeth N Lopez
- Department of Molecular Pathobiology, New York University College of Dentistry, New York, New York, USA
| | - Charles Sanky
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - William S Brooks
- Department of Cell, Developmental, and Integrative Biology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Meghan M Cotter
- Department of Academic Affairs, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - David L Davies
- Department of Neurobiology and Developmental Sciences, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Majid Doroudi
- Department of Cellular and Physiological Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jeffrey C Fahl
- Department of Anatomy, Albany Medical College, Albany, New York, USA
| | - Anna Farias
- Schulich School of Medicine and Dentistry, Windsor, Ontario, Canada
| | - Guinevere Granite
- Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Kelly M Harrell
- Department of Anatomy and Neurobiology, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
| | - Rekha Kar
- Department of Cell Systems and Anatomy, University of Texas Health San Antonio, San Antonio, Texas, USA
| | - Kenneth L Kramer
- Department of Medical Education, Creighton University, Omaha, Nebraska, USA
| | - Jon Jackson
- Anatomy & Cell Biology, Burrell College of Osteopathic Medicine, Las Cruces, New Mexico, USA
| | - Shiloh Jones
- Anatomical Sciences Education Center, Oregon Health & Science University, Portland, Oregon, USA
| | - Wendy Lackey-Cornelison
- Department of Medical Education, University of Toledo College of Medicine and Life Sciences, Toledo, Ohio, USA
| | - Jeffrey T Laitman
- Medical Education (Anatomy), Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Kimberly Latacha
- Department of Genetics, Cell Biology, and Anatomy, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Steven R Lewis
- New York Institute of Technology College of Osteopathic Medicine, Jonesboro, Arkansas, USA
| | - Amy Lovejoy Mork
- Department of Pathology and Anatomy, Morehouse School of Medicine, Atlanta, Georgia, USA
| | - Hassan Marzban
- Department of Human Anatomy and Cell Science, University of Manitoba, Winnipeg, Canada
| | - Thomas G McNary
- Division of Anatomy and Molecular Medicine, Alabama College of Osteopathic Medicine, Dothan, Alabama, USA
| | | | - Aftab Merchant
- Department of Health Sciences Education, University of Illinois College of Medicine, Rockford, Illinois, USA
| | - Jason C Mussell
- Department of Cell Biology and Anatomy, LSUHSC-NO, New Orleans, Louisiana, USA
| | - Melissa M Quinn
- Department of Biomedical Education and Anatomy, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Joy S Reidenberg
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Danielle Royer
- Department of Cell and Developmental Biology, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Alan Sakaguchi
- Department of Cell Systems and Anatomy, University of Texas Health San Antonio, San Antonio, Texas, USA
| | - F Kip Sawyer
- Department of Anesthesiology, Huntington Hospital, Pasadena, California, USA
| | - Daniel B Topping
- Department of Anatomy and Cell Biology, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Bruce Wainman
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Lawrence E Wineski
- Department of Pathology and Anatomy, Morehouse School of Medicine, Atlanta, Georgia, USA
| | - Ann C Zumwalt
- Department of Anatomy and Neurobiology, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
| | - Mark H Hankin
- Anatomical Sciences Education Center, Oregon Health & Science University, Portland, Oregon, USA
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Lai ER, Rukavina NA, Wisco JJ, Zumwalt AC. Comparing the emotional experiences of students in similar dissection- and prosection-based medical gross anatomy courses: A mixed-methods study. Anat Sci Educ 2023; 16:926-942. [PMID: 37060250 DOI: 10.1002/ase.2281] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 04/09/2023] [Accepted: 04/12/2023] [Indexed: 05/17/2023]
Abstract
The anatomy laboratory can incite strong emotional reactions in students, which can in turn facilitate growth in empathy, care for vulnerable others, and professionalism. Despite this, little is known about the relative emotional impacts of different laboratory modalities. The response to the COVID-19 pandemic created an opportunity to compare the emotional experiences of students in similar courses in which one group of students dissected donors and the other group learned from prosected donors. The courses were otherwise the same in content, length, instructional design, and assessment. Students in the dissection-based (Fall 2019) and prosection-based (Fall 2020) courses completed a previously validated survey that used quantitative and qualitative questions to assess their feelings about the donors and the anatomy laboratory experience. Students in both cohorts reported overall appreciation for having had the experience. Negative themes experienced by both groups included feeling anxiety, worries about depersonalizing donors, and physical discomfort in the laboratory. Students in the dissection course reported stronger connections with the donors and the donors' families but also more frequently felt negative feelings such as disgust, anxiety, and feeling alone. Students in the prosection course reported more consistently positive responses but worried about not using the donors to the fullest extent possible. Regardless of pedagogical design, students have complex emotional experiences in the anatomy laboratory and our results indicate that these feelings may be more intense in the context of dissection. Anatomists should foster educational settings that enable students to learn to process complex or challenging emotions.
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Affiliation(s)
- Emily R Lai
- Department of Anatomy and Neurobiology, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
| | - Nadia A Rukavina
- Department of Anatomy and Neurobiology, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
| | - Jonathan J Wisco
- Department of Anatomy and Neurobiology, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
| | - Ann C Zumwalt
- Department of Anatomy and Neurobiology, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
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Organ JM, Smith HF, Trainor PA, Allen K, Balta JY, Beresheim AC, Brewer-Deluce D, Brown KM, Burrows AM, Byers KT, Byram JN, Cale AS, Carroll MA, Champney T, Cornwall J, Dayal MR, DeLeon VB, Dunnwald M, Ferrigno C, Finn GM, Fox GM, Geller PL, Guttmann GD, Harper N, Harrell KM, Hartstone-Rose A, Hildebrandt S, Hortsch M, Jackson J, Johnson LE, Lohman Bonfiglio CM, McCumber TL, Menegaz RA, Mussell JC, O'Loughlin VD, Otobo TM, Oyedele O, Pascoe MA, Person D, Reidenberg JS, Robinson RE, Rogers KA, Ros MA, Ross CF, Sanders KA, Schmitt B, Schoenwolf GC, Smith TC, Smith TD, Sumner DR, Taylor AB, Taylor MJ, Teaford MF, Topp KS, Willmore KE, Wisco JJ, Yang J, Zumwalt AC. Personal autonomy and self-determination are crucial for professionalism in healthcare. Anat Sci Educ 2023. [PMID: 37014284 DOI: 10.1002/ase.2278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 04/01/2023] [Indexed: 05/10/2023]
Affiliation(s)
- Jason M Organ
- Editor-in-Chief, Anatomical Sciences Education
- Indiana University School of Medicine
| | | | - Paul A Trainor
- Editor-in-Chief, Developmental Dynamics
- Stowers Institute for Medical Research
- University of Kansas School of Medicine
| | - Kari Allen
- Washington University School of Medicine
| | - Joy Y Balta
- Point Loma Nazarene University
- University of California, San Diego
| | | | | | - Kirsten M Brown
- George Washington University School of Medicine & Health Sciences
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Jason C Mussell
- Louisiana State University Health Sciences Center - New Orleans
| | | | | | | | | | | | | | | | - Kem A Rogers
- Schulich School of Medicine and Dentistry, University of Western Ontario
| | - Marian A Ros
- Instituto de Biomedicina y Biotecnologia de Cantabria
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Ann C Zumwalt
- Boston University Chobanian & Avedisian School of Medicine
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5
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Rukavina NA, Lai ER, Wisco JJ, Zumwalt AC. Medical School Culture Influences How Students Think About Gross Anatomy Lab. FASEB J 2022. [DOI: 10.1096/fasebj.2022.36.s1.r4018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Nadia A. Rukavina
- Anatomy and NeurobiologyBoston University School of MedicineBostonMA
| | - Emily R. Lai
- Anatomy and NeurobiologyBoston University School of MedicineBostonMA
| | - Jonathan J. Wisco
- Anatomy and NeurobiologyBoston University School of MedicineBostonMA
| | - Ann C. Zumwalt
- Anatomy and NeurobiologyBoston University School of MedicineBostonMA
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6
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Mosaheb S, Afifi L, Wisco JJ, Zumwalt AC. The effective use of the Anatomage table as a teaching tool for learning the Infratemporal Fossa. FASEB J 2022. [DOI: 10.1096/fasebj.2022.36.s1.r2128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Sydney Mosaheb
- Anatomy & NeurobiologyBoston University School of MedicineBostonMA
| | - Linda Afifi
- Anatomy & NeurobiologyBoston University School of MedicineBostonMA
| | | | - Ann C. Zumwalt
- Anatomy & NeurobiologyBoston University School of MedicineBostonMA
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7
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Zumwalt AC, Lai ER, Rukavina NA, Wisco JJ. The Emotional Experiences of Students in Dissection‐ and Prosection‐based Cadaveric Anatomy Courses. FASEB J 2022. [DOI: 10.1096/fasebj.2022.36.s1.r2702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Ann C. Zumwalt
- Anatomy & NeurobiologyBoston University School of MedicineBostonMA
| | - Emily R. Lai
- Anatomy & NeurobiologyBoston University School of MedicineBostonMA
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8
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Lin DC, Bunch B, De Souza RZD, Chen D, Zhou J, Zumwalt AC, Wisco JJ. Effectiveness of Pedagogical Tools for Teaching Medical Gross Anatomy During the COVID-19 Pandemic. Med Sci Educ 2022; 32:411-422. [PMID: 35228893 PMCID: PMC8866923 DOI: 10.1007/s40670-022-01524-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/09/2022] [Indexed: 06/01/2023]
Abstract
UNLABELLED Medical institutions have been forced to modify gross anatomy pedagogy to comply with the health restrictions imposed by the novel coronavirus (COVID-19). Boston University School of Medicine (BUSM) is one such institution that temporarily restructured its course. We replaced cadaveric dissection activities with prosections and placed a greater emphasis on a flipped classroom model. This study investigates the effectiveness of new course materials developed to aid these curriculum changes. Course materials were developed for three purposes: (1) preparation before laboratory sessions (orientation videos and Complete Anatomy (3D4Medical, Elsevier) screens); (2) guidance during laboratory sessions (laboratory guides); and (3) review after laboratory sessions (Zoom recitation sessions). We performed a grounded theory thematic analysis of students' responses (80/160, 50% response) to qualitative survey questions and to focus group questions (16 students who self-selected between 4 different sessions). Data from both the survey and focus groups demonstrated that the vast majority of students agreed that the materials helped them navigate through learning gross anatomy. However, laboratory guides were used mostly for post-lab review as opposed to the intended direction during laboratory sessions. Students within all focus groups overwhelmingly touted the value of Zoom recitation sessions, with many stating that they were imperative to course success. When comparing performance data between 2019 (pre-COVID) and 2020 students, we found that the students who took the anatomy course during the onset of COVID had a slightly higher overall average score in all three modules of the course than compared to the 2019 students. We propose that the utilization of course materials that students perceived as time saving and pertinent to their exam performance, when combined with cadaveric prosection, emphasized the benefits of flipped-classroom learning to help students learn gross anatomy effectively and efficiently during the pandemic and beyond. SUPPLEMENTARY INFORMATION The online version contains supplementary material available at 10.1007/s40670-022-01524-x.
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Affiliation(s)
- Dustin C. Lin
- Department of Anatomy and Neurobiology, Boston University School of Medicine, Boston, MA 02118 USA
| | - Bailey Bunch
- Department of Anatomy and Neurobiology, Boston University School of Medicine, Boston, MA 02118 USA
| | | | - Dickson Chen
- Department of Anatomy and Neurobiology, Boston University School of Medicine, Boston, MA 02118 USA
| | - Jinyan Zhou
- Department of Anatomy and Neurobiology, Boston University School of Medicine, Boston, MA 02118 USA
| | - Ann C. Zumwalt
- Department of Anatomy and Neurobiology, Boston University School of Medicine, Boston, MA 02118 USA
| | - Jonathan J. Wisco
- Department of Anatomy and Neurobiology, Boston University School of Medicine, Boston, MA 02118 USA
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Zumwalt AC, Carter EE, Gell-Levey IM, Mulkey N, Streed CG, Siegel J. A Novel Curriculum Assessment Tool, Based on AAMC Competencies, to Improve Medical Education About Sexual and Gender Minority Populations. Acad Med 2022; 97:524-528. [PMID: 34108379 DOI: 10.1097/acm.0000000000004203] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
PROBLEM Medical education aspires to mitigate bias in future professionals by providing robust curricula that include perspectives of and practices for caring for sexual and gender minority (SGM) populations; however, implementation of these ideals remains challenging. Medical school leaders motivated to improve curricula on caring for SGM populations must survey their school's current curricula to identify strengths and opportunities for improvement. In 2014, the Association of American Medical Colleges (AAMC) published 30 SGM competencies that curricula should address. Here the authors describe the development of a tool to efficiently assess whether an undergraduate medical education (UME) curriculum adequately incorporates the AAMC-recommended SGM competencies. APPROACH In 2018, Boston University School of Medicine (BUSM) convened a group of faculty and students with experience and expertise regarding SGM health. The group distilled the 30 AAMC competencies into 12 SGM topic areas that should be addressed in any UME curriculum, and they developed a curriculum assessment tool to evaluate the presence and timing of these topic areas in the BUSM curriculum. This tool was distributed to all course and clerkship directors responsible for the required UME curriculum at BUSM to investigate where these topic areas are addressed (May-June 2019). OUTCOMES The curriculum assessment tool identified several strengths in the preclerkship and clerkship curricula, including faculty willingness and enthusiasm to include SGM content. The assessment tool also revealed that some SGM topic areas are underrepresented in the BUSM curriculum, particularly during clerkships. NEXT STEPS The curriculum assessment tool described here is a straightforward, standardized instrument to map SGM topic areas within any UME curriculum. It is designed to be comprehensible by individuals who are not familiar with SGM health. The tool minimizes barriers to medical curricular change by providing a mechanism to assess and understand how SGM health is incorporated into existing curricula.
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Affiliation(s)
- Ann C Zumwalt
- A.C. Zumwalt is associate professor, Department of Anatomy and Neurobiology, Boston University School of Medicine, Boston, Massachusetts; ORCID: https://orcid.org/0000-0002-4557-4273
| | - Erin E Carter
- E.E. Carter is a resident, Division of Urology, Department of Surgery, University of Utah, Salt Lake City, Utah, and, when this report was written, a fourth-year medical student, Boston University School of Medicine, Boston, Massachusetts; ORCID: http://orcid.org/0000-0003-2043-4474
| | - Isabelle M Gell-Levey
- I.M. Gell-Levey is a third-year medical student, Boston University School of Medicine, Boston, Massachusetts; ORCID: https://orcid.org/0000-0003-0756-7563
| | - Nat Mulkey
- N. Mulkey is a resident, Department of Psychiatry, University of Vermont, Burlington, Vermont, and, when this report was written, a fourth-year medical student, Boston University School of Medicine, Boston, Massachusetts; ORCID: https://orcid.org/0000-0003-4399-6074
| | - Carl G Streed
- C.G. Streed Jr is assistant professor, Section of General Internal Medicine, and research lead, Center for Transgender Medicine and Surgery, Boston Medical Center, Boston, Massachusetts; ORCID: https://orcid.org/0000-0003-3075-253X
| | - Jennifer Siegel
- J. Siegel is assistant professor, Section of General Internal Medicine, and director, Center for Transgender Medicine and Surgery, Boston Medical Center, Boston, Massachusetts; ORCID: https://orcid.org/0000-0002-5517-8004
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Zumwalt AC. Anticipatory Feelings About Dissection: An Exercise for the First Day of a Gross Anatomy Course. Anat Sci Educ 2021; 14:828-835. [PMID: 33369234 DOI: 10.1002/ase.2048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 12/21/2020] [Accepted: 12/22/2020] [Indexed: 06/12/2023]
Abstract
Studies have demonstrated that students experience a variety of intense emotions in anticipation of human anatomical dissection, including enthusiasm, gratitude, responsibility, apprehension, detachment, anxiety, and spiritual or moral reflection. The exercise described here provides an opportunity to start a conversation about the complexity of students' emotional reactions to the anatomy experience. The intention of this exercise is to normalize the variety of emotions that anatomy students experience, both to demonstrate to students that their emotions are normal and to encourage the empathy for others' reactions which may differ from their own. In the lecture hall setting before the first day of dissection, students are asked to draw how they feel about the dissection experience and are provided an opportunity to discuss their drawings with their peers. The course director then provides a slide show demonstration of drawings from previous years, and experienced anatomy faculty facilitate a large group discussion in which students react to the drawing exercise and slide show and ask questions which are addressed by the faculty. This exercise provides an opportunity for students to practice appropriately communicating about emotionally complex experiences in a professional setting. The exercise is straightforward to implement and is easily modifiable for different class sizes and curricular structures.
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Affiliation(s)
- Ann C Zumwalt
- Department of Anatomy and Neurobiology, Boston University School of Medicine, Boston, Massachusetts
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Abstract
Basic science educators are not trained as clinicians, yet are expected to adjust their content to mesh appropriately with its clinical application. While achievable, this is a challenge that requires intentional effort on the part of the basic science educators. A practical solution to facilitate curricular integration is to create experiential opportunities for basic scientists to observe the clinical application of their content and to pair these initiatives with training in effective medical education practices.
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Affiliation(s)
- Isabel Dominguez
- Department of Medicine, Boston University School of Medicine, Boston, Massachusetts
| | - Ann C Zumwalt
- Department of Anatomy and Neurobiology, Boston University School of Medicine, Boston, Massachusetts
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12
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Nist KM, Afifi LM, Zumwalt AC. Getting to the (Turning) Point: A Systematic Interactive Approach for Teaching Identification of Cross‐Sectional Cadaveric Structures. FASEB J 2020. [DOI: 10.1096/fasebj.2020.34.s1.02679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Zumwalt AC, Dominguez I. Correction to: Integrating the Educators: Outcomes of a Pilot Program to Prime Basic Science Medical Educators for Success in Integrated Curricula. Med Sci Educ 2019; 29:1157-1158. [PMID: 34459837 PMCID: PMC8368330 DOI: 10.1007/s40670-019-00807-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
[This corrects the article DOI: 10.1007/s40670-019-00742-0.].
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Affiliation(s)
- Ann C. Zumwalt
- Department of Anatomy and Neurobiology, Boston University School of Medicine, 72 E. Concord St, L-1004, Boston, MA 02118 USA
| | - Isabel Dominguez
- Section of Hematology and Medical Oncology, Boston University School of Medicine, 650 Albany St. X-430, Boston, MA 02118 USA
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Zumwalt AC, Dominguez I. Integrating the Educators: Outcomes of a Pilot Program to Prime Basic Science Medical Educators for Success in Integrated Curricula. Med Sci Educ 2019; 29:637-642. [PMID: 34457526 PMCID: PMC8368855 DOI: 10.1007/s40670-019-00742-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
"Integrating the Educators" is a program to prepare early career basic scientists to teach effectively in integrated medical curricula, where connections between basic sciences and clinical application are highlighted and emphasized. Advanced PhD trainees received didactic training in best practices in medical education followed by 3 months shadowing clinician educator mentors. This combination of experiences was designed to contrast the methods, focus, and pace of teaching in the clinical setting compared to the typical basic science classroom. Trainees' knowledge and attitudes shifted to recognize the faster pace and clinical focus necessary in integrated curricula.
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Affiliation(s)
- Ann C. Zumwalt
- Department of Anatomy and Neurobiology, Boston University School of Medicine, 72 E. Concord St, L-1004, Boston, MA 02118 USA
| | - Isabel Dominguez
- Section of Hematology and Medical Oncology, Boston University School of Medicine, 650 Albany St. X-430, Boston, MA 02118 USA
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Yang CY, Zumwalt AC, Larson AR. Dermatology and anatomy laboratory: comparing three formats of integration. Dermatol Online J 2018; 24:13030/qt26w5m0x1. [PMID: 30677791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Accepted: 01/15/2019] [Indexed: 06/09/2023] Open
Abstract
BACKGROUND Medical schools rarely offer exposure to clinical dermatology in the first-year curriculum. OBJECTIVE We describe and report student satisfaction results of three novel teaching methods for integrating basic dermatology concepts into gross anatomy laboratory. METHODS During the first year of the intervention, 180 students attended an hour-long anatomy laboratory session during which skin lesions were examined. One attending and three resident dermatologists spent time at all tables of students, then circulated to answer questions. During the second year, 189 students participated in the same teaching session preceded by a 30-minute in-class lecture. During the third year, 172 students were given the option to view a supplemental online video module before or after the teaching session. Each year following the teaching session, students were sent an optional online survey regarding the impact of the teaching session on their understanding of skin lesions and their cadaver experience. RESULTS Overall, students felt the intervention helped them develop a better understanding and appreciation for dermatology. Preceding the laboratory session with a lecture or educational video yielded higher satisfaction scores. CONCLUSIONS This brief teaching intervention illustrates an approach to introducing dermatologic entities within the foundational science curriculum of the first year of medical school.
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Affiliation(s)
| | | | - Allison R Larson
- Department of Dermatology, Boston University, Boston, Massachusetts.
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Babcock KJ, Kong E, Zumwalt AC. Using Brains to Inspire Minds: A Unique Outreach Collaboration with the Boston Museum of Science. FASEB J 2018. [DOI: 10.1096/fasebj.2018.32.1_supplement.631.5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | | | - Ann C. Zumwalt
- Anatomy & NeurobiologyBoston University School of MedicineBostonMA
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Yang CY, Zumwalt AC, Larson AR. Dermatology and anatomy laboratory: comparing three formats of integration. Dermatol Online J 2018. [DOI: 10.5070/d32412042353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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Zumwalt AC, Iyer A, Ghebremichael A, Frustace BS, Flannery S. Gaze patterns of gross anatomy students change with classroom learning. Anat Sci Educ 2015; 8:230-241. [PMID: 25156955 DOI: 10.1002/ase.1485] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/19/2013] [Revised: 07/27/2014] [Accepted: 07/31/2014] [Indexed: 05/28/2023]
Abstract
Numerous studies have documented that experts exhibit more efficient gaze patterns than those of less experienced individuals. In visual search tasks, experts use fewer, longer fixations to fixate for relatively longer on salient regions of the visual field while less experienced observers spend more time examining nonsalient regions. This study investigates whether changes in gaze patterns reflect learning by students in a medical gross anatomy course. Students were asked to examine photographs of dissections similar to those they experienced in class and to identify the tagged structure in each image. We postulated that, compared to naive behavior (behavior at baseline and when examining unfamiliar content) students would examine familiar content for longer and would direct proportionally more fixation time on cognitively salient regions of the images while using fewer, longer duration fixations. Our students examined familiar images for significantly longer than they did at baseline (P < 0.0001) or for unfamiliar images (P < 0.0001). They also spent significantly longer examining cognitively salient regions of familiar images, as compared to examining those regions at baseline (P < 0.0001) and on unfamiliar images (P < 0.0001). However, these gaze patterns were characterized by more numerous fixations rather than fewer, longer fixations. These individuals are successful learners in a challenging gross anatomy course, but are not experts in anatomy. Therefore we speculate that the gaze pattern they exhibit characterizes an earlier stage of the learning process than has previously been documented in studies of expertise, which have primarily focused on the gaze patterns of true experts.
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Affiliation(s)
- Ann C Zumwalt
- Department of Anatomy and Neurobiology, Boston University School of Medicine, Boston, Massachusetts
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Lufler RS, Zumwalt AC. Imaging the cadavers being dissected does not appear to improve the gross anatomy dissection experience. Anat Sci Educ 2014; 7:78-79. [PMID: 24115605 DOI: 10.1002/ase.1399] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2013] [Accepted: 07/29/2013] [Indexed: 06/02/2023]
Affiliation(s)
- Rebecca S Lufler
- Department of Anatomy and Cellular Biology, Tufts University School of Medicine, Boston, Massachusetts
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Abstract
INTRODUCTION Coordinates of anatomical landmarks are captured using dynamic MRI to explore whether a proposed two-sling mechanism underlies hyolaryngeal elevation in pharyngeal swallowing. A principal components analysis (PCA) is applied to coordinates to determine the covariant function of the proposed mechanism. METHODS Dynamic MRI (dMRI) data were acquired from eleven healthy subjects during a repeated swallows task. Coordinates mapping the proposed mechanism are collected from each dynamic (frame) of a dynamic MRI swallowing series of a randomly selected subject in order to demonstrate shape changes in a single subject. Coordinates representing minimum and maximum hyolaryngeal elevation of all 11 subjects were also mapped to demonstrate shape changes of the system among all subjects. MophoJ software was used to perform PCA and determine vectors of shape change (eigenvectors) for elements of the two-sling mechanism of hyolaryngeal elevation. RESULTS For both single subject and group PCAs, hyolaryngeal elevation accounted for the first principal component of variation. For the single subject PCA, the first principal component accounted for 81.5% of the variance. For the between subjects PCA, the first principal component accounted for 58.5% of the variance. Eigenvectors and shape changes associated with this first principal component are reported. DISCUSSION Eigenvectors indicate that two-muscle slings and associated skeletal elements function as components of a covariant mechanism to elevate the hyolaryngeal complex. Morphological analysis is useful to model shape changes in the two-sling mechanism of hyolaryngeal elevation.
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Affiliation(s)
- William G Pearson
- Department of Cellular Biology & Anatomy, Medical College of Georgia, Georgia Regents University, 1120 15th Street, CB-1101, Augusta, GA 30912, USA ; Department of Otolaryngology, Medical College of Georgia, Georgia Regents University, 1120 15th Street, CB-1101, Augusta, GA 30912, USA
| | - Ann C Zumwalt
- Department of Anatomy and Neurobiology, Boston University School of Medicine, 72 E. Concord Street, L-1004, Boston, MA 02118, USA
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Stefanik JJ, Zumwalt AC, Segal NA, Lynch JA, Powers CM. Association between measures of patella height, morphologic features of the trochlea, and patellofemoral joint alignment: the MOST study. Clin Orthop Relat Res 2013; 471:2641-8. [PMID: 23546847 PMCID: PMC3705075 DOI: 10.1007/s11999-013-2942-6] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2012] [Accepted: 03/14/2013] [Indexed: 01/31/2023]
Abstract
BACKGROUND Patellofemoral joint (PFJ) malalignment (lateral patella displacement and tilt) has been proposed as a cause of patellofemoral pain. Patella height and/or the morphologic features of the femoral trochlea may predispose one to patella malalignment. QUESTIONS/PURPOSES The purposes of our study were to assess the associations among patella height, morphologic features of the trochlea, and measures of PFJ alignment and to determine which measures of patella height and morphologic features of the trochlea were the best predictors of PFJ alignment. METHODS Measures of patella height (Insall-Salvati ratio and modified Insall-Salvati ratio), morphologic features of the trochlea (sulcus angle, trochlear angle, lateral trochlear inclination, medial trochlear inclination), and PFJ alignment (bisect offset and patella tilt angle) were assessed in 566 knees from the Multicenter Osteoarthritis Study. RESULTS Bisect offset was correlated with the Insall-Salvati ratio (r = 0.25) and lateral trochlear inclination (r = -0.38). Patella tilt angle correlated with the trochlear angle (-0.27) and lateral trochlear inclination (-0.32). Linear regression models including the Insall-Salvati ratio and lateral trochlear inclination explained 20% and 11% of the variance in bisect offset and patella tilt angle, respectively. CONCLUSIONS Of the variables measured in the current study, the Insall-Salvati ratio and lateral trochlear inclination were the best predictors of lateral patella displacement and lateral tilt. This knowledge will aid clinicians in the identification of anatomic risk factors for PFJ malalignment and/or PFJ dysfunction.
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Affiliation(s)
- Joshua J. Stefanik
- Clinical Epidemiology Research and Training Unit, Boston University School of Medicine, 650 Albany Street, Suite 200, Boston, MA 02118 USA
| | - Ann C. Zumwalt
- Department of Anatomy and Neurobiology, Boston University School of Medicine, 75 East Concord St, Boston, MA 02118 USA
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Pearson WG, Hindson DF, Langmore SE, Zumwalt AC. Evaluating swallowing muscles essential for hyolaryngeal elevation by using muscle functional magnetic resonance imaging. Int J Radiat Oncol Biol Phys 2012; 85:735-40. [PMID: 22995662 DOI: 10.1016/j.ijrobp.2012.07.2370] [Citation(s) in RCA: 85] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2012] [Revised: 07/06/2012] [Accepted: 07/23/2012] [Indexed: 12/22/2022]
Abstract
PURPOSE Reduced hyolaryngeal elevation, a critical event in swallowing, is associated with radiation therapy. Two muscle groups that suspend the hyoid, larynx, and pharynx have been proposed to elevate the hyolaryngeal complex: the suprahyoid and longitudinal pharyngeal muscles. Thought to assist both groups is the thyrohyoid, a muscle intrinsic to the hyolaryngeal complex. Intensity modulated radiation therapy guidelines designed to preserve structures important to swallowing currently exclude the suprahyoid and thyrohyoid muscles. This study used muscle functional magnetic resonance imaging (mfMRI) in normal healthy adults to determine whether both muscle groups are active in swallowing and to test therapeutic exercises thought to be specific to hyolaryngeal elevation. METHODS AND MATERIALS mfMRI data were acquired from 11 healthy subjects before and after normal swallowing and after swallowing exercise regimens (the Mendelsohn maneuver and effortful pitch glide). Whole-muscle transverse relaxation time (T2 signal, measured in milliseconds) profiles of 7 test muscles were used to evaluate the physiologic response of each muscle to each condition. Changes in effect size (using the Cohen d measure) of whole-muscle T2 profiles were used to determine which muscles underlie swallowing and swallowing exercises. RESULTS Post-swallowing effect size changes (where a d value of >0.20 indicates significant activity during swallowing) for the T2 signal profile of the thyrohyoid was a d value of 0.09; a d value of 0.40 for the mylohyoid, 0.80 for the geniohyoid, 0.04 for the anterior digastric, and 0.25 for the posterior digastric-stylohyoid in the suprahyoid muscle group; and d values of 0.47 for the palatopharyngeus and 0.28 for the stylopharyngeus muscles in the longitudinal pharyngeal muscle group. The Mendelsohn maneuver and effortful pitch glide swallowing exercises showed significant effect size changes for all muscles tested, except for the thyrohyoid. CONCLUSIONS Muscles of both the suprahyoid and the longitudinal pharyngeal muscle groups are active in swallowing, and both swallowing exercises effectively target muscles elevating the hyolaryngeal complex. mfMRI is useful in testing swallowing muscle function.
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Affiliation(s)
- William G Pearson
- Department of Anatomy and Neurobiology, Boston University School of Medicine, Boston, Massachusetts, USA.
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Zumwalt AC, Wice M, Bergethon P. The use of gaze tracking to quantify learning. FASEB J 2012. [DOI: 10.1096/fasebj.26.1_supplement.204.4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Pearson WG, Langmore SE, Yu LB, Zumwalt AC. Structural analysis of muscles elevating the hyolaryngeal complex. Dysphagia 2012; 27:445-51. [PMID: 22278076 DOI: 10.1007/s00455-011-9392-7] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2011] [Accepted: 12/29/2011] [Indexed: 12/23/2022]
Abstract
A critical event of pharyngeal swallowing is the elevation of the hyolaryngeal complex to open the upper esophageal sphincter. Current swallowing theory assigns this function to the submental and thyrohyoid muscles. However, the attachments of the long pharyngeal muscles indicate that they could contribute to this function, yet their role is uninvestigated in humans. In addition, there is evidence the posterior digastric and stylohyoid contribute to hyoid elevation. A cadaver model was used to document the structural properties of muscles. These properties were used to model muscle groups as force vectors and analyze their potential for hyolaryngeal elevation. Vector magnitude was determined using physiological cross-sectional areas (PCSAs) of muscles calculated from structural properties of muscle taken from 12 hemisected cadaver specimens. Vector direction (lines of action) was calculated from the three-dimensional coordinates of muscle attachment sites. Unit force vectors in the superior direction of submental, suprahyoid (which includes the submental muscles), long pharyngeal, and thyrohyoid muscles were derived and compared by an analysis of variance (ANOVA) to document each muscle's potential contribution to hyolaryngeal elevation. An ANOVA with Tukey HSD post hoc analysis of unit force vectors showed no statistically significant difference between the submental (0.92 ± 0.24 cm(2)) and long pharyngeal (0.73 ± 0.20 cm(2)) muscles. Both demonstrated greater potential to elevate the hyolaryngeal complex than the thyrohyoid (0.49 ± 0.18 cm(2)), with P < 0.01 and P < 0.05, respectively. The suprahyoid muscles (1.52 ± 0.35 cm(2)) demonstrated the greatest potential to elevate the hyolaryngeal complex: greater than both the long pharyngeal muscles (P < 0.01) and the thyrohyoid (P < 0.01). The submental and thyrohyoid muscles by convention are thought to elevate the hyolaryngeal complex. This study demonstrates that structurally the long pharyngeal muscles have similar potential to contribute to this critical function, with the suprahyoid muscles having the greatest potential. If verified by functional data, these findings would amend current swallowing theory.
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Affiliation(s)
- William G Pearson
- Department of Anatomy and Neurobiology, Boston University School of Medicine, Boston, MA 02118, USA.
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Lufler RS, Zumwalt AC, Romney CA, Hoagland TM. Effect of visual-spatial ability on medical students' performance in a gross anatomy course. Anat Sci Educ 2012; 5:3-9. [PMID: 22127919 DOI: 10.1002/ase.264] [Citation(s) in RCA: 99] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2011] [Revised: 10/25/2011] [Accepted: 10/27/2011] [Indexed: 05/28/2023]
Abstract
The ability to mentally manipulate objects in three dimensions is essential to the practice of many clinical medical specialties. The relationship between this type of visual-spatial ability and performance in preclinical courses such as medical gross anatomy is poorly understood. This study determined if visual-spatial ability is associated with performance on practical examinations, and if students' visual-spatial ability improves during medical gross anatomy. Three hundred and fifty-two first-year medical students completed the Mental Rotations Test (MRT) before the gross anatomy course and 255 at its completion in 2008 and 2009. Hypotheses were tested using logistic regression analysis and Student's t-test. Compared with students in the lowest quartile of the MRT, students who scored in the highest quartile of the MRT were 2.2 [95% confidence interval (CI) 1.2 and 3.8] and 2.1 (95% CI 1.2 and 3.5) times more likely to score greater than 90% on practical examinations and on both practical and written examinations, respectively. MRT scores for males and females increased significantly (P < 0.0001). Measurement of students' pre-existing visual-spatial ability is predictive of performance in medical gross anatomy, and early intervention may be useful for students with low visual-spatial ability on entry to medical school. Participation in medical gross anatomy increases students' visual-spatial ability, although the mechanism for this phenomenon is unknown.
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Affiliation(s)
- Rebecca S Lufler
- Department of Anatomy and Cellular Biology, Tufts University School of Medicine, Boston, Massachusetts, USA.
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26
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Stefanik JJ, Guermazi A, Zhu Y, Zumwalt AC, Gross KD, Clancy M, Lynch JA, Segal NA, Lewis CE, Roemer FW, Powers CM, Felson DT. Quadriceps weakness, patella alta, and structural features of patellofemoral osteoarthritis. Arthritis Care Res (Hoboken) 2011; 63:1391-7. [PMID: 21702087 DOI: 10.1002/acr.20528] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
OBJECTIVE To determine the relationship between quadriceps weakness and cartilage damage and bone marrow lesions (BMLs) in the patellofemoral joint (PFJ) and if this relationship is modified by patella alta. METHODS The Multicenter Osteoarthritis Study is a cohort study of persons ages 50-79 years with or at risk of knee osteoarthritis. Concentric knee extensor strength was measured using an isokinetic dynamometer. Patella alta was measured using the Insall-Salvati ratio (ISR) on the lateral radiograph, and cartilage damage and BMLs were graded on magnetic resonance imaging in the PFJ. We determined the association between quadriceps weakness with cartilage damage and BMLs in the PFJ among knees with (ISR ≥1.2) and without (ISR <1.2) patella alta using multiple binomial regression. RESULTS A total of 807 knees were studied (mean age 62 years, body mass index 30 kg/m(2) , ISR 1.10) and 64% were from women. Compared with the knees in the highest strength tertile, those in the lowest had 10.2% (95% confidence interval [95% CI] 3, 18), 9.1% (95% CI 2, 16), and 7.1% (95% CI 1, 13) higher prevalence of lateral PFJ cartilage damage, medial PFJ cartilage damage, and lateral PFJ BMLs, respectively. The association between quadriceps weakness with cartilage damage and BMLs was not different between knees with and without patella alta in the lateral PFJ. CONCLUSION Quadriceps weakness was associated with PFJ cartilage damage and BMLs. While both patella alta and quadriceps weakness were associated with PFJ damage, the combination of the two was not associated with more damage than either of these factors alone.
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Affiliation(s)
- Joshua J Stefanik
- Boston University School of Medicine, Boston, Massachusetts 02118, USA.
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Hirsch AE, Cuaron JJ, Janicek MJ, Mui K, Lee RJ, Wang DS, Babayan RK, Zumwalt AC, Gignac GA, Tao W, Ozonoff A, Zietman AL. Anatomic differences after robotic-assisted radical prostatectomy and open prostatectomy: implications for radiation field design. Pract Radiat Oncol 2011; 1:115-25. [PMID: 24673925 DOI: 10.1016/j.prro.2010.11.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2010] [Revised: 11/24/2010] [Accepted: 11/26/2010] [Indexed: 10/18/2022]
Abstract
PURPOSE To investigate the anatomy of the pelvis following robotic-assisted radical prostatectomy (RARP) compared to the anatomy of the pelvis following open prostatectomy (OP), and to determine if postoperative radiation field design should take surgical approach into consideration. METHODS AND MATERIALS This report is a retrospective review of the postoperative pelvic magnetic resonance imaging (MRI) scans for all OP patients (10) and all RARP patients (15) who presented consecutively to the radiation oncology clinic and subsequently underwent MRI scanning between January 2007 and December 2008. All patients who presented are included in the study. We measured 13 distinct anatomic distances, and we used t tests to examine mean differences in each of the parameters between RARP and OP and analysis of variance to examine mean differences controlling for length of follow-up MRI postsurgery (in days) and body mass index as covariates. RESULTS Of the measurements, we found that the superior levator separation is statistically significantly greater in the post-RARP group than in the post-OP group (P < .01). Similarly, the post-RARP group had a greater mean resection defect measurement (P = .01) as measured by a larger width of the bladder infundibulum. This suggests that the size of trigonal musculature defect is more pronounced after RARP. The total urethral length was statistically significantly longer in the RARP group (P = .03). The vesicorectal distance was variable depending on the location along the rectal wall but trended toward larger separation in the post-RARP group (P = .05). CONCLUSIONS The pelvic anatomy after RARP is considerably different from that after OP. The current standard field design for post-prostatectomy radiation is defined by the post-OP pelvis. Our data support that the clinical target volume borders be expanded posteriorly and laterally in men who have undergone RARP. As RARP continues to become a more widespread surgical option for the management of localized prostate cancer, radiation field design may need to be adjusted.
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Affiliation(s)
- Ariel E Hirsch
- Department of Radiation Oncology, Boston University Medical Center, Boston, Massachusetts; Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts.
| | - John J Cuaron
- Department of Radiation Oncology, Boston University Medical Center, Boston, Massachusetts
| | - Milos J Janicek
- Department of Radiology, Boston University Medical Center, Boston University Medical Center, Boston, Massachusetts
| | - Kit Mui
- Department of Surgery, Boston University Medical Center, Boston, Massachusetts
| | - Richard J Lee
- Department of Radiation Oncology, Boston University Medical Center, Boston, Massachusetts
| | - David S Wang
- Department of Urology, Boston University Medical Center, Boston, Massachusetts
| | - Richard K Babayan
- Department of Urology, Boston University Medical Center, Boston, Massachusetts
| | - Ann C Zumwalt
- Department of Anatomy and Neurobiology, Boston University Medical Center, Boston, Massachusetts
| | - Gretchen A Gignac
- Department of Hematology/Oncology, Boston University Medical Center, Boston, Massachusetts
| | - Wen Tao
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts
| | - Alexander Ozonoff
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts
| | - Anthony L Zietman
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts
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Pearson WG, Langmore SE, Yu LB, Zumwalt AC. Muscles Underlying the Elevation of the Hyolaryngeal Complex. FASEB J 2011. [DOI: 10.1096/fasebj.25.1_supplement.867.6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | | | - Lou B Yu
- Anatomy and NeurobiologyBoston University School of MedicineBostonMA
| | - Ann C Zumwalt
- Anatomy and NeurobiologyBoston University School of MedicineBostonMA
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Stefanik JJ, Zhu Y, Zumwalt AC, Gross KD, Clancy M, Lynch JA, Frey Law LA, Lewis CE, Roemer FW, Powers CM, Guermazi A, Felson DT. Association between patella alta and the prevalence and worsening of structural features of patellofemoral joint osteoarthritis: the multicenter osteoarthritis study. Arthritis Care Res (Hoboken) 2010; 62:1258-65. [PMID: 20506169 DOI: 10.1002/acr.20214] [Citation(s) in RCA: 73] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To examine the relationship between patella alta and the prevalence and worsening at followup of structural features of patellofemoral joint (PFJ) osteoarthritis (OA) on magnetic resonance imaging (MRI). METHODS The Multicenter Osteoarthritis Study is a cohort study of persons ages 50-79 years with or at risk for knee OA. Patella alta was measured using the Insall-Salvati ratio (ISR) on the baseline lateral radiograph, and cartilage damage, bone marrow lesions (BMLs), and subchondral bone attrition (SBA) were graded on MRI at baseline and at 30 months of followup in the PFJ. We examined the association of the ISR with the prevalence and worsening of cartilage damage, BMLs, and SBA in the PFJ using logistic regression. RESULTS A total of 907 knees were studied (mean age 62 years, body mass index 30 kg/m(2), ISR 1.10), 63% from female subjects. Compared with knees in the lowest ISR quartile at baseline, those in the highest quartile had 2.4 (95% confidence interval [95% CI] 1.7-3.3), 2.9 (95% CI 2.0-4.3), and 3.5 (95% CI 2.3-5.5) times the odds of having lateral PFJ cartilage damage, BMLs, and SBA, respectively, and 1.5 (95% CI 1.1-2.0), 1.3 (95% CI 0.9-1.8), and 2.2 (95% CI 1.4-3.4) times the odds of having medial PFJ cartilage damage, BMLs, and SBA, respectively. Similarly, those with high ISRs were also at risk for worsening of cartilage damage and BMLs over time than those with low ISRs. CONCLUSION A high ISR, indicative of patella alta, is associated with structural features of OA in the PFJ. Additionally, the same knees have an increased risk of worsening of these same features over time.
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Affiliation(s)
- J J Stefanik
- Boston University School of Medicine, Boston, Massachusetts 02118, USA.
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30
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Schmitt D, Zumwalt AC, Hamrick MW. The relationship between bone mechanical properties and ground reaction forces in normal and hypermuscular mice. J Exp Zool A Ecol Genet Physiol 2010; 313:339-51. [PMID: 20535766 PMCID: PMC3666574 DOI: 10.1002/jez.604] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Understanding the relationship between external load and bone morphology is critical for understanding adaptations to load in extant animals and inferring behavior in extinct forms. Yet, the relationship between bony anatomy and load is poorly understood, with empirical studies often producing conflicting results. It is widely assumed in many ecological and paleontological studies that bone size and strength reflect the forces experienced by the bone in vivo. This study examines that assumption by providing preliminary data on gait mechanics in a hypermuscular myostatin-deficient mouse model with highly mineralized and hypertrophied long bones. A small sample of hypermuscular and wild-type mice was video recorded while walking freely across a force platform. Temporal gait parameters, peak vertical and transverse (mediolateral) ground reaction forces (GRFs), vertical impulse, and loading rates were measured. The only gait parameters that differed between the two groups were the speeds at which the animals traveled and the transverse forces on the hind limb. The myostatin-deficient mice move relatively slowly and experienced the same magnitude of vertical forces on all limbs and transverse forces on the forelimb as the wild-type mice; though the myostatin-deficient mice did experience lower mediolateral forces on their hindlimbs compared with the wild-type mice. These preliminary results call into question the hypothesis that skeletal hypertrophy observed in hypermuscular mice is a result of larger GRFs experienced by the animals' limbs during locomotion. This calls for further analysis and a cautious approach to inferences about locomotor behavior derived from bony morphology in extant and fossil species.
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Affiliation(s)
- Daniel Schmitt
- Department of Evolutionary Anthropology, Duke University, Durham, North Carolina 27701, USA.
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Zumwalt AC, Lufler RS, Monteiro J, Shaffer K. Building the body: active learning laboratories that emphasize practical aspects of anatomy and integration with radiology. Anat Sci Educ 2010; 3:134-140. [PMID: 20496434 DOI: 10.1002/ase.153] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Active learning exercises were developed to allow advanced medical students to revisit and review anatomy in a clinically meaningful context. In our curriculum, students learn anatomy two to three years before they participate in the radiology clerkship. These educational exercises are designed to review anatomy content while highlighting its relevance to the study of radiology. Laboratory exercises were developed using inexpensive materials in the form of hands-on stations designed for use by students working together in small groups. Station exercises include model building, exploring relevant radiological imaging, and practicing clinical techniques. Students are encouraged to move from abstract conceptualization of the anatomy using models to applying knowledge to living tissues by using a portable ultrasound to explore superficial anatomy on each other. Stations are designed to integrate knowledge and reemphasize concepts in different contexts, so that upon completion students have a reinforced understanding of the three-dimensional anatomy of the region in question, the appearance of the anatomy on radiological images, and an appreciation of the relevance of the anatomy to radiological procedures.
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Affiliation(s)
- Ann C Zumwalt
- Department of Anatomy and Neurobiology, Boston University School of Medicine, 72 East Concord Street, Boston, MA 02118, USA.
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Lufler RS, Zumwalt AC, Romney CA, Hoagland TM. Incorporating radiology into medical gross anatomy: does the use of cadaver CT scans improve students' academic performance in anatomy? Anat Sci Educ 2010; 3:56-63. [PMID: 20213692 DOI: 10.1002/ase.141] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Radiological images show anatomical structures in multiple planes and may be effective for teaching anatomical spatial relationships, something that students often find difficult to master. This study tests the hypotheses that (1) the use of cadaveric computed tomography (CT) scans in the anatomy laboratory is positively associated with performance in the gross anatomy course and (2) dissection of the CT-scanned cadaver is positively associated with performance on this course. One hundred and seventy-nine first-year medical students enrolled in gross anatomy at Boston University School of Medicine were provided with CT scans of four cadavers, and students were given the opportunity to choose whether or not to use these images. The hypotheses were tested using logistic regression analysis adjusting for student demographic characteristics. Students who used the CT scans were more likely to score greater than 90% as an average practical examination score (odds ratio OR 3.6; 95% CI 1.4, 9.2), final course grade (OR 2.6; 95% CI 1.01, 6.8), and on spatial anatomy examination questions (OR 2.4; 95% CI 1.03, 5.6) than were students who did not use the CT scans. There were no differences in performance between students who dissected the scanned cadavers and those who dissected a different cadaver. These results demonstrate that the use of CT scans in medical gross anatomy is predictive of performance in the course and on questions requiring knowledge of anatomical spatial relationships, but it is not necessary to scan the actual cadaver dissected by each student.
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Affiliation(s)
- Rebecca S Lufler
- Department of Anatomy and Neurobiology, Boston University School of Medicine, Boston, Massachusetts 02118, USA.
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Hutchinson D, Ho V, Dodd M, Dawson HN, Zumwalt AC, Schmitt D, Colton CA. Quantitative measurement of postural sway in mouse models of human neurodegenerative disease. Neuroscience 2007; 148:825-32. [PMID: 17764851 PMCID: PMC2175386 DOI: 10.1016/j.neuroscience.2007.07.025] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2007] [Revised: 07/18/2007] [Accepted: 07/20/2007] [Indexed: 11/28/2022]
Abstract
Detection of motor dysfunction in genetic mouse models of neurodegenerative disease requires reproducible, standardized and sensitive behavioral assays. We have utilized a center of pressure (CoP) assay in mice to quantify postural sway produced by genetic mutations that affect motor control centers of the brain. As a positive control for postural instability, wild type mice were injected with harmaline, a tremorigenic agent, and the average areas of the 95% confidence ellipse, which measures 95% of the CoP trajectory values recorded in a single trial, were measured. Ellipse area significantly increased in mice treated with increasing doses of harmaline and returned to control values after recovery. We also examined postural sway in mice expressing mutations that mimic frontotemporal dementia with Parkinsonism linked to chromosome 17 (FTDP-17) (T-279, P301L or P301L-nitric oxide synthase 2 (NOS2)(-/-) mice) and that demonstrate motor symptoms. These mice were then compared with a mouse model of Alzheimer's disease (APPSwDI mice) that demonstrates cognitive, but not motor deficits. T-279 and P301L-NOS2(-/-) mice demonstrated a significant increase in CoP ellipse area compared with appropriate wild type control mice or to mice expressing the P301L mutation alone. In contrast, postural instability was significantly reduced in APPSwDI mice that have cognitive deficits but do not have associated motor deficits. The CoP assay provides a simple, sensitive and quantitative tool to detect motor deficits resulting from postural abnormalities in mice and may be useful in understanding the underlying mechanisms of disease.
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Affiliation(s)
- Daniel Hutchinson
- Division of Neurology, Duke University Medical Center, Durham NC 27710
| | - Venus Ho
- Department of Biology and Biochemistry, University of Bath, Bath, BA2 7AY England
| | - Michael Dodd
- Department of Biology and Biochemistry, University of Bath, Bath, BA2 7AY England
| | - Hana N. Dawson
- Division of Neurology, Duke University Medical Center, Durham NC 27710
| | - Ann C. Zumwalt
- Department of Biological Anthropology & Anatomy, Duke University Medical Center, Durham, NC 27710
| | - Daniel Schmitt
- Department of Biological Anthropology & Anatomy, Duke University Medical Center, Durham, NC 27710
| | - Carol A. Colton
- Division of Neurology, Duke University Medical Center, Durham NC 27710
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Zumwalt AC, Marks L, Halperin EC. Integrating gross anatomy into a clinical oncology curriculum: the oncoanatomy course at Duke University School of Medicine. Acad Med 2007; 82:469-74. [PMID: 17457069 DOI: 10.1097/acm.0b013e31803ea96a] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
The amount of time devoted to teaching gross anatomy to medical students is declining. This topic remains critically important for some medical students, especially those seeking training in anatomy-laden specialties. The authors describe a course currently offered in the department of radiation oncology in the Duke University School of Medicine, developed in 2005, that expands anatomy education into the medical school clinical years. The aim of the course is to help reinforce anatomy knowledge in the clinical context of radiation oncology priorities and concerns, as well as to provide direct visualization and palpation of human cadavers, thus enabling the understanding of complex three-dimensional and anatomic principles. The audience for this course consists of medical students rotating through and the residents and clinical faculty in the department of radiation oncology. Anatomists and radiation oncology residents together present monthly didactic lectures, clinical case presentations, and cadaver-based demonstrations about the relationships between a tumor's anatomic location and its symptoms, patterns of spread, and treatment considerations. Anonymous surveys were distributed to course participants to assess the three components of the course. Survey results indicate that the participants found the anatomy lectures, clinical case presentations, and dissection presentations all to be interesting, relevant, and of high quality. This course is therefore favored by students, residents, and faculty as a way to supplement gross anatomy education during training for a specialty in which anatomy knowledge is essential.
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Affiliation(s)
- Ann C Zumwalt
- Department of Biological Anthropology and Anatomy, Duke University School of Medicine, Durham, North Carolina 27710, USA.
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Zumwalt AC. Three specialized anatomy courses for advanced medical students: the impact of focused anatomy instruction. FASEB J 2006. [DOI: 10.1096/fasebj.20.5.a886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Ann C. Zumwalt
- Biological Anthropology and AnatomyDuke University Medical CenterBox 3170, Sands Building, DUMCDurhamnc27710
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