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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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Lufler RS, Stefanik JJ, Niu J, Sawyer FK, Hoagland TM, Gross KD. The Association of Forefoot Varus Deformity with Patellofemoral Cartilage Damage in Older Adult Cadavers. Anat Rec (Hoboken) 2016; 300:1032-1038. [PMID: 27884055 DOI: 10.1002/ar.23524] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Revised: 09/09/2016] [Accepted: 10/06/2016] [Indexed: 12/21/2022]
Abstract
Forefoot alignment may contribute to patellofemoral joint (PFJ) osteoarthritis (OA) via its influence on the closed chain kinematics of the lower limb. The purpose of this cadaveric study was to investigate the relationship between forefoot varus and ipsilateral cartilage damage in the medial and lateral PFJ. Forefoot alignment measurements were obtained from the feet of 25 cadavers (n = 50). Cartilage damage in the medial and lateral PFJ of each knee was scored using the Outerbridge scale. The relative odds of medial and lateral PFJ cartilage damage in limbs with forefoot varus and valgus were determined using logistic regression. The relationship between increasing varus alignment and increasing odds of medial and lateral PFJ cartilage damage was assessed. Of the 51% of limbs with forefoot varus, 91.3% had medial, and 78.3% had lateral PFJ cartilage damage, compared with 54.6% and 68.2% of those with forefoot valgus. The former also had 3.0 times (95% CI 1.2, 7.7) the odds of medial PFJ damage; no association was found with lateral damage (OR 1.4, 95% CI 0.7, 3.0). Feet in the highest tertile of varus alignment had 3.9 times (95% CI 10, 15.3, P = 0.058) the odds of medial PFJ damage as those in the lowest tertile. The results of this study suggest a relationship between forefoot varus and medial PFJ cartilage damage in older adults. As forefoot varus may be modified with foot orthoses, these findings indicate a potential role for orthoses in the treatment of medial PFJ OA. Anat Rec, 300:1032-1038, 2017. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Rebecca S Lufler
- Department of Integrative Physiology and Pathobiology Division of Medical Education, Tufts University School of Medicine, Boston, Massachusetts, 02111.,Department of Anatomy and Neurobiology, Boston University School of Medicine, Boston, Massachusetts, 02186
| | - Joshua J Stefanik
- Department of Physical Therapy Movement and Rehabilitation Science Bouve College of Health Sciences, Northeastern University, Boston, Massachusetts, 02115
| | - Jingbo Niu
- Department of Medicine, Division of Rheumatology, Clinical Epidemiology Research and Training Unit, Boston University School of Medicine, Boston, Massachusetts, 02118
| | - F Kip Sawyer
- Department of Integrative Physiology and Pathobiology Division of Medical Education, Tufts University School of Medicine, Boston, Massachusetts, 02111
| | - Todd M Hoagland
- Department of Anatomy and Neurobiology, Boston University School of Medicine, Boston, Massachusetts, 02186.,Department of Cell Biology Neurobiology and Anatomy Medical College of Wisconsin, Milwaukee, Wisconsin, 53226
| | - K Douglas Gross
- Department of Physical Therapy, Massachusetts General Hospital (MGH) Institute of Health Professions, Boston, Massachusetts, 02129
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