bluuebunny/crossref_metadata_2025 huggingface dataset:
Factors Directing Preclinical Medical Students towards Specialty of Choice
Authors: Shacfe Fathiah Nadine Hasan , Alhomoudi Reham Ibrahim , Peeran Ahmed Aftab , Abdeh Amal Iman , Obad Adam Subait , Shareef Mohammed Abrar
Published: November 2023

Introduction

Choosing a medical specialty could be difficult and confusing process for medical students. Hence, the aim of this study was to determine the factors and predictors that influence preclinical medical students' specialty preference.

Methods

A self‐administered, paper‐based, 19‐item anonymous questionnaire was distributed among preclinical medical student at Alfaisal University. The questionnaire examined factors related to: social life, profession, education, and seniors' advice. Confirmatory factor analysis and cronbach's alpha were used to validate the priori hypothesis and examine the internal consistency of the questionnaire, respectively. Moreover, Kruskal Wallis and Multinomial Logistic Regression tests were used to compare means and determine career choice predictors among medical students.

Results

A total of 306 students completed the questionnaire with highest choices as surgery 34% (n=99), 33% (n=95) “didn't have any idea about their future specialty preference”, and 9.8% (n=30) internal medicine. The least preferred specialty was family medicine (1.3% n=4). The questionnaire showed acceptable validity and good reliability. The four mean rating values for social, professional, educational, and senior's advice domains were 3.47, 3.4, 3.32, 3.4, respectively (5‐strongly agree, 1‐strongly disagree). Having a High GPA was predictive of choosing an academic career (PhD, P <0.001) and internal medicine (P < 0.001). Additionally, social and educational factors were of more concern to females compared to males (P = 0.029, P = 0.001, respectively). Other factors and domain items had variable importance for students' choice of their future specialties.

Conclusion

Students' choices were influenced by several social, professional and educational factors. Yet a remarkable number of students were not decisive about their future specialties. Understanding the factors that influence students' preference should prompt the adaptation of plans and curricular modifications to direct students towards highly demanded specialties. An additional emphasis on the importance of family medicine should be adopted by integrating related practical and theoretical activities into the curriculum.
A Mathematical Model of Beaver Incisor Tooth Morphology
Authors: Rinaldi Caroline E , Kuhn‐Hendricks Stephen M , Erickson Gregory M
Published: November 2023

A key evolutionary innovation of rodents was the development of ever‐growing incisors, characterized by their arc‐shaped form. These teeth grow and erupt throughout the life of the animal at approximately the same rate as wear occurs at their occlusal ends. Fortuitously, daily growth increments are visible on the surfaces of rodent incisors. These structures, known as periradicular bands, provide a moving, or kymographic record of each tooth's growth history. This record can be used to reconstruct tooth growth and wear rates occurring during the period of the animal's life represented by the bands, and the total number days over which the tooth formed. We studied the upper incisors of 18 Florida wild‐caught extant beavers (Castor canadensis) spanning ontogeny to develop a model incorporating gradients in incisor growth rates and form throughout the life of a typical individual. The specimens were digitized. Labial surface arc segments for representative size class incisors were sequentially aligned in ascending order of age and incisor size. Over 120 morphometric points were documented along the total alignment and a custom R‐script used to fit spiral equations. This was used to describe the pattern of typical incisor growth throughout an individual's lifetime. Log‐likelihood fitting suggests an Archimedean spiral best describes those data. Next, circadian growth increments on the right upper incisor of 36 Kansas wild‐caught beavers of varying season and age class were measured and size‐specific growth rates were calculated. We found that average daily dentin growth rate decreases with age, while total number of increments increases with age. We then incorporated the average increment width (a proxy for developmental stage growth rates) for each tooth to estimate the placement of age classes on the spiral and infer the total amount of growth occurring in the lifetime of an individual (~1.8 meters for C. canadensis). Based on the data sets used in this study, we observed 4 to 5 size classes occupying approximately 3 ½ revolutions of the spiral throughout beaver ontogeny. The development of models such as this makes it possible to estimate size and age of individuals on the basis of their chronological position within the spiral. This provides a new tool for estimating age and growth rates in both living and fossil rodents using isolated incisors. Furthermore, the models facilitate our understanding of dental form, function, and scaling in rodents.

Support or Funding Information

This work was partially funded by NSF EAR 0959029 presented to GME.
A major paradigm shift in fish, tetrapod and limb evolution: characteristic tetrapod musculoskeletal limb phenotype emerged more than 400 MYA in basal lobe‐finned fishes
Authors: Diogo Rui , Molnar Julia , Esteve‐Altava Borja , Johnson Peter
Published: November 2023

Previous accounts of the origin of tetrapod limbs have postulated a relatively sudden change, after the split between extant lobe‐finned fish and tetrapods, from a very simple fin phenotype with only two muscles to the highly complex tetrapod condition. The evolutionary changes that led to the muscular anatomy of tetrapod limbs has therefore remained relatively unexplored. We performed dissections, histological sections, and MRI scans of the closest living relatives of tetrapods: coelacanths and lungfish. Combined with previous comparative, developmental and paleontological information, our findings suggest that the characteristic tetrapod musculoskeletal limb phenotype was already present in the Silurian last common ancestor of extant sarcopterygians, with exception to the autopod (hand/foot) structures, which have no clear correspondence with fish structures. Remarkably, the two major steps in this long process – leading to the ancestral fin anatomy of extant sarcopterygians and limb anatomy of extant tetrapods, respectively – occurred at the same nodes as the two major similarity bottlenecks that led to the striking derived myological similarity between the pectoral and pelvic appendages within each taxon. Our identification of probable homologies between appendicular muscles of sarcopterygian fish and tetrapods will allow more detailed reconstructions of muscle anatomy in early tetrapods.

Support or Funding Information

Am. Assoc. Anat. postdoctoral grant to JLM, and European Union's Horizon 2020 Marie Skłodowska‐Curie grant No 654155 to BE‐A.
Seriated CT‐Scan of the Cranium in a Crocodylus niloticus from Madagascar (215 mm long) in the Three Planes of the Space
Authors: Le Floch‐Prigent Patrice Pierre , Verdeille Stéphane
Published: November 2023

A dry cranium with its mandible in a Crocodylus niloticus from Madagascar was laid on the table of a CT‐scan apparatus : a Somatom sensitive, Siemens one with 64 detectors. It was an authorized sample from a crocodyle farm with a number of registration. It was 215 mm long, The acquisition was made in the frontal plane with thin jointed cross‐sections. The two other planes were get from this native one : horizontal and sagittal ones. Reconstructions were then defined from the CT‐scan cross‐sections. The morphological and architectural results were excellent and analyzed.
Bending Properties of the Jugal Bone in Mallard Ducks and its Significance for Cranial Biomechanics
Authors: Smith Caitlyn Jennifer , Holliday Casey M. , Middleton Kevin M. , Bailleul Alida M.
Published: November 2023

Few species evolved skulls as derived as ducks and other Anseriform birds, which employ rapid, dexterous movements of the palate and jaws to feed. Despite their exceptional behavior and morphology, little is known about the structure and biomechanics of their jaw muscles, cranial joints, and linkages that facilitate cranial kinesis. In particular, the jugal bone is capable of bending considerably as it links the quadrate and the upper beak. Here we employ a series of methods including microCT imaging, morphometrics, 3D modeling and histology to discover how and why the jugal is capable of such astounding flexibility. Although a narrow suture connects the caudal limb of the jugal with the quadratojugal, flexibility instead appears to occur at narrow regions of the bone. This gross morphology is further complemented by changes to the skeletal tissues that compose the element. Moreover, the orientation of jaw muscle resultants and loading of the skull indicate the jugal experiences a range of loading during different instances of the gape cycle. These findings illustrate the complicated series of adaptations in morphology, histology and biomechanics ducks and other vertebrates employ to engage in derived forms of cranial kinesis and feeding.

In birds, cranial kinesis implies the ability to move the upper bill relative to the braincase, contributing to the evolution of the flexible skulls found in birds. The mechanism for elevation of the upper beak consists of a forward movement of the quadrate, exerting force through the jugal and the pterygoid that connect the quadrate to the upper jaw, and elevate the upper beak by bending of the nasofrontal hinge joint and possibly a flexion zone in the jugal. The jugal bone plays a significant role in Mallard feeding as it links the posterior part of the skull with the flexible anterior part of the skull. Interestingly the jugal is quite flexible and when removed from the skull; it is capable of bending 90 degrees while still returning to its original conformation. For the first time, we are studying the biomechanics of birds to determine how their skulls work; while primarily investigating the cause of the flexibility in the jugal bone. We have studied a sample of duck skulls through CT data, 3D modeling, and measurement of cross‐sectional properties of the element. From this data we have found areas of the jugal bone that afford greater consideration in determining the flexibility throughout the jugal bone. This project will create new data about the jugal bone's flexibility, which will contribute to the study of biomechanics of bones and cranial kinesis.
Femur measurement in photoanthropometric analysis. Surface projection of inguinal ligament, with or whitout garments is a reliable landmark?
Authors: Cusimano Maurizio
Published: November 2023

The surface projection of Inguinal ligament (SPIL) is a very important anatomical landmark for the inguinal region and the anatomy of the abdominal area. In the photoanthropometric analysis, the surface projection of Inguinal Ligament may be an important anatomical landmark to identify the caput femuri. We will demonstrate this by estimating the stature from photoanthropometric measurements of femur and comparing it with the real stature.

A group of 100 peoples of the female sex, aged between 30 and 50 years old, was measured in photo first without and then with garments and the video‐measurement of the femur was used for the anthropological estimation of stature. The results and the camparison between real stature and estimated stature (p<0.05), indicate that the Surface Projection of Inguinal Ligament is a good landmark for photoanthropometric measurements of the femur in female people, with or without garments.
Phylogenetic Utility of Mammalian Postcranial Characters
Authors: McCarthy Robert C , DiVito Thomas A , Bains Jasmine , Fatima Maimoona
Published: November 2023

In phylogenetic studies of extinct species, researchers often exclude postcranial data because postcranial elements are missing, underrepresented, or difficult to assign to particular species. However, in some cases these decisions revolve around the idea that postcranial data are inappropriate for phylogenetic analyses because they are functionally or developmentally integrated or otherwise “prone to homoplasy.” In this study, we used a character congruence approach to test the hypothesis that postcranial data cannot be used to reconstruct phylogenies instead of the taxonomic congruence approaches most often employed in paleoanthropological studies. We identified 98 published mammalian phylogenetic datasets that included sufficient numbers of characters from the skull, dentition, and postcranium to be included in the analysis. We calculated partitioned Bremer support (PBS) values for each data partition on each strict consensus cladogram using the programs Phylogenetic Analysis Using Parsimony (PAUP) v. 4.0b10 and TreeRot.v3, calculated partition congruence indices (PCI), and assessed significant differences between data partitions using Fischer's least significant difference test. Averaged across each cladogram, postcranial PBS values are greater than, or not significantly different from, 69.4% of skull PBS values (68 studies) and 64.3% of dental PBS values (63 studies). Postcranial data provided primary support (“winning sites”) at 301/1448 nodes (20.8%), exhibited positive values at 710/1483 nodes (47.9%), and “do no harm” at 1196/1483 nodes (80.6%). There is no correlation between PBS values and data partition size as long as there are at least ten characters in each data partition. These results highlight the potential for using postcranial data to construct hominin phylogenies and argue against their exclusion from phylogenetic analyses for a priori reasons.

Support or Funding Information

Undergraduate student research in this study was supported by the Benedictine University Natural Science Summer Research Program.
Musser's Cryptids: Resolving Unknown or Disputed Species Identities in Scientific Collections
Authors: Tuttle Kristy
Published: November 2023

White‐toothed rats (Berylmys) are native to the Indochinese region of south Asia. Taxonomic classifications in this group, and sister taxon Rattus, have traditionally been ambiguous and polyphyletic. The group was finally revised by Musser and Newcomb (1983) based on cranial and molar diagnostic characters. The four currently accepted species, B. bowersi, B. berdmorei, B. manipulus, and B. mackenziei, are subdivided into several isolated geographic populations; even among contiguous populations there is much morphological variation between regional groups. Regional variations and cranial characters in Berylmys, while useful in phenetic comparisons, have not been tested for statistical significance or for usefulness in separating species. In addition, many specimens held in museum collections are still of unknown or disputed species assignations. This study examines a dataset of eighteen cranial measurements of potential phylogenetic significance collected from specimens of Berylmys housed in the FMNH, AMNH, and NMNH mammal collections. Principal components analysis (PCA) is used to identify statistically significant variables, and discriminant function analysis (DFA) to test species assignations. Rostral‐length (RL), breadth of incisive foramina (BIF), and length of auditory bullae (LAB) account for the greatest variation seen in the dataset. 90% of individuals were correctly classified to their assigned species in DFA. RL and BIF were the best discriminators among species, along with length of the ectotympanic (LECTO). Specimen NMNH‐255354, collected from China, is classified as B. mackenziei in collection records and by Musser and Newcomb. However, it was re‐classified as B. bowersi under DFA and falls well within this group in PCA. NMNH‐321313, 321314, 321315, and 321316 are classified in museum collections as Vietnamese Berylmys of unknown species affinities. The author examined these four specimens, following Musser and Newcomb's previous diagnostic criteria for this specimen, and tentatively assigned them to B. mackenziei. All were correctly assigned to this species under DFA. These groups also fall within the range of B. mackenziei under PCA. DFA and PCA are potentially useful but underutilized tools for addressing the widespread problem of unknown or disputed species classifications in museum collections. DFA and PCA can be used to identify pre‐priori the most useful diagnostic characters out of a set of potential variables, and provide a quick but quantitative and non‐subjective approach when assigning individuals to a preliminary species group.

Support or Funding Information

Data collection was partially funded by a collections visitation grant from the American Museum of Natural History.
Using Focus Stacking in Anatomical Imaging: Does it Make a Difference?
Authors: McWatt Sean C. , Jadeski Lorraine C.
Published: November 2023

Human anatomy education relies heavily on the use of high‐quality images of cadaveric dissections for student reference. Despite continual advances in the available camera equipment for digital photography, depth of field remains a limitation when photographing anatomical specimens. To circumvent this issue, some anatomists use focus stacking algorithms to enhance depth of field in anatomical images. Focus stacking is a commonly used technique in microscopy whereby image processing software is used to fuse multiple digital images with different focal planes to create a single image with an extended depth of focus. This procedure aims to improve the quality of images used in anatomical education; however, objective evaluation of image quality is notoriously difficult. This is largely due to an inability to code algorithms that adequately parallel the human visual system (HVS). For this reason, subjective assessment has remained the gold standard for image quality evaluation. The goal of this study was to determine if focus stacked images were superior to non‐focus stacked images in subjective image quality. For this comparison, focus stacked cadaveric images were paired with identical non‐focus stacked controls (25 focus stacked, 25 non‐focus stacked) and analyzed for image quality by human subjects. Participants ranked the images on a slider labelled with five adjectives: “Bad”, “Poor”, “Fair”, “Good”, and “Excellent”, and scores were converted to integers between 1–100 for analysis. Statistical analysis is ongoing; however, preliminary results indicate that focus stacked images typically received higher ratings of quality than non‐focus stacked images. Ultimately, the purpose of capturing cadaveric images is to include them in educational material directed toward human anatomy students. Therefore, a difference between perceived image quality may have important implications for the creation of high quality educational material in human anatomy and student learning.
Clinical Educators' Views of a Paired Anatomy Teaching Assistant and Clinician Teaching Model for Ultrasound Training during Gross Anatomy
Authors: Royer Danielle F. , Kendall John L
Published: November 2023

INTRODUCTION

Ultrasound (US) is increasingly incorporated into medical education, and can be used to supplement traditional anatomy teaching. The University of Colorado School of Medicine incorporates five hands‐on US sessions in the first year gross anatomy block. A new teaching model was piloted in 2015: anatomy teaching assistants (TAs) trained in US were paired with clinical educators to enhance the integration of anatomy and US. Medical students surveyed previously reported high satisfaction with the new anatomy TA‐clinical educator facilitator pairing.

GOAL

The goal of this study was to evaluate clinical educators' perceptions of the new teaching model.

METHODS

Five anatomy TAs were paired with clinical educators to help facilitate the US sessions integrated with gross anatomy. Each TA had previously completed a graduate dissection‐based anatomy course with US training. The TAs also completed an additional US workshop before the start of medical gross anatomy, and participated in cadaver‐based reviews prior to every US session. For the five regional US labs, each clinical educator facilitated at least two (out of eight) 1‐hour scanning sessions paired with an anatomy TA, after which they were offered an anonymous, IRB‐exempt survey with six Likert items (1 = strongly disagree; 5 = strongly agree). Three items duplicate items used on a survey of the medical students; a Mann‐Whitney U test was used to identify significant differences between clinical educator (N = 29) and student (N = 152) responses.

RESULTS

Clinical educator response rate was 100%. 90% of clinical educators indicated that they want an anatomy TA present for all US sessions (mean = 4.38 ±0.67). The majority of clinical educators agreed that the TAs enhanced the scanning sessions (mean = 4.38 ±0.85), which echoes the views of medical students (mean = 4.23 ±0.88; p > 0.05). In particular, 86% of clinical educators reported that the TA's knowledge of US was sufficient to assist with live scanning (mean = 4.07 ±0.87), views that are similar those of medical students (mean = 4.24 ±0.86; p > 0.05). Several clinical educators commented on the specific benefits of the TA's expertise in gross anatomy. Indeed, 72% of clinical educators viewed the TA's knowledge of regional anatomy as superior to theirs (mean 4.0 ±0.98), and 93% believe that the student's understanding of anatomy during the US session was enhanced by the TAs (mean = 4.52 ±0.62). Students also reported a greater understanding of gross anatomy due to the TAs (mean = 4.18 ±0.86; p > 0.05).

CONCLUSIONS

Clinical educators and medical students alike perceived that anatomy TAs enhance the US training offered as a supplement to anatomy education. The teaching model outlined here – anatomy TAs paired with clinical educators – is a simple yet meaningful way to enhance anatomy education with US training, and may strengthen the integration of clinical and basic sciences in medical education.
Early Implementation of a Team Based Learning Session Focusing on Study Strategies and Content Knowledge Expectations Improves Student Performance on their First Anatomy Exam
Authors: Johnson Eric
Published: November 2023

A significant portion of students enter medical school with a poor understanding of the amount of detail and conceptual mastery necessary to pass an anatomical science exam. This year, we implemented an early Team Based Learning (TBL) session in the second week of their first semester to give the students a better idea of what will be expected of them throughout medical school. With the implementation of the early TBL session, there was a significant improvement of 5.0% in student scores for the same items tested in the first anatomy exam of 2015 and 2016. Interestingly, there was a significant decrease in the discrimination indices for the same questions which suggests that there was a smaller disparity in performance between the weaker and stronger students. The iRAT and tRAT for this early TBL session covered the anatomical science material presented in the first week of medical school. The application session for the second part of the TBL session was divided into three parts. The first part introduced the item analysis strategy promoted by Dr. John Pelley. The second part of the application session presented an exercise demonstrating the importance of making conceptual connections between events. The third part of the application session provided an example of how the anatomical knowledge the students are acquiring can be implemented in a clinical setting. These results suggest that an early TBL session focusing on study habits and knowledge expectations may accelerate the anatomical content mastery of first year medical students.
Using Flipped Model And Drawing Tutorials To Teach Neuroanatomy In Graduate Certificate Program In Intraoperative Neuromonitoring
Authors: Filipovic Radmila , Andalib Payam
Published: November 2023

Objective

In collaboration with partners in the healthcare industry, we have created a Graduate Certificate Program in Intraoperative Neuromonitoring that prepares students to be neuromonitoring clinicians in operating rooms. Neuromonitoring clinicians provide live feedback regarding the integrity and functionality of a patient's nervous system while undergoing surgical operations. Profound knowledge of neuroanatomy is significantly important for the clinicians in this field to allow better understanding of the nervous system and structures at risk during the operations that utilize neuromonitoring. Learning structures in the nervous system and their complicated connections could be challenging for students. Students struggle to memorize parts of the brain, their positions, and connections, and do not retain knowledge for a long time after the ending of the class.

Methods

To make learning engaging and effective we use a hybrid model for the course: Students watch brain dissection movies and drawing tutorials, followed by quizzes and assessments online. Subsequently, during class meetings, we discuss about the role of nervous system regions using case studies that illustrate common neuropathologies. Students are required to draw nervous system structures as they listen to the modules included in the online tutorial “Draw It to know It”. As a part of drawing tutorials, basic descriptions of case studies are included. During the class, student also use virtual cadavers on Sectra tables, which enable students to perform virtual dissections of the brain and spinal cord that replace the use of preserved postmortem human brain material, and discus in more details case studies.

Results

Our experience is that introductory online drawing tutorials help students to visualize three dimensional relationships of nervous system regions, and improved student engagement during class. However, when students were assigned to draw the complicated neuronal pathways before in class lecture, their cognitive skills and engagement were not improved.

Conclusion

In conclusion, our hybrid model with introductory assignments and drawing tutorials serve students to build in‐depth knowledge during class. Balanced online and in class activities provides solid knowledge to the students in our program and prepares them to practice in the intraoperative neuromonitoring field.

Support or Funding Information

Self supporting program
Impact of team‐based virtual microscopy on student learning in Histology
Authors: Potaliya Pushpa , Dixit Shilpi Gupta , Ghatak Surajit
Published: November 2023

Introduction

Histology teaching is based on theoretical didactic stratagem followed by practical training. Conventionally used optical microscopy to accomplish practical competence is getting replaced by newer communication technologies. As little pragmatic substantiation is there regarding the impact of virtual microscopy against optical microscopy on the acquisition of histology comprehension, this study was set up at AIIMS, Jodhpur, India.

Objective

Provide students with a core content resource that transcends the classroom.

Student feedback and the impact of a set of measures deliberated to improve an experimental group's understanding of histology.

To evaluate and compare overall Histology lab averages and individual test scores to determine the effects of using virtual microscopy.

Material and Method

A pretest‐post test and cross‐over design was adopted. The students' reactions to the instructional measures were assessed by course evaluation data. Analysis of covariance was done to study the differential gain in knowledge at T1 and T2. Quantitative assessment of students was based on laboratory quizzes.

Result

Both short and long term outcome of implementing such module shall be discussed at time of conference. Data from assessment scores and evaluation surveys indicated the significance of virtual microscope in improving student performance and learning efficiency.

Conclusion

Access to high‐quality digitized materials and boosting prerequisite skills are insufficient to boost final competence. Instead, the solution may lie in making students externally accountable for their learning throughout their training.

Support or Funding Information

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Anato‐Olympics: Can Group Based Competition Activity Among Undergraduate Students Improve Their Performance on the Real‐Time Restricted‐Practical Evaluation
Authors: Monroig Edgardo H , Solivan Javier A , Duprey‐Diaz Mildred V
Published: November 2023

Undergraduate students in the biological sciences typically perform less proficiently on practical exams in part due to the students' lack to aptly transfer the material from the anatomy lectures to the lab examination settings (Bolander et al., 2008). Additionally, the stress generated by tests along with the added stressor of time‐limit tend to undermine the student's confidence and performance (Ng et al., 2003a; 2003b; Singh et al., 2012). The primary objective of the present study was to determine if practical exam outcomes would improve if students designed practical questions and practiced the lab material on a similar evaluation atmosphere previous to the real examination. We also evaluated if dividing the classroom into groups, comprised of A‐level to D‐level students as of their last practical exam performance, would benefit lower‐grade‐level students in future examinations.

Each group randomly selected a theme from a list of topics related to the test material and were asked to design objective structured practical questions (OSPQs) consisting of true‐false and multiple choice questions. After thorough revision of the OSPQs to ensure their objectivity and validity, stations were prepared according to the materials requested the students. To increase time‐restrictive effects, students visited each station once with a 2‐min time‐restriction. Contrary to the experimental examination, the real test allowed two rounds per station each lasting 1:30 min and 1:00 min respectively. Students were allowed to rest in the station their group designed. Results were recorded on an answer sheet and graded by the staff members. Individual and group scores were calculated for future comparison with the real test scores.

Preliminary results from our sample show no apparent difference, when the average score for the second exam was compared to that obtained by the students on their first practical exam (n=40). A separate survey given to the participants made it clear that the majority of the students did not study in groups for the exam, a fact that could explain the poor improvement in the second test scores. For future studies, we want to replicate these experimental conditions while taking into consideration the effects of group work. We believe that intragroup encouragement could enhance student confidence. This educational experiment holds promise as we explore new tools and activities that would help the student overcome the negative effects of time‐restricted examinations, while promoting confidence, and improving their performance.
Creating a Master List of neuroscience topics for pre‐clinical medical education
Authors: Gould Douglas , Patino Gustavo , Osula Valerie
Published: November 2023

The objective of the current project is to describe the process by which neuroscience course content is selected in a highly‐integrated, clinically‐focused, systems‐based curriculum. With newly conceived integrated systems‐based curricula, where students get increased clinical exposure starting with year one, this often means less time spent covering foundational science principles. It is in this light that decisions on what material is necessary to prepare students for neurology clerkships and for performance on the United States Medical Licensing Examination (USMLE), must be made. In other words, it is no longer possible to ‘cover it all’ before starting the clinical phase of medical education. In order to determine course content in a structured and deliberate way, the faculty as the Oakland University William Beaumont School of Medicine (OUWB) was divided into 16 Discipline Teams. One of the tasks charged to each Discipline Team was to develop a Master List of topics that must be covered at some point in the pre‐ clerkship phase of medical school. The creation of a Master List is a critical first step in creating, implementing and evaluating any systems‐based integrated curricula. Neuroscience course content on Moodle (course management system) was evaluated against the Master using an iSEEk word count, indicating the course covered 88% of topics. The First Aid (FA) books are the most widely used board preparation materials; their content was similarly evaluated, the books covered 83% of topics. Areas in the OUWB neuroscience course that may be lacking were identified and will be programmed in for subsequent iterations of the course.
Vertical Integration of Anatomy: Achieving the Desired Outcomes?
Authors: Lazarus Michelle Denise , Rascoe Alex , Anderson Daniel , Black Kevin
Published: November 2023

Anatomy integration into clinical year medical education is oft recommended but rarely described. Previously we introduced an innovative approach integrating anatomy education into clinical year medicine. Here we present the effects of this vertically‐integrated musculoskeletal (MSK) elective in an effort to inform similar curricular innovations. Students participating in either a MSK (experimental, n = 25) or humanities course (control, n=19) were evaluated using a repeated measures, mixed methods approach. All participants took a published MSK competency exam. Additionally, experimental participants responded to Likert questions evaluating anatomical confidence, open‐ended questions ascertaining perceptions of the MSK elective, and were assessed on standardized patient (SP) exam performance. MSK competency exam scores significantly improved (p<0.05) following participation in the anatomy elective compared to both pre‐test performance and controls. This improvement was maintained up to 6 months post‐course. Experimental participants also significantly improved their confidence, from pre‐ to posttest, in clinical domains having high anatomical relevancy (p<0.05). Qualitative analysis identified two key themes perceived as impacting learning, “content structure” and “delivery format”. Subthemes suggest that students value “discipline integration” and “independent study”. Surprisingly, however, SP exam scores were unaltered following MSK course participation. Course participation positively affected MSK knowledge competency and retention, but did not affect clinical skill aptitude, suggesting that a mixture of clinical exposure and classroom teaching might be needed to positively impact both knowledge and application. Though effective vertical anatomy integration was previously shown to require dedicated classroom teaching time, these results suggest there is an optimal ratio between these two paradigms (knowledge vs. application) required for desired clinical competency.

Support or Funding Information

LWW/AAA Education Research Scholarship
Production and Qualitative Analysis on Histology Assessment Application for Online and Mobile Learning
Authors: Culleen Benjamin E.W. , Lee Lisa MJ
Published: November 2023

Over the past several decades, it has been well documented that anatomical sciences contact hours in medical and dental education are in a state of continued decline. The decrease in histology contact hours in particular, has been closely accompanied by the advent of technologies and ancillary educational resources, such as online virtual histology programs. While virtual histology programs have now become the norm in histology curricula, there has been little evidence of an increase in students' learning outcome with its use. Recent studies attribute the stagnant learning outcome with the virtual lab to the lack of student‐expert interaction. Previous studies by this group revealed that instructor simulator applications yield a higher learning outcome than the virtual lab alone. Currently, mobile assessment applications for histology are far and few between; those few that do exist are mainly flashcard‐based review tools rather than interactive applications. Therefore, the purpose of this study was to develop a set of digital self‐assessment tools called Brief Mobile Histology Quizzes (BMHQ). BMHQ would expand the library of, and accessibility to, instructor simulator tools. BMHQs are designed to assess users' histology competency in 3 incremental levels, which draw upon Bloom's Taxonomy of Learning. Level 1 explores baseline knowledge, such as an ability to define or simply identify key structures. Level 2 examines understanding of more complex concepts and ability to locate, classify and recognize key histological features. Level 3 probes the analytic, evaluative and integrative abilities of the user. A total of eighteen, 10‐item, BMHQs were created using Articulate Quizmaker ™; nine on the Digestive System and nine on Connective Tissue topics. Each BMHQ features image or text based questions and is designed to provide instant feedback upon answer submission. Users can access BMHQ at any difficulty level to assess their current state of content mastery. Users also receive instant feedback for each item, including some pitfalls or commonly misidentified structures. This is a unique feature of BMHQ in that no other app available provides the combination of image and/or text based questions, with such robust feedback. The BMHQs are user‐tested with graduate students who have previously completed a histology course. The survey included metrics on the BMHQ interface design, motivation to use, and perceived educational value. The survey results revealed an overall positive perception on the design, organization and educational value of the BMHQs. Series of BMHQs that simulate a short, low‐risk, on‐demand instructor‐interaction on digital platforms may be a powerful learning tool for students in the current educational environment.
Telequantum Medical Education: Developing Teleportation, Telecommunication and Tele Emotion Skills During Basic Science Curriculum to Train Medical Students Current and Future Telemedicine Healthcare
Authors: Chen Wilson W. , Benninger Brion
Published: November 2023

Introduction

Telemedicine (TM), telehealth and ehealth has been practiced at varying levels of sophistication under a number of disguises now peaking in popularity from the past four decades. Unfortunately, prevalence of chronic diseases and increased demand for physicians and doctor‐patient time has also peaked. Objective was to investigate andragogical methods developing TM skills during basic science curriculum.

Methods

Medical Students (MSs) n=103 was exposed to live and distant site streamed lectures. MSs used Google Glass during examinations, first person anatomy dissection tutorial videos and surface anatomy with physical examinations. Interactive ultrasound program and radiology site were MSs tutor. MSs created teaching videos of anatomy. Wearable ultrasound using Sonovate finger probe teleporting images in real time at distant sites was experienced. MSs used Percu Vision and endocavity scopes to familiarize site viewing. Sectra 3D imaging developed stereostructural anatomy for distant cross‐sectional imaging and scope viewing.

Results

Literature search revealed no obvious studies integrating multiple TM technologies for MSs. MSs reported enjoying teleporting, tele‐education, TM technologies. MSs preferred live lectures but appreciated streamed lectures. MSs, preferred Google Glass examinations to conventional examinations. Surface anatomy with physical examination tutorials preferred in first person versus bird's eye view. Percu Vision and cavity scopes were well received. Sectra 3D imaging reported invaluable during courses.

Discussion

TM is being appreciated because we are now able to execute tasks usefully and efficiently when previously they lacked development. With fewer health providers and more chronic disease patients, it appears necessary to train MSs telemedicine skills. This could be telequantum medical education as MSs integrated technology, telecommunication and tele‐emotion.

Conclusion

This pilot study successfully incorporated TM communication into a basic science curriculum to improve sender and consultant arenas.

Support or Funding Information

With the cordial support of Jim & Heather McDaniel, Dr. Jeff Heatherington, and the gracious donors who donated themselves for science.
Remodelling of the atrioventricular canal myocardium determines atrioventricular conduction patterns
Authors: Nanka Ondrej , Vicente‐Steijn Rebecca , Blom Nico A , Jongbloed Monique RM , Sedmera David
Published: November 2023

Aims

Based on our previous study showing accelerated conversion of ventricular activation sequence during hypoxic incubation correlating with increased apoptosis in the atrioventricular canal (AVC), we hypothesized that this slight increase in apoptosis could lead to an accelerated pruning of myocardial atrioventricular connections, which would manifest as earlier appearance of mature apex‐to‐base activation patterns.

Methods

To test this hypothesis, apoptosis was blocked with a caspase inhibitor (zVAD‐fmk) by intrapericardial injection in chick embryos at embryonic day (ED) 4. The epicardial contribution to AVC remodeling was studied by performing epicardial outgrowth inhibitions – microsurgical epicardial ablation at ED3. Ventricular activation was studied by optical mapping and apoptosis rates were quantified by Lysotracker Red and Active Caspase‐3 immunofluorescence staining.

Results

Apoptosis measurements and quantification in zVAD treated hearts shows decreased apoptosis in AVC myocardium at ED7. zVAD‐treated and epicardial ablated hearts showed increased frequency of immature ventricular activation patterns. In 5 of the 21 zVAD‐treated hearts we observed activation originating from the right AVC. This pattern was observed in neither control nor epicardial ablation hearts. The epicardial ablation hearts showed activation originating from the left AVC. Ventricular activation time in Base‐to‐Apex activation patterns in zVAD‐treated hearts was significantly longer than in controls.

Conclusion

AVC maturation requires apoptosis in the AVC myocardium and epicardium‐derived in growth. Disruption of proper AVC morphogenesis can lead to persistence of accessory atrioventricular connections, which form a morphological substrate for ventricular pre‐excitation.

Support or Funding Information

Supported by Charles University PRVOUK/PROGRES
Development of the Cardiac Conduction System in the Selected Groups of Reptiles as Determined by HNK‐1 Expression
Authors: Kvasilova Alena , Gregorovicova Martina , Sedmera David
Published: November 2023

Reptilian hearts show different stages of ventricular septation from its complete absence in the basal squamates to a fully septated heart in crocodiles. We have tested the hypothesis that evolution of the specialized ventricular conduction system is linked to ventricular septation, rather than homeiothermy, as originally postulated. We studied hearts of selected reptilian species (Pogona vitticeps – no ventricular septum, Varanus indicus – partial septum, Crocodylus siamensis – complete septum) at various stages of development to uncover any morphological evidence for specialized conduction pathways. Immunohistochemistry using smooth muscle or sarcomeric actin as myocardial markers and HNK‐1 as a marker of cardiac conduction system showed HNK‐1 expression in the myocardium of the sinus venosus, where the main cardiac pacemaker is located. There was also staining of various intensity in the extracellular matrix of cardiac cushions in all the species examined. There was an HNK‐1 positive ring‐like structure of the developing ventricular septum in the Crocodylus, and increased positivity in the Varanus, while there was no myocardial staining in the ventricle of the Pogona. In all species there was a strong staining in the cardiac nervous fibers and ganglia, and in the epicardium of the Varanus. We conclude that a primordial conduction system is present in reptilian hearts. The embryonic crocodilian hearts possess a morphological preferential conduction pathway similar to one present in the hearts of birds and mammals. Its emergence correlates with completion of ventricular septation.

Support or Funding Information

Supported by Ministry of Education PRVOUK P35/LF/5, institutional grant RVO: 67985823 (The Czech Academy of Sciences), and GA CR 16‐02972S.
Ciona as a simple Chordate model for heart development and regeneration
Authors: Anderson Heather Evans
Published: November 2023

Cardiac cell specification and the genetic determinants that govern this process are highly conserved among Chordates. Ciona intestinalis is a well‐characterized invertebrate model system that presents many advantages to understanding evolutionarily‐conserved regulatory mechanisms, especially in the study of congenital heart defects and cardiac regeneration. As a basal Chordate, the Ciona model system presents a simple scaffold that recapitulates the basic blueprint of cardiac development in Chordates. The development and cellular structure of the heart of the ascidian Ciona shares many developmental processes with other Chordates, principally vertebrates. Ultrastructure analyses of Ciona myocardium reveals significant anatomical differences between more complex Chordates that may underlie the reported regenerative capacity of the Ciona myocardium. Comparison of the Ciona model system to heart development in other Chordates presents great potential for dissecting the genetic mechanisms that underlie congenital heart defects and disease at the cellular level and might provide additional insight into potential pathways for therapeutic cardiac regeneration.
Functional characterization of stap2b in zebrafish vascular development
Authors: Wang Yi‐Shan , Wu Chang‐Yi
Published: November 2023

Molecular mechanism of vascular formation is still not fully understood. We previously identified the transcription factors Islet2 (Isl2) and nr2f1b required for specification of the vein and ISV growth mediated by Notch pathway in zebrafish, and identify the potential downstream targets by performing the microarray experiments. In this study, we focus on the activation target signal‐transducing adaptor protein 2b (stap2b) and confirmed this gene expressed in vessels during early development indicating stap2b function in vascular development.

stap2 is identified as an adaptor protein that has been showed functions in a variety of cellular signal pathways in immune system, however, there is no description of stap2b functioning in vascular development so far. Our in‐situ hybridization results showed stap2b mRNA expressed in developing vessels, suggesting its roles in vasculization. Knockdown of stap2b by morpholino injection causes vascular defects, suggesting the role of stap2b in controlling ISV and CVP growth. AO staining and TUNEL assay showed that vascular defects do not caused by cell death, but due to the impairment of migration and/or proliferation by examining ISV integrity and ISV cell numbers in Tg(kdrl:mCherry; fli:neGFPy7) fish. We also found a decreased expression of flk, stabilin, enphrinb2, and flt4 in stap2b morphants. Moreover, overexpression of stap2b enhanced the growth of ISV and promotes endothelial cell migration and/or proliferation. These data suggest that stap2b is necessary and sufficient to promote vascular development.

We further examine the interaction between stap2b and Notch signals, we showed stap2b is regulated by Notch signals to control ISV growth. In addition, stap2b may interact with BMP signaling to function in CVP formation. Together, we conclude that our microarray results identify stap2b acting downstream of isl2/ nr2f1b pathway. We also showed that stap2b plays an important role for vascular development in zebrafish.