Evaluation of usage of virtual microscopy for the study of histology in the medical,dental, and veterinary undergraduate programs of a UK University

This article describes the introduction of a virtual microscope (VM) that has allowed preclinical histology teaching to be fashioned to better suit the needs of approximately 900 undergraduate students per year studying medicine, dentistry, or veterinary science at the University of Bristol, United Kingdom. Features of the VM implementation include: (1) the facility for students and teachers to make annotations on the digital slides; (2) in‐house development of VM‐based quizzes that are used for both formative and summative assessments; (3) archiving of teaching materials generated each year, enabling students to access their personalized learning resources throughout their programs; and (4) retention of light microscopy capability alongside the VM. Student feedback on the VM is particularly positive about its ease of use, the value of the annotation tool, the quizzes, and the accessibility of all components off‐campus. Analysis of login data indicates considerable, although variable, use of the VM by students outside timetabled teaching. The median number of annual logins per student account for every course exceeded the number of timetabled histology classes for that course (1.6–3.5 times). The total number of annual student logins across all cohorts increased from approximately 9,000 in the year 2007–2008 to 22,000 in the year 2010–2011. The implementation of the VM has improved teaching and learning in practical classes within the histology laboratory and facilitated consolidation and revision of material outside the laboratory. Discussion is provided of some novel strategies that capitalize on the benefits of introducing a VM, as well as strategies adopted to overcome some potential challenges. Anat Sci Educ 7: 389–398. © 2013 American Association of Anatomists.     

Anatomy integration blueprint: A fourth‐year musculoskeletal anatomy elective model

Current undergraduate medical school curricular trends focus on both vertical integration of clinical knowledge into the traditionally basic science‐dedicated curricula and increasing basic science education in the clinical years. This latter type of integration is more difficult and less reported on than the former. Here, we present an outline of a course wherein the primary learning and teaching objective is to integrate basic science anatomy knowledge with clinical education. The course was developed through collaboration by a multi‐specialist course development team (composed of both basic scientists and physicians) and was founded in current adult learning theories. The course was designed to be widely applicable to multiple future specialties, using current published reports regarding the topics and clinical care areas relying heavily on anatomical knowledge regardless of specialist focus. To this end, the course focuses on the role of anatomy in the diagnosis and treatment of frequently encountered musculoskeletal conditions. Our iterative implementation and action research approach to this course development has yielded a curricular template for anatomy integration into clinical years. Key components for successful implementation of these types of courses, including content topic sequence, the faculty development team, learning approaches, and hidden curricula, were developed. We also report preliminary feedback from course stakeholders and lessons learned through the process. The purpose of this report is to enhance the current literature regarding basic science integration in the clinical years of medical school. Anat Sci Educ 7: 379–388. © 2014 American Association of Anatomists.     

Spatial visualization ability and laparoscopic skills in novice learners: Evaluating stereoscopic versus monoscopic visualizations

Elevated spatial visualization ability (Vz) is thought to influence surgical skill acquisition and performance. Current research suggests that stereo visualization technology and its association with skill performance may confer perceptual advantages. This is of particular interest in laparoscopic skill training, where stereo visualization may confer learning advantages to novices of variant Vz. This study explored laparoscopic skill performance scores in novices with variable spatial ability utilizing stereoscopic and traditional monoscopic visualization paradigms. Utilizing the McGill Inanimate System for Teaching and Evaluating Laparoscopic Skills (MISTELS) scoring protocol it was hypothesized that individuals with high spatial visualization ability (HVz) would achieve higher overall and individual MISTELS task scores as compared to low spatial visualization ability (LVz) counterparts. Further, we also hypothesized that a difference would exist between HVz and LVz individual scores based on the viewing modality employed. No significant difference was observed between HVz and LVz individuals for MISTELS tasks scores, overall or individually under both viewing modalities, despite higher average MISTELS scores for HVz individuals. The lack of difference between scores obtained under the stereo modality suggested that the additional depth that is conferred by the stereoscopic visualization may act to enhance performance for individuals with LVz, potentially equilibrating their performance with their HVz peers. Further experimentation is required to better ascertain the effects of stereo visualization in individuals of high and low Vz, though it appears stereoscopic visualizations could serve as a prosthetic to enhance skill performance. Anat Sci Educ 7: 295–301. © 2013 American Association of Anatomists.     

Determination of clinically relevant content for a musculoskeletal anatomy curriculum for physical medicine and rehabilitation residents

To address the need for more clinical anatomy training in residency education, many postgraduate programs have implemented structured anatomy courses into their curriculum. Consensus often does not exist on specific content and level of detail of the content that should be included in such curricula. This article describes the use of the Delphi method to identify clinically relevant content to incorporate in a musculoskeletal anatomy curriculum for Physical Medicine and Rehabilitation (PM&R) residents. A two round modified Delphi involving PM&R experts was used to establish the curricular content. The anatomical structures and clinical conditions presented to the expert group were compiled using multiple sources: clinical musculoskeletal anatomy cases from the PM&R residency program at the University of Toronto; consultation with PM&R experts; and textbooks. In each round, experts rated the importance of each curricular item to PM&R residency education using a five‐point Likert scale. Internal consistency (Cronbach's alpha) was used to determine consensus at the end of each round and agreement scores were used as an outcome measure to determine the content to include in the curriculum. The overall internal consistency in both rounds was 0.99. A total of 37 physiatrists from across Canada participated and the overall response rate over two rounds was 97%. The initial curricular list consisted of 361 items. After the second iteration, the list was reduced by 44%. By using a national consensus method we were able to objectively determine the relevant anatomical structures and clinical musculoskeletal conditions important in daily PM&R practice. Anat Sci Educ 7: 135–143. © 2013 American Association of Anatomists.     

Beyond Punnett Squares: Student Word Association and Explanations of Phenotypic Variation through an Integrative Quantitative Genetics Unit Investigating Anthocyanin Inheritance and Expression in Brassica rapa Fast Plants

Genetics instruction in introductory biology is often confined to Mendelian genetics and avoids the complexities of variation in quantitative traits. Given the driving question “What determines variation in phenotype (Pv)? (Pv=Genotypic variation Gv + environmental variation Ev),” we developed a 4-wk unit for an inquiry-based laboratory course focused on the inheritance and expression of a quantitative trait in varying environments. We utilized Brassica rapa Fast Plants as a model organism to study variation in the phenotype anthocyanin pigment intensity. As an initial curriculum assessment, we used free word association to examine students’ cognitive structures before and after the unit and explanations in students’ final research posters with particular focus on variation (Pv = Gv + Ev). Comparison of pre- and postunit word frequency revealed a shift in words and a pattern of co-occurring concepts indicative of change in cognitive structure, with particular focus on “variation” as a proposed threshold concept and primary goal for students’ explanations. Given review of 53 posters, we found ∼50% of students capable of intermediate to high-level explanations combining both Gv and Ev influence on expression of anthocyanin intensity (Pv). While far from “plug and play,” this conceptually rich, inquiry-based unit holds promise for effective integration of quantitative and Mendelian genetics.     

The influence of partner cues on the extinction of causal judgments in people

Studies in laboratory animals have shown that the extinction of a conditioned stimulus, A, is regulated by the associative history of a second stimulus, X, when the two are extinguished in simultaneous compound: An inhibitory X protects A from extinction (Rescorla Learning & Behavior, 31, 124–132, 2003), whereas an excitatory X facilitates, and under some circumstances deepens, the extinction of A (Rescorla Journal of Experimental Psychology: Animal Behavior Processes, 26, 251–260, 2000, Journal of Experimental Psychology: Animal Behavior Processes, 32, 135–144, 2006). In the present study, we used the allergist task to examine whether the extinction of causal judgments in people is similarly regulated by the causal status of co-present stimuli. Experiment 1 showed that a cue trained as a conditioned inhibitor protected a target cue from extinction: The target extinguished in compound with the inhibitor was rated as being more causal of the outcome than was a target extinguished in compound with a control cue lacking inhibitory properties. In contrast, the remaining experiments showed that the extinction of a target cue was regulated by the presence, but not the causal status, of a partner cue: Target cues extinguished in compound were protected from extinction, and no evidence showed that an already extinguished partner conferred more protection (Exp. 2), or that an excitatory partner conferred any less protection (Exps. 2 and 3), or that an excitatory partner deepened the extinction of its already extinguished target. These findings are inconsistent with elemental models that rely on a common error term to explain associative changes in extinction. They are largely, but not completely, consistent with the configural model proposed by Pearce (Psychological Review, 94, 61–73, 1987), which predicts an ordering of levels of protection that was not observed.     

Benzodiazepine administration prevents the use of error-correction mechanisms during fear extinction

Three experiments examined the effect of systemic administration of the benzodiazepine midazolam on extinction and re-extinction of conditioned fear. Experiment 1 demonstrated that midazolam administration prior to extinction of a conditioned stimulus (CS) impaired that extinction when rats were subsequently tested drug free; however, extinction was spared if rats were extinguished, reconditioned, and re-extinguished under midazolam. Experiment 2 provided a replication of this effect within-subjects; rats were conditioned to two CSs (A and B), extinguished to one (A-), reconditioned to both, and then extinguished/re-extinguished to both stimuli in compound (AB-), under either vehicle or midazolam. On the drug-free test, rats given midazolam froze more to the CS that had been extinguished (B) than the one that been re-extinguished (A). The final experiment examined whether extinction under midazolam was regulated by prediction error. Rats were trained with three CSs (A, B, C) and extinguished to two (A-, C-). These stimuli then underwent additional extinction under midazolam or vehicle, with one CS now presented in compound with the non-extinguished CS (AB-, C-). Rats were then tested for fear of A relative to C. Rats given vehicle showed a deepening of extinction to A relative to C, as is predicted from error-correction models; however, rats given midazolam failed to show any such discrepancy in responding. The results are interpreted to indicate that the drug reduced prediction error during extinction by reducing fear, and rats were able to re-extinguish fear via a retrieval mechanism that is independent of prediction error.