内镜黏膜下剥离术治疗早期食管癌及食管癌前病变

研究内镜黏膜下剥离术(ESD)治疗早期食管癌及食管癌前病变的治疗价值。对25例早期食管癌及食管癌前病变在确定病变范围及浸润深度后行黏膜下剥离术。先超声内镜判断浸润深度及利用Lugol液染色确定病灶范围,后采用术中标记、粘膜下注射、边缘粘膜切开、剥离及创面处理等方法。结果显示,病灶完整切除,术中无穿孔、出血;术后3、6、12月常规随访,均无复发。1例术后3个月出现食管狭窄,给予扩张后狭窄缓解。结果表明,对早期食管癌及食管癌前病变,内镜黏膜下剥离术是一种安全的内镜下治疗方法。     

Design and validation of a novel learning tool, the "Anato-Rug," for teaching equine topographical anatomy

Recognition of anatomical landmarks in live animals (and humans) is key for clinical practice, but students often find it difficult to translate knowledge from dissection‐based anatomy onto the live animal and struggle to acquire this vital skill. The purpose of this study was to create and evaluate the use of an equine anatomy rug (“Anato‐Rug”) depicting topographical anatomy and key areas of lung, heart, and gastrointestinal auscultation, which could be used together with a live horse to aid learning of “live animal” anatomy. Over the course of 2 weeks, 38 third year veterinary students were randomly allocated into an experimental group, revising topographical anatomy from the “Anato‐Rug,” or a control group, learning topographical anatomy from a textbook. Immediately post activity, both groups underwent a test on live anatomy knowledge and were retested 1 week later. Both groups then completed a questionnaire to ascertain their perceptions of their learning experiences. Results showed that the experimental groups scored significantly higher than the control group at the first testing session, experienced more enjoyment during the activity and gained more confidence in identifying anatomical landmarks than the control group. There was not a significant difference in scores between groups at the second testing session. The findings indicate that the anatomy rug is an effective learning tool that aids understanding, confidence, and enjoyment in learning equine thorax and abdominal anatomy; however it was not better than traditional methods with regards to longer term memory recall. Anat SciEduc. © 2012 American Association of Anatomists.     

Quality management of body donation program at the University of Padova

Quality management improvement has become a recent focus of attention in medical education. The program for the donation of bodies and body parts (Body Donation Program) at the University of Padova has recently been subjected to a global quality management standard, the ISO 9001:2008 certification. The aim of the present work is to show how the above standard is useful in enhancing the efficiency of body donation procedures and the quality and output of medical education. The program is managed by means of the following interlinked procedures: the collection of body donations, death certificates, data, and body parts from living donors; the transportation and identification of cadavers; the management of bodies, body parts, equipment, instruments, purchasing of necessary materials, and setting up anatomical training sessions; the management of preventive and corrective actions; the management of documents and registration; the management of internal and external quality audits; and the review of outcomes and improvement planning. Monitoring indicators are identified in the numbers of donors and of donated body parts per year, education sessions, and satisfaction of learners and donors, as evaluated by questionnaires. The process management approach, the integrated involvement of medical, technical, and administrative staff in defining procedures, and the application of monitoring indicators allow quality improvement in all aspects of the Body Donation Program. Anat Sci Educ. © 2012 American Association of Anatomists.     

Anatomy education in Namibia: balancing facility design and curriculum development

The anatomy curriculum at Namibia's first, and currently only, medical school is clinically oriented, outcome-based, and includes all of the components of modern anatomical sciences i.e., histology, embryology, neuroanatomy, gross, and clinical anatomy. The design of the facilities and the equipment incorporated into these facilities were directed toward simplification of work flow and ease of use by faculty, staff, and students. From the onset, the integration of state of the art technology was pursued to facilitate teaching and promote a student-centered pedagogical approach to dissections. The program, as realized, is comprised of three 16-week semesters with seven hours of contact time per week, namely three hours of lectures and four hours of dissection laboratory and microscopy time. Set outcomes were established, each revolving around clinical cases with integrated medical imaging. The design of the facility itself was not constrained by a legacy structure, allowing the School of Medicine, in collaboration with architects and contractors, to design the building from scratch. A design was implemented that allows for the sequential processing of cadaveric material in a unidirectional flow from reception, to preparation, embalming, storage, dissection, and maceration. Importantly, the odor of formaldehyde typically associated with anatomy facilities was eliminated outside of the dissection areas and minimized within via a high-performance ventilation system. By holistically incorporating an integrated curriculum, facility design, and teaching at an early stage, the authors believe they have created a system that might serve as a model for new anatomy programs.     

Reduction of mental distress in the dissection course by introducing the body donor experience through anatomical demonstrations of organ systems

The practice of dissection teaches students not only the foundations of anatomical knowledge but also encourages the development of professional competencies. Yet, the dissection of cadavers in the gross anatomy course can be a stress factor for medical students. There are a minor proportion of students who demonstrate strong emotional reactions in anticipation of being confronted with a cadaver. Therefore, in 2008, the authors implemented a voluntary course entitled, “Anatomical demonstrations of organ systems” (AD‐OS) in advance of the dissection course to ease this psychological burden. The question of whether attendees of AD‐OS showed less mental distress at the start of the dissection course compared with those that had not or only infrequently visited AD‐OS was addressed. AD‐OS attendees assessed their expected mental distress using a five‐point Likert scale before starting the dissection course and a second time at the end of their first day, after they had been confronted with a cadaver. AD‐OS was evaluated as excellent and the majority of students participated actively during teaching sessions. Overall, female students showed higher levels of mental distress. AD‐OS attendees assessed themselves as being less burdened by mental distress than members of the control group. Longitudinal analysis revealed that students who visited AD‐OS showed a marked decrease of their mental distress level, comparing prospective and retrospective ratings. This was significantly (P < 0.001; Z = ?6.061) different from nonattendees or those who visited AD‐OS only infrequently. AD‐OS satisfied its intended teaching goals and proved that a step‐by‐step introduction of dissection through anatomical demonstrations helped to reduce the mental distress of students. Future studies are planned to measure mental distress with objective instruments. Anat Sci Educ © 2012 American Association of Anatomists.     

Modernization of an anatomy class: From conceptualization to implementation. A case for integrated multimodal–multidisciplinary teaching

It has become increasingly apparent that no single method for teaching anatomy is able to provide supremacy over another. In an effort to consolidate and enhance learning, a modernized anatomy curriculum was devised by attempting to take advantage of and maximize the benefits from different teaching methods. Both the more traditional approaches to anatomy teaching, as well as modern, innovative educational programs were embraced in a multimodal system implemented over a decade. In this effort, traditional teaching with lectures and dissection was supplemented with models, imaging, computer‐assisted learning, problem‐based learning through clinical cases, surface anatomy, clinical correlation lectures, peer teaching and team‐based learning. Here, we review current thinking in medical education and present our transition from a passive, didactic, highly detailed anatomy course of the past, to a more interactive, as well as functionally and clinically relevant anatomy curriculum over the course of a decade. Anat Sci Educ. © 2012 American Association of Anatomists.     

Loosely‐guided,self‐directed learning versus strictly‐guided,station‐based learning in gross anatomy laboratory sessions

Anatomy students studying dissected anatomical specimens were subjected to either a loosely‐guided, self‐directed learning environment or a strictly‐guided, preformatted gross anatomy laboratory session. The current study's guiding questions were: (1) do strictly‐guided gross anatomy laboratory sessions lead to higher learning gains than loosely‐guided experiences? and (2) are there differences in the recall of anatomical knowledge between students who undergo the two types of laboratory sessions after weeks and months? The design was a randomized controlled trial. The participants were 360 second‐year medical students attending a gross anatomy laboratory course on the anatomy of the hand. Half of the students, the experimental group, were subjected without prior warning to station‐based laboratory sessions; the other half, the control group, to loosely‐guided laboratory sessions, which was the course's prevailing educational method at the time. The recall of anatomical knowledge was measured by written reproduction of 12 anatomical names at four points in time: immediately after the laboratory experience, then one week, five weeks, and eight months later. The strictly‐guided group scored higher than the loosely‐guided group at all time‐points. Repeated ANOVA showed no interaction between the results of the two types of laboratory sessions (P = 0.121) and a significant between‐subject effect (P ≤ 0.001). Therefore, levels of anatomical knowledge retrieved were significantly higher for the strictly‐guided group than for the loosely‐guided group at all times. It was concluded that gross anatomy laboratory sessions with strict instructions resulted in the recall of a larger amount of anatomical knowledge, even after eight months. Anat Sci Educ. © 2012 American Association of Anatomists.     

Autopsy-Based Learning is Essential But Underutilized in Medical Education: A Questionnaire Study

To this day, autopsies and dissections have been essential in medical education, but declining autopsy numbers have endangered this long-standing tradition. Students' perceptions of these teaching methods should be constantly updated to help educators understand how to achieve their teaching goals. The purpose of this study was to explore the state of autopsy- and dissection-based teaching in two Finnish universities based on the experiences of the students, survey their perceptions of such teaching, and to compare the Finnish situation with students' perceptions in other countries as it emerges from medical literature. A questionnaire went to 859 second-, fourth-, and sixth-year medical students. The questions concerned dissection and autopsy classes these students had attended, the views of the students in regard to the number of classes, and the benefits of and attitudes towards autopsy teaching. An open question of how to improve autopsy teaching was included. The response rate was 19.4%. Most respondents requested more autopsy and dissection classes, especially practical education. They found autopsies most beneficial in learning anatomy and dealing with one's own emotions related to death. Their experiences proved least beneficial for interaction with the relatives of a deceased patient and for people skills. Integrational methods and focusing on the main learning outcomes were suggested as improvements. Overall, students found dissection and autopsy teaching important, but felt concerned about the diminishing autopsy numbers. Focusing on main learning objectives and better integration of autopsies in the teaching of different specialties could help to utilize autopsies to a greater extent.     

Effect of Dental Course Cycle on Anatomical Knowledge and Dental Carving Ability of Dental Students

This study assessed the effect of the course cycle on theoretical knowledge of dental morphology and the dental carving ability of dental students. Thirty-two dental students from the third semester (initial cycle) and 30 students from the eighth and tenth semesters of the dental course (end cycle) had their theoretical knowledge on dental morphology assessed using a questionnaire with ten closed questions. Their dental carving ability was also assessed using wax carvings in macro models of plaster (for the third [S3] and eight [S8] semesters) and natural-sized artificial teeth (for the tenth [S10] semester). The teeth chosen for the dental carving activity were #16 and #47. The scores were statistically analyzed using the t-test, Kruskal–Wallis test, and Mann–Whitney test (α = 0.05). Students from the initial cycle presented better theoretical knowledge than the other groups did (P < 0.007). No significant differences in carving score were found between the initial and end cycles (P > 0.05), although S10 students obtained a higher score for teeth #16 and #47 (P < 0.05). Natural-sized artificial teeth received a higher evaluation score in dental carvings than the macro models (P < 0.001). Within the limits of this study, it was possible to conclude that students from the initial cycle (S3) presented higher theoretical knowledge, whereas no difference in carving ability was observed between the initial and end cycles. The tenth semester (S10) students performed dental carvings with better quality. Furthermore, carvings in natural-sized artificial teeth presented better quality compared with the macro models.     

The effect of simulation-based education before a cadaver dissection course

Although the methods for medical education continue to evolve due to the development of medicines, the cadaver dissection course still plays a fundamental role. The cadaver dissection course allows students to learn to handle instruments correctly while actively exploring three-dimensional anatomy. However, dissection comes with the risk of accidental injury. In recent years, the number of classes offered for the cadaver dissection course has decreased while the amount of knowledge required in clinical medicine has increased. Simulation-based education (SBE) has been proven to be an effective educational method that enhances the development of practical skills by integrating learners' knowledge and skills. This study aimed to investigate the effect of SBE as a preparatory education course when taken prior to a medical student's enrollment in the cadaver dissection course. In the present study, an SBE assuming practical cadaver dissection course was performed in the Clinical Simulation Center. The frequency of injury rates per 1000 h of cadaver dissection course was significantly less in 2017 and 2018 compared to that in 2016. Two years after the implementation of the SBE, average student self-efficacy scores and written examination scores significantly increased, whereas self-contentment scores were relatively unchanged. The results showed that the implementation of SBE decreased the incidence of injuries and improved students' overall self-efficacy scores and increased acquisition of knowledge evident on written examination score. Therefore, SBE as a preparatory education course may effectively promote the combined development of dissection skills and anatomical knowledge in the subsequent fundamental cadaver dissection course.