Neuroanatomical photogrammetric models using smartphones: a comparison of apps.

OBJECTIVES: A deep knowledge of the surgical anatomy of the target area is mandatory for a successful operative procedure. For this purpose, over the years, many teaching and learning methods have been described, from the most ancient cadaveric dissection to the most recent virtual reality, each with their respective pros and cons. Photogrammetry, an emergent technique, allows for the creation of three-dimensional (3D) models and reconstructions. Thanks to the spreading of photogrammetry nowadays it is possible to generate these models using professional software or even smartphone apps. This study aims to compare the neuroanatomical photogrammetric models generated by the two most utilized smartphone applications in this domain, Metascan and 3D-Scanner, through quantitative analysis. METHODS: Two human head specimens (four sides) were examined. Anatomical dissection was segmented into five stages to systematically expose well-defined structures. After each stage, a photogrammetric model was generated using two prominent smartphone applications. These models were then subjected to both quantitative and qualitative analysis, with a specific focus on comparing the mesh density as a measure of model resolution and accuracy. Appropriate consent was obtained for the publication of the cadaver's image. RESULTS: The quantitative analysis revealed that the models generated by Metascan app consistently demonstrated superior mesh density compared to those from 3D-Scanner, indicating a higher level of detail and potential for precise anatomical representation. CONCLUSION: Enabling depth perception, capturing high-quality images, offering flexibility in viewpoints: photogrammetry provides researchers with unprecedented opportunities to explore and understand the intricate and magnificent structure of the brain. However, it is of paramount importance to develop and apply rigorous quality control systems to ensure data integrity and reliability of findings in neurological research. This study has demonstrated the superiority of Metascan in processing photogrammetric models for neuroanatomical studies.

"Visualization matters" - stereoscopic visualization of 3D graphic neuroanatomic models through AnaVu enhances basic recall and radiologic anatomy learning when compared with monoscopy.

BACKGROUND: The authors had previously developed AnaVu, a low-resource 3D visualization tool for stereoscopic/monoscopic projection of 3D models generated from pre-segmented MRI neuroimaging data. However, its utility in neuroanatomical education compared to conventional methods (specifically whether the stereoscopic or monoscopic mode is more effective) is still unclear. METHODS: A three-limb randomized controlled trial was designed. A sample (n = 152) from the 2022 cohort of MBBS students at Government Medical College, Thiruvananthapuram (GMCT), was randomly selected from those who gave informed consent. After a one-hour introductory lecture on brainstem anatomy and a dissection session, students were randomized to three groups (S - Stereo; M - Mono and C - Control). S was given a 20-min demonstration on the brainstem lesson module in AnaVu in stereoscopic mode. M was given the same demonstration, but in monoscopic mode. The C group was taught using white-board drawn diagrams. Pre-intervention and post-intervention tests for four domains (basic recall, analytical, radiological anatomy and diagram-based questions) were conducted before and after the intervention. Cognitive loads were measured using a pre-validated tool. The groups were then swapped -S→ M, M →S and C→S, and they were asked to compare the modes. RESULTS: For basic recall questions, there was a statistically significant increase in the pre/post-intervention score difference of the S group when compared to the M group [p = 0.03; post hoc analysis, Bonferroni corrections applied] and the C group [p = 0.001; ANOVA test; post hoc analysis, Bonferroni corrections applied]. For radiological anatomy questions, the difference was significantly higher for S compared to C [p < 0.001; ANOVA test; post hoc analysis, Bonferroni corrections applied]. Cognitive load scores showed increased mean germane load for S (33.28 ± 5.35) and M (32.80 ± 7.91) compared with C (28.18 ± 8.17). Subjective feedbacks showed general advantage for S and M compared to C. Out of the S and M swap cohorts, 79/102 preferred S, 13/102 preferred M, and 6/102 preferred both. CONCLUSIONS: AnaVu tool seems to be effective for learning neuroanatomy. The specific advantage seen when taught with stereoscopy in basic recall and radiological anatomy learning shows the importance of how visualization mode influences neuroanatomy learning. Since both S and M are preferred in subjective feedbacks, these results have implications in choosing methods (stereoscopic - needs 3D projectors; monoscopic - needs web based or hand-held devices) to scale AnaVu for anatomy teaching in medical colleges in India. Since stereoscopic projection is technically novel and cost considerations are slightly higher compared to monoscopic projection, the specific advantages and disadvantages of each are relevant in the Indian medical education scenario.

User acceptance of neuroanatomy virtual reality course: Contrasting views between undergraduate and postgraduate students.

Virtual Reality (VR) offers cost-efficient and effective tools for spatial 3-dimensional neuroanatomy learning. Enhancing users-system relationship is necessary for successful adoption of the system. The current study aimed to evaluate students' acceptance of VR for neuroanatomy. An exploratory qualitative case study based on Unified Theory of Acceptance and Use of Technology (UTAUT) framework carried out at [details omitted for double-anonymized peer review]. Participants in this study were students participating in a VR session, followed by a semi-structured interview. Deductive framework analysis employed to retrieve students' perspective and experience. A total of six undergraduate and 13 postgraduate students participated in this study. The following UTAUT constructs validated to be significant: Performance Expectancy, Effort Expectancy and Facilitating Conditions. System usability, depth of lesson and hardware optimizations are among concern for further improvements. In conclusion, students are accepting VR as a neuroanatomy learning resource. The findings of this research highlight the importance of system performance and user-centred approach in technology development for educational purposes.

Photogrammetry scans for neuroanatomy education - a new multi-camera system: technical note.

Photogrammetry scans has directed attention to the development of advanced camera systems to improve the creation of three-dimensional (3D) models, especially for educational and medical-related purposes. This could be a potential cost-effective method for neuroanatomy education, especially when access to laboratory-based learning is limited. The aim of this study was to describe a new photogrammetry system based on a 5 Digital Single-Lens Reflex (DSLR) cameras setup to optimize accuracy of neuroanatomical 3D models. One formalin-fixed brain and specimen and one dry skull were used for dissections and scanning using the photogrammetry technique. After each dissection, the specimens were placed inside a new MedCreator® scanner (MedReality, Thyng, Chicago, IL) to be scanned with the final 3D model being displayed on SketchFab® (Epic, Cary, NC) and MedReality® platforms. The scanner consisted of 5 cameras arranged vertically facing the specimen, which was positioned on a platform in the center of the scanner. The new multi-camera system contains automated software packages, which allowed for quick rendering and creation of a high-quality 3D models. Following uploading the 3D models to the SketchFab® and MedReality® platforms for display, the models can be freely manipulated in various angles and magnifications in any devices free of charge for users. Therefore, photogrammetry scans with this new multi-camera system have the potential to enhance the accuracy and resolution of the 3D models, along with shortening creation time of the models. This system can serve as an important tool to optimize neuroanatomy education and ultimately, improve patient outcomes.

3D Models as a Source for Neuroanatomy Education: A Stepwise White Matter Dissection Using 3D Images and Photogrammetry Scans.

White matter dissection (WMD) involves isolating bundles of myelinated axons in the brain and serves to gain insights into brain function and neural mechanisms underlying neurological disorders. While effective, cadaveric brain dissections pose certain challenges mainly due to availability of resources. Technological advancements, such as photogrammetry, have the potential to overcome these limitations by creating detailed three-dimensional (3D) models for immersive learning experiences in neuroanatomy. This study aimed to provide a detailed step-by-step WMD captured using two-dimensional (2D) images and 3D models (via photogrammetry) to serve as a comprehensive guide for studying white matter tracts of the brain. One formalin-fixed brain specimen was utilized to perform the WMD. The brain was divided in a sagittal plane and both cerebral hemispheres were stored in a freezer at -20 °C for 10 days, then thawed under running water at room temperature. Micro-instruments under an operating microscope were used to perform a systematic lateral-to-medial and medial-to-lateral dissection, while 2D images were captured and 3D models were created through photogrammetry during each stage of the dissection. Dissection was performed with comprehensive examination of the location, main landmarks, connections, and functions of the white matter tracts of the brain. Furthermore, high-quality 3D models of the dissections were created and housed on SketchFab®, allowing for accessible and free of charge viewing for educational and research purposes. Our comprehensive dissection and 3D models have the potential to increase understanding of the intricate white matter anatomy and could provide an accessible platform for the teaching of neuroanatomy.

GRAVEN: a database of teaching method that applies gestures to represent the neurosurgical approach's blood vessels and nerves.

BACKGROUND: In this era of rapid technological development, medical schools have had to use modern technology to enhance traditional teaching. Online teaching was preferred by many medical schools. However due to the complexity of intracranial anatomy, it was challenging for the students to study this part online, and the students were likely to be tired of neurosurgery, which is disadvantageous to the development of neurosurgery. Therefore, we developed this database to help students learn better neuroanatomy. MAIN BODY: The data were sourced from Rhoton's Cranial Anatomy and Surgical Approaches and Neurosurgery Tricks of the Trade in this database. Then we designed many hand gesture figures connected with the atlas of anatomy. Our database was divided into three parts: intracranial arteries, intracranial veins, and neurosurgery approaches. Each section below contains an atlas of anatomy, and gestures represent vessels and nerves. Pictures of hand gestures and atlas of anatomy are available to view on GRAVEN ( www.graven.cn ) without restrictions for all teachers and students. We recruited 50 undergraduate students and randomly divided them into two groups: using traditional teaching methods or GRAVEN database combined with above traditional teaching methods. Results revealed a significant improvement in academic performance in using GRAVEN database combined with traditional teaching methods compared to the traditional teaching methods. CONCLUSION: This database was vital to help students learn about intracranial anatomy and neurosurgical approaches. Gesture teaching can effectively simulate the relationship between human organs and tissues through the flexibility of hands and fingers, improving anatomy interest and education.

Investigating the impact of remote neuroanatomy education during the COVID-19 pandemic using online examination performance in a National Undergraduate Neuroanatomy Competition.

Neuroanatomy is a notoriously challenging subject for medical students to learn. Due to the coronavirus disease-19 (COVID-19) pandemic, anatomical education transitioned to an online format. We assessed student performance in, and attitudes toward, an online neuroanatomy assessment compared to an in-person equivalent, as a marker of the efficacy of remote neuroanatomy education. Participants in the National Undergraduate Neuroanatomy Competition (NUNC) 2021 undertook two online examinations: a neuroanatomically themed multiple-choice question paper and anatomy spotter. Students completed pre- and post-examination questionnaires to gauge their attitudes toward the online competition and prior experience of online anatomical teaching/assessment. To evaluate performance, we compared scores of students who sat the online (2021) and in-person (2017) examinations, using 12 identical neuroradiology questions present in both years. Forty-six percent of NUNC 2021 participants had taken an online anatomy examination in the previous 12 months, but this did not impact examination performance significantly (p > 0.05). There was no significant difference in examination scores between in-person and online examinations using the 12 neuroradiology questions (p = 0.69). Fifty percent of participants found the online format less enjoyable, with 63% citing significantly fewer networking opportunities. The online competition was less stressful for 55% of participants. This study provides some evidence to suggest that student performance is not affected when undertaking online examinations and proposes that online neuroanatomy teaching methods, particularly for neuroradiology, may be equally as effective as in-person approaches within this context. Participants perceived online examinations as less stressful but raised concerns surrounding the networking potential and enjoyment of online events.

Creating a neuroanatomy education model with augmented reality and virtual reality simulations of white matter tracts.

OBJECTIVE: The utilization of digital technologies has experienced a notable surge, particularly in cases where access to cadavers is constrained, within the context of practical neuroanatomy training. This study evaluates augmented reality (AR)- and virtual reality (VR)-based educational models for neuroanatomy education. METHODS: Three-dimensional models were created using advanced photogrammetry. VR- and AR-based educational models were developed by arranging these 3D models to align with the learning objectives of neurosurgery residents and second-year medical students whose cadaveric training was disrupted due to an earthquake in Turkey. Participants engaged with and evaluated the VR- and AR-based educational models, followed by the completion of a 20-item graded user experience survey. A 10-question mini-test was given to assess the baseline knowledge level prior to training and to measure the achievement of learning objectives after training. RESULTS: Forty neurosurgery residents were trained with a VR-based educational model using VR headsets. An AR-based educational model was provided online to 200 second-year medical students for their practical neuroanatomy lesson. The average correct answer rates before the training were 7.5/10 for residents and 4.8/10 for students. These rates were significantly improved after the training to 9.7/10 for residents and to 8.7/10 for students (p < 0.001). Feedback from the users concurred that VR- and AR-based training could significantly enhance the learning experience in the field of neuroanatomy. CONCLUSIONS: VR/AR-based educational models have the potential to improve education. VR/AR-based training systems can serve as an auxiliary tool in neuroanatomy training, offering a realistic alternative to traditional learning tools.

Towards a Terminologia Anatomica Humana.

Unfortunately, the long-awaited revision of the official anatomical nomenclature, the Terminologia Anatomica 2 (TA2), which was issued in 2019 and after a referendum among the Member Societies officially approved by the General Assembly of the International Federation of Associations of Anatomists in 2020, is built on a new version of the Regular Anatomical Terminology (RAT) rules. This breaks with many traditional views of terminology. These changes in the Terminologia Anatomica of 1998 (TA98) met great resistance within many European Anatomical Societies and their members are not willing to use terms following the RAT rules. European anatomy teachers and scientists using traditional Latin in their teaching, textbooks and atlases will keep using the TA98. The German Anatomical Society (Anatomische Gesellschaft) recently announced the usage of the TA2023AG in curricular anatomical media such as textbooks and atlases, based on the TA98 and the Terminologia Neuroanatomica (TNA). We are preparing a more extensive improvement of the TA98, called Terminologia Anatomica Humana (TAH). This project is fully based on the noncontroversial terms of TA98, incorporating the recent digital version (2022) of the TNA from 2017. Further, it is completed with many new terms, including those in TA2, along with their definitions and relevant references, clinical terms, and correcting inconsistencies in the TA98. The TAH is still in process, but many chapters are already freely available at the IFAA Website in Fribourg ( https://ifaa.unifr.ch ) as is the digital version of the TNA.

Mixed reality compared to the traditional ex cathedra format for neuroanatomy learning: the value of a three-dimensional virtual environment to better understand the real world.

OBJECTIVE: Neuroanatomy comprehension is a keystone of understanding intracranial surgeries. Traditionally taught to students during ex cathedra courses, neuroanatomy is described as complex. Mixed reality (MxR) opens new perspectives in the learning process. This study aims to compare MxR-based courses with traditional ex cathedra lectures for neuroanatomy education. METHODS: Two lectures describing the neuroanatomy of the anterior circulation arteries ("Vascular Lecture" [VS]) and important white matter fiber tracts ("White Fibers Lecture" [WF]) were designed and delivered in ex cathedra and MxR-based formats with the same audio content. Ninety-one medical students were randomly assigned to group A (ex cathedra WF/MxR VS) or group B (MxR WF/ex cathedra VS). The MxR content was delivered via MxR goggles. Prior to each lecture, students took a 10-item multiple choice question (MCQ) pretest. After the lectures, students took a 20-item MCQ posttest (75% neuroanatomy, 25% clinical correlation). RESULTS: The pretest scores showed no statistical difference between groups. Median posttest scores increased by 14.3% after using the MxR-based format compared to the ex cathedra format (16.00 [13.0, 18.0] vs 14.0 [11.0, 17.0], respectively, p < 0.01). Regarding the VS, students scored 21.7% better using the MxR format compared to the ex cathedra format (14.0 [12.0, 16.0] vs 11.5 [10.0, 14.0], p < 0.001). Concerning the WF, the median score using MxR was 18.0 (17.0, 19.0), and the median score using the ex cathedra format was 17.0 (16.0, 18.0; p < 0.01). Students showed high motivation to learn neuroanatomy in the future using MxR (74%) rather than ex cathedra format (25%; p < 0.001). Mild discomfort using the MxR goggles was reported by 48.3% of participants. Most participants (95.5%) preferred the MxR-based teaching. CONCLUSIONS: Students acquired a better knowledge of the anatomy of the anterior circulation arteries and white fiber tracts using MxR-based teaching as compared to the standard ex cathedra format. The perception of lecture quality and learning motivation was better using MxR-based teaching despite some mild discomfort. The development of MxR-based solutions is promising to improve neuroanatomy education.

Creation of a microsurgical neuroanatomy laboratory and virtual operating room: a preliminary study.

OBJECTIVE: A comprehensive understanding of microsurgical neuroanatomy, familiarity with the operating room environment, patient positioning in relation to the surgery, and knowledge of surgical approaches is crucial in neurosurgical education. However, challenges such as limited patient exposure, heightened patient safety concerns, a decreased availability of surgical cases during training, and difficulties in accessing cadavers and laboratories have adversely impacted this education. Three-dimensional (3D) models and augmented reality (AR) applications can be utilized to depict the cortical and white matter anatomy of the brain, create virtual models of patient surgical positions, and simulate the operating room and neuroanatomy laboratory environment. Herein, the authors, who used a single application, aimed to demonstrate the creation of 3D models of anatomical cadaver dissections, surgical approaches, patient surgical positions, and operating room and laboratory designs as alternative educational materials for neurosurgical training. METHODS: A 3D modeling application (Scaniverse) was employed to generate 3D models of cadaveric brain specimens and surgical approaches using photogrammetry. It was also used to create virtual representations of the operating room and laboratory environment, as well as the surgical positions of patients, by utilizing light detection and ranging (LiDAR) sensor technology for accurate spatial mapping. These virtual models were then presented in AR for educational purposes. RESULTS: Virtual representations in three dimensions were created to depict cadaver specimens, surgical approaches, patient surgical positions, and the operating room and laboratory environment. These models offer the flexibility of rotation and movement in various planes for improved visualization and understanding. The operating room and laboratory environment were rendered in three dimensions to create a simulation that could be navigated using AR and mixed reality technology. Realistic cadaveric models with intricate details were showcased on internet-based platforms and AR platforms for enhanced visualization and learning. CONCLUSIONS: The utilization of this cost-effective, straightforward, and readily available approach to generate 3D models has the potential to enhance neuroanatomical and neurosurgical education. These digital models can be easily stored and shared via the internet, making them accessible to neurosurgeons worldwide for educational purposes.

Comparison of the study performance of dental students in different subfields of neuroanatomy at the Charité - Universitätsmedizin Berlin and evaluation of the neuroanatomy course in the fourth preclinical semester.

INTRODUCTION: The dentist's main working area is the head and neck region, which is innervated by the cranial nerves. On a daily basis, dentists must administer local anaesthesia to ensure pain-free treatment and differentiate between dental pain and neuropathies to avoid mistreatment. Therefore, neuroanatomical training, especially on the cranial nerves, is of immense importance for clinical practice. In order to adopt the curriculum, it is essential to constantly evaluate the quality of the training and to investigate whether there is a correlation between the students' performance and the relevance of the subfields to their work. MATERIAL AND METHODS: To address this issue, the results of MC exams in the neuroanatomy course for dental students at Charité-Universitätsmedizin Berlin from winter semester 2014/2015 to winter semester 2019/2020 were analysed. Each question was assigned to a specific subfield of neuroanatomy. We then compared cranial nerves and cranial nerve nuclei (clinically relevant) with the remaining subfields (clinically less/not relevant) to investigate whether students performed better in anatomy subfields that are more aligned with the clinical practice of a dentist. We also conducted an anonymous survey (n=201) of the dental students. RESULTS: From winter semester 2014/2015 to winter semester 2019/2020, students performed significantly (***, p< 0.001) better on the clinically relevant questions of the MC examination than on the less/not clinically relevant questions. However, when looking at each of the eleven semesters separately, only three semesters actually performed significantly better on the clinically relevant questions. Our survey also showed that students perceived the subfield of cranial nerves and cranial nerve nuclei to be the most relevant and studied it more intensively out of their own interest. DISCUSSION: The study showed that students perceived the subfield of cranial nerves and cranial nerve nuclei to be the most relevant. However, there was no direct correlation between student performance and clinically relevant questions. Using student performance alone as an indicator of relevance is not optimal, as factors such as motivation to learn can have a significant impact. CONCLUSION: Greater clinical relevance influences what students learn more intensively out of their own interest, but does not influence the results of the MC examination in favour of the subspecialty. Based on the available evidence, it is recommended that the structure of the neuroanatomy course be reconsidered.

Projection of realistic three-dimensional photogrammetry models using stereoscopic display: A technical note.

The 3D stereoscopic technique consists in providing the illusional perception of depth of a given object using two different images mimicking how the right and left eyes capture the object. Both images are slightly different and when overlapped gives a three-dimensional (3D) experience. Considering the limitations for establishing surgical laboratories and dissections courses in some educational institutions, techniques such as stereoscopy and photogrammetry seem to play an important role in neuroanatomy and neurosurgical education. The aim of this study was to describe how to combine and set up realistic models acquired with photogrammetry scans in 3D stereoscopic projections. Three donors, one dry skull, embalmed brain and head, were scanned using photogrammetry. The software used for displaying the final realistic 3D models (Blender, Amsterdam, the Netherlands) is a free software and allows stereoscopic projection without compromising the interactivity of each model. By default, the model was exported and immediately displayed as a red cyan 3D mode. The 3D projector used in the manuscript required a side-by-side 3D mode which was set up with simple commands on the software. The final stereoscopy projection offered depth perception and a visualization in 360° of each donor; this perception was noted especially when visualizing donors with different cavities and fossae. The combination of 3D techniques is of paramount importance for neuroanatomy education. Stereoscopic projections could provide a valuable tool for neuroanatomy instruction directed at clinical trainees and could be especially useful when access to laboratory-based learning is limited.

Neuroanatomy in virtual reality: Development and pedagogical evaluation of photogrammetry-based 3D brain models.

Anatomy studies are an essential part of medical training. The study of neuroanatomy in particular presents students with a unique challenge of three-dimensional spatial understanding. Virtual Reality (VR) has been suggested to address this challenge, yet the majority of previous reports have implemented computer-generated or imaging-based models rather than models of real brain specimens. Using photogrammetry of real human bodies and advanced editing software, we developed 3D models of a real human brain at different stages of dissection. Models were placed in a custom-built virtual laboratory, where students can walk around freely, explore, and manipulate (i.e., lift the models, rotate them for different viewpoints, etc.). Sixty participants were randomly assigned to one of three learning groups: VR, 3D printed models or read-only, and given 1 h to study the white matter tracts of the cerebrum, followed by theoretical and practical exams and a learning experience questionnaire. We show that following self-guided learning in virtual reality, students demonstrate a gain in spatial understanding and an increased satisfaction with the learning experience, compared with traditional learning approaches. We conclude that the models and virtual lab described in this work may enhance learning experience and improve learning outcomes.

Creating evidence-based engaging online learning resources in neuroanatomy.

Online anatomical resources are rising in popularity since the COVID-19 pandemic, but the pedagogical principles and effectiveness of their use remain unclear. This article aims to demonstrate evidence-informed ways in which fellow educators can create engaging online learning resources in clinical neuroanatomy and compare the effectiveness of text-based and online learning resources. Data were analyzed from the Soton Brain Hub (SBH) YouTube page. Separately, a cross-sectional study comparing the learning gain of using text-based and video resources was done. The knowledge gain and retention were compared between groups using a pre-teaching and post-teaching multiple choice questions. YouTube analytics showed the average time a viewer spends on a video was found to be highly correlated to the length of the video, r = 0.77, p < 0.001 (0.69-0.82). The cross-sectional study indicated a significant difference in mean normalized learning gain of video resources 61.9% (n = 53, CI 56.0-67.7%) versus text resources 49.6% (n = 23, CI 39.1-60.1%) (p = 0.030). However, there was no difference in retained learning gain between video resources 39.1% (n = 29, CI 29.2-49.0%) versus text-based 40.0% (n = 13, CI 23.9-56.1%) (p = 0.919). Students engage most with short videos less than 5 min which reduces the intrinsic load of learning. Online resources are as effective as text-based resources in providing learning gain and retention. In the future, the continued rise in popularity of online learning resources may result in further reduction in traditional face-to-face teaching.

Medical Undergraduates' Assessment Status Regarding Clinical Neuroanatomy.

The study of Anatomy is essential to the learning of different subjects of medicine. Neuroanatomy is a fundamental part of the Anatomy portion of the undergraduate medical (MBBS) curriculum of different universities of Bangladesh. The clinical relevance of Neuroanatomy is beyond doubt in the context of increasing numbers of cases like stroke, head injury and meningitis in Bangladesh. Contemporary Neuroanatomy books are inclined to a clinically-oriented approach in their presentation. However, there is no organized attempt to analyze these recent trends of highlighting the significance of clinically-oriented approach reflected in the learning pattern or student-assessment in the medical undergraduate courses of Bangladesh. Such analyses can offer an insight into the situation and facilitate teachers and curriculum planners to make necessary modifications. The present study was planned- i) to analyze the Neuroanatomy portion of the recent undergraduate Anatomy written question papers of four public universities of Bangladesh for understanding how clinically relevant knowledge has been assessed in the questions ii) to determine the ability of the medical undergraduates to answer clinically-oriented written questions as compared to their ability to answer non-clinically-oriented questions in Neuroanatomy. It was a comparative study with some descriptive components. For Part-A of the study, all the 'Question-segment's of question (SAQ and MCQ) dealing with Neuroanatomy in all the available First Professional MBBS Exams' Anatomy written question papers of four public universities of Bangladesh of the last five years (2005 to 2009) were identified. The frequency of 'Question-segment's those assessing the ability of the clinically relevant knowledge were determined. It was a descriptive study. For Part-B of the study, total 136 New 3rd year medical undergraduates of one Bangladeshi governmental medical college and one private medical college were taken as participants. The medical undergraduates of each medical college were divided into two equal groups by randomization. One group was given 100 clinically-oriented questions and the other was given 100 non-clinically-oriented questions based on the content of Snell. The scores (frequencies of correct responses) of the two groups were compared using an unpaired 't' test. The frequencies of 'Question-segment's assessing clinically relevant knowledge was 6.14%. The performance of the undergraduates answering clinically-oriented questions was significantly poorer (p=0.01) than answering non-clinically-oriented questions (the mean score being 38.49±10.50 and 45.04±8.48 respectively). Teaching and assessment of Neuroanatomy should be designed in a way to orient medical undergraduates towards more clinically-oriented understanding and performance in Neuroanatomy. The clinically relevant knowledge dealing with Neuroanatomy needs to be addressed with appropriate weighting in the First Professional MBBS written questions of Bangladesh. Necessary changes in the curriculum are also suggested in meeting the above expectations.

A Know-Brainer: The Power of Cadaver-Based Instruction to Teach Clinical Neuroanatomy.

PURPOSE: Learning experiences that incorporate cadaver prosection or dissection of the brain have shown to enhance the acquisition and retention of neuroanatomy and improve standardized examination scores when included within medical curriculum. However, the role of cadaver-based instruction within allied health fields, and particularly in the field of communication sciences and disorders (CSD), remains limited and less understood. METHOD: The effectiveness of a cadaver-based lab compared to lecture to teach neuroanatomy within an undergraduate/postbaccalaureate clinical neuroscience course for CSD majors was explored within a crossover design. Fifty-four participants were stratified by class rank between two initial training sessions: lab-first versus lecture-first. Neuroanatomical knowledge was tested via labeling tasks at baseline, after the first allocated training, and at 1-week follow-up after crossover training had been completed. RESULTS: Both cohorts demonstrated significant gains in neuroanatomical knowledge following training, yet after the initial training session, students that received cadaver-based instruction produced a significantly greater number (p < .001) and more accurate (p < .001) anatomical labels than students that received lecture. After completion of the crossover design, students receiving cadaver-based instruction prior to lecture continued to demonstrate superior labeling accuracy at follow-up testing (p = .022). CONCLUSIONS: Cadaver-based instruction was more effective in improving students' ability to identify neuroanatomy compared to lecture for CSD students. Interestingly, cadaver-based demonstrations were also most effective in bolstering students' retention of structural knowledge when conducted before, instead of after, a lecture. Clinical training programs, specifically student learning outcomes, benefit from cadaver-based instruction that provides both three-dimensional orientation and a deep appreciation of the human elements of clinical anatomy. Furthermore, both the acquisition and retention of anatomical concepts may be enhanced through strategic instructional design, particularly in regard to the order of lecture and lab experiences.

A Simple and Consistent Rule for Easy Learning of Neuroanatomy: Three Neurons of Afferent Nerves / Una Regla Simple y Consistente para Facilitar el Aprendizaje de la Neuroanatomía: Tres Neuronas de los Nervios Aferentes

SUMMARY: Many students regard neuroanatomy as a terrifying subject due to the complicated neuronal connections. Purpose of this research was to promote the easy and logical learning of neuroanatomy by systematizing a rule "three neurons of afferent nerves." The rule, in which the second neuron decussates and reaches the thalamus, was applied to as many structures as possible. The three neurons are drawn in a constant pattern to intuitively demonstrate the rule. The rule could be applied not only to the spinothalamic tract, medial lemniscus pathway, sensory cranial nerves (visual pathway, trigeminothalamic tract, taste pathway, and auditory pathway) and ascending reticular activating system, but also to the pontocerebellum (afferent to cerebrum), basal nuclei (direct pathway), and limbic system (medial limbic circuit). Exceptionally, some afferent nerves do not exactly follow the suggested rule. This simple rule, which corresponds to many pathways of the neuroanatomy, is expected to make the learning by novice students easier.

Muchos estudiantes consideran la neuroanatomía como un tema aterrador debido a las complicadas conexiones neuronales. El propósito de esta investigación fue promover el aprendizaje fácil y lógico de la neuroanatomía mediante la sistematización de una regla "tres neuronas de los nervios aferentes". La regla, en la que la segunda neurona se decusa y llega al tálamo, se aplicó a todas las estructuras cuando esto fue posible. Las tres neuronas se dibujan en un patrón constante para demostrar la regla intuitivamente. La regla podría aplicarse no solo al tracto espinotalámico, la vía del lemnisco medial, los nervios craneales sensoriales (vía visual, tracto trigeminotalámico, vía gustativa y vía auditiva) y el sistema de activación reticular ascendente, sino también al pontocerebelo (aferente al cerebro), núcleos basales (vía directa) y sistema límbico (circuito límbico medial). Excepcionalmente, algunos nervios aferentes no siguen exactamente la regla sugerida. Se espera que esta simple regla, que corresponde a muchas vías de la neuroanatomía, facilite el aprendizaje de los estudiantes principiantes.

A neuroanatomy lab practical exam format in alignment with the universal design for learning framework.

The traditional format for neuroanatomy lab practical exams involves stations with a time limit for each station and inability to revisit stations. Timed exams have been associated with anxiety, which can lead to poor performance. In alignment with the universal design for learning (UDL), Timed Image Question and Untimed Image Question exam formats were designed to determine which format supports student success, especially for those who performed poorly in the traditional format. Only the Untimed Image Question format allowed students to revisit questions. All three formats were administered in a randomized order within a course for three cohorts of medical students. When all students' scores were analyzed together, the type of format had no effect. However, when analyses were conducted only on students who performed poorly in the traditional format, the type of format had an effect. These students increased their score, on average, by at least one grade level in the Untimed Image Question format compared to the traditional format. Students who performed well in the traditional format maintained their A, on average, in the two new formats. More students indicated Untimed Image Question as their most preferred format after experiencing all three formats. Most students associated the inability to revisit questions with high levels of anxiety. A neuroanatomy lab exam format was therefore identified as consistent with the UDL framework such that all students, regardless of test anxiety levels, can equally demonstrate what they learned. This format allowed for unlimited time per question and ability to revisit questions.