The Anatomical Society's Core Anatomy Syllabus for Dental Undergraduates.

The Anatomical Society has developed a series of learning outcomes in consultation with dentists, dental educators and anatomists delivering anatomical content to undergraduate dental students. A modified Delphi methodology was adopted to select experts within the field that would recommend core anatomical content in undergraduate dental programmes throughout the UK. Utilising the extensive learning outcomes from two UK Dental Schools, and neuroanatomy learning outcomes that remained outside the Anatomical Society's Core Gross Anatomy Syllabus for Medical Students, a modified Delphi technique was utilised to develop dental anatomical learning outcomes relevant to dental graduates. The Delphi panel consisted of 62 individuals (n = 62) from a wide pool of educators associated with the majority of undergraduate dental schools in the UK, representing a broad spectrum of UK Higher Education Institutions. The output from this study was 147 anatomical learning outcomes deemed to be applicable to all dental undergraduate programmes in the UK. The new recommended core anatomy syllabus for dental undergraduates, grouped into body regions, offers a comprehensive anatomical framework with which to scaffold clinical practice. The syllabus, presented as a set of learning outcomes, may be used in a variety of pedagogic situations, including where anatomy teaching exists within an integrated dental curriculum (both horizontally in the basic sciences part of the curriculum and vertically within the clinical years).

Successful treatment of forehead lipoma depends on knowledge of the surgical anatomy: a step-by-step guide.

We review the anatomy of the frontal scalp in relation to the clinical features and surgical management of frontalis-associated lipoma. Awareness of this entity, coupled with sound regional anatomical knowledge, is essential to achieve good outcomes.

Anatomical Society core regional anatomy syllabus for undergraduate medicine: the Delphi process.

A modified Delphi method was employed to seek consensus when revising the UK and Ireland's core syllabus for regional anatomy in undergraduate medicine. A Delphi panel was constructed involving 'expert' (individuals with at least 5 years' experience in teaching medical students anatomy at the level required for graduation). The panel (n = 39) was selected and nominated by members of Council and/or the Education Committee of the Anatomical Society and included a range of specialists including surgeons, radiologists and anatomists. The experts were asked in two stages to 'accept', 'reject' or 'modify' (first stage only) each learning outcome. A third stage, which was not part of the Delphi method, then allowed the original authors of the syllabus to make changes either to correct any anatomical errors or to make minor syntax changes. From the original syllabus of 182 learning outcomes, removing the neuroanatomy component (163), 23 learning outcomes (15%) remained unchanged, seven learning outcomes were removed and two new learning outcomes added. The remaining 133 learning outcomes were modified. All learning outcomes on the new core syllabus achieved over 90% acceptance by the panel.

The Anatomical Society core regional anatomy syllabus for undergraduate medicine.

The Anatomical Society's core syllabus for anatomy (2003 and later refined in 2007) set out a series of learning outcomes that an individual medical student should achieve on graduation. The core syllabus, with 182 learning outcomes grouped in body regions, referenced in the General Medical Council's Teaching Tomorrow's Doctors, was open to criticism on the grounds that the learning outcomes were generated by a relatively small group of anatomists, albeit some of whom were clinically qualified. We have therefore used a modified Delphi technique to seek a wider consensus. A Delphi panel was constructed involving 'experts' (n = 39). The revised core syllabus of 156 learning outcomes presented here is applicable to all medical programmes and may be used by curriculum planners, teachers and students alike in addressing the perennial question: 'What do I need to know ?'

Proposal of landmarks for clamping neurovascular elements during endoscopic surgery of the supraglottic region.

BACKGROUND: Bleeding within the supraglottic region can be a lethal complication after CO(2) laser microsurgery. Our aim was to propose endoluminal anatomical landmarks to locate the superior laryngeal vessels resulting in a safer microsurgery. METHODS: Endoluminal dissections were made in 22 larynges without laryngeal disease. RESULTS: The neurovascular structures were in the superior third of a triangle defined by the vocal process, the anterior commissure, and the epiglottic attachment of the aryepiglottic fold. They overlapped in 4 different ways: pattern I (70.4%): superior laryngeal vein (SLV), superior laryngeal artery (SLA), and internal laryngeal nerve (ILN); pattern II (13.6%): SLA, SLV, ILN; pattern III (4.6%): SLV, ILN, and SLA; pattern IV (4.6%): SLA, ILN, and SLV. CONCLUSION: Microsurgery in the supraglottic region may be safer if surgeons are aware of the superior third of the above-defined triangle, "danger area", where the vascular elements of this region are located.

Does empathy change in first-year dental students?

INTRODUCTION: Professionalism is a central tenet of the dental undergraduate curriculum. Dental undergraduate curricula and standards expect the dentist to put the patient's interests first, and in this respect, an important attitude is empathy. OBJECTIVE: This study examined the self-reported empathy levels of first-year dental students before and after an early analytical exposure to behavioural sciences and the clinical encounter. METHOD: First-year dental undergraduates were given an attitudinal questionnaire to complete before and after the behavioural science course. The questionnaire consisted of the HP version of the Jefferson Scale of Physician Empathy and the Patient-Practitioner Orientation Scale. Paired non-parametric tests and Spearman's Rho correlations, along with simple descriptive statistics, were used to test the statistical significance of observations. RESULTS: A total of 66 paired questionnaires were returned, giving a response rate of 75%. There were no correlations between age and total mean score of JSPE or PPOS, and no gender differences. There was a significant increase (P<0.01) in empathy as measured by the JSPE between pre- and post-course scores. The PPOS did not record any significant change in the sharing, caring or total scale scores pre- to post-course. CONCLUSION: The modified JSPE has potential utility in assessing the cognitive-affective aspect of dental students' empathy. Using the JSPE, short-term measurable empathy changes can be detected in first-year dental undergraduates after the structured and assessed analytical introduction to the clinical encounter and environment.

A national survey of UK final year students' opinion of undergraduate oral surgery teaching.

BACKGROUND: A national survey was undertaken to establish a baseline of our final year students' perception of how their undergraduate oral surgery education has equipped them for key areas of general dental practice. MATERIALS AND METHODS: Questionnaires were distributed to the 13 UK schools with final year students, towards the end of the academic year in 2009. The questionnaires were completed anonymously and were optically scanned. RESULTS: In total, 632 questionnaires were returned, which represents 66% of the students of the graduating year. The majority (83%) of the respondents perceived that the teaching in oral surgery had given them sufficient knowledge to undertake independent practise. Most respondents (99%) felt confident to perform forceps exodontia, but confidence in the various aspects of surgical exodontia was lower. A majority (83%) had experience of an outreach scheme performing forceps exodontia (75%) and surgical exodontia (16%) in this environment. Twenty per cent indicated a desire to undertake a career in oral surgery, 6% in oral and maxillofacial surgery and 35% in another speciality. CONCLUSION: This survey suggests that the majority of the students perceive that the oral surgery education has prepared them well for key areas of general practice. It also suggests that there is, however, a need to provide further improvement in the delivery of surgical skills and knowledge.

A generic consensus assessment of undergraduate competence in forceps exodontia in the United Kingdom.

UNLABELLED: The assessment of competence in clinical skills has become more frequent in published healthcare curricula and syllabuses recently. There are agreed mechanisms for the assessment of competence in the post-graduate environment, but no consensus within the undergraduate curriculum. This paper seeks to develop an agreed generic checklist for the assessment of competence in forceps exodontia. MATERIALS AND METHODS: A modified Delphi process was undertaken with representatives from all UK dental schools (n = 13) to develop a generic checklist for the assessment of competence in forceps exodontia. A content analysis of the assessments employed by each school was used to help discussion and inform the Delphi process. RESULTS: Seven schools currently employ a summative assessment of competence in forceps exodontia, with the majority employing a structured clinical objective test (n = 6). From the seven assessments, there were a total of 29 putative items and 10 putative domains identified for a generic checklist. These were reduced to five domains and 19 items through the content analysis and Delphi process, and a generic overarching checklist was created. CONCLUSION: Using this generic checklist, it may now be possible to pool data inter-institution to perform more powerful analyses on how our students obtain, or fail to obtain competence in forceps exodontia.

Evaluation of a virtual anatomy course for clinical undergraduates.

AIM: To implement and evaluate a series of interactive clinically applied anatomy tutorials for final year dental undergraduate students. METHODS: A 6-week voluntary virtual program of tutorials for final year dental undergraduates, with pre- and post-tutorial testing, was evaluated using a priority sequence model (QualQuan). A purposive sample (n = 15) was taken of the year group (n = 69) and the initial qualitative phase in depth interviews were carried out until data saturation (n = 13). The emergent recurrent themes from the qualitative data were then phrased into a variety of non-leading questions. These questions were issued in the form of an anonymous electronic questionnaire to the whole student body. RESULTS: There was a good uptake of the tutorials with 84% of the students accessing at least one tutorial before sitting their final examinations. A response rate of 70% was achieved for the quantitative evaluative questionnaire phase of the study. Overall perceptions of the course were favourable although a number of modifications were suggested. These included a more concise presentation of the mainstream tutorial text with hyper links to more detailed content. Students also indicated a desire for more line diagrams. These changes, it was suggested, would help with the on-line readability of the tutorials. The primary focus for the students' learning appeared to be provided by the pre- and post-tutorial tests even though explicit learning outcomes were provided for each tutorial. CONCLUSION: This study demonstrates that a well-designed virtual course can help to vertically integrate, and make clinically relevant, one of the basic sciences underpinning dental surgery. It has shown that formative assessment acts as a powerful tool to focus student attention and direct student learning. This leads to the conclusion that formative assessments have to be designed with as much care and attention as summative assessments.

Brainstem motor nuclei respond differentially to degenerative disease in the mutant mouse wobbler.

Degenerative motoneurone diseases, whether in humans, animals, or transgenic mouse models, do not affect all types of motoneurone to the same degree. Understanding the relative differences in vulnerability of certain motor pools may be the key to developing therapies. Expression of calbindin (CB) and parvalbumin (PV) immunoreactivity, which are potentially neuroprotective calcium-binding proteins, and NADPH-diaphorase (NADPH-d) histochemical reactivity, a marker for neurodegeneration, was studied in brainstem sections from mutant wobbler mice and their normal littermates during the motoneurone degeneration phase (3-8 weeks of age). The motor trigeminal and facial nuclei reacted in a manner previously observed in spinal somatic motoneurones in the wobbler. Many motoneurones expressed moderate NADPH-d reactivity, correlated with the appearance of vacuolated motoneurones in Nissl-stained sections. This was not observed in littermate controls. Motoneurone counts from Nissl-stained sections from 14-month-old wobblers and littermates revealed significantly fewer (approximately 27%) motoneurones in the trigeminal nucleus of wobblers. In contrast, the wobbler hypoglossal nucleus contained neither vacuolated nor NADPH-d reactive motoneurones. However, expression of CB immunoreactivity by the majority of wobbler hypoglossal motoneurones was observed but not in littermate controls or in any other motor nucleus. Counts in older animals showed a smaller but still significant difference in motoneurone number between wobblers and controls (approximately 9% reduction). Finally, the wobbler abducens nucleus displayed neither vacuolated neurones, nor NADPH-d reactivity nor CB immunoreactivity. Motor nuclei innervating extraocular muscles appear to be protected in many forms of motoneurone disease in man and other species. However, there were still markedly fewer abducens motoneurones in the old wobblers compared to controls (approximately 29% reduction). Sparing of oculomotor neurones in other diseases has been attributed to their relatively high PV expression, which we also observed in the abducens nucleus of both wobblers and littermates, and to a lesser extent in the other motor nuclei too. In conclusion, our results suggest that, in the wobbler mouse, motoneurone degeneration may occur without overt signs such as cell body vacuolation and NADPH-d expression. Induced CB expression may be neuroprotective but that constitutive expression of PV may not.

Expression of nitric oxide synthase by motor neurones in the spinal cord of the mutant mouse wobbler.

The expression of nitric oxide synthase (NOS) has been studied in the spinal cord of the mutant mouse wobbler, a recessive mutation in which there is motor neurone degeneration, using nicotinamide dinucleotide phosphate-diaphorase (NADPH-d) histochemistry. Abnormal NOS positive large neuronal profiles could be found in the ventral born of affected mutant animals but not their unaffected littermate controls. The number of abnormal profiles observed was dependent upon the age of the animal. A small number of these NOS positive large neuronal profiles were seen at the onset of the disease at 3-4 weeks of age, larger numbers were found in animals aged 5-8 weeks coincident with the main period of motor neurone death, whilst in the spinal cords of older animals aged 9-12 months, when motor neurone death is minimal, none were found. These NOS positive profiles seen in younger wobbler mouse ventral horn had a morphology and size similar to that of degenerating motor neurones seen in Nissl stained preparations. It was concluded that these NOS positive profiles were degenerating motor neurones. These observations provide further evidence that induction of nitric oxide synthase expression may play a role in motor neurone death. Though no NOS positive motor neurones were found in the spinal cords of older wobblers increased numbers of NOS positive varicose axons were observed in the ventral horn often forming tangled accumulations on the border of the grey and white matter.

The effect of age on motor neurone death following axotomy in the mouse.

The ability of mouse motor neurones to survive axotomy during the first month of life was studied. The motor neurones that lie in the dorsolateral columns of spinal segments C7 and C8 and supply the flexor muscles of the forepaw were axotomized by cutting and removing part of the median and ulnar nerves above the elbow. The number and position of cell bodies with axons in these nerves were confirmed by retrograde labelling of the cut axons with horseradish peroxidase. The ability of these neurones to survive axotomy varies with the age of the animal at the time of axotomy. When the axons are sectioned within the first four postnatal days, 80-90% of the cell bodies will die, more than half of this death occurring in less than one week after axotomy. If the animals are one week old at the time the nerves are cut, a significantly smaller number (50%) die (P = 0.013), and the time-course of death is different, with eight to ten days elapsing before half the death has occurred. 40% of the neurones will die if sectioned at two weeks of age, and it is not until four weeks of age that more than 90% of the cells can survive axotomy. We conclude, therefore, that the kinetics of motor neurone death, as well as the final extent of neuronal loss, are affected by the age at which the animal is axotomized.

Loss of motor neurons from the median nerve motor nucleus of the mutant mouse 'wobbler'.

This paper describes the location and number of motor neurons in the median nerve pool of wobbler mice and normal littermates as determined by retrograde labelling of the cut median nerve with horseradish peroxidase (HRP) in animals from 3 weeks to 1-year-old. The median nerve motor nucleus is located in spinal segments C5-T1, and in normal animals contains 199 (6) (mean (SEM] motor neurons. Three-week-old wobbler mice have the same number of labelled neurons as control animals, and this number falls to 75% of normal values by 4 weeks of age, and to approximately 60% by 6 weeks of age and older. Numerous swollen, pale and frequently vacuolated perikarya are present in the same 3-6-week-old mice. In the 3-week-old mutants these comprise on average 17% of the total large (greater than 20 microns) neuronal cell bodies counted in segments C5-T1. By 6 weeks this figure has fallen to 10%, and to less than 4% in adult wobblers. We conclude that the most active period in the expression of the wobbler phenotype is from 3 to 6 weeks of age.

Measurement of intra-embryonic pH during the early stages of development in the chick embryo.

Measurements have been made of the pH in the extracellular space, adjacent to the neural tube, in 73 isolated chick embryos in vitro at stages from 4-22 somites. A pH of 7.8-8.4 was observed in the segmented region, while caudally, in the segmental plate, the pH was consistently lower falling by as much as 0.5 pH units at the regressing primitive streak. Variations were noted in the pH of embryos of the same age but the regional variation in pH was a consistent finding in all of the embryos examined. The buffering capacity of the extracellular space was found to be 12.9 mequiv/pH unit/l in the segmented region and 13.9 mequiv/pH unit/l in the segmental plate. Thus it is unlikely that the regional variations in pH result from local variations in the buffering power of the extracellular space. Varying the K+, Cl-, Mg2+ or HCO3- ion concentrations in the bathing medium caused little change in the intra-embryonic pH, while reducing the concentrations of Na+ or Ca2+ caused a small acidification. This suggests that the ectoderm and endoderm form an effective barrier between the embryo and the external environment. Exposure of the embryo to KCN reduced the intra-embryonic pH suggesting that the alkaline environment is maintained by active processes.

The sizes of motoneurons supplying hindlimb muscles in the mouse.

Motoneurons supplying identified muscle groups in the mouse spinal cord were labelled by retrograde transport of horseradish peroxidase. The size of motoneurons was estimated by measuring perimeter and cross-sectional area at the level of the nucleolus for the following seven major muscle groups: quadriceps femoris, adductors and gracilis, gluteal musculature, hamstring muscles, posterior crural musculature, anterolateral crural musculature and intrinsic musculature of the foot. The qualitative observation of two size ranges of motoneuron was supported by the measurements. Frequency distribution histograms of motoneuronal cross sectional area were bimodal for all motoneuronal groups except for the foot musculature. The population parameters and proportions for the six bimodal histograms were estimated by the method of maximum likelihood. It was found that the mean area of the small neuron component, which were presumed to be gamma motoneurons, was similar for the six bimodal systems. In contrast to this the mean area of the large neuron component, presumed to be alpha motoneurons, was found to be different for the six bimodal systems; motoneurons supplying more proximal muscles showed a larger mean area than those supplying distal muscles. The mean area of both components was unaffected by survival time and this was interpreted as indicating that changes in survival time did not label greater numbers of small or large motoneurons. The proportion of motoneurons in the small neuron component was found to vary from 9 to 27%.