Effectiveness of blended learning in radiological anatomy for first year undergraduate medical students.

PURPOSE: The aim of the study was to assess the effectiveness of blended learning modules for radiological anatomy among first-year medical students by estimating knowledge gain and evaluating student perceptions. METHODS: A single-group, pre- and post-test study design was utilized. Five radiological anatomy modules consisting of online presentations and self-assessment quizzes were developed for the upper limb, lower limb, head and neck, thorax, and abdomen and pelvis. The content of the modules was uploaded on to a learning management system called TYRO. Each module focused on the normal anatomical features observed on plain and contrast radiographs. Other relevant imaging modalities and clinical contexts were also introduced. During the classroom session, the students were instructed to peruse the modules and answer the self-assessment quiz. The teacher in the classroom acted as a facilitator and was available to the students for any clarifications. A pre- and post-test was administered to the students before and after exposure to the modules, respectively. A paired t test was used to estimate differences in the pre- and post-test scores. Students' perceptions were assessed using a questionnaire. RESULTS: One-hundred students attended both the tests. The mean and standard deviation of pre- and post-test scores were 17 ± 5.5 and 26 ± 7.6, respectively, and this difference was significant. Students' perceptions about the intervention were on the whole positive. CONCLUSION: A significant improvement in the knowledge of radiological anatomy was noted after exposure to five blended learning modules of radiological anatomy. The modules were well received by the students.

Peer-assisted learning versus didactic teaching in osteology for first-year Indian undergraduate medical students: a quasi-experimental study.

PURPOSE: The utility of peer-assisted learning (PAL) in anatomy education has been recognized. In this study, PAL was incorporated into osteology teaching for the first-year medical students and compared to traditional didactic methods (TDM). METHODS: This was a cross-over intervention study. The class of 60 students was divided into two equal groups. The first group underwent PAL for five upper limb osteology sessions and TDM for all lower limb osteology classes. The second group underwent TDM for five upper limb osteology classes and PAL for lower limb osteology classes. A pre-session test (PrST) and post-session test (PoST) were conducted for each session using multiple choice type questions. Perceptions of students about PAL were collected using a questionnaire. Between and within group differences were estimated using the independent sample T test and paired T test, respectively. The responses in the questionnaire were summarized and open-ended responses categorized into broad themes. RESULTS: Greater group differences were noted in the PrST as compared to the PoST mean scores, with the PAL group showing higher mean scores for both upper and lower limb sessions. Significantly higher PoST scores compared to PrST scores for all the sessions were observed regardless of the method used. Significantly higher scores in the PrST or PoST scores were noted in the PAL group for five sessions. Most aspects of PAL were appreciated by the students. CONCLUSIONS: This study provides evidence that PAL is at least as effective as TDM in learning osteology among the first-year medical students.

Computed tomography-based classification of axis vertebra: choice of screw placement.

PURPOSE: The purpose of the study was to: (1) introduce a new CT-based parameter: free facet area and provide its normative data; (2) standardize the method of measuring isthmus width and height of the axis vertebra; (3) propose a new grading system to predict the difficulty in inserting transarticular and C2 pedicle screws. METHODS: Spiral CT scans of 47 adult dry axis vertebrae were studied. The methods of measuring isthmus width, isthmus height and free facet area are described. RESULTS: The mean isthmus width was 5.04 mm on the right side and 5.42 mm on the left side. The mean isthmus height was 5.21 mm on the right side and 5.45 mm on the left side. Mean free facet area was 61.23 % on the right side and 70.18 % on the left side. A novel grading system is proposed on the basis of these three parameters. As per this grading system, 40.4 % of the sides were found to be difficult for transarticular and 24.5 % sides for C2 pedicle screw insertion (total score 2, 3, 4). A Management protocol is suggested on the basis of the grading system. CONCLUSION: Inserting a transarticular screw was more frequently difficult as compared to pedicle screw. A new CT-based parameter (free facet area) and an efficient grading have been proposed to help surgeons choose the appropriate screw options, appreciate the complex anatomy of this region and compare data across various studies.

Effects of targeted remediation in anatomy for first year medical students.

The aim of this study was to assess the effectiveness of a questionnaire to guide targeted remediation among undergraduate medical students in anatomy. Seventy-five students from a medical college in South India who failed in the first internal theory examination were administered a validated 35-item questionnaire. The total and domain specific questionnaire scores were calculated. Specific weekly interventions for each student based on the questionnaire scores were conducted by appointed academic mentors for three months prior to the second internal examination. The dependent variable was performance in the second internal examination. The students were re-administered the questionnaire after the second internal examination. The independent variables were the marks obtained in the first internal examination, domain specific and total questionnaire scores, sex, and regularity of the student in attending the remedial sessions. Inferential statistical tests used were the chi-square test, independent sample t test, paired t test, multiple regression and binomial logistic regression. Of the 75 students who underwent remediation, 54 (72%) passed in the second internal examination. The scores in the second internal examination among these students was found to be significantly higher as compared to the first internal examination. The total, subject related and study skills questionnaire score were significantly lower after remediation. Students who were irregular had a significantly lower pass rate. The multivariate analysis showed that only the first internal marks added significantly to the prediction about second internal performance. This study provides evidence to show that struggling students perceive a benefit from targeted remediation.

Anatomical Variations of the Temporomesial Structures in Normal Adult Brain - A Cadaveric Study.

BACKGROUND: Despite significant evolutional, functional, and clinical interest, the anatomical variations of the temporomesial structures in cadaveric samples have received little attention. This study was undertaken to document the anatomical variations observed in the temporal lobe of human brain with emphasis on the structures present in temporomesial region. MATERIALS AND METHODS: Using 26 postmortem cadaveric cerebral hemispheres (13 right and 13 left hemispheres), several neurosurgically significant mesial structures were studied by blunt dissection under the operating microscope. The observed surface-based qualitative variations and right-left asymmetries were tabulated under well-defined, moderately defined, and ill-defined classification. RESULTS: Among the areas, uncus (100%), limen insulae (88.4%), rhinal sulcus and hippocampus (81%), intralimbic gyrus (77%), Heschl's gyrus (73%), gyrus ambiens, semilunar gyrus, sulcus semiannularis, and calcar avis (69.2%) were well defined, and band of Giacomini (38.4%) was found to be distinctly ill-defined areas in the list. Further, our analysis confirmed the presence of consistent left-greater-than-right asymmetry in all the areas of interest in temporal region under well-defined category. Rightward asymmetry was noticed in moderately defined and ill-defined classification. However, no asymmetry was detected in the uncal region. P value for all the obtained results was >0.05. CONCLUSION: Our study offers a preliminary anatomic foundation toward the better understanding of temporal lobe structures. These variations may prove valuable to neurosurgeons when designing the appropriate and least traumatic surgical approaches in operating the temporomesial lesions.

Analysis of Fetal Palate to Assist Pre-natal Ultrasound.

INTRODUCTION: Cleft palate is one of the major facial congenital malformation in newborns. Pre-natal detection of this malformation is limited to detection of clefting of hard palate but isolated soft palate clefting still remains challenge for sonologists. As Indian literature is limited present study was attempted to provide dimensions and position of fetal palate by digitized images. AIM: To study dimensions, position and differences in parameters between second and third trimester fetuses. MATERIALS AND METHODS: Median sagittal section of 32 formalin fixed fetuses was selected from the Department of Anatomy, St John's Medical College, Bangalore, Karnataka, India. Anatomical landmarks-The Nasion (N), Sellaturcica (S), Anterior Nasal Spine (ANS), Posterior Nasal Spine (PNS), tip of Uvula (U) were marked on sections. Length of hard palate (from ANS to PNS), Length of soft palate (from PNS to U), Hard palate/soft palate angle was defined. The anterior position of soft palate and its posterior position in relation to anterior cranial base were marked as N-S-PNS and N-S-U angle, respectively. The measurements were acquired directly from the digitized images using ImageJ software. Statistical analysis was done using SPSS 16. RESULTS: The mean values of ANS-PNS and PNS-U were 23.59±3.69mm and 14.39±2.70mm, respectively. The mean values of hard palate/soft palate angle, N-S-PNS and N-S-U angle were 144.720±11.11,51.150±9.09 and 93.370±9.58, respectively. Significant difference was noted between trimesters for length of hard and soft palate but not for palatal angles. CONCLUSION: During Pre-natal assessment of cleft palate, it is important for sonologist to keep in mind that the dimensions of palate proportionately increased in last two trimesters while the position remains constant.

Morphometric and radiological assessments of dimensions of Axis in dry vertebrae: A study in Indian population.

BACKGROUND: The technique of intralaminar screw placement for achieving axis (C2) fixation has been recently described. The purpose of the study was to provide the morphometric and radiological measurements in Indian population and to determine the feasibility of safe translaminar screw placement in this population. To the best of our knowledge there is no study (cadaveric or radiological) done in Indian population to detect suitability of axis bone for laminar screw fixation. MATERIAL AND METHODS: 38 dry axis vertebrae from adult South Indian population were subjected to morphometric measurement and CT scan analysis. Height of posterior arch, midlaminar width(bilateral) in upper 1/3(rd), middle 1/3(rd) and lower 1/3(rd) were measured using high precision Vernier Calipers. Each vertebra was subjected to a spiral CT scan (Philips brilliance 16 slice) thin 0.5 mm slices were taken and reconstruction was done in coronal and sagittal plane. Analysis was done on a CT work station. Using axial slices, sagittal cuts were reconstructed in plane perpendicular to the lamina at the mid laminar point and upper-middle and lower 1/3(rd) width of the lamina measured. Height of the posterior arch was measured in the sagittal plane. Intralaminar angle was measured bilaterally. RESULTS: Middle 1/3(rd) lamina was the thickest portion (mean 5.17 mm +/- 1.42 mm). A total of 32 (84.2%) specimen were having midlaminar width in both lamina greater than 4 mm, however only 27 (71%) out of them had spinous process more than 9 mm. CT scan measurement in middle and lower 1/3(rd) lamina was found to be strongly correlated with the direct measurement. CONCLUSION: There is high variability in the thickness of the C2 lamina. As compared to western population, the axis bones used in the present study had smaller profiles. Hence the safety margin for translaminar screw insertion is low.