Profiling learning strategies of medical students: A person-centered approach.

BACKGROUND: Students within a cohort might employ unique subsets of learning strategies (LS) to study. However, little research has aimed to elucidate subgroup-specific LS usage among medical students. Recent methodological developments, particularly person-centred approaches such as latent profile analysis (LPA), offer ways to identify relevant subgroups with dissimilar patterns of LS use. In this paper, we apply LPA to explore subgroups of medical students during preclinical training in anatomy and examine how these patterns are linked with learning outcomes. METHODS: We analysed the LS used by 689 undergraduate, 1st and 2nd-year medical students across 6 German universities who completed the short version of the Learning Strategies of University Students (LIST-K) questionnaire, and answered questions towards external criteria such as learning resources and performance. We used the thirteen different LS facets of the LIST-K (four cognitive, three metacognitive, three management of internal and three management of external resources) as LPA indicators. RESULTS: Based on LPA, students can be grouped into four distinct learning profiles: Active learners (45% of the cohort), collaborative learners (17%), structured learners (29%) and passive learners (9%). Students in each of those latent profiles combine the 13 LS facets in a unique way to study anatomy. The profiles differ in both, the overall level of LS usage, and unique combinations of LS used for learning. Importantly, we find that the facets of LS show heterogeneous and subgroup-specific correlations with relevant outcome criteria, which partly overlap but mostly diverge from effects observed on the population level. CONCLUSIONS: The effects observed by LPA expand results from variable-centered efforts and challenge the notion that LS operate on a linear continuum. These results highlight the heterogeneity between subgroups of learners and help generate a more nuanced interpretation of learning behaviour. Lastly, our analysis offers practical implications for educators seeking to tailor learning experiences to meet individual student needs.

Developing formalin-based fixative agents for post mortem brain MRI at 9.4 T.

PURPOSE: To develop fixative agents for high-field MRI with suitable dielectric properties and measure MR properties in immersion-fixed brain tissue. METHODS: Dielectric properties of formalin-based agents were assessed (100 MHz-4.5 GHz), and four candidate fixatives with/without polyvinylpyrrolidone (PVP) and different salt concentrations were formulated. B1 field and MR properties (T1 , R2∗ , R2 , R2' , and magnetic susceptibility [QSM]) were observed in white and gray matter of pig brain samples during 0.5-35 days of immersion fixation. The kinetics were fitted using exponential functions. The immersion time required to reach maximum R2∗ values at different tissue depths was used to estimate the Medawar coefficient for fixative penetration. The effect of replacing the fixatives with Fluoroinert and phosphate-buffered saline as embedding media was also evaluated. RESULTS: The dielectric properties of formalin were nonlinearly modified by increasing amounts of additives. With 5% PVP and 0.04% NaCl, the dielectric properties and B1 field reflected in vivo conditions. The highest B1 values were found in white matter with PVP and varied significantly with tissue depth and embedding media, but not with immersion time. The MR properties depended on PVP yielding lower T1 , higher R2∗ , more paramagnetic QSM values, and a lower Medawar coefficient (0.9 mm/h ; without PVP: 1.5). Regardless of fixative, switching to phosphate-buffered saline as embedder caused a paramagnetic shift in QSM and decreased R2∗ that progressed during 1 month of storage, whereas no differences were found with Fluorinert. CONCLUSION: In vivo-like B1 fields can be achieved in formalin fixatives using PVP and a low salt concentration, yielding lower T1 , higher R2∗ , and more paramagnetic QSM than without additives. The kinetics of R2∗ allowed estimation of fixative tissue penetration.

The impact of physicians' recommendations on treatment preference and attitudes: a randomized controlled experiment on shared decision-making.

Making decisions based on their own evaluation of relevant information and beliefs is very challenging for patients. Many patients feel that they lack the knowledge to make a decision and expect a recommendation by their physician. We conducted an experimental study to examine the impact of physicians' recommendations on the decision-making process. N = 194 medical laypeople were placed in a hypothetical scenario where they suffered from a cruciate ligament rupture and were faced with the decision about a treatment (surgery or physiotherapy). In a 3 × 2 between-group design we investigated the impact of physicians' recommendations (for surgery, for physiotherapy, no recommendation) and reasoning style (scientific, narrative) on treatment preference, certainty and satisfaction regarding treatment preference, and attitudes. We found that the recommendation had a significant influence on treatment preference and attitudes toward both treatments. Additionally, we found a significant increase in certainty and satisfaction after the intervention, independently of whether they received a recommendation. This finding suggested that a recommendation was not required to strengthen participants' confidence in their decision. There were no effects of reasoning style. We discuss the implications and suggest that physicians should be careful with recommendations in situations in which patients' preferences are important.

Clinically relevant variations of the superior thyroid cornu.

PURPOSE: The superior thyroid cornu (STC) of the thyroid cartilage is a variable structure that maybe associated with different clinical symptoms. This study evaluates the three-dimensional anatomy of the STC. METHODS: Measurements were conducted on 97 CT scans (45 male and 52 female). The protocol models a vector from the base to the tip of the STC and references the cornu to the midline. From these data, the length (C), the rotation angle (γ), the inclination angle (ß), and the deviation of STC base (X 2) and tip (X 3) from the midline were measured. An additional measure of the medial inclination quotient (Q = X 3/X 2) was calculated. RESULTS: The STC has a mean length of 13.9 ± 3.26 mm. The male STC is more bent inwards (rotation angle (γ) 60.95° vs. 12.15°; p < 0.001), and the female STC is more steep (inclination angle (ß) 75.44° vs. 73.44°; p < 0.001). The mean Q in men was significantly lower (0.85 ± 0.15 vs. 0.97 ± 0.15; p < 0.001). An extreme medial deformation was found in 13.4 % of the patients. This variation is associated with Q ≤ 0.7, most of the time unilateral and more common in men (86.7 vs. 13.3 %). Furthermore, we can describe STC variations with close proximity to the common carotid artery or the cervical spine. CONCLUSIONS: The clinically most relevant variation of the STC seems to be the extreme medial deviation, which may lead to symptoms described with the superior thyroid cornu syndrome. The evaluation of Q in axial CT scans is easily done and may propose a helpful tool for clinical diagnostics.

Fronto-temporal branch of facial nerve within the interfascial fat pad: is the interfascial dissection really safe?

BACKGROUND: The study was conducted to clarify the presence or absence of fronto-temporal branches (FTB) of the facial nerve within the interfascial (between the superficial and deep leaflet of the temporalis fascia) fat pad. METHODS: Eight formalin-fixed cadaveric heads (16 sides) were used in the study. The course of the facial nerve and the FTB was dissected in its individual tissue planes and followed from the stylomastoid foramen to the frontal region. RESULTS: In the fronto-temporal region, above the zygomatic arch, FTB gives several small twigs running anteriorly in the fat pad above the superficial temporalis fascia and a branch within the temporo-parietal fascia (TPF) to the muscles of the forehead. There were no twigs of the FTB within the interfascial fat pad. CONCLUSIONS: No branches of the FTB are found in the interfascial (between the superficial and deep leaflet of the temporalis fascia) fat pad. The interfascial dissection can be safely performed without risk of injury to the FTB and potential subsequent frontalis palsy.

Influence of learning strategies and motivation on anatomy test performance of undergraduate medical students.

To learn and comprehend the large amount of information in gross anatomy, undergraduate students must self-regulate their learning to be properly prepared for the exams within the available time. Even though there are many studies on learning strategies and their influence on test results and motivation, the aim of this study is to investigate characteristics of learning strategies in detail and in relation to the anatomy course of first semester students and how their use is related to anatomy test performance. For assessing the learning strategies, we used the short version of the questionnaire "Learning Strategies of University Students" (LIST-K) (Klingsieck, 2018). Further, we investigated potential influences of motivation and resources used during the self-regulated learning process. The participants in this study (N = 108) filled in the above-mentioned questionnaire LIST-K and a written multiple-choice anatomy test. A k-means cluster analysis revealed three groups of students differing in their self-reported use of learning strategies. Students used either (1) predominantly metacognitive and resource-related strategies, (2) predominantly cognitive strategies, or (3) no specific learning strategies at all. We found no significant overall relationships between the use of learning strategies and test performance. A stepwise linear regression identified the use of cognitive learning strategies (ß =.269) as a significant predictor for test performance (R² =.149, p =.003), possibly as these specific learning strategies help with a systematic and effective approach while studying anatomy and retrieving large amount of memorized information. Further, motivation was identified as a negative predictor (ß = -.277), which might be a result of the short time periods students have to study for exams. Overall findings underline the importance of self-regulated learning as a positive predictor for academic performance. By understanding these factors, a more student-centered approach could be adopted by educators to improve medical education and equip students with valuable approaches for their continuous education, even beyond university.

Distribution of corpora amylacea in the human midbrain: using synchrotron radiation phase-contrast microtomography, high-field magnetic resonance imaging, and histology.

Corpora amylacea (CA) are polyglucosan aggregated granules that accumulate in the human body throughout aging. In the cerebrum, CA have been found in proximity to ventricular walls, pial surfaces, and blood vessels. However, studies showing their three-dimensional spatial distribution are sparse. In this study, volumetric images of four human brain stems were obtained with MRI and phase-contrast X-ray microtomography, followed up by Periodic acid Schiff stain for validation. CA appeared as hyperintense spheroid structures with diameters up to 30 µm. An automatic pipeline was developed to segment the CA, and the spatial distribution of over 200,000 individual corpora amylacea could be investigated. A threefold-or higher-density of CA was detected in the dorsomedial column of the periaqueductal gray (860-4,200 CA count/mm3) than in the superior colliculus (150-340 CA count/mm3). We estimated that about 2% of the CA were located in the immediate vicinity of the vessels or in the peri-vascular space. While CA in the ependymal lining of the cerebral aqueduct was rare, the sub-pial tissue of the anterior and posterior midbrain contained several CA. In the sample with the highest CA density, quantitative maps obtained with MRI revealed high R2* values and a diamagnetic shift in a region which spatially coincided with the CA dense region.

Effects of tablet-based drawing and paper-based methods on medical students' learning of gross anatomy.

The way medical students learn anatomy is constantly evolving. Nowadays, technologies such as tablets support established learning methods like drawing. In this study, the effect of drawing on a tablet on medical students' anatomy learning was investigated compared to drawing or summarizing on paper. The quality of drawings or summaries was assessed as a measure of the quality of strategy implementation. Learning outcome was measured with an anatomy test, both immediately afterward and after 4-6 weeks to assess its sustainability. There were no significant group differences in learning outcome at both measurement points. For all groups, there was a significant medium strength correlation between the quality of the drawings or summaries and the learning outcome (p < 0.05). Further analysis revealed that the quality of strategy implementation moderated outcomes in the delayed test: When poorly implemented, drawing on a tablet (M = 48.81) was associated with lower learning outcome than drawing on paper (M = 58.95); The latter (M = 58.89) was related to higher learning outcome than writing summaries (M = 45.59). In case of high-quality strategy implementation, drawing on a tablet (M = 60.98) outperformed drawing on paper (M = 52.67), which in turn was outperformed by writing summaries (M = 62.62). To conclude, drawing on a tablet serves as a viable alternative to paper-based methods for learning anatomy if students can make adequate use of this strategy. Future research needs to identify how to support student drawing, for instance, by offering scaffolds with adaptive feedback to enhance learning.

Microvascular imaging of the unstained human superior colliculus using synchrotron-radiation phase-contrast microtomography.

Characterizing the microvasculature of the human brain is critical to advance understanding of brain vascular function. Most methods rely on tissue staining and microscopy in two-dimensions, which pose several challenges to visualize the three-dimensional structure of microvessels. In this study, we used an edge-based segmentation method to extract the 3D vasculature from synchrotron radiation phase-contrast microtomography (PC-µCT) of two unstained, paraffin-embedded midbrain region of the human brain stem. Vascular structures identified in PC-µCT were validated with histology of the same specimen. Using the Deriche-Canny edge detector that was sensitive to the boundary between tissue and vascular space, we could segment the vessels independent of signal variations in PC-µCT images. From the segmented volumetric vasculature, we calculated vessel diameter, vessel length and volume fraction of the vasculature in the superior colliculi. From high resolution images, we found the most frequent vessel diameter to be between 8.6-10.2 µm. Our findings are consistent with the known anatomy showing two types of vessels with distinctive morphology: peripheral collicular vessels and central collicular vessels. The proposed method opens up new possibilities for vascular research of the central nervous system using synchrotron radiation PC-µCT of unstained human tissue.

Observing Interprofessional Collaboration: Impact on Attitude and Knowledge Acquisition.

Interprofessional collaboration (IPC) in the medical field is an important factor for good clinical outcomes and should be taught as early as in undergraduate medical education. Since implementing IPC training is an organizational challenge, students are often limited in their opportunities to experience real-life IPC. Therefore, an approach where students observe successful IPC activities of role models in an applied anatomical format was proposed. It was studied whether observing IPC activities in undergraduate anatomical education has an impact on both students' attitude toward IPC and on knowledge acquisition. Further, it was examined whether the attitudes and knowledge of students from different medical disciplines were influenced in different ways. Therefore, 75 medical students and thirty-eight physiotherapy students participated in a study with the task of observing a live broadcast of an interprofessional teaching session. Participants were asked about their attitudes toward interprofessional learning, their evaluation of professional responsibilities, and their profession-specific knowledge before and after observing the IPC session. The participants' attitude toward interprofessional learning improved for both groups of students. Moreover, students of physiotherapy adjusted their evaluation of their own and others' professional responsibilities after observing IPC. In both student groups, knowledge increased, in particular, with respect to the field of knowledge in other professions. So, observing IPC can modify students' attitudes and support knowledge acquisition. The implementation of IPC observations provides students from various healthcare disciplines with a clearer impression of professionals' responsibilities and gives learners the opportunity to acquire knowledge from healthcare fields unfamiliar to them.