Comparison of faculty and student perceptions of sexual and gender minority content in a preclerkship medical curriculum.

BACKGROUND: Sexual and gender minority (SGM) persons experience stark health disparities. Efforts to mitigate disparities through medical education have met some success. However, evaluations have largely focused on subjective perspectives rather than objective measures. This study aimed to quantify Boston University School of Medicine's sexual and gender minority (SGM) education through surveys of course directors (CDs) and medical students regarding where SGM topics were taught in the preclerkship medical curriculum. Responses were compared to identify concordance between faculty intention and student perceptions regarding SGM education. METHODS: A cross-sectional survey was distributed to preclerkship CDs and current medical students in Spring 2019 and 2021, respectively, regarding where in the mandatory preclerkship curriculum CDs deliberately taught and where first- and second-year students recalled having learned 10 SGM topic domains. RESULTS: 64.3% of CDs (n = 18), 47.0% of the first-year class (n = 71), and 67.3% of the second-year class (n = 101) responded to the surveys. Results indicate that, as anticipated, deliberate SGM teaching correlates with greater student recall as students recalled topics that were reported by CDs as intentionally taught at a significantly higher rate compared to those not intentionally taught (32.0% vs. 15.3%; p < 0.01). Students most commonly recalled learning SGM-related language and terminology, which is likely partly but not entirely attributed to curricular modifications and faculty development made between distribution of the faculty and student surveys, indicating the importance of all faculty being trained in appropriate SGM terminology and concepts. Discordance between faculty intention and student recall of when topics were taught reveals opportunities to enhance the intentionality and impact of SGM teaching. CONCLUSIONS: Students perceive and recall SGM content that is not listed as learning objectives, and all faculty who utilize this material in their teachings should receive foundational training and be thoughtful about how information is framed. Faculty who intentionally teach SGM topics should be explicit and direct about the conclusions they intend students to draw from their curricular content.

Unusual bilateral variation of the flexor digitorum accessorius longus muscle and its relation on tarsal tunnel syndrome.

PURPOSE: During standard anatomical dissection for a medical anatomy course, we encountered an unusual bilateral variant of a unipennate flexor digitorum accessorius longus (FDAL) muscle, a supernumery muscle of the deep posterior leg and medial ankle. METHODS: We documented the muscles course and measured the diameter and length of the FDAL muscle belly, as well as the full length of its tendinous attachments. RESULTS: On both right and left legs, the FDAL originated from the proximal posterior fibula and distal one-third of the flexor hallucis longus muscle. The tendon had a distal attachment on the flexor digitorum longus (FDL) tendon and traveled with the FDL tendon as it inserted on the third distal phalanx. The left FDAL full length was 42.54 cm; the length of the muscle belly was 16.26 cm; and the circumference of the muscle belly was 4.44 cm. The right FDAL full length was 44.20 cm; the length of muscle belly was 12.06; and the circumference (belly) was 4.44 cm. Surrounding musculature and neurovasculature follow standard anatomical courses. CONCLUSION: This anatomical documentation provides opportunities for clinicians to consider mechanical influences of the FDAL on plantar foot function and further consider the accessory ankle muscles that have the potential to cause compressive neuropathies such as tarsal tunnel syndrome.

Integrating the basic sciences in medical curricula: focus on the basic scientists.

Basic science educators are not trained as clinicians, yet are expected to adjust their content to mesh appropriately with its clinical application. While achievable, this is a challenge that requires intentional effort on the part of the basic science educators. A practical solution to facilitate curricular integration is to create experiential opportunities for basic scientists to observe the clinical application of their content and to pair these initiatives with training in effective medical education practices.

Dermatology and anatomy laboratory: comparing three formats of integration.

BACKGROUND: Medical schools rarely offer exposure to clinical dermatology in the first-year curriculum. OBJECTIVE: We describe and report student satisfaction results of three novel teaching methods for integrating basic dermatology concepts into gross anatomy laboratory. METHODS: During the first year of the intervention, 180 students attended an hour-long anatomy laboratory session during which skin lesions were examined. One attending and three resident dermatologists spent time at all tables of students, then circulated to answer questions. During the second year, 189 students participated in the same teaching session preceded by a 30-minute in-class lecture. During the third year, 172 students were given the option to view a supplemental online video module before or after the teaching session. Each year following the teaching session, students were sent an optional online survey regarding the impact of the teaching session on their understanding of skin lesions and their cadaver experience. RESULTS: Overall, students felt the intervention helped them develop a better understanding and appreciation for dermatology. Preceding the laboratory session with a lecture or educational video yielded higher satisfaction scores. CONCLUSIONS: This brief teaching intervention illustrates an approach to introducing dermatologic entities within the foundational science curriculum of the first year of medical school.

Association between measures of patella height, morphologic features of the trochlea, and patellofemoral joint alignment: the MOST study.

BACKGROUND: Patellofemoral joint (PFJ) malalignment (lateral patella displacement and tilt) has been proposed as a cause of patellofemoral pain. Patella height and/or the morphologic features of the femoral trochlea may predispose one to patella malalignment. QUESTIONS/PURPOSES: The purposes of our study were to assess the associations among patella height, morphologic features of the trochlea, and measures of PFJ alignment and to determine which measures of patella height and morphologic features of the trochlea were the best predictors of PFJ alignment. METHODS: Measures of patella height (Insall-Salvati ratio and modified Insall-Salvati ratio), morphologic features of the trochlea (sulcus angle, trochlear angle, lateral trochlear inclination, medial trochlear inclination), and PFJ alignment (bisect offset and patella tilt angle) were assessed in 566 knees from the Multicenter Osteoarthritis Study. RESULTS: Bisect offset was correlated with the Insall-Salvati ratio (r = 0.25) and lateral trochlear inclination (r = -0.38). Patella tilt angle correlated with the trochlear angle (-0.27) and lateral trochlear inclination (-0.32). Linear regression models including the Insall-Salvati ratio and lateral trochlear inclination explained 20% and 11% of the variance in bisect offset and patella tilt angle, respectively. CONCLUSIONS: Of the variables measured in the current study, the Insall-Salvati ratio and lateral trochlear inclination were the best predictors of lateral patella displacement and lateral tilt. This knowledge will aid clinicians in the identification of anatomic risk factors for PFJ malalignment and/or PFJ dysfunction.

Comparing the emotional experiences of students in similar dissection- and prosection-based medical gross anatomy courses: A mixed-methods study.

The anatomy laboratory can incite strong emotional reactions in students, which can in turn facilitate growth in empathy, care for vulnerable others, and professionalism. Despite this, little is known about the relative emotional impacts of different laboratory modalities. The response to the COVID-19 pandemic created an opportunity to compare the emotional experiences of students in similar courses in which one group of students dissected donors and the other group learned from prosected donors. The courses were otherwise the same in content, length, instructional design, and assessment. Students in the dissection-based (Fall 2019) and prosection-based (Fall 2020) courses completed a previously validated survey that used quantitative and qualitative questions to assess their feelings about the donors and the anatomy laboratory experience. Students in both cohorts reported overall appreciation for having had the experience. Negative themes experienced by both groups included feeling anxiety, worries about depersonalizing donors, and physical discomfort in the laboratory. Students in the dissection course reported stronger connections with the donors and the donors' families but also more frequently felt negative feelings such as disgust, anxiety, and feeling alone. Students in the prosection course reported more consistently positive responses but worried about not using the donors to the fullest extent possible. Regardless of pedagogical design, students have complex emotional experiences in the anatomy laboratory and our results indicate that these feelings may be more intense in the context of dissection. Anatomists should foster educational settings that enable students to learn to process complex or challenging emotions.

Essential anatomy for core clerkships: A clinical perspective.

Clerkships are defining experiences for medical students in which students integrate basic science knowledge with clinical information as they gain experience in diagnosing and treating patients in a variety of clinical settings. Among the basic sciences, there is broad agreement that anatomy is foundational for medical practice. Unfortunately, there are longstanding concerns that student knowledge of anatomy is below the expectations of clerkship directors and clinical faculty. Most allopathic medical schools require eight "core" clerkships: internal medicine (IM), pediatrics (PD), general surgery (GS), obstetrics and gynecology (OB), psychiatry (PS), family medicine (FM), neurology (NU), and emergency medicine (EM). A targeted needs assessment was conducted to determine the anatomy considered important for each core clerkship based on the perspective of clinicians teaching in those clerkships. A total of 525 clinical faculty were surveyed at 24 United States allopathic medical schools. Participants rated 97 anatomical structure groups across all body regions on a 1-4 Likert-type scale (1 = not important, 4 = essential). Non-parametric ANOVAs determined if differences existed between clerkships. Combining all responses, 91% of anatomical structure groups were classified as essential or more important. Clinicians in FM, EM, and GS rated anatomical structures in most body regions significantly higher than at least one other clerkship (p = 0.006). This study provides an evidence-base of anatomy content that should be considered important for each core clerkship and may assist in the development and/or revision of preclinical curricula to support the clinical training of medical students.

Structural analysis of muscles elevating the hyolaryngeal complex.

A critical event of pharyngeal swallowing is the elevation of the hyolaryngeal complex to open the upper esophageal sphincter. Current swallowing theory assigns this function to the submental and thyrohyoid muscles. However, the attachments of the long pharyngeal muscles indicate that they could contribute to this function, yet their role is uninvestigated in humans. In addition, there is evidence the posterior digastric and stylohyoid contribute to hyoid elevation. A cadaver model was used to document the structural properties of muscles. These properties were used to model muscle groups as force vectors and analyze their potential for hyolaryngeal elevation. Vector magnitude was determined using physiological cross-sectional areas (PCSAs) of muscles calculated from structural properties of muscle taken from 12 hemisected cadaver specimens. Vector direction (lines of action) was calculated from the three-dimensional coordinates of muscle attachment sites. Unit force vectors in the superior direction of submental, suprahyoid (which includes the submental muscles), long pharyngeal, and thyrohyoid muscles were derived and compared by an analysis of variance (ANOVA) to document each muscle's potential contribution to hyolaryngeal elevation. An ANOVA with Tukey HSD post hoc analysis of unit force vectors showed no statistically significant difference between the submental (0.92 ± 0.24 cm(2)) and long pharyngeal (0.73 ± 0.20 cm(2)) muscles. Both demonstrated greater potential to elevate the hyolaryngeal complex than the thyrohyoid (0.49 ± 0.18 cm(2)), with P < 0.01 and P < 0.05, respectively. The suprahyoid muscles (1.52 ± 0.35 cm(2)) demonstrated the greatest potential to elevate the hyolaryngeal complex: greater than both the long pharyngeal muscles (P < 0.01) and the thyrohyoid (P < 0.01). The submental and thyrohyoid muscles by convention are thought to elevate the hyolaryngeal complex. This study demonstrates that structurally the long pharyngeal muscles have similar potential to contribute to this critical function, with the suprahyoid muscles having the greatest potential. If verified by functional data, these findings would amend current swallowing theory.

Effectiveness of Pedagogical Tools for Teaching Medical Gross Anatomy During the COVID-19 Pandemic.

Medical institutions have been forced to modify gross anatomy pedagogy to comply with the health restrictions imposed by the novel coronavirus (COVID-19). Boston University School of Medicine (BUSM) is one such institution that temporarily restructured its course. We replaced cadaveric dissection activities with prosections and placed a greater emphasis on a flipped classroom model. This study investigates the effectiveness of new course materials developed to aid these curriculum changes. Course materials were developed for three purposes: (1) preparation before laboratory sessions (orientation videos and Complete Anatomy (3D4Medical, Elsevier) screens); (2) guidance during laboratory sessions (laboratory guides); and (3) review after laboratory sessions (Zoom recitation sessions). We performed a grounded theory thematic analysis of students' responses (80/160, 50% response) to qualitative survey questions and to focus group questions (16 students who self-selected between 4 different sessions). Data from both the survey and focus groups demonstrated that the vast majority of students agreed that the materials helped them navigate through learning gross anatomy. However, laboratory guides were used mostly for post-lab review as opposed to the intended direction during laboratory sessions. Students within all focus groups overwhelmingly touted the value of Zoom recitation sessions, with many stating that they were imperative to course success. When comparing performance data between 2019 (pre-COVID) and 2020 students, we found that the students who took the anatomy course during the onset of COVID had a slightly higher overall average score in all three modules of the course than compared to the 2019 students. We propose that the utilization of course materials that students perceived as time saving and pertinent to their exam performance, when combined with cadaveric prosection, emphasized the benefits of flipped-classroom learning to help students learn gross anatomy effectively and efficiently during the pandemic and beyond. Supplementary Information: The online version contains supplementary material available at 10.1007/s40670-022-01524-x.

A Novel Curriculum Assessment Tool, Based on AAMC Competencies, to Improve Medical Education About Sexual and Gender Minority Populations.

PROBLEM: Medical education aspires to mitigate bias in future professionals by providing robust curricula that include perspectives of and practices for caring for sexual and gender minority (SGM) populations; however, implementation of these ideals remains challenging. Medical school leaders motivated to improve curricula on caring for SGM populations must survey their school's current curricula to identify strengths and opportunities for improvement. In 2014, the Association of American Medical Colleges (AAMC) published 30 SGM competencies that curricula should address. Here the authors describe the development of a tool to efficiently assess whether an undergraduate medical education (UME) curriculum adequately incorporates the AAMC-recommended SGM competencies. APPROACH: In 2018, Boston University School of Medicine (BUSM) convened a group of faculty and students with experience and expertise regarding SGM health. The group distilled the 30 AAMC competencies into 12 SGM topic areas that should be addressed in any UME curriculum, and they developed a curriculum assessment tool to evaluate the presence and timing of these topic areas in the BUSM curriculum. This tool was distributed to all course and clerkship directors responsible for the required UME curriculum at BUSM to investigate where these topic areas are addressed (May-June 2019). OUTCOMES: The curriculum assessment tool identified several strengths in the preclerkship and clerkship curricula, including faculty willingness and enthusiasm to include SGM content. The assessment tool also revealed that some SGM topic areas are underrepresented in the BUSM curriculum, particularly during clerkships. NEXT STEPS: The curriculum assessment tool described here is a straightforward, standardized instrument to map SGM topic areas within any UME curriculum. It is designed to be comprehensible by individuals who are not familiar with SGM health. The tool minimizes barriers to medical curricular change by providing a mechanism to assess and understand how SGM health is incorporated into existing curricula.

Evaluating the structural properties of suprahyoid muscles and their potential for moving the hyoid.

Superior and anterior hyoid movements are important events in pharyngeal deglutition. This cross-sectional study uses a cadaver model to document the structural properties of the muscles underlying these movements in an effort to understand how their morphology influences function. Measurements to determine physiological cross-sectional areas (PCSAs) of swallowing muscles were taken from hemisected head and neck formalin-fixed cadaver specimens (n = 13). Coordinates of muscle attachment sites and PCSAs were used to calculate î and j unit force vectors, where î and j represent anterior-posterior and superior-inferior directions, respectively. The suprahyoid muscle subsamples were grouped for analysis as follows: digastric (DG), geniohyoid (GH), mylohyoid (MH), and stylohyoid (SH). The ANOVA with Tukey HSD post hoc analysis of unit force vectors showed the following results: GH (-0.44 ± 0.15 cm(2)) >MH (-0.02 ± 0.21 cm(2)), DG (-0.05 ± 0.11 cm(2)), SH (0.14 ± 0.04 cm(2)), with negative values representing the anterior direction (p < 0.01); and MH (0.91 ± 0.28 cm(2)) >DG (0.29 ± 0.14 cm(2)), SH (0.22 ± 0.08 cm(2)), GH (12 ± 0.08 cm(2)), with positive values representing the superior direction (p < 0.01). The morphology of the suprahyoid muscles suggests that based on structural properties, the geniohyoid has the most potential to displace the hyoid in the anterior direction and the mylohyoid has the most potential to displace the hyoid in the superior direction. These data in complement with physiological findings may provide greater insight into these movements for those developing novel treatments for dysphagia.

Anticipatory Feelings About Dissection: An Exercise for the First Day of a Gross Anatomy Course.

Studies have demonstrated that students experience a variety of intense emotions in anticipation of human anatomical dissection, including enthusiasm, gratitude, responsibility, apprehension, detachment, anxiety, and spiritual or moral reflection. The exercise described here provides an opportunity to start a conversation about the complexity of students' emotional reactions to the anatomy experience. The intention of this exercise is to normalize the variety of emotions that anatomy students experience, both to demonstrate to students that their emotions are normal and to encourage the empathy for others' reactions which may differ from their own. In the lecture hall setting before the first day of dissection, students are asked to draw how they feel about the dissection experience and are provided an opportunity to discuss their drawings with their peers. The course director then provides a slide show demonstration of drawings from previous years, and experienced anatomy faculty facilitate a large group discussion in which students react to the drawing exercise and slide show and ask questions which are addressed by the faculty. This exercise provides an opportunity for students to practice appropriately communicating about emotionally complex experiences in a professional setting. The exercise is straightforward to implement and is easily modifiable for different class sizes and curricular structures.

Integrating the Educators: Outcomes of a Pilot Program to Prime Basic Science Medical Educators for Success in Integrated Curricula.

"Integrating the Educators" is a program to prepare early career basic scientists to teach effectively in integrated medical curricula, where connections between basic sciences and clinical application are highlighted and emphasized. Advanced PhD trainees received didactic training in best practices in medical education followed by 3 months shadowing clinician educator mentors. This combination of experiences was designed to contrast the methods, focus, and pace of teaching in the clinical setting compared to the typical basic science classroom. Trainees' knowledge and attitudes shifted to recognize the faster pace and clinical focus necessary in integrated curricula.

Correction to: Integrating the Educators: Outcomes of a Pilot Program to Prime Basic Science Medical Educators for Success in Integrated Curricula.

[This corrects the article DOI: 10.1007/s40670-019-00742-0.].

Integrating gross anatomy into a clinical oncology curriculum: the oncoanatomy course at Duke University School of Medicine.

The amount of time devoted to teaching gross anatomy to medical students is declining. This topic remains critically important for some medical students, especially those seeking training in anatomy-laden specialties. The authors describe a course currently offered in the department of radiation oncology in the Duke University School of Medicine, developed in 2005, that expands anatomy education into the medical school clinical years. The aim of the course is to help reinforce anatomy knowledge in the clinical context of radiation oncology priorities and concerns, as well as to provide direct visualization and palpation of human cadavers, thus enabling the understanding of complex three-dimensional and anatomic principles. The audience for this course consists of medical students rotating through and the residents and clinical faculty in the department of radiation oncology. Anatomists and radiation oncology residents together present monthly didactic lectures, clinical case presentations, and cadaver-based demonstrations about the relationships between a tumor's anatomic location and its symptoms, patterns of spread, and treatment considerations. Anonymous surveys were distributed to course participants to assess the three components of the course. Survey results indicate that the participants found the anatomy lectures, clinical case presentations, and dissection presentations all to be interesting, relevant, and of high quality. This course is therefore favored by students, residents, and faculty as a way to supplement gross anatomy education during training for a specialty in which anatomy knowledge is essential.

Force plate for measuring the ground reaction forces in small animal locomotion.

The importance of kinetic force plate studies of locomotion in small animals has grown recently with the increasing use of rodent models for studies of musculoskeletal diseases. However, the force plates for use with animals much smaller than a cat are difficult to design and use. Here we present data on a commercially available small force plate that accurately collects whole-body and, in a modified form, single-limb ground reaction forces in mice. The method used here is convenient, inexpensive, and readily adaptable for use with a variety of small species.

Gaze patterns of gross anatomy students change with classroom learning.

Numerous studies have documented that experts exhibit more efficient gaze patterns than those of less experienced individuals. In visual search tasks, experts use fewer, longer fixations to fixate for relatively longer on salient regions of the visual field while less experienced observers spend more time examining nonsalient regions. This study investigates whether changes in gaze patterns reflect learning by students in a medical gross anatomy course. Students were asked to examine photographs of dissections similar to those they experienced in class and to identify the tagged structure in each image. We postulated that, compared to naive behavior (behavior at baseline and when examining unfamiliar content) students would examine familiar content for longer and would direct proportionally more fixation time on cognitively salient regions of the images while using fewer, longer duration fixations. Our students examined familiar images for significantly longer than they did at baseline (P < 0.0001) or for unfamiliar images (P < 0.0001). They also spent significantly longer examining cognitively salient regions of familiar images, as compared to examining those regions at baseline (P < 0.0001) and on unfamiliar images (P < 0.0001). However, these gaze patterns were characterized by more numerous fixations rather than fewer, longer fixations. These individuals are successful learners in a challenging gross anatomy course, but are not experts in anatomy. Therefore we speculate that the gaze pattern they exhibit characterizes an earlier stage of the learning process than has previously been documented in studies of expertise, which have primarily focused on the gaze patterns of true experts.

Visualizing Hyolaryngeal Mechanics in Swallowing Using Dynamic MRI.

INTRODUCTION: Coordinates of anatomical landmarks are captured using dynamic MRI to explore whether a proposed two-sling mechanism underlies hyolaryngeal elevation in pharyngeal swallowing. A principal components analysis (PCA) is applied to coordinates to determine the covariant function of the proposed mechanism. METHODS: Dynamic MRI (dMRI) data were acquired from eleven healthy subjects during a repeated swallows task. Coordinates mapping the proposed mechanism are collected from each dynamic (frame) of a dynamic MRI swallowing series of a randomly selected subject in order to demonstrate shape changes in a single subject. Coordinates representing minimum and maximum hyolaryngeal elevation of all 11 subjects were also mapped to demonstrate shape changes of the system among all subjects. MophoJ software was used to perform PCA and determine vectors of shape change (eigenvectors) for elements of the two-sling mechanism of hyolaryngeal elevation. RESULTS: For both single subject and group PCAs, hyolaryngeal elevation accounted for the first principal component of variation. For the single subject PCA, the first principal component accounted for 81.5% of the variance. For the between subjects PCA, the first principal component accounted for 58.5% of the variance. Eigenvectors and shape changes associated with this first principal component are reported. DISCUSSION: Eigenvectors indicate that two-muscle slings and associated skeletal elements function as components of a covariant mechanism to elevate the hyolaryngeal complex. Morphological analysis is useful to model shape changes in the two-sling mechanism of hyolaryngeal elevation.

Evaluating swallowing muscles essential for hyolaryngeal elevation by using muscle functional magnetic resonance imaging.

PURPOSE: Reduced hyolaryngeal elevation, a critical event in swallowing, is associated with radiation therapy. Two muscle groups that suspend the hyoid, larynx, and pharynx have been proposed to elevate the hyolaryngeal complex: the suprahyoid and longitudinal pharyngeal muscles. Thought to assist both groups is the thyrohyoid, a muscle intrinsic to the hyolaryngeal complex. Intensity modulated radiation therapy guidelines designed to preserve structures important to swallowing currently exclude the suprahyoid and thyrohyoid muscles. This study used muscle functional magnetic resonance imaging (mfMRI) in normal healthy adults to determine whether both muscle groups are active in swallowing and to test therapeutic exercises thought to be specific to hyolaryngeal elevation. METHODS AND MATERIALS: mfMRI data were acquired from 11 healthy subjects before and after normal swallowing and after swallowing exercise regimens (the Mendelsohn maneuver and effortful pitch glide). Whole-muscle transverse relaxation time (T2 signal, measured in milliseconds) profiles of 7 test muscles were used to evaluate the physiologic response of each muscle to each condition. Changes in effect size (using the Cohen d measure) of whole-muscle T2 profiles were used to determine which muscles underlie swallowing and swallowing exercises. RESULTS: Post-swallowing effect size changes (where a d value of >0.20 indicates significant activity during swallowing) for the T2 signal profile of the thyrohyoid was a d value of 0.09; a d value of 0.40 for the mylohyoid, 0.80 for the geniohyoid, 0.04 for the anterior digastric, and 0.25 for the posterior digastric-stylohyoid in the suprahyoid muscle group; and d values of 0.47 for the palatopharyngeus and 0.28 for the stylopharyngeus muscles in the longitudinal pharyngeal muscle group. The Mendelsohn maneuver and effortful pitch glide swallowing exercises showed significant effect size changes for all muscles tested, except for the thyrohyoid. CONCLUSIONS: Muscles of both the suprahyoid and the longitudinal pharyngeal muscle groups are active in swallowing, and both swallowing exercises effectively target muscles elevating the hyolaryngeal complex. mfMRI is useful in testing swallowing muscle function.

Effect of visual-spatial ability on medical students' performance in a gross anatomy course.

The ability to mentally manipulate objects in three dimensions is essential to the practice of many clinical medical specialties. The relationship between this type of visual-spatial ability and performance in preclinical courses such as medical gross anatomy is poorly understood. This study determined if visual-spatial ability is associated with performance on practical examinations, and if students' visual-spatial ability improves during medical gross anatomy. Three hundred and fifty-two first-year medical students completed the Mental Rotations Test (MRT) before the gross anatomy course and 255 at its completion in 2008 and 2009. Hypotheses were tested using logistic regression analysis and Student's t-test. Compared with students in the lowest quartile of the MRT, students who scored in the highest quartile of the MRT were 2.2 [95% confidence interval (CI) 1.2 and 3.8] and 2.1 (95% CI 1.2 and 3.5) times more likely to score greater than 90% on practical examinations and on both practical and written examinations, respectively. MRT scores for males and females increased significantly (P < 0.0001). Measurement of students' pre-existing visual-spatial ability is predictive of performance in medical gross anatomy, and early intervention may be useful for students with low visual-spatial ability on entry to medical school. Participation in medical gross anatomy increases students' visual-spatial ability, although the mechanism for this phenomenon is unknown.