Novel Approach to Residents Training in Breast Surgery Using Human Donors.

INTRODUCTION: Given the high incidence rate of breast cancer and shortage of fellowship trained specialists, general surgeons are frequently responsible for these patients. Residents have less operative exposure to breast surgery due to duty hour restrictions and decreased resident autonomy. We created a curriculum using human donors designed to teach junior residents to perform breast lumpectomy and sentinel lymph node biopsies. METHODS: All eighteen junior surgery residents were invited. We chose fresh human donors to represent tissue planes more accurately. We inserted Savi Scout reflectors (Merit Oncology, Inc) in each breast for tumor localization. An olive pit plus 1 mL of methylene blue was inserted in the axilla for SLN identification. In session 1, attendings discussed proper technique and residents performed the procedures and received feedback. In session 2 after 2 mo, residents performed the same operation without any guidance. They were graded on technique during both sessions and filled out a postsession survey to gauge confidence. RESULTS: Seven PGY1 and six PGY2 residents participated. Half of the respondents strongly felt this session improved their understanding of lumpectomies, sentinel lymph node biopsies, and axillary anatomy. Most felt strongly that their skills improved and these skills were transferable to the operating room. In attending evaluations, PGY1 residents significantly improved in all aspects of the procedures; PGY2 residents showed nonstatistical significant improvement. CONCLUSIONS: Residents find these sessions helpful in learning anatomy, improving confidence and efficiency, and facilitating skill acquisition that is transferable to the operating room. We believe this approach should be considered in general surgery training programs.

Validity and Reliability of the Insole3 Instrumented Shoe Insole for Ground Reaction Force Measurement during Walking and Running.

Pressure-detecting insoles such as the Insole3 have potential as a portable alternative for assessing vertical ground reaction force (vGRF) outside of specialized laboratories. This study evaluated whether the Insole3 is a valid and reliable alternative to force plates for measuring vGRF. Eleven healthy participants walked overground at slow and moderately paced speeds and ran at a moderate pace while collecting vGRF simultaneously from a force plate (3000 Hz) and Insole3 (100 Hz). Intraclass correlation coefficients (ICC) demonstrated excellent vGRF agreement between systems during both walking speeds for Peak 1, Peak 2, the valley between peaks, and the vGRF impulse (ICC > 0.941). There was excellent agreement during running for the single vGRF peak (ICC = 0.942) and impulse (ICC = 0.940). The insoles slightly underestimated vGRF peaks (−3.7% to 0.9% bias) and valleys (−2.2% to −1.8% bias), and slightly overestimated impulses (4.2% to 5.6% bias). Reliability between visits for all three activities was excellent (ICC > 0.970). The Insole3 is a valid and reliable alternative to traditional force plates for assessing vGRF during walking and running in healthy adults. The excellent ICC values during slow walking suggests that the Insole3 may be particularly suitable for older adults in clinical and home settings.

The Feasibility of Using Augmented Auditory Feedback From a Pressure Detecting Insole to Reduce the Knee Adduction Moment: A Proof of Concept Study.

The objective of this work was to conduct a proof of concept study utilizing auditory feedback from a pressure-detecting shoe insole to shift plantar pressure medially in order to reduce the knee adduction moment (KAM). When compared with normal walking, 32 healthy subjects significantly reduced their peak KAM using feedback (p < 0.001). When compared with medial thrust gait, an established gait modification, walking with pressure-based feedback was equally effective at reducing the peak KAM, yet it successfully mitigated other potentially detrimental gait measures such as the peak knee flexion moment (KFM), knee internal rotation moment (KIrM), and a reduction in speed.

Anatomy's missing faces: An assessment of representation gaps in atlas and textbook imagery.

Previous research suggests that underrepresentation in medical curricula perpetuates inequities in healthcare. This study aimed to quantify the prevalence of human phenotypic diversity (e.g., skin tone, sex, body size, and age) across 11 commonly used anatomy atlases and textbooks in pre-clerkship medical education, published from 2015 to 2020. A systematic visual content analysis was conducted on 5001 images in which at least one phenotypic attribute was quantifiable. Anatomy images most prevalently portrayed light skin tones, males, persons with intermediate body sizes, and young to middle-aged adults. Of the 3883 images in which there was a codable skin tone, 81.2% (n = 3154) depicted light, 14.3% (n = 554) depicted intermediate, and 4.5% (n = 175) depicted dark skin tones. Of the 2384 images that could be categorized into a sex binary, 38.4% (n = 915) depicted females and 61.6% (n = 1469) depicted males. A male bias persisted across all whole-body and regional-body images, including those showing sex organs or those showing characteristics commonly associated with a specific sex (e.g. for males, facial hair and/or muscle hypertrophy). Within sex-specific contexts, darker skin was underrepresented, but male depictions displayed greater overall skin tone variation. Although most images could not be assigned to a body size or age category, when codable, these images overwhelmingly depicted adults (85.0%; 482 of 567) with smaller (34.7%; 93 of 268) or intermediate (64.6%; 173 of 268) body sizes. Ultimately, these outcomes provide reference metrics for monitoring ongoing and future efforts to address representation inequalities portrayed in anatomical imagery.

Employment benefits across U.S. allopathic medical schools: National norms and relationships with institutional wealth.

This study summarizes employment benefits from across 155 U.S. allopathic medical schools, investigates differences in employment benefits according to institutional characteristics, and explores possible connections between employment benefits and institutional wealth. Employment benefits data were extracted from institutions' websites across four categories: time-off, time-away, retirement contributions, and Employee Assistance Programs (EAPs)/family benefits. This dataset was mixed with other publicly available datasets sourced through the Association of American Medical Colleges (AAMC), the American Council on Education (ACE), and the American Association of University Professors (AAUP) to conduct additional analyses. Nationally, medical schools offered an average of 31 vacation/sick days and 12 paid holidays. Schools typically offered 4 out of 8 time-away benefits. Employers' retirement contributions ranged from 3.0% to 15.5%, with a mean contribution of 8.5%. A total of 43.2% (67 of 155) of medical schools offered a pension. Collectively, private medical schools offered fewer time-away benefits and more EAP/family benefits compared to public schools. Universities with larger endowments per student were associated with a higher number of EAP/family benefits offerings (r = 0.543, p < 0.001). Institutional wealth did not influence other benefits offerings. The quantity/quality of most employment benefits offered at allopathic medical schools were wide-ranging, tended not to vary by region or school control, and were not a function of institutional wealth.

Pulling back the curtain: Exploring norms and practices among a sample of anatomy-related departments in U.S. medical schools.

Anatomy-related departments have access to comparative research productivity data (e.g., Blue Ridge Institute for Medical Research), yet no datasets exist for comparing departments' general practices pertinent to education-focused faculty. Practice trends in anatomy-related departments across U.S. medical schools were explored by surveying departmental leaders. The survey inquired about: (i) faculty time allocations, (ii) anatomy teaching services, (iii) faculty labor distribution models, and (iv) faculty compensation practices. A nationally representative sample of 35 departments (of 194) responded to the survey. On average, anatomy educators are allotted 24% (median = 15%) protected time for research, irrespective of funding, 62% for teaching and course administration (median = 68%), 12% for service, and 2% for administration. Forty-four percent (15 of 34) of departments taught at least five different student populations, often across multiple colleges. Many departments (65%; 11 of 17) applied formulaic methods for determining faculty workloads, often as a function of course credits or contact hours. Average base salaries for assistant and associate professors reported by this survey were consistent (p ≥ 0.056) with national means (i.e., Association of American Medical Colleges Annual Faculty Salary Report). Merit-based increases and bonuses averaged 5% and 10% of faculty's salaries, respectively, when awarded. Cost-of-living increases averaged 3%. Overall, departments' workload and compensation practices vary widely, likely a consequence of different institutional cultures, locations, needs, and financial priorities. This sample dataset allows anatomy-related departments to compare and reflect upon their practices and competitiveness in recruiting and retaining faculty.

Accuracy of the fully integrated Insole3's estimates of spatiotemporal parameters during walking.

This study investigated the accuracy of the Insole3 wireless shoe device in estimating several clinically useful spatiotemporal parameters (STPs). Eleven subjects walked at slow (0.8-1.0 m/s) and moderate-paced (1.2-1.4 m/s) speeds. Data were simultaneously recorded using the Insole3 and an industry-standard, three-dimensional motion capture (MOCAP) system. An error analysis compared the resulting STP data from the two systems. The mean bias error (MBE) was generally lower for temporal variables, and somewhat higher, but acceptable, for spatial variables. The MBE for temporally-related cadence and cycle time were the lowest (less than ±0.45%), with 100% (110/110) of slow-paced walking trial values and 99.1% (109/110) of moderate-paced walking trial values within 5% of the MOCAP estimates. The MBE was highest for speed (3.23-4.91%) and stride length (3.68-4.63%), with between 52.7 and 69.1% of trial values falling within the 5% error range. Stance time and swing time ranged between -0.98 and 4.38% error for both walking conditions. The results of this study suggest that the Insole3 is a potential alternative to MOCAP for estimating several STPs, namely cadence, stance time, and cycle time, particularly for use outside of the laboratory setting.

A cigar in the left hand, a paintbrush in the right: Illustration and the anatomical sciences.

The anatomical sciences heavily rely on art and illustration to convey form, depth, and relationship within living structures. Today, biomedical illustrators carry forward traditions from 16th century artists through the likes of 20th century champions such as Frank Netter to help educators and researchers convey their messages to their listening, and more importantly, viewing audiences. Biomedical illustration programs are a valuable resource for academics to package their research as published figures, including graphical abstracts, in scientific journals. Here, we describe an innovative art-science collaboration among The Anatomical Record, the Department of Anatomy and Cell Biology at Rush University, and the Master's Program in Biomedical Visualization at University of Illinois at Chicago, whose students were invited to create and submit scientific illustrations for consideration as cover art for the journal.

Iliocapsularis: An exploration of the muscle and its omission in education.

Anterior hip joint musculature is classically characterized to include iliacus, psoas major, rectus femoris, and sartorius muscles. A lesser-known muscle, iliocapsularis muscle (ICm), has made infrequent appearances in the literature for the last ~70 years, but potentially has important functional and clinical value. The purpose of this study is to review the historical prevalence of the ICm in peer-reviewed literature (PRL), further explore the prevalence of the muscle in current anatomical textbooks (ATBs), characterize the muscle with a new series of dissections, assess the muscle's perceived importance to clinicians and educators, and comment on the possible functional significance of the muscle. The ICm was mentioned in 28 peer-reviewed articles and the muscle was present in 518 of 521 (99%) dissected hips in 13 publications which assessed prevalence. In an audit of 30 recently published ATBs, three texts mentioned the ICm. In 28 anterior hip dissections performed in the current study, the muscle was present in all hips. Anatomy educators were surveyed to determine if the ICm was presently taught in their curricula, and clinicians of various specialties were surveyed regarding their perceptions of the ICm and its clinical relevance. The ICm inclusivity within anatomical curricula from educators reported 8.5%, while 4% of clinicians reported trainees should have an educational background of the ICm. This study confirms that while the ICm is present within PRL, and is ubiquitous amongst human-donor dissection, the ICm is not mentioned in most ATBs and is absent in the vast majority of anatomical curricula. Lack of inclusion in curricula may lead to a perceived insignificance to currently practicing clinicians despite the potential functional importance at the hip. This discordance suggests that the ICm should be included in ATBs and anatomical curricula so that future clinicians can consider the ICm when evaluating and treating patients.

Gut Games: a Board Game to Integrate Basic and Clinical Sciences for the Classroom.

Medical schools are moving away from traditional lectures in favor of small-group learning. Here we present a game-based activity designed to improve student engagement while serving as a course review. The activity incorporated 32 questions submitted by eleven discipline directors. The 133 student participants reviewed the session positively, rating it highest of the 11 course sessions with an overall quality of a 4.68 (± 0.84) out of a 6-point Likert scale. The students remarked that the activity was fun and engaging, yet long. It reviewed a breadth of content over several specialties in a format that encouraged active, team-based learning.

Unsupervised gait retraining using a wireless pressure-detecting shoe insole.

BACKGROUND: The knee adduction moment (KAM) is a surrogate measure of mediolateral distribution of loads across the knee joint and is correlated with progression and severity of knee osteoarthritis (OA). Existing biomechanical approaches for unloading the arthritic medial knee compartment vary in their effectiveness in reducing KAM. This study employed a completely wireless, pressure-detecting shoe insole capable of generating auditory feedback via a smartphone. RESEARCH QUESTION: To investigate whether auditory cues from a smartphone can prompt subjects to adjust their gait pattern and reduce KAM. METHODS: Nineteen healthy subjects underwent gait training inside the lab (Phase 1) and received auditory cues during mid- and terminal stance to medialize their foot COP (center-of-pressure). This initial training period was continued unsupervised while walking around campus (Phase 2). RESULTS: After Phase 1, subjects reduced their KAM by 20.6% (p = 0. 001), a finding similar to a previous study that used a wired, lab-based insole system. After further unsupervised training outside the lab during Phase 2, subjects were able to execute the newly learned gait pattern without auditory feedback still showing a KAM reduction of 17.2% (p < 0.001). Although, speed at Phase 2 was lower than at baseline (p = 0.013), this reduction had little effect on KAM (r = 0.297, p = 0.216). In addition, the adduction angular impulse was reduced (p = 0.001), despite the slower speed. SIGNIFICANCE: Together, these results suggest that the wireless insole is a promising tool for gait retraining to lower the KAM and will be implemented in a home-based clinical trial of gait retraining for subjects with knee OA.

From normal to fast walking: Impact of cadence and stride length on lower extremity joint moments.

This study aimed to clarify the influence of various speeding strategies (i.e. adjustments of cadence and stride length) on external joint moments. This study investigated the gait of 52 healthy subjects who performed self-selected normal and fast speed walking trials in a motion analysis laboratory. Subjects were classified into three separate groups based on how they increased their speed from normal to fast walking: (i) subjects who increased their cadence, (ii) subjects who increased their stride length and (iii) subjects who simultaneously increased both stride length and cadence. Joint moments were calculated using inverse dynamics and then compared between normal and fast speed trials within and between three groups using spatial parameter mapping. Individuals who increased cadence, but not stride length, to walk faster did not experience a significant increase in the lower limb joint moments. Conversely, subjects who increased their stride length or both stride length and cadence, experienced a significant increase in all joint moments. Additionally, our findings revealed that increasing the stride length had a higher impact on joint moments in the sagittal plane than those in the frontal plane. However, both sagittal and frontal plane moments were still more responsive to the gait speed change than transverse plane moments. This study suggests that the role of speed in altering the joint moment patterns depends on the individual's speed-regulating strategy, i.e. an increase in cadence or stride length. Since the confounding effect of walking speed is a major consideration in human gait research, future studies may investigate whether stride length is the confounding variable of interest.

A reduction in the knee adduction moment with medial thrust gait is associated with a medial shift in center of plantar pressure.

The knee adduction moment (KAM) is an established marker of compartmental load distribution across the tibiofemoral joint. Research suggests a link between the magnitude of the KAM and center of plantar pressure (COP) thus alterations in the two may be related. The objective of this study was to investigate whether the COP predictably shifts when the KAM is reduced through a gait adaptation. Twenty healthy adults underwent gait analysis walking with their normal gait pattern and with medial thrust gait, a gait adaptation known to significantly reduce the KAM. Simultaneous COP and 3-D kinetics were acquired to allow for a comparison of the change in COP to the change in the KAM. The COP was quantified by determining a customized medial-lateral pressure index (MLPI) which compares the COP tracing line during the first and second halves of stance to the longitudinal axis of the foot. Linear regressions assessing the association between the changes in KAM and MLPI indicated that 48.3% (p=0.001) of the variation in MLPI during the first half of stance can be explained by the KAM during the same period. A trend was observed between the association between the KAM and MLPI during the second half of stance (R(2)=0.16, p=0.080). Backwards elimination regression analysis was used to explore whether simultaneous consideration of the KAM and other potential confounding factors such as sagittal plane knee moments and speed explained variance in the MLPI during the first half of stance. Only the KAM exhibited explanatory power (ß=0.695, p=0.001). During medial thrust gait, a reduction in the KAM was associated with a medial shift in the MLPI, and an increase in the KAM was associated with a lateral shift in the MLPI, especially in the first half of the stance phase. Together, these results demonstrate an inherent link between foot pressure and the KAM during medial thrust gait, and suggest that manipulating foot pressure may be a biomechanical mechanism for an intervention designed to improve loading conditions at the knee.