Quantitative MRI in the Local Staging of Prostate Cancer: A Systematic Review and Meta-Analysis.

BACKGROUND: Local staging of prostate cancer (PCa) is important for treatment planning. Radiologist interpretation using qualitative criteria is variable with high specificity but low sensitivity. Quantitative methods may be useful in the diagnosis of extracapsular extension (ECE). PURPOSE: To assess the performance of quantitative MRI markers for detecting ECE. STUDY TYPE: Systematic review and meta-analysis. SUBJECTS: 4800 patients from 28 studies with histopathologically confirmed PCa on radical prostatectomy were pooled for meta-analysis. Patients from 46 studies were included for systematic review. FIELD STRENGTH/SEQUENCE: Diffusion-weighted, T2-weighted, and dynamic contrast-enhanced MRI at 1.5 T or 3 T. ASSESSMENT: PubMed, Embase, Web of Science, Scopus, and Cochrane databases were searched to identify studies on diagnostic test accuracy or association of any quantitative MRI markers with ECE. Results extracted by two independent reviewers for tumor contact length (TCL) and mean apparent diffusion coefficient (ADC-mean) were pooled for meta-analysis, but not for other quantitative markers including radiomics due to low number of studies available. STATISTICAL TESTS: Hierarchical summary receiver operating characteristic (HSROC) curves were computed for both TCL and ADC-mean, but summary operating points were computed for TCL only. Heterogeneity was investigated by meta-regression. Results were significant if P ≤ 0.05. RESULTS: At the 10 mm threshold for TCL, summary sensitivity and specificity were 0.76 [95% confidence interval (CI) 0.71-0.81] and 0.68 [95% CI 0.63-0.73], respectively. At the 15 mm threshold, summary sensitivity and specificity were 0.70 [95% CI 0.53-0.83] and 0.74 [95% CI 0.60-0.84] respectively. The area under the HSROC curves for TCL and ADC-mean were 0.79 and 0.78, respectively. Significant sources of heterogeneity for TCL included timing of MRI relative to biopsy. DATA CONCLUSION: Both 10 mm and 15 mm thresholds for TCL may be reasonable for clinical use. From comparison of the HSROC curves, ADC-mean may be superior to TCL at higher sensitivities. LEVEL OF EVIDENCE: 3 TECHNICAL EFFICACY STAGE: 2.

Magnetic resonance imaging study of the sciatic nerve variation in the pediatric gluteal region: Implications for the posterior approach of the sciatic nerve blockade.

INTRODUCTION: In pediatric patients, the sciatic nerve is one of the most commonly blocked peripheral nerves during orthopedic procedures of the lower limb. Ultrasound guidance is the current standard for a successful localization of the sciatic nerve in the gluteal region. Relevant anatomical landmarks are also used to determine the nerve location when ultrasound is not available or inadequate. However, reports have demonstrated paucity of information regarding the sciatic nerve location and variation in the hip throughout pediatric development. This imaging study aimed to document and analyze the relative morphometric relationship of the sciatic nerve in the pediatric gluteal region throughout development. METHODS: The location of the sciatic nerve in relation to bony landmarks was measured in 84 pediatric magnetic resonance imaging of patients aged 0.7-15.8 years. RESULTS: The sciatic nerve was identified medial to the most lateral point of greater trochanter at the level of ischial spine and the tip of coccyx. The strong positive correlation between sciatic nerve to landmark distances and age and stature demonstrated linear variation between sciatic nerve location with age and growth of children. To predict the nerve location in the gluteal region, regression equations using patient age were created, having implications for the posterior approach of the sciatic nerve blockade in children. Clinically significant differences were found between sexes, specifically in the older age group. CONCLUSION: Despite the small sample size of younger age group, this study is the first to document the morphometric changes of the sciatic nerve in the gluteal region across pediatric development and may be useful for providing confirmatory guidelines for nerve location when ultrasound is not accessible or cannot be utilized for practice.

Technology enhanced neuroanatomy teaching techniques: A focused BEME systematic review of current evidence: BEME Guide No. 75.

BACKGROUND: In response to growing curriculum pressures and reduced time dedicated to teaching anatomy, research has been conducted into developing innovative teaching techniques. This raises important questions for neuroanatomy education regarding which teaching techniques are most beneficial for knowledge acquisition and long-term retention, and how they are best implemented. This focused systematic review aims to provide a review of technology-enhanced teaching methods available to neuroanatomy educators, particularly in knowledge acquisition and long-term retention, compared to traditional didactic techniques, and proposes reasons for why they work in some contexts. METHODS: Electronic databases were searched from January 2015 to June 2020 with keywords that included combinations of 'neuroanatomy,' 'technology,' 'teaching,' and 'effectiveness' combined with Boolean phrases 'AND' and 'OR.' The contexts and outcomes for all studies were summarised while coding, and theories for why particular interventions worked were discussed. RESULTS: There were 4287 articles identified for screening, with 13 studies included for final analysis. There were four technologies of interest: stereoscopic views of videos, stereoscopic views of images, augmented reality (AR), and virtual reality (VR). No recommendation for a particular teaching method was made in six studies (46%) while recommendations (from weak to moderate) were made in seven studies (54%). There was weak to moderate evidence for the efficacy of stereoscopic images and AR, and no difference in the use of stereoscopic videos or VR compared to controls. CONCLUSIONS: To date, technology-enhanced teaching is not inferior to teaching by conventional didactic methods. There are promising results for these methods in complex spatial anatomy and reducing cognitive load. Possible reasons for why interventions worked were described including students' engagement with the object, cognitive load theory, complex spatial relationships, and the technology learning curve. Future research may build on the theorised explanations proposed here and develop and test innovative technologies that build on prior research.

Instructional Design of Virtual Learning Resources for Anatomy Education.

Virtual learning resources (VLRs) developed using immersive technologies like virtual reality are becoming popular in medical education, particularly in anatomy. However, if VLRs are going to be more widely adopted, it is important that they are designed appropriately. The overarching aim of this study was to propose guidelines for the instructional design of VLRs for anatomy education. More specifically, the study grounded these guidelines within cognitive learning theories through an investigation of the cognitive load imposed by VLRs. This included a comparison of stereoscopic and desktop VLR deliveries and an evaluation of the impact of prior knowledge and university experience. Participants were voluntarily recruited to experience stereoscopic and desktop deliveries of a skull anatomy VLR (UNSW Sydney Ethics #HC16592). A MyndBand® electroencephalography (EEG) headset was used to collect brainwave data and theta power was used as an objective cognitive load measure. The National Aeronautics and Space Administration task load index (NASA-TLX) was used to collect perceptions as a subjective measure. Both objective and subjective cognitive load measures were higher overall for the stereoscopic delivery and for participants with prior knowledge, and significantly higher for junior students (P = 0.038). Based on this study's results, those of several of our previous studies and the literature, various factors are important to consider in VLR design. These include delivery modality, their application to collaborative learning, physical fidelity, prior knowledge and prior university experience. Overall, the guidelines proposed based on these factors suggest that VLR design should be learner-centred and aim to reduce extraneous cognitive load.

Pediatric regional anesthesia: A review of the relevance of surface anatomy and landmarks used for peripheral nerve blockades in infants and children.

In regional anesthesia, accurate knowledge of surface anatomy and landmarks are essential for successful nerve blockades with least possible complications. The long-established anatomical landmarks used for peripheral nerve blockades in adult patients have also gained a place in pediatric anesthesia. Despite the continuing benefits and need for more effective peripheral techniques in pediatrics, there is a paucity of data on pediatric landmarks, and hence the absence of more appropriate techniques for the different age groups of children. Recent advancement in imaging has shown that there is a greater awareness for the different surface projections at various stages of postnatal development, as compared with that of adults. Thus, if adult landmarks are not appropriately adapted for use in children, complication rates may rise due to injuries to anatomical structures. This review evaluated the existing evidence of the pediatric nerve block landmarks in the reported literature, in order to highlight the limitations in our current understanding of pediatric surface anatomy and landmarks. A literature search was done using five databases to obtain 141 references. Only a few of these studies provided detailed reports of the relations of relevant nerves to anatomical landmarks. A few clinical imaging studies have provided new anatomical landmarks in children with reference to their age-related growth and anatomy. Most landmarks need to be standardized in children of various ages, and furthermore, inconsistencies in the current descriptions of the surface landmarks need to be validated and standardized for use in pediatric clinical practice. Clin. Anat. 32:803-823, 2019. © 2019 Wiley Periodicals, Inc.

A computed tomography and magnetic resonance imaging study of the variations of the sciatic nerve branches of the pediatric knee: Implications for peripheral nerve blockade.

In pediatric patients, peripheral anesthetic blockade of the sciatic nerve is useful for postoperative pain relief after orthopedic procedures of the lower limb. The identification of the sciatic and its branches relative to the surrounding anatomical structures of the knee significantly contribute to the successful nerve blockade. However, reports have demonstrated complications arising from the inadequate and inconsistent understanding of the anatomy of the nerves in the knee region. In addition, the paucity of information regarding the location of the nerves of the knee throughout the pediatric development needs to be addressed in order for peripheral nerve blockades to become more readily used among the pediatric population. This clinical imaging study therefore aimed to document and analyze the relative morphometric relationship of the nerves in the knee region throughout the different stages of pediatric development. The locations of the sciatic, tibial, and common fibular nerves were measured in relation to relevant anatomical structures in 142 pediatric magnetic resonance imaging and computed tomography. A strong correlation was found between age and the distance from the common fibular nerve to the semitendinosus muscle, and thus can be used to predict stature. Significant differences were found between males and females, specifically after puberty, suggesting that sexual dimorphism emerges more distinctively at puberty. In order to predict the location of the nerves at the popliteal fossa, a regression formula using the patient's age and bicondylar width was created. These finding may have significant implications for popliteal approach of the sciatic nerve blockade in pediatric patients. Clin. Anat. 32:836-850, 2019. © 2019 Wiley Periodicals, Inc.

3D Modelling and Printing Technology to Produce Patient-Specific 3D Models.

BACKGROUND: A comprehensive knowledge of mitral valve (MV) anatomy is crucial in the assessment of MV disease. While the use of three-dimensional (3D) modelling and printing in MV assessment has undergone early clinical evaluation, the precision and usefulness of this technology requires further investigation. This study aimed to assess and validate 3D modelling and printing technology to produce patient-specific 3D MV models. METHODS: A prototype method for MV 3D modelling and printing was developed from computed tomography (CT) scans of a plastinated human heart. Mitral valve models were printed using four 3D printing methods and validated to assess precision. Cardiac CT and 3D echocardiography imaging data of four MV disease patients was used to produce patient-specific 3D printed models, and 40 cardiac health professionals (CHPs) were surveyed on the perceived value and potential uses of 3D models in a clinical setting. RESULTS: The prototype method demonstrated submillimetre precision for all four 3D printing methods used, and statistical analysis showed a significant difference (p<0.05) in precision between these methods. Patient-specific 3D printed models, particularly using multiple print materials, were considered useful by CHPs for preoperative planning, as well as other applications such as teaching and training. CONCLUSIONS: This study suggests that, with further advances in 3D modelling and printing technology, patient-specific 3D MV models could serve as a useful clinical tool. The findings also highlight the potential of this technology to be applied in a variety of medical areas within both clinical and educational settings.

The orbit: A re-appraisal of the surgical landmarks of the medial and lateral walls.

The anterior ethmoidal foramen (AEF) and posterior ethmoidal foramina (AEF and PEF, respectively) on the medial wall and the cranio-orbital foramen (COF) on the lateral wall are used as landmarks in orbital surgeries. In surgery these foramina, the neurovascular structures they transmit and other orbital structures in close proximity need to be identified to minimise their risk of damage. Despite the clinical importance, the current understandings lack consistency in the precise location, microanatomy and morphology of the foramina. This study therefore aimed to document and analyze the microanatomy, location, and morphometric relations of the EF and COF to determine a standardized guideline to accessing the foramina. One hundred dry orbits were morphometrically analyzed, and a further six orbits were micro-dissected to determine the locations of the EF and COF. The orbital size dimensions were measured for each dry orbit and correlated with the morphometric distances. A complete morphometric and quantitative analysis showed the distances of the EF and COF to be variable, with greater variations observed in the incidence of the accessory EF and PEF distances in the medial wall, and in the presence of the COF and the accessory COF in the lateral orbital wall. Significant correlations were observed between the length of the medial orbital wall and some EF distances. This study is the first to suggest a standardized method of locating these foramina in the orbit irrespective of population and sex differences, in order to help improve clinical applications in crucial orbital surgeries. Clin. Anat. 29:998-1010, 2016. © 2016 Wiley Periodicals, Inc.

An appraisal of the short lateral rotators of the hip joint.

The short lateral rotators (piriformis, obturator internus, superior and inferior gemelli, obturator internus, and quadratus femoris) are functionally important muscles, significantly contributing to hip joint stability. They act as "postural muscles", holding the femoral head in the acetabulum during hip movements, thus are frequently monitored in gait analysis and for muscle rehabilitation post-injury. Despite the need to precisely identify and repair these muscles for stability postoperatively, clinical complications have resulted from the inadequate and inconsistent understanding of their morphological and functional anatomy. Furthermore, the short lateral rotators have complex entheses (osteotendinous insertions on bone) and may be subject to overuse injury in sport. This study aims to review the reported morphology of the short lateral rotators in order to ascertain whether discrepancies exist in our understanding of these muscles, and if further investigation is required to aid in gait analysis, clinical management of hip pathologies, and prevention of overuse injuries. Following a literature search strategy, 59 primary references were retrieved from three databases, with additional 26 anatomical textbooks selected for critical evaluation. Numerous inaccuracies and inconsistencies in the anatomical descriptions of the attachments, patterns of innervation and actions exist, and often insufficiently supported by primary findings. There is also a paucity of information regarding the architectural pattern of the muscles, which would be useful in clarifying the function of these dynamic stabilizers of the hip joint. A better anatomical understanding of these muscles will better inform hip reconstruction and lead to improved surgical outcomes by reducing post-operative complications.

Normal morphometry of the biliary tree in pediatric and adult populations: A systematic review and meta-analysis.

PURPOSE: This study aimed to characterise the normal morphometry of the biliary tree in pediatric and adult populations, through a systematic review and meta-analysis. METHODS: This study, conducted using the PRISMA guidelines and registered with PROSPERO, searched MEDLINE, EMBASE, SCOPUS and Web of Science databases up to October 2022, and updated to August 2023. Studies that reported extractable data on diameter and length of the right, left and common hepatic ducts (LHD, RHD and CHD), and common bile duct (CBD) were included. Quality of the included studies were assessed using the Anatomical Quality Assessment (AQUA) tool. Statistical analysis included subgroup analyses according to sex, age, geographical location, and imaging modality. RESULTS: In total, 60 studies were included, of which 44 studies reported adequate data for meta-analysis on 23,796 subjects. Overall, the pooled mean diameter of the CBD was 4.69 mm (95 % CI: 4.28-5.11). Significant differences were found between pediatric (1.32 mm, 95 % CI: 1.03-1.61) and adult (4.97 mm, 95 % CI: 4.67-5.27) subjects, as well as US (3.82 mm, 95 % CI: 3.15-4.49) and other imaging modalities, including MRI (6.21 mm, 95 % CI: 4.85-7.57) and ERCP (7.24 mm, 95 % CI: 6.08-8.40). The CBD diameter measured significantly larger distally (5.20 mm, 95 % CI: 4.60-5.80) than proximally (4.01 mm, 95 % CI: 3.51-4.51). CONCLUSIONS: The results obtained from this evidence-based study may guide the establishment of standardised reference values and ranges of the normal biliary tree in pediatric and adult populations and aid clinical understanding.

Macro and micro ethics in fetal and embryological collections: Exploring the paradigms of informed consent among Australian education-focused stakeholders.

The management of human fetal and embryological collections presents an ethical challenge that can be explored from different perspectives, particularly when considering informed consent. The "micro ethics" level focuses on parties engaged in giving and receiving human tissue while the "macro ethics" level focusses on the collective responsibility of the discipline and society. Additionally, adopting a framework, where ways of working are designed with relevant communities, requires understanding the perspectives of individuals, communities, and organizations. The aim of this study therefore was to assess the perceptions of education-focused Australian stakeholders. A survey collected the perspectives of 198 participants. The majority of participants (61.6%; n = 122/198) indicated that human fetal and embryological remains obtained prior to era of informed consent should be retained for use in education/research. It is likely that their perspective is based on the notion that if human fetal and embryological collections are used for good, then disposing of them would deny this benefit. Women (p < 0.001) indicated a preference for obtaining fetuses and embryos with informed consent for education and research (38.4%; n = 76/198). Majority were in favor of recording both maternal (MI) (59.6%; n = 118/198) and paternal information (PI) (58.1%; n = 115/198) with each donation. Majority (56.1%; n = 111/198) expressed that donations should be accepted from both parental sources. Consideration of stakeholder perspectives is important in developing guidelines regarding these collections. The results from this study demonstrate a level of discomfort with respect to collections without informed consent, which should be considered at the macro ethical and micro ethical level.

Phillip V. Tobias as an anatomist.

The article outlines the career of the renowned South African scientist Phillip Vallentine Tobias. While he made substantial contributions to a number of scientific disciplines, Tobias spent most of his career teaching anatomy at his alma mater, University of the Witwatersrand, Johannesburg, and saw himself primarily as an anatomist. The first part of this article presents Tobias' major contributions to science and demonstrates that his profound knowledge of anatomy was the basis of many of his groundbreaking research accomplishments. The second part of the article focuses on Tobias' career in anatomy and his significant contribution to anatomy teaching and administration, particularly in establishing and organizing the Anatomical Society of Southern Africa. The article also demonstrates how Tobias' academic career was constrained by the oppressive system of apartheid South Africa and how social engagement was an integral part of his intellectual activities.

A systematic review and meta-analysis of portal vein morphometry in pediatric and adult populations: Drawing the line between normal and abnormal findings.

PURPOSE: The morphometry of the hepatic portal vein is of clinical importance, particularly in pre-operative assessments, surgical management, and diagnoses of liver conditions. This systematic review and meta-analysis aimed to characterize the morphometry of the normal portal vein in both pediatric and adult patients. METHODS: The study, conducted using the PRISMA guidelines and registered with PROSPERO, utilized the MEDLINE, EMBASE, SCOPUS and Web of Science databases up to May 2020, and updated to May 2023. All studies reporting extractable data on diameter, length, and cross-sectional area (CSA) of the main, left, and right portal veins (PV, LPV, RPV, respectively) were included. The AQUA Tool was used to assess the quality of the included studies. Data analysis included subgroup analyses based on geographical location, sex, age, and imaging modality. RESULTS: A total of 122 studies with 11,637 subjects were eligible for inclusion. Overall, the pooled mean diameter of the PV (PVD) was 10.09 mm (95% CI: 9.56-10.62). Significant differences in diameter were found between pediatric (6.60 mm; 95% CI: 5.38-7.82) and adult (10.72 mm; 95% CI: 10.25-11.19) subjects. Additionally, there was a significantly larger PVD measurement from computed tomography (CT) than other imaging modalities: CT, 13.28 mm (95% CI: 11.71-14.84); magnetic resonance imaging (MRI), 10.50 mm (95% CI: 9.35-11.66) and ultrasound (US), 9.81 mm (95% CI: 9.47-10.16). The mean diameters of the LPV and RPV were 8.27 mm (95% CI: 6.78-9.77) and 8.33 mm (95% CI: 6.70-9.95), respectively. Mean PV length in adults is 48.63 mm (95% CI: 35.63-61.64). Mean CSA of the PV was 1.09 cm2. CONCLUSIONS: The study obtained aim to improve the understanding of portal vein anatomy, especially with relevance to surgical interventions of the liver in both pediatric and adult patients. Measurements from ultrasound imaging closely approximates the generated pooled PVD mean for pediatric and adult patients. CT imaging, however, significantly exceeded the established 13 mm threshold for adults. For pediatric patients, a threshold of 8 mm is proposed as a diagnostic upper limit for a normal PVD. Although not significant, the PVD decreased from the portal confluence towards its bifurcation.

Musculoskeletal anatomy core syllabus for Australian chiropractic programs: A pilot study.

OBJECTIVE: The aim of this study is to conduct a pilot survey to determine core anatomy content for chiropractic curriculum based on the perception of chiropractors and anatomy educators involved in teaching in an Australian chiropractic program. METHODS: A survey of anatomical structures previously used in a medical survey, with similar criteria for synthesizing responses, was used and classified according to whether the respondents rated an item as essential, important, acceptable, or not required in a chiropractic program. The item was scored as core if ≥60% of respondents rated it essential, recommended if 30%-59% rated it essential, not recommended if 20%-29% rated it essential, or not core if <20% rated it essential. RESULTS: The respondents rated 81.6% of all musculoskeletal concepts as core and 18.4% as recommended, 88.8% of the vertebral column items as core, and 11.2% of the items as recommended, 69.4% upper limb and pectoral girdle items as core, 23.7% of items as recommended, 5.5% as not recommended and 1.3% as not core items for inclusion, 85.3% of all lower limb and pelvic girdle items as core, 14.4% as recommended and 0.3% not recommended. CONCLUSION: Chiropractors and anatomists involved in teaching in an Australian chiropractic program rated most musculoskeletal items as essential for inclusion in a chiropractic teaching program to ensure adequate preparation for safe practice and to promote alignment with the standards of anatomy education delivered into the clinical professions.

A global perspective on embryological and fetal collections: Where to from here?

Human fetal and embryos collections (FECs) peaked in the late 19th century, an era before informed consent, and hence have unclear provenance. These collections are not only historical artifacts, but prized resources for education and research. This study aimed to determine, via a narrative review, the present location, status, and profile of reported human fetal and embryonic collections. Twenty-seven articles that reported on collections appropriate to the study were selected from an initial search pool of 120 articles. The reported collections were in: Australia (n = 1), Germany (n = 6), Japan (n = 1), Spain (n = 1), and the United States (n = 5). The largest collection is reported to contain 45,000 prenatal remains and the smallest, three remains. The purpose of establishing majority of the collections was for education and research. Eight collections contain both embryos and fetuses, one collection contained embryos, exclusively. Another collection contained only fetuses and one neonatal cadaver. The provenance, where mentioned, specified gynecologists and obstetricians as the main source of remains (n = 5). Except for the Kyoto Collection, information regarding informed consent from the next-of-kin was lacking. This paper draws upon the three themes of purpose, provenance, and profile and highlights the need to establish agreed international guidelines for the most appropriate ethical and sustainable practice with respect to establishment, procurement of remains, access, and maintenance of these collections. Nine domains for these guidelines are recommended: consent, privacy, commercial gain, digital and emerging technologies, commemorations and memorials, destruction and disposal, dignity of donors, global database and collaboration, and sustainability.

Musculoskeletal anatomy knowledge in Australian chiropractors.

Anatomy is a key knowledge area in chiropractic and is formally offered in the undergraduate component of chiropractic education. There is the potential for loss of anatomy knowledge before the opportunity to apply it in a clinical setting. This study aimed to determine whether chiropractic clinicians retain a level of anatomy knowledge comparable to that of chiropractic students and to compare chiropractors' self-rating of their anatomical knowledge against an objective knowledge assessment tool. A previously validated multiple-choice test was utilized to measure retention of limb musculoskeletal (MSK) knowledge in Australian chiropractors. One hundred and one registered chiropractors completed the questionnaire and responses were scored, analyzed, and compared to scores attained by undergraduate and postgraduate chiropractic students who had previously completed the same questionnaire. The results indicated that practitioners retained their anatomy knowledge, with a significantly higher total mean score than the undergraduate group [total mean score = 36.5% (±SD 13.6%); P < 0.01] but not significantly different to the postgraduate group [total mean score = 52.2% (±SD 14.1%); P = 0.74]. There was a weak positive correlation between chiropractors' self-rated knowledge and test performance scores indicating the effectiveness of this Australian chiropractic group in self-assessing their anatomy knowledge. This study found that Australian chiropractors' knowledge of MSK anatomy was retained during the transition from university to clinical practice and they accurately evaluated their own test performance.

Real Or Not Real: The Impact of the Physical Fidelity of Virtual Learning Resources on Learning Anatomy.

Technological advancements have made it possible to create realistic virtual representations of the real world, although it is unclear in medical education whether high physical fidelity is required in virtual learning resources (VLRs). This study, therefore, aimed to compare the effectiveness of high-fidelity (HF) and low-fidelity (LF) VLRs for learning anatomy. For this study, HF and LF VLRs were developed for liver anatomy and participants were voluntarily recruited from two cohorts (cohorts 1 and 2). Knowledge outcomes were measured through pre- and post-tests, task outcomes including activity score and completion time were recorded and participants' perceptions of the VLRs were surveyed. A total of 333 participants (165 HF and 168 LF) took part in this study. Knowledge outcomes were higher for the HF activity in cohort 1 and for the LF activity in cohort 2, although not significantly. There were no significant differences in activity score within either cohort, although completion time was significantly longer for the HF activity in cohort 1 (P = 0.001). There were no significant differences within either cohort in perceptions of the VLRs regarding usefulness for reviewing conceptual knowledge, esthetics, quality, mental effort experienced, or future use, although the LF VLR was scored significantly higher regarding the value for understanding in cohort 1 (P = 0.027).This study suggests that high physical fidelity is not necessarily required for anatomy VLRs, although may potentially be valuable for improving knowledge outcomes. Also, level of prior knowledge may be an important factor when considering the physical fidelity of anatomy VLRs.

Beyond the Sex Binary: Toward the Inclusive Anatomical Sciences Education.

Developments in biology and genetics in recent decades have caused significant shifts in the understanding and conceptualization of human biological variation. Humans vary biologically in different ways, including individually, due to age, ancestry, and sex. An understanding of the complexities of all levels of biological variation is necessary for efficient health care delivery. Important steps in teaching medical students about human variation could be carried out in anatomy classes, and thus, it is important that anatomical education absorbs new developments in how biological variation is comprehended. Since the early 1990s biological sex in humans has been vigorously investigated by scientists, social scientists, and interest groups. Consequently, the binary division in male and female sex has been called into question and a more fluid understanding of sex has been proposed. Some of the major textbooks teach anatomy, particularly of the urogenital system, as a male-female binary. Anatomical sciences curricula need to adopt a more current approach to sex including the introduction of the category of "intersex"/"differences in sexual development" and present sex as a continuum rather than two sharply divided sets of characteristics. This approach offers a better understanding of the complexity of sex differences and, at the same time, provides students with an improved theoretical framework for understanding human variation in general, transcending the limitations of biological typology. When well delivered, the non-binary approach could play a significant contribution to the formation of competent and responsible medical practitioners and avoidance of problematic practices such as non-consensual "normalizing" surgeries.

Spending Wisely: The Role of Cost and Value Research in the Pursuit of Advancing Anatomical Sciences Education.

Studies of "cost and value" in anatomical sciences education examine not only what works, but at what cost, thus evaluating the inputs and outputs of education. This research provides insights into how to use available resources (e.g., academic time, budgets, infrastructure) as a mechanism to obtaining the maximum outcomes available. The purpose of this viewpoint article is to expand on the application of cost and value concepts to anatomical sciences education, contextualizing these concepts through a deeper dive into the more costly educational approaches of human donor dissection. In doing so, both questions and opportunities are raised for the discipline of anatomical sciences going forward. Educational decisions, inclusive of cost and value appraisals, consider the range of outcomes for which the activity is designed to achieve, and the activity's integration with the philosophy of the educational program it is contributing to; these decisions, thus, evaluate more than just cost alone. Healthcare students' engagement with human donor dissection pedagogy offers an array of reported non-economic benefits, including non-traditional discipline-independent skill (NDIS) development (e.g., professionalism, teamwork skills). These skills are often harder to measure, but are no less important to the final pedagogical decision-making process. The goal of cost and value research is to create an evidence-base toward education that delivers maximum value for a given spend. Anatomy educators, researchers, and decision makers who embrace cost and value dialogue, and interpret and apply findings from studies of educational costs, are best positioned to improve the educational value for their learners and provide effective outputs for all stakeholders.

Australian chiropractors' perception of the clinical relevance of anatomical sciences and adequacy of teaching in chiropractic curricula.

BACKGROUND: Human anatomy education is compulsory in the undergraduate curriculum in all Australian chiropractic education programs. There is very little data on clinicians' perceptions of the adequacy of their anatomy training and its relevance to practice. The aims of this study were to evaluate Australian registered chiropractors' perceptions on the relevance and adequacy of anatomy training for clinical practice and analyse their opinion on the usefulness of the teaching resources utilized during their preprofessional training. METHODS: A questionnaire-based survey was conducted on a sample of Australian registered chiropractors focussing on the adequacy of their anatomical science (gross anatomy, histology, neuroanatomy and embryology) training and the clinical relevance of each individual sub-discipline, and the perceived value of each of the different anatomy teaching resources utilized. RESULTS: A total of 128 completed surveys were returned from an estimated 387 attendees at two national chiropractic conferences (estimated 33% response rate). The respondents represent 2.6% of registered chiropractors in Australia in 2016 and were representative in terms of gender (66.4% male) but not age, with older generations being over-represented (peak age group 35-44 vs. 25-34). The majority of the survey respondents obtained their chiropractic qualification in Australia (89.1%) and graduated after 1990 with an average of 21.7 years (SD = 11.3, range = 1-44) in practice. Respondents were equally likely to have undertaken anatomy training in Medicine, Science, Health Science, or other faculties. The disciplines perceived most relevant for clinical practice were neuroanatomy (100% of respondents agreeing) and gross anatomy (99.2%), followed by histology (86.0%) and embryology (81.1%). Respondents also perceived their training to be most adequate in neuroanatomy (99.3%) and gross anatomy (99.2%) followed by histology (91.4%) and embryology (85%). Respondents confirmed exposure to a varied suite of anatomy teaching tools utilized during their pre-professional training and highly valued access to cadavers and prosected specimens. CONCLUSIONS: The majority of respondents perceived anatomy as highly relevant to their clinical practice and noted that it was adequately taught within a wide range of educational approaches. These results will assist educators to refine content and delivery of anatomy course offerings to maximize relevance in chiropractic clinical practice.