Creating a sport and exercise medicine undergraduate syllabus: a delphi study.

BACKGROUND: Sport and Exercise Medicine (SEM) is a growing speciality in the United Kingdom (UK). This growth has not been replicated in SEM teaching at an undergraduate level and SEM-related topics in schools of medicine in the UK are under-represented. As SEM continues to develop as a specialty it is important to consider how it is embedded at all levels of training. The aim of this project was to establish a consensus on SEM-related skills and knowledge relevant for undergraduate medical students in the UK, ultimately creating a curriculum of learning objectives (LOs). METHODS: A modified Delphi survey was utilised to seek consensus on LOs suitable for incorporation into UK medical school curricula. An expert panel with adequate knowledge in the field was recruited. The initial curriculum was created by the research team using already established postgraduate SEM curricula. All learning objectives were sent to the expert panel for opinions in phases. Levels of agreement and comments made by the expert panel were reviewed after each phase until a consensus on each learning objective was made. RESULTS: The expert panel was made up of 45 individuals, with 35 also completing phase 2 (78% retention rate). The initial curriculum contained 58 learning objectives separated into 9 themes. In phase 1 31% (18/58) were accepted outright, 48% (28/58) were altered and 19% (11/58) were rejected. Two additional learning objectives were added. Of the 49 LOs included in phase 2, 98% (48/49) were accepted. The final curriculum was made up of 9 sub-themes and 48 LOs. CONCLUSION: Sport and Exercise Medicine is a broad ranging and rapidly growing speciality. It is important to establish SEM education in all levels of medical education, including undergraduate level. This is the first published version of a Delphi SEM curriculum for undergraduate medical teaching.

A new classification system for the anatomical variations of the human circle of Willis: A systematic review.

The circle of Willis (CoW) is an anastomotic arterial network located on the base of the brain. Studies have shown that it demonstrates considerable anatomical variation in humans. This systematic review aimed to identify and catalogue the described anatomical variations of the CoW in humans to create a new, comprehensive variation classification system. An electronic literature search of five databases identified 5899 studies. A two-phase screening process was performed, and studies underwent quality assessment. A total of 42 studies were included in the review. Data were extracted and circles were reconstructed digitally using graphics software. The classification system contains 82 CoW variations in five continuous groups. Group one contains 24 circles with one or more hypoplastic segments only. Group two contains 11 circles with one or more absent segments only. Group three contains 6 circles with hypoplastic and absent segments only. Group four contains 26 circles with one or more accessory segments. Group five contains 15 circles with other types of anatomical variation. Within each group, circles were subcategorised according to the number or type of segments affected. An original coding system was created to simplify the description of anatomical variations of the CoW. The new classification system provides a comprehensive ontology of the described anatomical variations of the CoW in humans. When used with the coding system, it allows the description and categorisation of recorded and unrecorded variants identified in past and future studies. It is applicable to current clinical practice and the anatomical community, including human anatomy education and research.

Anatomical variations of the circle of Willis and their prevalence, with a focus on the posterior communicating artery: A literature review and meta-analysis.

The circle of Willis is an anastomotic network of arteries surrounding the base of the brain, providing collateral circulation to prevent ischemia. It has, however, long been established that it exhibits considerable anatomical variation when compared to Thomas Willis' originally described circle. This study aimed primarily to determine an accurate prevalence of the variation of the circle of Willis in the general population and the prevalence of common posterior communicating artery variations. Additional aims were to explain why such a wide range of reported variations exist, and whether different types of studies report significantly different prevalence of variation. A comprehensive literature search identified 764 papers. A three-phase screening process was undertaken, involving a critical analysis of papers, and a total of 33 papers were selected for analysis and literature review. A descriptive statistics test with bootstrap was performed to estimate the average prevalence of variations. The estimated prevalence of general variation, unilateral, and bilateral posterior communicating artery hypoplasia or aplasia was 68.22 ± 14.32%, 19.45 ± 8.63%, and 22.83 ± 14.58%, respectively. Over half of the population exhibit a circle of Willis with some form of variation. To provide a more accurate estimation for the prevalence of variations, a universal classification system needs to be established, collating all the work from high-quality studies, to provide a comprehensive database of the circle's variations. Knowing the prevalence of variations and how they can impact neurosurgical approaches or patterns of ischemic pathology can be crucial in providing effective patient care.

Student's perspectives of inclusive practices in anatomy education.

There is a drive to implement inclusive practices in anatomy by adapting curricula and utilizing inclusive language and resources that negate biases. However, to date there is no data regarding student's perception of inclusivity. Therefore, the study aims to investigate anatomy student's opinions on inclusive practices in anatomy education based on the protected characteristics of age, disability, ethnicity, gender affirmation and sex. One hundred and forty-five students completed a questionnaire with 21 Likert-scale and two open-ended questions. Kruskal-Wallis tests compared responses by groups defined by the protected characteristics of the Equality Act (2010). Most students (71.2%; n = 84) agreed or strongly agreed that "improving inclusivity in anatomy education should be educator's priority". In terms of representation, there was a statistically different response rate from students from different ethnic backgrounds to the statements "there are anatomy educators" (p < 0.001), "images in textbooks" (p < 0.001) and "models in the dissection room" (p < 0.001) "that look like me". Most students agreed or strongly agreed to statements relating to the protected characteristics of age (70.4%; n = 68), disability (78.6%; n = 77), ethnicity (59.8%; n = 64), gender affirmation (46.3%; n = 46) and sex (51.5%; n = 62). Themes identified relating to improving inclusivity included "reflecting reality", "teaching the truth", "the invisibility of women" and the "learning environment". Students have confirmed that anatomists, as gatekeepers of the knowledge of the human body, should foster inclusive teaching practices that will benefit all students and potentially future patient care.

Exploring the inclusion of anatomical variation in medical education.

The role of anatomical variability in safe clinical practice is underappreciated. A lack of familiarity of anatomical variations is at the center of a multitude of medical and surgical errors. The recent rise in litigation due to such errors suggests that patient care may be compromised. This makes the knowledge of anatomical variation essential to medical education. Empirical studies were identified by searching several databases and repositories, and the Medical Education Research Quality Instrument (MERSQI) was used to assess study quality. Eight studies were eligible for this systematic review; three of which were conference abstracts. Thematic summary of these studies yielded six themes namely: (1) importance of anatomical variation in medical education; (2) the ideal time to introduce anatomical variation in medical education; (3) important anatomical variations to include in medical education; (4) approaches to teaching anatomical variation; (5) assessing knowledge on anatomical variation; (6) barriers to including anatomical variation in medical education. Including anatomical variations in medical education would improve clinical reasoning and surgical outcomes. Following the completion of this review, three recommendations were made: (1) increasing the emphasis of anatomical variation in medical education; (2) developing more resources for anatomical variation education; (3) investigating the implications of lack of knowledge of anatomical variation in medical education through further research.

"Preparing them for the profession": An interpretative phenomenological analysis of anatomy educators coping with complexity in the United Kingdom curriculum.

Efforts to integrate the basic sciences into the ever-changing curriculum are a trending area of research in health professions education. Low-stakes, high-frequency assessment methods such as the progress test are now widely implemented in the United Kingdom and Northern Ireland as a means of furthering curricular integration toward contemporary goals of competency and professional identity formation. The anatomy educator's experience vis-à-vis these curricular changes is not well understood. This study aimed to explore how anatomy educators make sense of the shifting demands of their role. The interviews were semi-structured, particularly concerned with the phenomenon of teachers adapting to the complexity of their learning environment. The study used interpretative phenomenological analysis (IPA) to focus on the lived experiences of participants coping with the phenomena in question: how do anatomy educators make sense of the learning environment in the United Kingdom? Interviews were transcribed verbatim and interpreted inductively, identifying four key themes: confidence through connectedness, variations in appraisals of curricular integration, managing expectations to perform in paradoxical situations, and the emergence of innovative teaching. Results point to the learning environment as a complex system and highlight the importance of feeling support from and connection to colleagues, enabling individual educators to develop confidence, meet the top-down demands of changing curricula, and experience personal identity development and uncertainty tolerance within their role. This IPA study offers insight into the lived experiences of anatomy educators whose experiential interpretations of a complex and changing curriculum can uniquely inform stakeholders in health professions education.

Creating a Sport and Exercise Medicine Masters syllabus for doctors: a Delphi study.

Objective: Sport and Exercise Medicine (SEM) Masters curricula vary. This Delphi study is aimed to create a consensus curriculum for doctors undertaking SEM Masters courses. Methods: A modified Delphi survey was used. An expert panel was established of individuals deemed to have adequate knowledge of the field. The research group developed the initial draft of the curriculum by collating and reviewing previously published UK-based postgraduate SEM-related curricula. There were two phases. In phase 1 the expert group either accepted, rejected or modified each learning objective (LO). During phase 2 the expert group were asked to accept or reject each LO that did not get accepted outright previously. The research group analysed the levels of agreements and the comments given by the expert panel after each phase. Results: The expert panel consisted of 45 individuals, with 35 completing phase 2 (78% retention rate). Of the 136 LOs initially collated: 71 (52%) were accepted outright, 60 (44%) were altered in some way and reincluded in phase 2, and 5 (4%) were removed after phase 1. The research group added 2 (1%) new LOs on reflection over comments made by the expert panel. The final curriculum contained 133 LOs, divided into 11 subthemes. Conclusions: The findings will better inform educators when developing SEM Masters curricula and inform students what they should look for when considering an SEM Masters. This consensus curriculum is an important step in standardising postgraduate SEM education.

UK Doctors Delivering Physical Activity Advice: What Are the Challenges and Possible Solutions? A Qualitative Study.

Despite strategies to enable Health Care Professionals (HCPs) to give physical activity (PA) advice to patients, this appears to be rarely done in consultations. The aims of the present study were to gain an understanding of doctors' awareness of current PA guidelines and to explore their opinions on barriers and solutions. A qualitative approach using semi-structured interviews was adopted. This study included 15 doctors currently working in the UK's National Health Service (NHS). A thematic analysis approach was used to analyse the transcripts. Four themes and twelve sub-themes were deciphered. Intrinsic factors limiting the delivery of PA advice included a lack of knowledge of PA guidelines and PA being an afterthought. Barriers to delivering PA guidance included a lack of PA education, time pressures, and patient engagement. Solutions included staff training, incorporating PA into undergraduate training, and encouraging staff to be physically active. Methods to optimise PA guidance included individualised PA advice, local exercise services and schemes, utilising online and visual resources, and motivational interviewing. This study provides an updated insight into doctors' opinions on barriers and solutions to discussing PA with patients. It is clear that further work is needed to ensure greater awareness of PA guidelines amongst clinicians.

Clay-Based Modeling in the Anatomist's Toolkit: A Systematic Review.

Anatomical education has suffered from reduced teaching time and poor availability of staff and resources over the past thirty years. Clay-based modeling (CBM) is an alternative technique for teaching anatomy that can improve student knowledge and experience. This systematic review aimed to summarize and appraise the quality of the literature describing the uses, advantages, and limitations of CBM compared to alternative methods of teaching human gross anatomy to students or qualified healthcare professionals. A systematic search of Embase, MEDLINE, Scopus, and Web of Science databases was conducted, and the Medical Education Research Quality Instrument (MERSQI) was used to assess study quality. Out of the 829 studies identified, 12 papers met the inclusion criteria and were eligible for this review. The studies were of high quality, with a mean MERSQI score of 11.50/18. Clay-based modeling can be used to teach all gross anatomical regions, and 11 studies demonstrated a significant improvement in short-term knowledge gain in students who used CBM in comparison to other methods of learning anatomy. Eight studies that included subjective assessment showed that CBM is rated highly. However, some studies showed that students viewed CBM as juvenile and experienced difficulty making the models. Additionally, there is no evidence to suggest that CBM improves long-term knowledge. Clay-based modeling is an effective learning method for human gross anatomy and should be incorporated into the anatomists' toolkit. In the future, more randomized controlled studies with transparent study designs investigating the long-term impact of CBM are needed.

Online Assessment of Applied Anatomy Knowledge: The Effect of Images on Medical Students' Performance.

Anatomical examinations have been designed to assess topographical and/or applied knowledge of anatomy with or without the inclusion of visual resources such as cadaveric specimens or images, radiological images, and/or clinical photographs. Multimedia learning theories have advanced the understanding of how words and images are processed during learning. However, the evidence of the impact of including anatomical and radiological images within written assessments is sparse. This study investigates the impact of including images within clinically oriented single-best-answer questions on students' scores in a tailored online tool. Second-year medical students (n = 174) from six schools in the United Kingdom participated voluntarily in the examination, and 55 students provided free-text comments which were thematically analyzed. All questions were categorized as to whether their stimulus format was purely textual or included an associated image. The type (anatomical and radiological image) and deep structure of images (question referring to a bone or soft tissue on the image) were taken into consideration. Students scored significantly better on questions with images compared to questions without images (P < 0.001), and on questions referring to bones than to soft tissue (P < 0.001), but no difference was found in their performance on anatomical and radiological image questions. The coding highlighted areas of "test applicability" and "challenges faced by the students." In conclusion, images are critical in medical practice for investigating a patient's anatomy, and this study sets out a way to understand the effects of images on students' performance and their views in commonly employed written assessments.

Integrating sport and exercise medicine clinics into the National Health Service: a qualitative study.

OBJECTIVES: To explore the services National Health Service (NHS)-based sport and exercise medicine (SEM) clinics can offer, and the barriers to creating and integrating SEM services into the NHS. METHODS: Semi-structured interviews were undertaken to collect data from identified 'stakeholders'. Stakeholders were identified as individuals who had experience and knowledge of the speciality of SEM and the NHS. An inductive thematic analysis approach was taken to analyse the data. RESULTS: N=15 stakeholder interviews. The management of musculoskeletal (MSK) injuries (both acute and chronic) and concussion were highlighted as the two key services that SEM clinics can offer that would most benefit the NHS. MSK ultrasound was also mentioned by all stakeholders as a critical service that SEM clinics should provide. While exercise medicine is an integral part of SEM, SEM clinics should perhaps not have a heavy exercise medicine focus. The key barriers to setting up SEM clinics were stated to be convincing NHS management, conflict with other specialities and a lack of awareness of the speciality. CONCLUSION: The management of acute MSK injuries and concussion should be the cornerstone of SEM services, ideally with the ability to provide MSK ultrasound. Education of others on the speciality of SEM, confirming consistent 'unique selling points' of SEM clinics and promoting how SEM can add value to the NHS is vital. If the successful integration of SEM into the NHS is not widely achieved, we risk the NHS not receiving all the benefits that SEM can provide to the healthcare system.