A core syllabus for histology within the medical curriculum - The cardiovascular and lymphoid systems, the respiratory and digestive systems, and the integument.

Medical courses worldwide are undergoing significant curricular changes, including the teaching and learning of histology. In order to set international standards for the anatomical sciences, the International Federation of Associations of Anatomists (IFAA) is developing core anatomical syllabuses by means of Delphi panels. Already published is a core syllabus for the teaching of the cell and the basic tissues within medicine. Here, we record the deliberations of an IFAA Delphi panel commissioned to develop core subject matter for the teaching within a medical histology course of the cardiovascular and lymphatic circulatory system, the lymphoid, respiratory, and digestive systems, and the integument. The Delphi panel was comprised of academics from multiple countries who were required to review relevant histological topics/items by evaluating each topic as being either "Essential," "Important," "Acceptable," or "Not required." Topics that were rated by over 60% of the panelists as being "Essential" are reported in this paper as being core topics for the teaching of medical histology. Also reported are topics that, while not reaching the threshold for being designated as core material, may be recommended or not required within the curriculum.

Descriptive and functional anatomy of the Heschl Gyrus: historical review, manual labelling and current perspectives.

PURPOSE: The Heschl Gyrus (HG), which includes the Primary Auditory Cortex (PAC), lies on the upper surface of the superior temporal gyrus (T1). It has been the subject of growing interest in the fields of neuroscience over the past decade. Given the considerable interhemispheric and interindividual variability of its morphology, manual labelling remains the gold standard for its radio-anatomical study. The aim of this study was to revisit the original work of Richard L. Heschl, to provide a broad overview of the available anatomical knowledge and to propose a manually labelled 3D digital model. METHODS: We reviewed existing works on the HG, from Heschl's original publication of 1878, Dejerine neuroanatomical atlas of 1895 to the most recent digital atlases (Julich-Brain Cytoarchitectonic Atlas, the Human Connectome Project). Our segmentation work was based on data from the BigBrain Project and used the MRIcron 2019 software. RESULTS: The original publication by Heschl has been translated into French and English. We propose a correspondence of previous nomenclatures with the most recent ones, including the Terminologia Neuroanatomica. Finally, despite the notable anatomical variability of the HG, clear and coherent segmentation criteria allowed us to generate a 3D digital model of the HG. DISCUSSION AND CONCLUSION: Heschl's work is still relevant and could impulse further anatomical and functional studies. The segmentation criteria could serve as a reference for manual labelling of the HG. Furthermore, a thorough, and historically based understanding of the morphological, microstructural and functional characteristics of the HG could be useful for manual segmentation.

Homologies of spinal ascending nociceptive pathways between rats and macaques: can we transpose to human? A review and analysis of the literature.

PURPOSE: Due to the difficulty of using neural tracers in humans, knowledge of the nociceptive system's anatomy is mainly derived from studies in animals and mainly in rats. The aim of this study was to investigate the morphological differences of the ascending spinal nociceptive pathways between the rat and the macaque monkey; in order to evaluate the variability of this anatomy during phylogenesis, and thus to know if the anatomical description of these pathways can be transposed from the rat to the human. METHODS: A review and analysis of the literature were performed. The criteria used for comparison were: origins, pathways, their terminations in target structures, and projections from target structures of ascending spinal nociceptive pathways. The monkey was used as an intermediate species for comparison because of the lack of data in humans. The hypothesis of transposition of anatomy between rat and human was considered rejected if differences were found between rat and monkey. RESULTS: An anatomical difference in termination was found for the spino-annular or spino-periaqueductal grey (spino-PAG) pathway and transposition of its anatomy from rat to human was rejected. No difference was found in other pathways and the transposition of their anatomy from rat to human was therefore, not rejected. CONCLUSION: This work highlights the conservation of most of the ascending spinal nociceptive pathways' anatomy between rat and monkey. Thus, the possibility for a transposition of their anatomy between rat and human is not rejected.

A core syllabus for histology within the medical curriculum-The cell and basic tissues.

The International Federation of Associations of Anatomists (IFAA) are developing core syllabuses for the anatomical sciences by means of Delphi panels. In this article, we provide the core subject matter for the teaching of the cell and of basic tissues within a medical histology course. The goal is to set an international standard providing guidelines for such a core syllabus. The Delphi panel, composed of members across multiple countries, required two rounds to evaluate 257 relevant items/topics approved by the IFAA. Based on the perception of the core knowledge of histology, the items were to be rated by each member of the Delphi panel as being "Essential," "Important," "Acceptable," or "Not required." Topics that were rated by over 60% of the panelists as being "Essential" and "Important" are provided in this article and are recommended for the teaching of medical histology.

A core syllabus for the teaching of gross anatomy of the thorax to medical students.

Discussion is ongoing concerning the need to ensure the clinical relevance of the biomedical sciences. However, clinical relevance within health care courses presupposes that there is internationally agreed core material to be taught and learned. For anatomy, by the initial use of Delphi Panels that comprise anatomists, scientists, and clinicians, the International Federation of Associations of Anatomists (IFAAs) is developing internationally accepted core syllabuses for all anatomical sciences disciplines in the health care professions. In this article, the deliberations of a Delphi Panel for the teaching of thoracic anatomy in the medical curriculum are presented, prior to their publication on the IFAA's website. To develop the syllabus further, it is required that anatomical societies, as well as individual anatomists and clinicians, comment upon, elaborate, and amend this draft recommended syllabus. The aim is to set internationally recognized standards and thus to provide guidelines concerning the knowledge of the human thorax expected of graduating medical professionals. Such information should be borne in mind by those involved in the development of medical courses. Clin. Anat. 33:300-315, 2020. © 2019 Wiley Periodicals, Inc.

Do medical students who are multilingual have higher spatial and verbal intelligence and do they perform better in anatomy examinations?

We have already reported that medical students who have prior knowledge of classical Greek and Latin perform better in anatomy examinations. It has also been shown that fluency in more than one language can influence spatial and verbal intelligence and here we hypothesize that medical students who have linguistic skills develop higher spatial and verbal intelligence compared with monolingual students, that there are gender differences, and that there are positive effects on performance in anatomy examinations. One hundred and seventy-three second year medical students at Cardiff University responded to spatial and verbal intelligence questions that were adapted from the British MENSA website. This is a 63% response rate for the student cohort. The students were then categorized into different groups depending upon their linguistic knowledge and skills. Across all groups, no gender differences were discerned for either spatial or verbal intelligence. Students who were categorized as monolingual (with only skills in English) had lower spatial and verbal intelligence than those who were multilingual. Medical students who had fluency in English and non-European languages showed greater spatial and verbal intelligence than other groups. However, there was no significant improvement in their examination marks for anatomy, although the examination performance might be complicated by cultural considerations. A further finding from our study was that, where an anatomy test required spatial recognition using cadaveric specimens, students with low spatial intelligence had significantly poorer performances. Furthermore, where tests used multiple choice questions, the level of spatial and verbal intelligences had no influence. We would advocate that, when all newly-recruited medical students are tutored in medical terminologies to help them develop the extensive vocabulary required for their professional careers, they should also be made aware of any deficiencies in spatial and verbal skills that could affect their learning abilities. Given that we would expect students to benefit in their careers from developing spatial and verbal skills, we also recommend that examination tests in anatomy should avoid the exclusive use of multiple choice questions. Clin. Anat., 2018. © 2018 Wiley Periodicals, Inc.

Attitudes and Responses of Medical Students and Professional Anatomists to Dissecting Different Regions of the Body.

Although there have been many studies assessing emotional responses of medical students to the dissecting room experience, little is known about whether dissecting particular regions of the human body cause more concern than others. Furthermore, no studies have been conducted on the concerns of professional anatomists. In this study, we assessed the hypothesis that medical students are more concerned about the dissection of the face, the perineum and the extremities of the limbs. We also hypothesized that there are gender differences. For the reactions of a group of professional anatomists from the United States and Europe we hypothesized that they were less concerned than the medical students and showed no differences across the regions of the body. The hypotheses were tested by means of questionnaires distributed to medical students at Cardiff University and at the Descartes Paris University who had recently completed their anatomy courses and to anatomists working at universities in Europe and the USA. Ethical approval for the study was obtained from the ethical committees at the Cardiff School of Biosciences and at Paris and all data was obtained by consent of the respondents and remained confidential. The findings were complex, although the level of concern was low overall. Some regional differences were discerned, particularly concerning the face, the perineum, the hand and the female chest. Anatomists were less concerned than the students and female students and female anatomists showed more concern than their male counterparts. Few differences were discerned however between student respondents who had positive and neutral attitudes to gender "politics" and those who espoused negative views. We recommend that, at the start of an anatomy dissection course, time is spent dealing with sensitive issues (including equality and diversity issues), emotional responses, and matters pertaining to mortality. However, we argue that this should not involve hiding regions of the body, nor overreacting to the natural anxiety of students, since doing either of these things could enhance negative reactions and stifle the progress of the student from being a layperson to a competent healthcare professional. Clin. Anat. 32:253-267, 2019. © 2018 Wiley Periodicals, Inc.

Gross anatomy examination performances in relation to medical students' knowledge of classical latin and greek.

The ability of medical students to acquire anatomical and medical terminologies could be influenced by their knowledge of classical Greek and Latin. In a previous study (Stephens and Moxham , Clin. Anat. 29:696at. ), it was reported that, while newly recruited medical students have a very favorable attitude toward the need to understand these classical languages, final year students see no benefit. In this study, we tested the hypothesis that, regardless of attitude, students in the initial stages of their medical education perform better at both summative and formative anatomy examinations if they have prior knowledge of Greek and Latin. First year medical students at Cardiff University who had been involved in the previous study concerning attitudes toward the relevance of the classical languages to medical education were evaluated in terms of their examination results in anatomy. Two hundred and twenty-seven students responded to a questionnaire (83% of the class) that categorized students into their linguistic knowledge and skills and their performances in formative and summative examinations were analyzed. For medical students with prior knowledge of classical Greek and Latin performed better in both summative and formative anatomy examinations. The results are therefore consistent with our hypothesis. Clin. Anat. 31:501-506, 2018. © 2018 Wiley Periodicals, Inc.

The development of a core syllabus for the teaching of oral anatomy, histology, and embryology to dental students via an international 'Delphi Panel'.

The formulation of core syllabuses for the biomedical sciences within medical and dental courses is partially driven by the need to cope with decreased time allocations for these subjects as a result of major curricular changes taking place worldwide. There is also a requirement to deal with the request for increased clinical relevance. In response to such demands, the International Federation of Associations of Anatomists (IFAA) is devising core syllabuses for the anatomical sciences relating to the education and training of both scientific and clinical professions. The process initially involves using Delphi Panels consisting of a team of anatomists, scientists, and clinicians who evaluate syllabus content in detail and accord each element/topic 'essential,' 'important,' 'acceptable,' or 'not required' status. Their conjectures, published on the IFAA website, provide merely a framework to enable other stakeholders to comment. The approach is international in scope, is conceptually 'democratic,' and is developmentally fluid in being readily available for amendment. The aim is to set internationally recognized standards and thus to provide guidelines concerning anatomical knowledge when engaged in course development. This article presents the deliberations of an IFAA Delphi Panel into a core syllabus for oral anatomy, histology, and embryology within the dental curriculum. Clin. Anat. 31:231-249, 2018. © 2017 Wiley Periodicals, Inc.

A critique of utilitarian and instrumentalist concepts for the teaching of gross anatomy to medical and dental students: Provoking debate.

Medical and dental curricula, together with anatomical sciences courses, are increasingly having to change, mainly because there is a drive to being what is termed, without adequate definition, "clinically relevant." The concept of "clinical anatomy" has accordingly been invented and it is expected that, at all times, the teaching of anatomy is directly focused on clinical scenarios, meaning almost invariably the disease-based model of medicine and dentistry. Furthermore, students are not expected to have a detailed knowledge of gross anatomy and the time devoted to teaching and learning the subject has decreased significantly. The notion being fostered is that knowledge is not required "just in case" but "just in time." However, the absence of agreed core syllabuses that are internationally accepted complicates a discussion about what is relevant practically and what does not need to be taught. In this article, we critique such an utilitarian and instrumentalist approach to the teaching of gross anatomy within medical and dental curricula. We draw attention to the need to embrace the functionality-based model of medicine and dentistry by returning to an understanding that the role of the medical or dental practitioner is to value health and to restore to functionality the ill person or the pathologically affected region/organ/system. A fuller knowledge of anatomy than is presently taught is regarded as a prerequisite for appreciating normality and health. A further problem with the instrumentalist approach to medical education is that, by concentrating on what is seen to be at the time "useful" or "clinically relevant," there is the danger of undermining, or discouraging, future developments that rely on what contemporaneously seems "useless" and "irrelevant" knowledge. Finally, the reliance instrumentalism has on just what is pragmatic and regardless of scientific validity is contrary to the ethos and practice of a university education that values deep learning and the development of learnèd professions. Clin. Anat. 30:912-921, 2017. © 2017 Wiley Periodicals, Inc.

Medical students and professional anatomists do not perceive gender bias within imagery featuring anatomy.

Previous studies suggest that, while both medical students and professional anatomists recognize the importance of gender issues and do not wish to associate with sexism, most are unaware of the possible negative aspects of sexism within anatomy (Morgan et al. , J. Anat. 224:352-365; , Clin. Anat. 29:892-910). To further investigate this issue, we provided second year medical students at Cardiff University (n = 293) and at the University of Paris Descartes, Sorbonne Paris Cité (n = 142) and professional anatomists (n = 208) with a questionnaire inviting them to address the possibility that gender factors within anatomical imagery (both historical and contemporary) hinder the dispassionate representation of anatomy. Ethical approval for the survey was obtained from the universities at both Cardiff and Paris. In the light of previous findings, the hypothesis tested was that medical students and professional anatomists do not perceive a gender bias when reflected in imagery that is based on anatomical iconography. Our survey results support this hypothesis and suggest that most students and anatomists are unaware of the possible negative aspects of sexism within the culture of anatomy. We consequently recommend that teachers of anatomy and authors of anatomical textbooks should be aware of the possibility of adverse effects on professional matters relating to equality and diversity issues when using imagery. Clin. Anat. 30:711-732, 2017. © 2017Wiley Periodicals, Inc.

A core syllabus for the teaching of embryology and teratology to medical students.

Clinical relevance in the teaching of biomedical sciences within health care courses presupposes that there is internationally agreed core material within the curricula. However, with the exception of a syllabus for neuroanatomy and gross anatomy of the head and neck for medical students, core syllabuses within many of the specialized anatomical sciences have yet to be developed. The International Federation of Associations of Anatomists aims to formulate internationally accepted core syllabuses for all anatomical sciences disciplines initially using Delphi Panels that comprise anatomists, scientists, and clinicians who evaluate syllabus content. Here, the suggestions of a Delphi Panel for embryology and teratology are presented prior to their publication on the website of the International Federation of Associations of Anatomists. Hence, to obtain a more definitive syllabus, it is required that anatomical and embryological/teratological societies, as well as individual anatomists, embryologists and clinicians, freely comment upon, elaborate and amend, this draft syllabus. The goal is to set internationally recognized standards and thereby provide guidelines concerning embryological and teratological knowledge when involved with course development. Clin. Anat. 30:159-167, 2017. © 2016 Wiley Periodicals, Inc.

The attitudes of medical students in Europe toward the clinical importance of histology.

Many studies have been undertaken to assess the attitudes of medical students to the clinical importance of gross anatomy. However, much less is known about their attitudes toward the clinical importance of histology. Using Thurstone and Chave methods to assess attitudes, over 2,000 early stage medical students across Europe provided responses to a survey that tested the hypothesis that the students have a high regard for histology's clinical relevance. Regardless of the university and country surveyed, and of the teaching methods employed for histology, our findings were not consistent with our hypotheses, students providing a more moderate assessment of histology's importance compared to gross anatomy but more positive than their attitudes toward embryology. Histology should play a significant role in medical education in terms of appreciating not just normal structure and function but also pathology. We conclude that teachers of histology should pay special attention to informing newly-recruited medical students of the significant role played by histology in attaining clinical competence and in underpinning their status as being learned members of a healthcare profession. This work was conducted under the auspices of the Trans-European Pedagogic Research Group (TEPARG). Clin. Anat. 30:635-643, 2017. © 2017 Wiley Periodicals, Inc.

How optional should regional anatomy be in a medical course? An opinion piece.

The use of optional (elective) courses within the medical curriculum is increasingly being seen as a way of allowing students to pursue their studies according to their personal interests. For anatomy, particularly where the subject is being taught in an integrative curriculum and by means of a systemic approach, the development of elective regional anatomy courses is being employed to reintroduce regional anatomy and/or dissection by students. However, there is presently little evidence that objectively evaluates optional/elective courses. In this paper we critique the concept and practice of using elective courses and assess whether their deployment is ultimately in the interests of medical education, the medical profession, society in general and the layperson (potential patient) in particular. Clin. Anat. 29:702-710, 2016. © 2016 Wiley Periodicals, Inc.

The attitudes of medical students toward the importance of understanding classical Greek and Latin in the development of an anatomical and medical vocabulary.

Students on entering medical school are faced with acquiring new, and voluminous, anatomical and medical terminologies. A reason why acquiring these terminologies may be problematic relates to the fact that many terms are derived from classical Greek and Latin; languages nowadays that are rarely taught at school. It might also be supposed that the often reported reduction in exposure to anatomy, and time spent in the dissection room, impairs the students' knowledge and understanding of anatomical relationships, and thus further complicates the acquisition of the terminologies. To date, there have been no studies that have quantified the attitudes of medical students toward the importance of understanding classical Greek and Latin during their medical training. In order to assess these attitudes, this study was undertaken for the newly-recruited (First Year) medical students and for the Final Year medical students at Cardiff University. They were provided with a brief questionnaire that was devised in accordance with Thurstone and Chave (1951) principles and with ethical approval. One hundred and eighty First Year students and one hundred and nineteen Final Year students responded. Our initial hypothesis was that students throughout the medical curriculum have an unfavorable attitude toward the importance of classical Greek and Latin. This hypothesis was supported by the attitudes of the Final Year students but not by the First Year medical students. While we would still advocate that First Year medical students should acquire some understanding of and have some formal or informal instruction in, classical Greek and Latin as they pertain to medical terminologies, we acknowledge that Final Year students are likely to have become reasonably well-versed in the origins of medical terminologies without formal instruction. Clin. Anat. 29:696-701, 2016. © 2016 Wiley Periodicals, Inc.

Sexism within anatomy as perceived by professional anatomists and in comparison with the perceptions of medical students.

Two hundred and eight professional anatomists responded to a questionnaire inviting them to address the possibility that social/gender factors hinder the dispassionate representation of anatomy. Ethical approval for the study was obtained from Cardiff University. The results of the survey provided comparisons with the attitudes of medical students that have previously been reported (Morgan et al., 2014). Although a few differences were discerned between females and males in our surveys and between anatomists and medical students, overall our findings suggest that, while both professional anatomists and medical students recognize the importance of gender issues and do not wish to associate with sexism, most are unaware of the possible negative aspects of sexism within anatomy. We recommend that teachers of anatomy should become more aware of the possibility of adverse effects on professional matters relating to equality and diversity issues. Clin. Anat. 29:892-910, 2016. © 2016 Wiley Periodicals, Inc.

The attitudes of medical students in Europe toward the clinical importance of embryology.

Although there have been many studies reporting the attitudes of medical students to the clinical importance of gross anatomy, little is known about their opinions concerning the clinical importance of embryology. Using Thurstone and Chave methods to assess attitudes, nearly 1,600 medical students across Europe in the early stages of their training provided responses to a survey that tested the hypothesis that they do not regard embryology as highly clinically relevant. Indeed, we further proposed that student attitudes to gross anatomy are much more positive than those toward embryology. Our findings show that our hypotheses hold, regardless of the university and country surveyed and regardless of the teaching methods employed for embryology. Clearly, embryology has a significant part to play in medical education in terms of understanding prenatal life, of appreciating how the organization of the mature human body has developed, and of providing essential information for general medical practice, obstetrics and pediatrics, and teratology. However, while newly recruited medical students understand the importance of gross anatomy in the development of professional competence, understanding the importance of embryology requires teachers, medical educationalists, and devisors of medical curricula to pay special attention to informing students of the significant role played by embryology in attaining clinical competence and achieving the knowledge and understanding of the biomedical sciences that underpins becoming a learned member of a health care profession.

A core syllabus for the teaching of neuroanatomy to medical students.

There is increasingly a call for clinical relevance in the teaching of biomedical sciences within all health care courses. However, this presupposes that there is a clear understanding of what can be considered core material within the curricula. To date, the anatomical sciences have been relatively poorly served by the development of core syllabuses, particularly for specialized core syllabuses such as neuroanatomy. One of the aims of the International Federation of Associations of Anatomists (IFAA) and of the European Federation for Experimental Morphology (EFEM) is to formulate, on an international scale, core syllabuses for all branches of the anatomical sciences using Delphi Panels consisting of anatomists, scientists, and clinicians to initially evaluate syllabus content. In this article, the findings of a Delphi Panel for neuroanatomy are provided. These findings will subsequently be published on the IFAA website to enable anatomical (and other cognate learned) societies and individual anatomists, clinicians, and students to freely comment upon, and elaborate and amend, the syllabuses. The aim is to set internationally recognized standards and thus to provide guidelines concerning neuroanatomical knowledge when engaged in course development.

Building an open academic environment - a new approach to empowering students in their learning of anatomy through 'Shadow Modules'.

Teaching and learning in anatomy is undertaken by a variety of methodologies, yet all of these pedagogies benefit from students discussing and reflecting upon their learning activities. An approach of particular potency is peer-mediated learning, through either peer-teaching or collaborative peer-learning. Collaborative, peer-mediated, learning activities help promote deep learning approaches and foster communities of practice in learning. Students generally flourish in collaborative learning settings but there are limitations to the benefits of collaborative learning undertaken solely within the confines of modular curricula. We describe the development of peer-mediated learning through student-focused and student-led study groups we have termed 'Shadow Modules'. The 'Shadow Module' takes place parallel to the formal academically taught module and facilitates collaboration between students to support their learning for that module. In 'Shadow Module' activities, students collaborate towards curating existing online open resources as well as developing learning resources of their own to support their study. Through the use of communication technologies and Web 2.0 tools these resources are able to be shared with their peers, thus enhancing the learning experience of all students following the module. The Shadow Module activities have the potential to lead to participants feeling a greater sense of engagement with the subject material, as well as improving their study and group-working skills and developing digital literacy. The outputs from Shadow Module collaborative work are open-source and may be utilised by subsequent student cohorts, thus building up a repository of learning resources designed by and for students. Shadow Module activities would benefit all pedagogies in the study of anatomy, and support students moving from being passive consumers to active participants in learning.

Sexism and anatomy, as discerned in textbooks and as perceived by medical students at Cardiff University and University of Paris Descartes.

Contemporary textbooks of anatomy and surface anatomy were evaluated to ascertain whether they were gender-neutral. The evidence of this, and previous studies, suggests that, both in terms of imagery and text, many textbooks lack neutrality. To further investigate such matters, we provided second-year medical students studying at Cardiff University (n = 293) and at the Paris Descartes University (n = 142) during the 2011-2012 academic year with a questionnaire inviting them to address the possibility that social/gender factors hinder the dispassionate representation of anatomy. Ethical approval was obtained from both Cardiff and Paris universities. Eighty-six percent of the students at Cardiff and 39% at Paris Descartes responded and provided data for analysis. The hypothesis tested is that medical students perceive a gender bias that is reflected in the books they read and the tuition they receive. Our findings suggest that, while students recognise the importance of gender issues and do not wish to associate with sexism, most are unaware of the possible negative aspects of sexism within anatomy. In this respect, the findings do not support our hypothesis. Nevertheless, we recommended that teachers of anatomy and authors of anatomy textbooks should be aware of the possibility of adverse effects on professional matters relating to equality and diversity issues.