The principles of anatomical nomenclature revision: They're more like guidelines anyway.

Revision of the international standard anatomical terminology is required periodically to add names for new entities, delete archaic terms, and correct errors in existing terms. In addition to a small set of nomenclature rules, three principles have guided revisions: names should not be changed unless they are wrong; corrections of perceived errors should not be pedantic; and inclusion of every minor structure should not be attempted. These principles have served well, and are expected to continue to do so, but they have also proven to be subjective because their application through the history of the international terminology has varied. Specific efforts to deal with existing problems and new organizational initiatives to prevent future issues are presented. Clin. Anat. 33:327-331, 2020. © 2019 Wiley Periodicals, Inc.

Developing an international standard for the classification of surface anatomic location for use in clinical practice and epidemiologic research.

BACKGROUND: There is currently no universally adopted terminology for defining human surface anatomic location. The lack of precision, accuracy, and reliability of terms used by health care providers, in particular dermatologic surgeons, is unsatisfactory both for epidemiologic research and for high-quality patient care. OBJECTIVE: We sought to create a clinically relevant yet concise surface anatomy terminology for international use including the International Classification of Diseases and to map it to existing disparate terminologies. METHODS: Widely used surface anatomy terminology data sets and diagrams were reviewed. A Delphi consensus convened to create a novel surface anatomy terminology. The new terminology was hierarchically mapped to Systematized Nomenclature of Medicine terms and New York University numbers and physically mapped to 2-dimensional anatomic diagrams for clarity and reproducibility. RESULTS: The final terminology data set contains 519 discrete terms arranged in a 9-level hierarchy and has been adopted by the World Health Organization for the International Classification of Diseases, 11th revision. LIMITATIONS: Specification of most locations requires linking to laterality qualifiers. Fine granularity for larger sites may require the use of additional qualifiers. CONCLUSION: Consistent use of precise and accurate surface anatomy terms is crucial to the practice of dermatology, particularly procedural dermatology. The proposed terminology is designed to form the basis for evolution of a universally adoptable terminology set to improve patient care, interprovider communication, and epidemiologic tracking.

Integrated virtual and cadaveric dissection laboratories enhance first year medical students' anatomy experience: a pilot study.

BACKGROUND: Radiology integration into medical anatomy courses is well established, but there is a paucity of literature on integrating virtual dissection into cadaveric dissection laboratories. Virtual dissection is the digital dissection of medical images on touchscreen anatomy visualization tables. The purpose of this pilot study was to investigate the feasibility of integrating virtual dissection into a first-year medical cadaver-based anatomy course and to assess students' overall attitude towards this new technology. METHODS: All students in first-year medicine at a single medical school participated in this study (n = 292). Six virtual dissection laboratories, which focused on normal anatomy, were developed and integrated into a cadaver-based anatomy course. The virtual dissection table (VDT) was also integrated into the final anatomy spot exam. Following the course, students completed a short evidence-informed survey which was developed using a theoretical framework for curriculum evaluation. Numerical data were tabulated, and qualitative content analysis was performed on students' unstructured comments. RESULTS: The survey response rate was 69.2% (n = 202/292). Most (78.7%) students reported that virtual dissection enhanced their understanding of the cadaveric anatomy and the clinical applications of anatomy. Most (73.8%) students also felt that the VDT was an effective use of the laboratory time. Thirteen narrative comments were collected, most of which (61.5%) identified strengths of the curriculum. CONCLUSIONS: In this pilot study, students perceived that their learning was enhanced when virtual dissection was combined with a cadaver-based anatomy laboratory. This study demonstrates that there is potential for virtual dissection to augment cadaveric dissection in medical education.

Teaching anatomy using an active and engaging learning strategy.

BACKGROUND: Various evidence-based and student-centered strategies such as team-based learning (TBL), case-based learning (CBL), and flipped classroom have been recently applied to anatomy education and have shown to improve student engagement and interaction. These strategies shift the focus of teaching from knowledge transmission to knowledge construction by students and encourage the use of tasks. This study discusses the use of an active and engaging learning strategy to teach the musculoskeletal system to Year 1 MBBS students (Faculty of Medical Sciences, The University of the West Indies, Cave Hill, Barbados) and examines the correlation between assessment modalities and student performance. METHODS: The "Active and Engaging Learning Strategy" was used to assess student learning in the form of oral presentations. Students had presentations on muscle attachments, muscle actions, blood and nerve supply, and applied anatomy of the limb musculature. Questions on the limbs (Locomotor System) were included in pre and post-presentation spotters, in-course assessments, and final examinations. Percentages, paired t-test, independent sample t-test, and zero-order correlations were performed to confirm the results for the different objectives of the study. RESULTS: The main modes of presentation chosen were poems (37.1%), followed by stories (21.2%), songs (11.4%), and skits (10.6%). The majority of students (84%) found the strategies beneficial and recommended such sessions for future cohorts (92%). Students achieved significantly better scores in post-presentation spotters (p < 0.01) and the marks of in-course and final examinations also showed significant improvement (p < 0.01). CONCLUSION: Our study highlighted that the active and engaging learning strategy can be used as an effective learning tool in anatomy. Students were proactive in preparing the muscle presentations by utilizing their own creativity, curiosity, and intelligence. Further studies should be conducted using randomized controlled trials to assess the effectiveness of various learning strategies which could open a new door to medical education.

The First Organ-Based Ontology for Arthropods (Ontology of Arthropod Circulatory Systems - OArCS) and its Integration into a Novel Formalization Scheme for Morphological Descriptions.

Morphology, the oldest discipline in the biosciences, is currently experiencing a renaissance in the field of comparative phenomics. However, morphological/phenotypic research still suffers on various levels from a lack of standards. This shortcoming, first highlighted as the "linguistic problem of morphology", concerns the usage of terminology and also the need for formalization of morphological descriptions themselves, something of paramount importance not only to the field of morphology but also when it comes to the use of phenotypic data in systematics and evolutionary biology. We therefore argue, that for morphological descriptions, the basis of all systematic and evolutionary interpretations, ontologies need to be utilized which are based exclusively on structural qualities/properties and which in no case include statements about homology and/or function. Statements about homology and function constitute interpretations on a different or higher level. Based on these "anatomy ontologies", further ontological dimensions (e.g., referring to functional properties or homology) may be exerted for a broad use in evolutionary phenomics. To this end we present the first organ-based ontology for the most species-rich animal group, the Arthropoda. Our Ontology of Arthropod Circulatory Systems (OArCS) contains a comprehensive collection of 383 terms (i.e., labels) tied to 296 concepts (i.e., definitions) collected from the literature on phenotypic aspects of circulatory organ features in arthropods. All of the concepts used in OArCS are based exclusively on structural features, and in the context of the ontology are independent of homology and functional assumptions. We cannot rule out that in some cases, terms are used which in traditional usage and previous accounts might have implied homology and/or function (e.g. heart, sternal artery). Concepts are composed of descriptive elements that are used to classify observed instances into the organizational framework of the ontology. That is, descriptions in ontologies are only descriptions of individuals if they are necessary/and or sufficient representations of attributes (independently) observed and recorded for an individual. In addition, we here present for the first time an entirely new approach to formalizing phenotypic research, a semantic model for the description of a complex organ system in a highly disparate taxon, the arthropods. We demonstrate this with a formalized morphological description of the hemolymph vascular system in one specimen of the European garden spider Araneus diadematus. Our description targets five categories of descriptive statement: "position", "spatial relationships", "shape", "constituents", and "connections", as the corresponding formalizations constitute exemplary patterns useful not only when talking about the circulatory system, but also in descriptions in general. The downstream applications of computer-parsable morphological descriptions are widespread, with their core utility being the fact that they make it possible to compare collective description sets in computational time, that is, very quickly. Among other things, this facilitates the identification of phenotypic plasticity and variation when single individuals are compared, the identification of those traits which correlate between and within taxa, and the identification of links between morphological traits and genetic (using GO, Gene Ontology) or environmental (using ENVO, Environmental Ontology) factors. [Arthropoda; concept; function; hemolymph vascular system; homology; terminology.].

Effectiveness of PBL methodology in a hybrid dentistry program to enhance students' knowledge and confidence. (a pilot study).

BACKGROUND: Knowledge and self-confidence are two critical determinants of future success of dental students. The present pilot study was conducted with an objective to simultaneously assess both knowledge and confidence gained by dental undergraduate students in the Head and Neck Anatomy course by employing didactic lecture-based and problem-based learning methods. METHODS: A paper-based assessment tool comprising of 30 Multiple choice questions to assess knowledge, followed by a Likert's scale to assess students' confidence to answer the given knowledge question was designed. This tool was used in a cohort of first year dental students before the commencement of Head and Neck Anatomy course (Pre-course), immediately after the completion of Head and Neck Anatomy course (Post-course), and again in third year before the same cohort entered their clinical courses (Pre-clinics). The difference in students' knowledge and confidence through both pedagogies was evaluated by Paired 't' test. Pearson correlation analysis was done to determine the correlation between knowledge scores and self-reported confidence. RESULTS: A statistically significant increase (p < 0.05) was noted in the mean knowledge and confidence scores in the post-course evaluation, through both didactic lecture-based and problem-based learning methods. On the other hand, a significant decrease (p < 0.05) in the mean knowledge and confidence scores of didactic lecture-based items in comparison to problem-based items was noted in the pre-clinics evaluation.. The post-course evaluation results yielded a Pearson correlation coefficient of r = 0.514, p = 0.002 for lecture-based items and r = 0.495, p = 0.003 for problem-based items, denoting a positive moderate correlation between the knowledge and confidence scores for both lecture-based and problem-based methods. CONCLUSION: A significant improvement in both knowledge and self-reported confidence demonstrated at the end of Head and Neck Anatomy course proves both didactic lectures and problem-based learning methods to be equally effective in a hybrid dentistry program in the short term. However, the non-significant reduction in the pre-clinics knowledge and confidence scores among the PBL lessons proves it to be a potent learning tool for long term retention of knowledge, and sustainability of confidence.

Loss of philological purity: Hybrid vigor or mongrelism?

Although disparaged by philologists, hybrid words enrich technical and scientific vocabularies. They are common, so, like it or not, they are here to stay. On the other hand, where there are pre-existing purebred compound or affixed words, they should generally be given preference over hybrids. Some adjectives (e.g., laryngeus and sphenoideus) are discussed to illustrate these recommendations. Clin. Anat. 31:771-773, 2018. © 2018 Wiley Periodicals, Inc.

Another new organ! is this a golden age of discovery in anatomy?

Twice in fifteen months the popular press has published reports of the discovery of a new human organ. The claims that the mesentery and interstitium are organs come from medical practitioners, not from anatomical scientists. Although both of these anatomical entities are important in the functioning of the body, neither satisfies the requirements that an organ be composed of two or more tissues and perform a special function. Also missing in the recent claim that the interstitium, that is, connective tissues with fluid-filled spaces, is an organ, is a statement to that effect in the original research report. Alas, it appears to be much ado about nothing. Clin. Anat. 31:648-649, 2018. © 2018 Wiley Periodicals, Inc.

Students as anatomy near-peer teachers: a double-edged sword for an ancient skill.

BACKGROUND: A near-peer instructors (NPI) program was designed for 1st year medical students who successfully finished the Anatomy course, in order to develop their didactic ability and teaching skills, mostly for cadaver dissection. METHODS: Graduates of the training program were administered a voluntary survey at the end of the program, annually. Best graduates of the training program were offered a NPI position in the next academic year. They were evaluated by the first-year students, at the end of the Anatomy block. RESULTS: In a debriefing questionnaire at the end of the NPI training, on the five-point Likert scale (1 = lowest to 5 = highest), the overall rating ranged from 3.63 in 2013 to 3.71 in 2015. Learning prosection and anatomy demonstration skills scored on average from 4.30 to 4.36, respectively. The NPIs were then evaluated by first-year students at the end of the next year's Anatomy block. On the Likert scale, the average score of NPIs ranged from 4.10 in 2014 to 4.75 in 2016, on the par with the general satisfaction score for the professional preclinical teachers during the same period (which ranged from 3.80 to 4.26). CONCLUSIONS: It is suggested that students as near-peer instructors can make a valuable contribution to the teaching faculty, especially in a new medical school.

One vowel or two? Diphthongs, digraphs, ligatures, and diaereses, oh my!

This is the first in a short series about orthography in anatomical Latin. Although phonology is an important aspect of diphthongs and digraphs, the focus here is on spelling, not the more complicated topic of pronunciation. Recommendations are made for standard spellings of words that contain or may appear to contain diphthongs in Latin anatomical words or their ancient Greek sources. Ligatures and diaereses (typographical symbols that were developed after the classical period) are not recommended for use in anatomical Latin terms. Clin. Anat. 30:1013-1016, 2017. © 2017 Wiley Periodicals, Inc.

Ordering by the numbers in anatomy and by letters Too.

Here, new rules of Latin anatomical nomenclature are proposed to deal with cases not covered by existing or other recommended rules. Determiners (e.g., numerals, letters, alphanumeric strings, and Latin names of Greek letters) should follow the noun they specify or limit, just as it is recommended that adjectives should follow the noun they modify. In general, Roman numerals, Latin letters, and Latin names of Greek letters are preferable to Arabic numerals and Greek letters in Latin anatomical terms. It is also noted that the word typus (type) appears to be superfluous and unnecessary in the Latin anatomical nomenclature. Clin. Anat. 30:700-702, 2017. © 2017Wiley Periodicals, Inc.

Development of the anatomical quality assessment (AQUA) tool for the quality assessment of anatomical studies included in meta-analyses and systematic reviews.

Critical appraisal of anatomical studies is essential before the evidence from them undergoes meta-epidemiological synthesis. However, no instrument for appraising anatomical studies with inherent applicability to different study designs is available. We aim to develop a generic yet comprehensive tool for assessing the quality of anatomical studies using a formal consensus method. The study steering committee formulated an initial conceptual design and generated items for a preliminary tool on the basis of a literature review and expert opinion. A Delphi procedure was then adopted to assess the validity of the preliminary tool. Feedback from the Delphi panelists was used to improve it. The Delphi procedure involved 12 experts in anatomical research. It comprised two rounds, after which unanimous consensus was reached about the items to be included. The preliminary tool consisted of 20 items, which were phrased as signaling questions and organized into five domains: 1. Aim and subject characteristics, 2. Study design, 3. Characterization of methods, 4. Descriptive anatomy, and 5. Results reporting. Each domain was set to end with a risk of bias question. Following round 1, some of the items underwent major revision, although agreement was reached regarding inclusion of all the domains and signaling questions in the preliminary tool. The tool was revised only for minor language inaccuracies after round 2. The AQUA Tool was designed to assess the quality and reliability of anatomical studies. It is currently undergoing a validation process. Clin. Anat. 30:6-13, 2017. © 2016 Wiley Periodicals, Inc.

Development of the Anatomical Quality Assurance (AQUA) checklist: Guidelines for reporting original anatomical studies.

The rise of evidence-based anatomy has emphasized the need for original anatomical studies with high clarity, transparency, and comprehensiveness in reporting. Currently, inconsistencies in the quality and reporting of such studies have placed limits on accurate reliability and impact assessment. Our aim was to develop a checklist of reporting items that should be addressed by authors of original anatomical studies. The study steering committee formulated a preliminary conceptual design and began to generate items on the basis of a literature review and expert opinion. This led to the development of a preliminary checklist. The validity of this checklist was assessed by a Delphi procedure, and feedback from the Delphi panelists, who were experts in the area of anatomical research, was used to improve it. The Delphi procedure involved 12 experts in anatomical research. It comprised two rounds, after which unanimous consensus was reached regarding the items to be included in the checklist. The steering committee agreed to name the checklist AQUA. The preliminary AQUA Checklist consisted of 26 items divided into eight sections. Following round 1, some of the items underwent major revision and three new ones were introduced. The checklist was revised only for minor language inaccuracies after round 2. The final version of the AQUA Checklist consisted of the initial eight sections with a total of 29 items. The steering committee hopes the AQUA Checklist will improve the quality and reporting of anatomical studies. Clin. Anat. 30:14-20, 2017. © 2016 Wiley Periodicals, Inc.

Human anatomy nomenclature rules for the computer age.

Information systems are increasing in importance in biomedical sciences and medical practice. The nomenclature rules of human anatomy were reviewed for adequacy with respect to modern needs. New rules are proposed here to ensure that each Latin term is uniquely associated with an anatomical entity, as short and simple as possible, and machine-interpretable. Observance of these recommendations will also benefit students and translators of the Latin terms into other languages. Clin. Anat. 30:300-302, 2017. © 2016 Wiley Periodicals, Inc.

Polish translation of the Anatomical Quality Assurance (AQUA) Checklist: new guidelines for reporting in original anatomical studies.

Recently, an improvement of the quality of reporting and methodology in original research has been observed. Major fields in research have introduced checklists aimed at promoting clear and univocal reporting of methods and results. The basis of evidence-based medicine (EBM) lies in transparent reporting of primary studies. Although clinical research progressed rapidly into evidence-based guidelines, the basic sciences, including anatomy, just recently started to use the rules of EBM. No anatomy-specific standardized research checklist has been introduced so far. Evidence-based anatomy (EBA) emerged as a new approach to research in anatomy that incorporates methods, such as meta-analysis and systematic review. High quality methodology and clear reporting of results of original studies are the basis of EBA. The Anatomical Quality Assurance (AQUA) Checklist is a new tool aimed to introduce univocal reporting of original anatomical studies. The checklist consists of 29 reporting items, which are essential in obtaining unambiguous and high-quality reporting of methods and results and ensuing straightforward interpretation and reproducibility. The AQUA Checklists been endorsed by anatomical associations, including the International Federation of Associations of Anatomists. Therefore, the authors of this study believe that introduction of the Polish version of AQUA Checklist into practice will improve the quality of original anatomical studies in Poland and will promote the EBA standards for years to come.

The naming game: A discrepancy among the medical community.

As anatomists we rely on the nomenclature of structures in order to describe them appropriately, particularly their orientation in respect to their surrounding. The terminology used by the anatomist to describe an organ, muscle, or nerve within the body is taught to medical students as law. Students learn to describe structures in the "anatomical position", which has been accepted in the literature since the original Latin Nomina Anatomica. They therefore familiarize themselves with the use of terms such as superior, inferior, posterior and anterior to describe all anatomical structures, except in respect of the heart. The heart is still described in the original Valentine position. As anatomists we owe it to the medical and research community to correct the nomenclature to minimize confusion, and to describe the heart properly in respect to its surrounding structures.

Contribution to the anatomical nomenclature concerning general anatomy and anatomical variations.

Nomenclature of the general and variant anatomy belongs to the most neglected parts of the Latin anatomical nomenclature in Terminologia Anatomica. Although many important small structures are included in Terminologia Anatomica, when describing and teaching particular anatomy of any part of the human body, the general terms are necessary, such as planes, lines and flexion grooves. Moreover, Terminologia Anatomica contains only 149 terms of variant structures, enlisted in the parentheses to differentiate them from constant ones. They are only a rather representative selection and some more should be added, both from the educational and clinical point of view. The authors present some terms, completed with their definitions or explanations concerning the general and variant anatomy to evoke broader discussion on this topic which should issue in incorporation of proposed terms (or their equivalents) into the Terminologia Anatomica.

Appraising the methodological quality of cadaveric studies: validation of the QUACS scale.

Although systematic reviews are conducted in the field of anatomical research, no instruments exist for the assessment of study quality. Thus, our objective was to develop a valid tool that reliably assesses the methodological quality of observational cadaveric studies. The QUACS scale (QUality Appraisal for Cadaveric Studies) was developed using an expert consensus process. It consists of a 13-item checklist addressing the design, conduct and report of cadaveric dissection studies. To evaluate inter-rater reliability, a blinded investigator obtained an initial pool of 120 observational cadaveric studies. Sixty-eight of them were selected randomly according to sample size calculations. Three independent researchers rated each publication by means of the QUACS scale. The reliability of the total score was estimated using the intraclass correlation coefficient (ICC). To assess agreement among individual items, margin-free kappa values were calculated. For construct validity, two experts (an anatomist and an experienced physician) categorized the quality of 15 randomly selected studies as 'excellent' (4 points), 'moderate to good' (3 points), poor to moderate' (2 points) or 'poor' (1 point). Kendall's tau rank correlation was used to compare the expert ratings with the scores on the QUACS scale. An evaluation of feasibility was carried out during the reliability analysis. All three raters recorded the duration of quality appraisal for each article. Means were used to describe average time exposure. The ICC for the total score was 0.87 (95% confidence interval: 0.82-0.92; P < 0.0001). For individual items, margin-free kappa values ranged between 0.56 and 0.96 with an agreement of 69-97% among the three raters. Kendall's tau B coefficient of the association between expert ratings and the results obtained with the QUACS scale was 0.69 (P < 0.01). Required rating time per article was 5.4 ±â€…1.6 min. The QUACS scale is highly reliable and exhibits strong construct validity. Thus, it can confidently be applied in assessing the methodological quality of observational dissection studies.