Accessing abortion in a highly restrictive legal regime: characteristics of women and pregnant people in Malta self-managing their abortion through online telemedicine.

OBJECTIVE: To examine the numbers and characteristics of women and pregnant people in Malta seeking at-home medical abortion using online telemedicine from 2017 to 2021. DESIGN: Population-based study. SETTING: Republic of Malta PARTICIPANTS: Between 1 January 2017 and 31 December 2021, 1090 women and pregnant people requested at-home medical abortion through one online telemedicine provider (Women on Web). Mifepristone and misoprostol were shipped to 658 women (60.4% of requests). MAIN OUTCOME MEASURES: The numbers and demographics of persons to which abortion pills were shipped, their reasons for accessing abortion, and reasons for requesting medical abortion via telemedicine between January 2017 and December 2021 were analysed. Selected data were compared across different groups. RESULTS: The number of people in Malta to whom medical abortion pills were shipped increased significantly in the 5 years analysed. Women and pregnant people requesting medical abortion were diverse with respect to age, pregnancy circumstances and reasons for seeking an abortion. More than half had existing children and over 90% reached out to Women on Web at <7 weeks. Among those completing a medical abortion, 63% did not use contraception, and in 30% there was contraception failure. The most common reasons for ordering medical abortion pills online were difficulty accessing abortion because of legal restrictions (73%) and abortion pills not being available (45%) in the country. CONCLUSIONS: Despite a complete ban on abortion, the number of women and pregnant people residing in Malta completing at-home medical abortions is considerable and has been steadily increasing.

The attitudes of European medical students towards the clinical importance of neuroanatomy.

The attitudes of medical students towards the clinical importance of neuroanatomy have been little studied. Because it has been reported that medical students find neuroanatomy difficult and can have 'neurophobia', here we test the hypothesis that early-stage medical students across Europe have a low regard for neuroanatomy's clinical relevance. The work was conducted under the auspices of the Trans-European Pedagogic Research Group (TEPARG), with just over 1500 students from 12 European medical schools providing responses to a survey (52% response rate) that assessed their attitudes using Thurstone and Chave methodologies. Regardless of the university surveyed, and of the teaching methods employed for neuroanatomy, our findings were not consistent with our hypothesis. However, the students had a less favourable opinion of neuroanatomy's importance compared to gross anatomy; although their attitudes were more positive than previously reported for histology and embryology. The extent to which neuroanatomy plays a significant role in the early years of medical education is moot. Nevertheless, we conclude that in addition to newly recruited medical students being informed of the subject's role in a healthcare profession, we advocate the use of modern imaging technologies to enhance student understanding and motivation and cognisance of the core syllabus for the subject being developed by the International Federation of Associations of Anatomists (IFAA).

Undergraduate peer assisted learning tutors' performance in summative anatomy examinations: a pilot study.

OBJECTIVES: To compare summative anatomy examination results of Peer Assisted Learning (PAL) tutors and learners in the same undergraduate classroom. METHODS: Comparative study of Year-1 medical students who did/did not serve as PAL tutors. PAL tutors gave six hours of teaching in lower limb anatomy. Percent marks for written and spotting examinations were compared between PAL tutors and PAL learners. RESULTS: The 12 self-selected PAL tutors were not significantly different from their peers (n=191) in terms of age or nationality, but 20% were female compared to 51% of PAL learners. Except for upper limb anatomy, PAL tutors performed at the same level as their tutees in all basic science examinations taken before PAL was introduced. PAL tutors performed better (M=89.0, SD=8.2) in the lower limb examinations than PAL learners (M=79.7, SD=13.0), but these differences were only statistically significantly bigger in the subject they had taught (t(184) = 2.40, p=0.002). Overall PAL tutors performed better in all anatomy spotting exams in both pre-clinical years (Year-1: M=80.4, SD=7.4; Year-2: M=74.8, SD=3.4) compared to PAL learners (Year-1: M=75.1, SD=6.6; Year-2: M=67.2, SD=3.0; (t(1) = 4.2, p=0.07). CONCLUSIONS: Undergraduate PAL tutors performed better than PAL learners in the subject they taught and continued to do so in all anatomy spotting exams, even after the PAL experience had ended, suggesting that actively involving anatomy students as PAL tutors should be encouraged especially among undergraduate medical students.

Supported self-directed learning of Clinical Anatomy: a pilot study of doughnut rounds

Doughnut Rounds (DRs) are an innovative approach to self-directed learning (SDL). The purpose of this study was to explore the usefulness of DRs in learning the clinical anatomy of the lower limb. Seventeen Year 1 medical students attended six weekly hour-long sessions in small groups. Each student prepared five questions on a different clinical anatomy topic every week. During each session, students took turns to ask their questions to others in the group. Each incorrect/correct answer was then explained to the students. Each student took an identical MCQ test before and after each session to assess changes in their knowledge of the relevant clinical anatomy. The average pre/post MCQ scores increased by 39% (p<0.01). Overall there was no statistically significant difference in the summative lower limb final examination results between DR participants and non-participants, perhaps because the effect, if any, of the DRs on learning was diluted by good exam preparation of the whole cohort. However, participation in the DRs reflected insignificant improvement in both written and practical final examination results in those students who were previously behind academically in their final end-of-semester exam results, when compared with non-participants in the same cohort. The majority of students either agreed or strongly agreed that the sessions improved their anatomical knowledge (87%) and confidence (77%). The great majority also agreed that the sessions were enjoyable, that formulating questions aided in their retention of knowledge, and that the sessions were valuable in relation to the time and effort in preparing for them. Formulating, asking and answering questions during Doughnut Rounds improve students' anatomical knowledge in an effective and enjoyable manner. We believe that this type of SDL can be applied to any number of topics across various medical disciplines

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Designing courses in anatomy

Medical school has changed. Curricula have become more integrated, more systems based and the teaching of anatomy more clinically relevant. Notwithstanding the efforts by the Anatomical Society to define the “core curriculum”, the difficulty lies in ensuring that what is being taught in the anatomy class is not only relevant to clinical training but is vertically integrated with it across the whole academic programme of studies. Deciding what to leave out, while maintaining standards has become very difficult indeed.Yet the purpose of teaching anatomy must surely lie in its clinical application. As teachers, our goal is to light the fire under our students, in such a way as to stimulate them to look for the answers to common clinical problems for which a knowledge of anatomy is essential. This increasing emphasis on learning within context is particularly important for adult learners, which one would expect most of our students to be. Cadaver dissection and/or examination of prosected material remains at the core of anatomy learning, because the learning, and perhaps more importantly, the recall of anatomy, is based on the twin principles of observation and visualization. Deeper learning of key principles and clinically-relevant anatomy requires students to assess themselves regularly. At a time when increasing numbers of atlases and textbooks are being published, those that stand out include study and review questions and answers as opportunities for self- assessment. The visible and palpable anatomy that forms the basis of clinical examination can only be learned through practice on normal subjects, usually fellow students and oneself. The design of an anatomy course must include opportunities for students to do this under supervision. Correlating these features with imaging studies further enhances deeper learning

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