Curating a Case Catalog: Development and Implementation of a Process for Revising Small Group Teaching Cases for Pre-clerkship Medical Education.

Small group, case-based learning (CBL) is an integral component of many pre-clerkship undergraduate medical education (UME) curricula. We report here an institutional process for curating a catalog of CBL cases utilized in a pre-clerkship curriculum, providing a practical guide for faculty. We describe the structured revision process conducted by a team of foundational and clinical science faculty, which incorporates student and faculty feedback. Revisions take into account core attributes of a case catalog, producing a collection of cases that are more relevant and instructional, realistic, challenging, consistent, current, diverse and inclusive, patient-centered, and mission-centered. Measurable outcomes after implementation of this process include increased focus on primary care as well as humanization and diversification of the case patients.

A multi-year evaluation of medical student performance on and perceptions of collaborative gross anatomy laboratory examinations.

Collaborative testing and its benefits have been reported in diverse disciplines across different types of academic institutions. However, there has been minimal research conducted on collaborative assessments in medical schools, particularly in the gross anatomy laboratory. The objectives of this study were to explore the effect of collaborative anatomy laboratory examinations on student performance and to gauge student perceptions of this assessment format. This study examined five academic years of medical students' performance on a two-stage, collaborative anatomy laboratory examination wherein each student's overall score was a weighted combination of scores from the individual and team examination. Analyses of a descriptive survey capturing students' perceptions of the assessment method were also performed. Individual examination averages increased since implementing the collaborative assessment (p < 0.001), and team examination averages were higher than individual examination averages (p < 0.001). Teams outperformed each of their team members 98% of the time. Teams had a greater than 0.90 incidence of answering a question correctly if more than one person in the group got the answer correct on the individual portion, and a 0.66 incidence of answering correctly if only one person in their group answered correctly on the individual portion. Student feedback identified the discussions and learning that took place during the team portion to be a beneficial feature of this assessment format. Students also reported that this collaborative assessment made them feel a higher level of responsibility to perform well, and that it improved their understanding of gross anatomy.

Changes in wingstroke kinematics associated with a change in swimming speed in a pteropod mollusk, Clione limacina.

In pteropod mollusks, the gastropod foot has evolved into two broad, wing-like structures that are rhythmically waved through the water for propulsion. The flexibility of the wings lends a tremendous range of motion, an advantage that could be exploited when changing locomotory speed. Here, we investigated the kinematic changes that take place during an increase in swimming speed in the pteropod mollusk Clione limacina. Clione demonstrates two distinct swim speeds: a nearly constant slow swimming behavior and a fast swimming behavior used for escape and hunting. The neural control of Clione's swimming is well documented, as are the neuromuscular changes that bring about Clione's fast swimming. This study examined the kinematics of this swimming behavior at the two speeds. High speed filming was used to obtain 3D data from individuals during both slow and fast swimming. Clione's swimming operates at a low Reynolds number, typically under 200. Within a given swimming speed, we found that wing kinematics are highly consistent from wingbeat to wingbeat, but differ between speeds. The transition to fast swimming sees a significant increase in wing velocity and angle of attack, and range of motion increases as the wings bend more during fast swimming. Clione likely uses a combination of drag-based and unsteady mechanisms for force production at both speeds. The neuromuscular control of Clione's speed change points to a two-gaited swimming behavior, and we consider the kinematic evidence for Clione's swim speeds being discrete gaits.

Neuromechanics: an integrative approach for understanding motor control.

Neuromechanics seeks to understand how muscles, sense organs, motor pattern generators, and brain interact to produce coordinated movement, not only in complex terrain but also when confronted with unexpected perturbations. Applications of neuromechanics include ameliorating human health problems (including prosthesis design and restoration of movement following brain or spinal cord injury), as well as the design, actuation and control of mobile robots. In animals, coordinated movement emerges from the interplay among descending output from the central nervous system, sensory input from body and environment, muscle dynamics, and the emergent dynamics of the whole animal. The inevitable coupling between neural information processing and the emergent mechanical behavior of animals is a central theme of neuromechanics. Fundamentally, motor control involves a series of transformations of information, from brain and spinal cord to muscles to body, and back to brain. The control problem revolves around the specific transfer functions that describe each transformation. The transfer functions depend on the rules of organization and operation that determine the dynamic behavior of each subsystem (i.e., central processing, force generation, emergent dynamics, and sensory processing). In this review, we (1) consider the contributions of muscles, (2) sensory processing, and (3) central networks to motor control, (4) provide examples to illustrate the interplay among brain, muscles, sense organs and the environment in the control of movement, and (5) describe advances in both robotics and neuromechanics that have emerged from application of biological principles in robotic design. Taken together, these studies demonstrate that (1) intrinsic properties of muscle contribute to dynamic stability and control of movement, particularly immediately after perturbations; (2) proprioceptive feedback reinforces these intrinsic self-stabilizing properties of muscle; (3) control systems must contend with inevitable time delays that can simplify or complicate control; and (4) like most animals under a variety of circumstances, some robots use a trial and error process to tune central feedforward control to emergent body dynamics.