Inclusion of cross-sectional and radiological images for better understanding of musculoskeletal anatomy and decreasing the risk of adverse events during dry needling in undergraduate physiotherapy students.

Since there is an increasing rate of physiotherapists using invasive procedures during the clinical practice, understanding the cross-sectional anatomy and radiological images is essential for ensuring patients' safety during these interventions. Therefore, the aim of this study was to analyze the students' opinion of including cross-sectional and radiological images to traditional methodologies, to evaluate whether these additional resources improve their ability to identify musculoskeletal structures in radiological images and their understanding of neurovascular and visceral structures related with specific muscles to be avoided during invasive procedures. First-year undergraduate physiotherapy students were enrolled in the study. A brief online survey asking about their opinion about the use of cross-sectional and radiological images as complementary resources was built. In addition, two open-answer tests (before and after the inclusion of these resources) were conducted to evaluate their ability to identify correctly musculoskeletal structures in magnetic resonance and ultrasound images and to evaluate their awareness of high-risk structures related with specific muscles. One-hundred-thirty-two students returned the online survey and one-hundred-forty-eight completed all the tests. In general, students opined cross-sectional images to be of utility for learning anatomy (81.8%) and radiological images (93.9%) and felt they benefited from cross-sectional and ultrasound images (78.0%). All tests showed significant improvements after the inclusion of these complementary resources (all, p < 0.001) except for trunk structures in MRI (p = 0.777). The implementation of anatomical cross-sectional and radiological images resulted in better understanding of radiological images and better cognition of possible risk during invasive procedures.

Multimodal Three-Dimensional Visualization Enhances Novice Learner Interpretation of Basic Cross-Sectional Anatomy.

While integrated delivery of anatomy and radiology can support undergraduate anatomical education, the interpretation of complex three-dimensional spatial relationships in cross-sectional and radiological images is likely to be demanding for novices. Due to the value of technology-enhanced and multimodal strategies, it was hypothesized that simultaneous digital and physical learning could enhance student understanding of cross-sectional anatomy. A novel learning approach introduced at a United Kingdom university medical school combined visualization table-based thoracic cross-sections and digital models with a three-dimensional printed heart. A mixed-method experimental and survey approach investigated student perceptions of challenging anatomical areas and compared the multimodal intervention to a two-dimensional cross-section control. Analysis of seven-point Likert-type responses of new medical students (n = 319) found that clinical imaging (mean 5.64 SD ± 1.20) was significantly more challenging (P < 0.001) than surface anatomy (4.19 ± 1.31) and gross anatomy (4.92 ± 1.22). Pre-post testing of students who used the intervention during their first anatomy class at medical school (n = 229), identified significant increases (P < 0.001) in thoracic cross-sectional anatomy interpretation performance (mean 31.4% ± 15.3) when compared to the subsequent abdominal control activity (24.1% ± 17.6). Student test scores were independent of mental-rotation ability. As depicted on a seven-point Likert-type scale, the intervention may have contributed to students considering cross-sectional interpretation of thoracic images (4.2 ± 1.23) as significantly less challenging (P < 0.001) than comparable abdominal images (5.59 ± 1.14). These findings could have implications for how multimodal cross-sectional anatomy learning approaches are implemented within medical curricula.

Sectioned and segmented images of the male whole body, female whole body, male head, and female pelvis from the Visible Korean.

In the Visible Korean, serially sectioned images with real color and high resolution have been prepared from four cadaveric subjects: male whole body, female whole body, male head, and female pelvis. Recently, segmented images of the female whole body were manufactured, permitting the distribution of the complete four data sets. The purpose of this report was to promote the applications of sectioned and segmented images from the Visible Korean by announcing them. Reduced image data were loaded to self-developed browsing software; using the browsing software, the contents could be quickly grasped and evaluated by other investigators. The four data sets were compared to disclose the individual merits and demerits. The sectioned and segmented images showed the possibility to be used to reconstruct the stereoscopic volume and surface models of body structures. The Visible Korean is expected to contribute to the interactive simulation of medical learning and clinical practice.

Impresiones 3D de cortes transversales de un cuerpo humano: un recurso didáctico para el estudio de la anatomía seccional / 3D prints of cross sections of a human body: a teaching resource for the study of sectional anatomy

Los cursos de anatomía constituyen un componente esencial del currículo de medicina, aportando las bases morfológicas para el examen clínico, la interpretación de imágenes médicas y la práctica segura de intervenciones quirúrgicas y procedimientos. Recientemente, la tecnología de impresión 3D ha permitido generar réplicas de disecciones de segmentos corporales a escala real que se utilizan como recursos docentes para el estudio de la anatomía humana, generando así modelos docentes de alta verosimilitud que sirven como alternativa al uso de preparaciones cadavéricas para la docencia anatómica. En este trabajo presentamos los resultados obtenidos al utilizar nuestro kit KAN3D que incluye réplicas físicas de secciones transversales del tronco y de las extremidades y una plataforma que aloja los modelos digitales debidamente rotulados, producto financiado con el proyecto FONDEF IT16I10073. La aplicación de estos productos en docencia señalan que las réplicas de secciones transversales de segmentos corporales presentan una alta verosimilitud en términos de forma, color, topografía y texturas, características que las validan como un excelente recurso docente para la docencia y el aprendizaje de la anatomía seccional humana. El kit KAN3D pone a disposición de los estudiantes de las carreras de la salud recursos de alta verosimilitud, disponibles a libre demanda, que les permita reproducir la experiencia de la actividad práctica de Morfología en el momento y lugar en que ellos se encuentren dispuestos, superando así las limitaciones de acceso a los pabellones de Anatomía y a material cadavérico de calidad.

Anatomy courses constitute an essential component of the medical curriculum, providing the morphological basis for the clinical examination, the interpretation of medical images and the safe practice of surgical interventions and procedures. Recently, 3D printing technology has allowed to generate replicas of dissections of body segments on a real scale that are used as teaching resources for the study of human anatomy, thus generating high-likelihood teaching models that serve as an alternative to the use of cadaveric preparations for Anatomical teaching. In this paper we present the results obtained by using our KAN3D kit that includes physical replicas of cross sections of the trunk and extremities and a platform that houses properly labeled digital models, a product financed with the FONDEF IT16I10073 project. The application of these products in teaching indicate that replicas of cross sections of body segments have a high likelihood in terms of shape, color, topography and textures, characteristics that validate them as an excellent teaching resource for teaching and learning the human sectional anatomy. The KAN3D kit makes available to students of health careers a high-likelihood resources, accesible on demand, that allows them to reproduce the experience of the practical activity of Morphology at the time and place where they are willing, exceeding thus the limitations of access to the Anatomy pavilions and quality cadaveric material.

A Hands-On Organ-Slicing Activity to Teach the Cross-Sectional Anatomy.

The presentation of pre-sliced specimens is a frequently used method in the laboratory teaching of cross-sectional anatomy. In the present study, a new teaching method based on a hands-on slicing activity was introduced into the teaching of brain, heart, and liver cross-sectional anatomy. A randomized, controlled trial was performed. A total of 182 third-year medical students were randomized into a control group taught with the prosection mode (pre-sliced organ viewing) and an experimental group taught with the dissection mode (hands-on organ slicing). These teaching methods were assessed by testing the students' knowledge of cross-sectional specimens and cross-sectional radiological images, and analyzing students' feedback. Using a specimen test on three organs (brain, heart, and liver), significant differences were observed in the mean scores of the control and experimental groups: for brain 59.6% (±14.2) vs. 70.1% (±15.5), (P < 0.001, Cohen's d = 0.17); for heart: 57.6% (±12.5) vs. 75.6% (±15.3), (P < 0.001, d = 0.30); and for liver: 60.4% (±14.5) vs. 81.7% (±14.2), (P < 0.001, d = 0.46). In a cross-sectional radiological image test, better performance was also found in the experimental group (P < 0.001). The mean scores of the control vs. experimental groups were as follows: for brain imaging 63.9% (±15.1) vs. 71.1% (±16.1); for heart imaging 64.7% (±14.5) vs. 75.2% (±15.5); and for liver imaging 61.1% (±15.5) vs. 81.2% (±14.6), respectively. The effect sizes (Cohen's d) were 0.05, 0.23, and 0.52, respectively. Students in the lower tertile benefited the most from the slicing experiences. Students' feedback was generally positive. Hands-on slicing activity can increase the effectiveness of anatomy teaching and increase students' ability to interpret radiological images.

Neuroanatomy Learning: Augmented Reality vs. Cross-Sections.

Neuroanatomy education is a challenging field which could benefit from modern innovations, such as augmented reality (AR) applications. This study investigates the differences on test scores, cognitive load, and motivation after neuroanatomy learning using AR applications or using cross-sections of the brain. Prior to two practical assignments, a pretest (extended matching questions, double-choice questions and a test on cross-sectional anatomy) and a mental rotation test (MRT) were completed. Sex and MRT scores were used to stratify students over the two groups. The two practical assignments were designed to study (1) general brain anatomy and (2) subcortical structures. Subsequently, participants completed a posttest similar to the pretest and a motivational questionnaire. Finally, a focus group interview was conducted to appraise participants' perceptions. Medical and biomedical students (n = 31); 19 males (61.3%) and 12 females (38.7%), mean age 19.2 ± 1.7 years participated in this experiment. Students who worked with cross-sections (n = 16) showed significantly more improvement on test scores than students who worked with GreyMapp-AR (P = 0.035) (n = 15). Further analysis showed that this difference was primarily caused by significant improvement on the cross-sectional questions. Students in the cross-section group, moreover, experienced a significantly higher germane (P = 0.009) and extraneous cognitive load (P = 0.016) than students in the GreyMapp-AR group. No significant differences were found in motivational scores. To conclude, this study suggests that AR applications can play a role in future anatomy education as an add-on educational tool, especially in learning three-dimensional relations of anatomical structures.

The Benefits of an Augmented Reality Magic Mirror System for Integrated Radiology Teaching in Gross Anatomy.

Early exposure to radiological cross-section images during introductory anatomy and dissection courses increases students' understanding of both anatomy and radiology. Novel technologies such as augmented reality (AR) offer unique advantages for an interactive and hands-on integration with the student at the center of the learning experience. In this article, the benefits of a previously proposed AR Magic Mirror system are compared to the Anatomage, a virtual dissection table as a system for combined anatomy and radiology teaching during a two-semester gross anatomy course with 749 first-year medical students, as well as a follow-up elective course with 72 students. During the former, students worked with both systems in dedicated tutorial sessions which accompanied the anatomy lectures and provided survey-based feedback. In the elective course, participants were assigned to three groups and underwent a self-directed learning session using either Anatomage, Magic Mirror, or traditional radiology atlases. A pre- and posttest design with multiple choice questions revealed significant improvements in test scores between the two tests for both the Magic Mirror and the group using radiology atlases, while no significant differences in test scores were recorded for the Anatomage group. Furthermore, especially students with low mental rotation test (MRT) scores benefited from the Magic Mirror and Anatomage and achieved significantly higher posttest scores compared to students with a low MRT score in the theory group. Overall, the results provide supporting evidence that the Magic Mirror system achieves comparable results in terms of learning outcome to established anatomy learning tools such as Anatomage and radiology atlases.

Impact of fetal brain ultrasound tutor smartphone application on normal anatomy learning.

OBJECTIVE: The "Fetal Brain Tutor 4us" (FBTApp) is a recently developed application for interactive multiplanar navigation through the normal fetal brain. The purpose of this work was to assess its impact on normal anatomy learning. METHODS: A multiple-choice quiz (MCQ) was administered to first-year resident doctors in Obstetrics and Gynecology in two separate sessions, before and 2 weeks after downloading the FBTApp. For each MCQ, the junior trainee was asked to use one out of five items to label a specific cerebral structure on an ultrasound image of a normal midtrimester fetal brain. Six sonographic images of the fetal brain on each of the three scanning planes (axial, sagittal, and coronal) were shown to the participants at either session. The results of the two sessions were analysed and compared. RESULTS: Overall, 216 questions were administered to the trainees in the 2-week study, 108 before and 108 after the use of the FBTApp. From the first to the second sessions, a significant increase of correct answers was noted (from 47/108 or 43% to 77/108 or 71%, P < 0.01). Particularly, a better improvement was obtained in the correct labelling of cerebral structures on the nonaxial (from 32% to 67%, +35%) vs axial (from 67% to 81%, +14%) view planes of the brain (P < 0.01). CONCLUSION: The use of FBTApp seems capable to improve the knowledge of the normal fetal brain anatomy in subjects naive to dedicated prenatal ultrasound. This improvement seems greater on nonaxial planes.

A sectional anatomy learning tool for medical students: development and user-usage analytics.

BACKGROUND: A sound knowledge of cross-sectional anatomy is needed to interpret radiological images. Ultrathin E12-plastinated slices serve as good learning resources to begin with, but effective utilisation of these resources are often challenging due to their fragility and lack of adequate laboratory time. To enhance interpretation of E12 slices, and also to promote independent learning, we developed a web-based self learning resource. METHODS: An interactive online sectional anatomy learning tool (SALT) to learn the cross-sectional anatomy of the spinal levels, thorax, abdomen and pelvis was developed using Courselab software. SALT was piloted on third-year medical students learning regional and clinical anatomy of the human body. At the end of the academic year, student participation within the resource was analysed, and the resource usage was compared with the users' academic performance. RESULTS: Each aspect of SALT was accessed 338 times on average, by 51% of the class. The majority medical students accessed the resource after class hours. Continued research usage was observed on weekends and holidays, which peaked during exam periods. SALT usage also had a positive impact on the users' academic performance (p < 0.05). Students also used the resource after exams and during their subsequent years of study. CONCLUSION: SALT promoted independent learning, as well as enhanced students' learning experience and academic performance. Having the benefit of online access, the resource was used almost 24/7, both on and off-campus. Educators should be encouraged to develop and trial their own simple inexpensive online resources tailormade to meet student needs and supplement to the existing traditional teaching techniques.

Visualización de modelos digitales tridimensionales en la enseñanza de anatomía: principales recursos y una experiencia docente en neuroanatomía / Visualisation of digital 3D models in anatomical teaching: main resources and a teaching experience in neuroanatomy

La conformación de las estructuras anatómicas es compleja en los 3 planos del espacio. Históricamente, la enseñanza de la anatomía se ha hecho a partir de representaciones bidimensionales, de modelos físicos tridimensionales o de cuerpos reales. Solo recientemente ha sido factible crear modelos anatómicos digitales tridimensionales, que pueden ser explorados en línea a través de Internet. El objetivo del presente trabajo es analizar 2 de las herramientas en línea más conocidas para la visualización anatómica (Anatomography® y BioDigital® Human), y presentar una experiencia docente de uso en el área de neurociencias. Se crearon imágenes de estructuras cerebrales animadas que se usaron en clase posteriormente, y se preguntó a los alumnos sobre su interés y utilidad. Los resultados indicaron que la utilización de este tipo de recursos es interesante por su flexibilidad, atractivo y coste

The conformation of anatomical structures is complex in the 3 spatial planes. Historically, anatomy teaching has been carried out using 2-dimensional representation, 3-dimensional physical models, or real bodies. Only recently has it been possible to create digital 3-dimensional anatomical models that can be explored online or downloaded. The aim of this work is to critically describe two of the best-known online tools for anatomical visualisation (Anatomography® and BioDigital® Human), and to present a teaching experience in the neuroscience domain. Animated images of brain structures were created and later used in class, and students were asked about their interest and usefulness. Results indicated that the use of this kind of resource is interesting, due to its flexibility, attractiveness and cost

Implementation and modification of an anatomy-based integrated curriculum.

Morehouse School of Medicine elected to restructure its first-year medical curriculum by transitioning from a discipline-based to an integrated program. The anatomy course, with regional dissection at its core, served as the backbone for this integration by weaving the content from prior traditional courses into the curriculum around the anatomy topics. There were four primary goals for this restructuring process. Goal 1: develop new integrated courses. Course boundaries were established at locations where logical breaks in anatomy content occurred. Four new courses were created, each containing integrated subject content. Goal 2: establish a curriculum management team. The team consisted of course directors, subject specialists, and a curriculum director. This team worked together to efficiently manage the new curriculum. Goal 3: launch contemporary examination and question banking methods. An electronic system, in which images could be included, was implemented for examinations and quizzes, and for storing and refining questions. Goal 4: ensure equitable distribution of standardized examinations and course grading systems among all courses. Assessments included quizzes, in-course examinations, and National Board of Medical Examiners® (NBME® ) Subject Examinations. A standard plan assigned the contribution of each to the final course grade. Significant improvement was seen on subject examinations. Once the obstacles and challenges of integration were overcome, a robust and efficient education program was developed. The curriculum is expected to continue evolving and improving, while retaining full regional dissection as a core element. Anat Sci Educ 10: 262-275. © 2016 American Association of Anatomists.

The effect of image quality, repeated study, and assessment method on anatomy learning.

The use of two-dimensional (2D) images is consistently used to prepare anatomy students for handling real specimen. This study examined whether the quality of 2D images is a critical component in anatomy learning. The visual clarity and consistency of 2D anatomical images was systematically manipulated to produce low-quality and high-quality images of the human hand and human eye. On day 0, participants learned about each anatomical specimen from paper booklets using either low-quality or high-quality images, and then completed a comprehension test using either 2D images or three-dimensional (3D) cadaveric specimens. On day 1, participants relearned each booklet, and on day 2 participants completed a final comprehension test using either 2D images or 3D cadaveric specimens. The effect of image quality on learning varied according to anatomical content, with high-quality images having a greater effect on improving learning of hand anatomy than eye anatomy (high-quality vs. low-quality for hand anatomy P = 0.018; high-quality vs. low-quality for eye anatomy P = 0.247). Also, the benefit of high-quality images on hand anatomy learning was restricted to performance on short-answer (SA) questions immediately after learning (high-quality vs. low-quality on SA questions P = 0.018), but did not apply to performance on multiple-choice (MC) questions (high-quality vs. low-quality on MC questions P = 0.109) or after participants had an additional learning opportunity (24 hours later) with anatomy content (high vs. low on SA questions P = 0.643). This study underscores the limited impact of image quality on anatomy learning, and questions whether investment in enhancing image quality of learning aids significantly promotes knowledge development. Anat Sci Educ 10: 249-261. © 2016 American Association of Anatomists.

Evaluation of an innovative hands-on anatomy-centered ultrasound curriculum to supplement graduate gross anatomy education.

Ultrasound (US) can enhance anatomy education, yet is incorporated into few non-medical anatomy programs. This study is the first to evaluate the impact of US training in gross anatomy for non-medical students in the United States. All 32 master's students enrolled in gross anatomy with the anatomy-centered ultrasound (ACUS) curriculum were recruited. Mean Likert ratings on pre- and post-course surveys (100% response rates) were compared to evaluate the effectiveness of the ACUS curriculum in developing US confidence, and gauge its impact on views of US. Post-course, students reported significantly higher (P < 0.001) mean confidence ratings in five US skills (pre-course versus post-course mean): obtaining scans (3.13 ±1.04 versus 4.03 ±0.78), optimizing images (2.78 ±1.07 versus 3.75 ±0.92), recognizing artifacts (2.94 ±0.95 versus 3.97 ±0.69), distinguishing tissue types (2.88 ±0.98 versus 4.09 ±0.69), and identifying structures (2.97 ±0.86 versus 4.03 ±0.59), demonstrating the success of the ACUS curriculum in students with limited prior experience. Views on the value of US to anatomy education and to students' future careers remained positive after the course. End-of-semester quiz performance (91% response rate) provided data on educational outcomes. The average score was 79%, with a 90% average on questions about distinguishing tissues/artifacts, demonstrating positive learning outcomes and retention. The anatomy-centered ultrasound curriculum significantly increased confidence with and knowledge of US among non-medical anatomy students with limited prior training. Non-medical students greatly value the contributions that US makes to anatomy education and to their future careers. It is feasible to enhance anatomy education outside of medical training by incorporating US. Anat Sci Educ 10: 348-362. © 2016 American Association of Anatomists.

Measuring medical students' motivation to learning anatomy by cadaveric dissection.

Motivation and learning are inter-related. It is well known that motivating learners is clearly a complex endeavor, which can be influenced by the educational program and the learning environment. Limited research has been conducted to examine students' motivation as a method to assess the effectiveness of dissection in medical education. This study aimed to assess and analyze students' motivation following their dissection experience. A 29-item survey was developed based on the Attention, Relevance, Confidence, and Satisfaction model of motivation. Descriptive statistics were undertaken to describe students' motivation to the dissection experience. T-test and ANOVA were used to compare differences in motivational scores between gender and educational characteristics of students. Dissection activities appear to promote students' motivation. Gender difference was statistically significant as males were more motivated by the dissection experience than females. Comparison between students with different knowledge of anatomy was also significantly different. The study is an important step in the motivational design to improve students' motivation to learn. The outcome of this study provides guidance to the selection of specific strategies to increase motivation by generating motivational strategies/tactics to facilitate learning. Anat Sci Educ 10: 363-371. © 2016 American Association of Anatomists.

Colonoscopy tutorial software made with a cadaver's sectioned images.

Novice doctors may watch tutorial videos in training for actual or computed tomographic (CT) colonoscopy. The conventional learning videos can be complemented by virtual colonoscopy software made with a cadaver's sectioned images (SIs). The objective of this study was to assist colonoscopy trainees with the new interactive software. Submucosal segmentation on the SIs was carried out through the whole length of the large intestine. With the SIs and segmented images, a three dimensional model was reconstructed. Six-hundred seventy-one proximal colonoscopic views (conventional views) and corresponding distal colonoscopic views (simulating the retroflexion of a colonoscope) were produced. Not only navigation views showing the current location of the colonoscope tip and its course, but also, supplementary description views were elaborated. The four corresponding views were put into convenient browsing software to be downloaded free from the homepage (anatomy.co.kr). The SI colonoscopy software with the realistic images and supportive tools was available to anybody. Users could readily notice the position and direction of the virtual colonoscope tip and recognize meaningful structures in colonoscopic views. The software is expected to be an auxiliary learning tool to improve technique and related knowledge in actual and CT colonoscopies. Hopefully, the software will be updated using raw images from the Visible Korean project.

Slide shows vs graphic tablet live drawing for anatomy teaching.

INTRODUCTION: Blackboard drawing is the traditional and still widely learned method for anatomy teachers. However, for practical reasons, more and more lessons are done using slide shows. New digital learning tools are developed to create a more attractive teaching method. The objective of this study was to compare the use of graphic tablet live drawing versus slide shows. METHODS: Sixty-five second-year students of the Faculty of Medicine participated in this study during their first semester of 2013-2014 academic year. The selected lecture dealt about neuroanatomy; two brain sections were taught: median sagittal and transverse. The sagittal section was presented via a slide show. The transverse section was taught using a graphics tablet using drawing software. Students were evaluated three times: before the lecture, immediately after the lecture and 8 weeks later. Means were compared using a t-test. RESULTS: Scores were significantly higher immediately after the lecture and 8 weeks later tests in comparing the transverse section (using the graphics tablet) versus the sagittal section (using PowerPoint®). Student satisfaction regarding the use of the tablet was high. CONCLUSION: The graphics tablet is a usable and efficient drawing tool in anatomy teaching. This tool requires a specific teacher training and preparation.

A digital interactive human brain atlas based on Chinese visible human datasets for anatomy teaching.

As we know, the human brain is one of the most complicated organs in the human body, which is the key and difficult point in neuroanatomy and sectional anatomy teaching. With the rapid development and extensive application of imaging technology in clinical diagnosis, doctors are facing higher and higher requirement on their anatomy knowledge. Thus, to cultivate medical students to meet the needs of medical development today and to improve their ability to read and understand radiographic images have become urgent challenges for the medical teachers. In this context, we developed a digital interactive human brain atlas based on the Chinese visible human datasets for anatomy teaching (available for free download from http://www.chinesevisiblehuman.com/down/DHBA.rar). The atlas simultaneously provides views in all 3 primary planes of section. The main structures of the human brain have been anatomically labeled in all 3 views. It is potentially useful for anatomy browsing, user self-testing, and automatic student assessment. In a word, it is interactive, 3D, user friendly, and free of charge, which can provide a new, intuitive means for anatomy teaching.

Accessible and informative sectioned images, color-coded images, and surface models of the ear.

In our previous research, we created state-of-the-art sectioned images, color-coded images, and surface models of the human ear. Our ear data would be more beneficial and informative if they were more easily accessible. Therefore, the purpose of this study was to distribute the browsing software and the PDF file in which ear images are to be readily obtainable and freely explored. Another goal was to inform other researchers of our methods for establishing the browsing software and the PDF file. To achieve this, sectioned images and color-coded images of ear were prepared (voxel size 0.1 mm). In the color-coded images, structures related to hearing, equilibrium, and structures originated from the first and second pharyngeal arches were segmented supplementarily. The sectioned and color-coded images of right ear were added to the browsing software, which displayed the images serially along with structure names. The surface models were reconstructed to be combined into the PDF file where they could be freely manipulated. Using the browsing software and PDF file, sectional and three-dimensional shapes of ear structures could be comprehended in detail. Furthermore, using the PDF file, clinical knowledge could be identified through virtual otoscopy. Therefore, the presented educational tools will be helpful to medical students and otologists by improving their knowledge of ear anatomy. The browsing software and PDF file can be downloaded without charge and registration at our homepage (http://anatomy.dongguk.ac.kr/ear/).

Should Gross Anatomy be taught systemically or regionally?

While the teaching of gross anatomy remains a topic of considerable discussion (and occasional controversy), in terms of the time allocated, timing within the course, content and clinical relevance, and the use of cadavers and dissection by students, there is relatively little discourse about whether gross anatomy should be taught systemically and/or regionally or whether anatomy should be integrated or a stand-alone course. This brief article analyses the differences between the systemic and region approaches, suggests ways in which the efficacy of these approaches might be investigated, and assesses how they might be integrated into other biomedical sciences and into clinical disciplines. Overall, we conclude that, even within health care studies courses such as medicine that are integrated, there should be a standalone component for the study of gross anatomy that takes a regional approach; although undoubtedly study of anatomy both systemically and regionally would be the ideal situation (time and resources permitting) (AU)

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Computer-assisted learning in anatomy at the international medical school in Debrecen, Hungary: a preliminary report.

The University of Debrecen's Faculty of Medicine has an international, multilingual student population with anatomy courses taught in English to all but Hungarian students. An elective computer-assisted gross anatomy course, the Computer Human Anatomy (CHA), has been taught in English at the Anatomy Department since 2008. This course focuses on an introduction to anatomical digital images along with clinical cases. This low-budget course has a large visual component using images from magnetic resonance imaging and computer axial tomogram scans, ultrasound clinical studies, and readily available anatomy software that presents topics which run in parallel to the university's core anatomy curriculum. From the combined computer images and CHA lecture information, students are asked to solve computer-based clinical anatomy problems in the CHA computer laboratory. A statistical comparison was undertaken of core anatomy oral examination performances of English program first-year medical students who took the elective CHA course and those who did not in the three academic years 2007-2008, 2008-2009, and 2009-2010. The results of this study indicate that the CHA-enrolled students improved their performance on required anatomy core curriculum oral examinations (P < 0.001), suggesting that computer-assisted learning may play an active role in anatomy curriculum improvement. These preliminary results have prompted ongoing evaluation of what specific aspects of CHA are valuable and which students benefit from computer-assisted learning in a multilingual and diverse cultural environment.