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 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.

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).

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.

Neuroanatomy, the Achille's Heel of Medical Students. A Systematic Analysis of Educational Strategies for the Teaching of Neuroanatomy.

Neuroanatomy has been deemed crucial for clinical neurosciences. It has been one of the most challenging parts of the anatomical curriculum and is one of the causes of "neurophobia," whose main implication is a negative influence on the choice of neurology in the near future. In the last decades, several educational strategies have been identified to improve the skills of students and to promote a deep learning. The aim of this study was to systematically review the literature to identify the most effective method/s to teach human neuroanatomy. The search was restricted to publications written in English language and to articles describing teaching tools in undergraduate medical courses from January 2006 through December 2017. The primary outcome was the observation of improvement of anatomical knowledge in undergraduate medical students. Secondary outcomes were the amelioration of long-term retention knowledge and the grade of satisfaction of students. Among 18 selected studies, 44.4% have used three-dimensional (3D) teaching tools, 16.6% near peer teaching tool, 5.55% flipped classroom tool, 5.55% applied neuroanatomy elective course, 5.55% equivalence-based instruction-rote learning, 5.55% mobile augmented reality, 5.55% inquiry-based clinical case, 5.55% cadaver dissection, and 5.55% Twitter. The high in-between study heterogeneity was the main issue to identify the most helpful teaching tool to improve neuroanatomical knowledge among medical students. Data from this study suggest that a combination of multiple pedagogical resources seems to be the more advantageous for teaching neuroanatomy.

A Look at the Anatomy Educator Job Market: Anatomists Remain in Short Supply.

In 2002, a widely publicized report projected an anatomy educator shortage based on department chairpersons' perceptions. Now, 17 years later, the question lingers: "Does an anatomy educator shortage persist and, if so, how severe is the shortage?" Trends in the number, type, and fill rate of anatomy educator job openings were explored by analyzing job posting in the United States over the past two years. A survey was distributed to leaders of anatomy-related departments in the United States, Canada, and European Union. Most departmental leaders who responded (65% or more) from the United States/Canada (n = 81) and the European Union (n = 52) anticipate they will have "moderate" to "great" difficulty hiring anatomy educators in gross anatomy, histology, and embryology over the next five years. Within the United States, the number of anatomy educator job postings at medical schools more than doubled from at least 21 postings in 2017 to 52 postings in 2018. Twenty-one percent of postings between 2017 and 2018 were never filled. While the number of anatomy educator openings within the United States/Canada is perceived to remain in a steady state for the next five years, the European Union estimates a five-fold increase in the number of openings. Departmental leaders prioritize anatomy educator applicants who have teaching experience (mean ± SD = 4.64 ± 0.84 on five-point Likert scale), versatility in teaching multiple anatomy disciplines (3.93 ± 1.07), and flexibility in implementing various teaching pedagogies (3.69 ± 1.17). Collectively, these data suggest the shortage of anatomy educators continues in the United States/Canada and the European Union.

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.

Dejerine-Roussy syndrome: Historical cases.

On June 7, 1906, Jules Dejerine (1849-1917) and Gustave Roussy (1874-1948) presented to the Société de Neurologie de Paris the first description of the thalamic syndrome with serial-section microscopic images. They also provided the first account of central poststroke pain (CPSP). They suggested that pain is one of the primary symptoms of the syndrome, although one of their own patients ("Hud") did not have pain. Several contemporary studies have highlighted the involvement of the anterior part of the pulvinar (PuA) in patients with CPSP of thalamic origin. Two historical observations (cases Jos and Hud) are reviewed here using the Morel nuclei staining atlas (2007). Dejerine and Roussy proposed the "irritative theory" to explain CPSP of thalamic origin and, in line with the most recent literature, they invoked the involvement of the PuA. When matching images for the Jos and Hud cases with the Morel atlas, it appears that the lesions involved what Dejerine then termed the noyau externe; that is, the ventral posterolateral nucleus and the PuA. In the Jos case, the lesion extended medially to what Dejerine termed the noyau médian de Luys; that is, the central medial-parafascicular nuclei, whereas in the Hud case the lesion extended more inferiorly. From the finding in the Hud case, one can hypothesize that impairment of the PuA alone does not assure pain. The work of Dejerine and Roussy, based on clinico-anatomical correlations, remains relevant to this day.

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.

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.

Clinically-Orientated Anatomy: Five exemplars to portray the concept

It has become almost a truism that, as for many biomedical sciences courses, gross anatomy tuition for healthcare curricula (including medicine and dentistry) should be integrated with clinical components to improve vocational relevance. Nevertheless, many fundamental questions remain to be answered relating to the content to be taught, who teaches the discipline, how the students react, and whether the students are prepared to integrate the clinical and biomedical components. We additionally need evidence of how the delivery of clinical content is influenced by technical developments such as medical imaging. This article documents some examples, or case scenarios, showing how interactions between professional anatomists and clinicians can be fostered, as well as providing illustrations of different teaching styles. From a review of the literature, as well as from our own experiences, we conclude that, for many branches of medicine, it is essential to have access to human bodies for both anatomical and clinical education and training and that postgraduate anatomical teaching remains important for a variety of specialities. We therefore support the notion that a close relationship between professional anatomists and surgeons can reinforce core anatomical knowledge by deepening the understanding of its clinical importance. Paradoxically, however, there is evidence that medical students do not believe that the teachers of anatomy should necessarily be clinically qualified. Furthermore, while students appreciate the value of using clinical examples, scenarios or case histories in anatomy teaching, they remain ambivalent about their use in assessments or examinations. This article also emphasises that anatomy is important both as a scientific and a clinical, translational discipline and argues that the discipline is crucial for appreciation of the human body, not just in disease, but also in health

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The perceptions of anatomists in the US and Europe of the skills and attributes required of newly-recruited medical students.

BACKGROUND AND PURPOSE: Admission procedures for recruiting students to medical school vary considerably across the world. Notwithstanding such variability, it is important to know what skills and attributes (including attitudes and personality traits) are required of the students by their teachers on entering medical school. PROCEDURES: Anatomists are often the teachers who first meet the students as they enter medical school and this report analyses, by means of a paper-based questionnaire, the putative skills required of their medical students by anatomists from the U.S.A. and Europe. Questionnaires were distributed to 150 anatomists, of varying ages and teaching experience, with 108 responding with completed questionnaires (i.e. 72% returns). FINDINGS: The findings from a questionnaire suggest that there are few differences between anatomists in the U.S.A. and Europe, even though medical students are postgraduates in the U.S.A. but undergraduates in Europe. Furthermore, the skill requirements expected of the students differed only slightly according to the gender and age of the anatomists and to whether or not they had clinical qualifications. In order of perceived importance, the most important skills and attributes required of the students were found to be: good study skills, memory/factual retention, conscientiousness, emotional stability, understanding of biology (but not chemistry, physics, mathematics, statistics, or understanding of the scientific method), life-long learning skills, ability to study independently, problem-solving abilities, readiness to be challenged, communication skills, and teamwork skills. CONCLUSIONS: Anatomists within the U.S.A. and Europe essentially agree on the skills and attributes initially required of their medical students, as well as those not deemed initially important. These findings are presented with the view of enhancing admission policies and procedures for admitting students into medical schools.

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.

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.