Mathematical analysis of fracture configuration in predicting outcome in complex anterior skull base trauma.

Craniofacial trauma involving the anterior skull base produces a heterogenous injury with variance in fracture pattern, complexity and outcome. Variance is influenced by the biomechanical properties of the craniofacial construct and by the magnitude and vector of the impacting energy. Fractal dimension and other metrics applied to individual fracture patterns allows quantification of fracture complexity and severity, which can be used to correlate with neurological outcome. Frontobasal fractures from 81 patients admitted to two UK major trauma centres were analysed. Patients were divided into two groups: those with anteriorly-based vectors of impact and those with laterally-based vectors. Osseous disruption was quantified by: fractal dimension, fracture length, number of termini, and number of nodes, and then compared with neurological outcome using first recorded Glasgow Coma Score (GCS), and requirement for intubation. As fracture length increased, fractures from anterior impacts became more complex and reticulated compared with lateral impacts; fractal dimension also increased more rapidly for anterior impacts. Longer fracture length in both groups was associated with a significantly lower GCS, and increased requirement for intubation (p < 0.001 and p < 0.001 respectively). Fracture propagation and severity of head injury was different in anterior-directed trauma compared to lateral-directed trauma. Consequently, we suggest that the central region of the anterior skull base acts to primarily absorb impact force thereby behaving as a protective ' crumple zone ' . In severe mechanisms the protective mechanism is exceeded and the fracture length tended to that of the lateral group worsening prognosis.

Introduction of the Modified Neuroanatomy Motivation Questionnaire and Its Role in Comparing Medical Student Attitudes Towards Learning Neuroanatomy Between Neuro-enthusiasts and Standard Students.

BACKGROUND: Neurophobia has been identified as a potential barrier to adequate knowledge of neurology in the medical community, and therefore to patient safety. There is a drive to identify the source of neurophobia, in the hope of tackling it. Comparing the learning motivations of standard medical students with those who enjoy neuroanatomy may be a way of doing this. METHODS: The science motivation questionnaire (SMQ) was modified for neuroanatomy. It was distributed to three cohorts of second year medical students and students attending the extracurricular National Undergraduate Neuroanatomy Competition (NUNC). Cohen's D test for effect size was used to compare standard medical students and those attending the NUNC. RESULTS: Five hundred ninety-seven questionnaires were completed by second year students, and 320 by NUNC attendees. The differences in motivation to learn neuroanatomy between the 2 groups mainly fell into themes of career motivation, personal relevance, intrinsic motivation and assessment anxiety. CONCLUSION: This study has demonstrated the use of the SMQ in neuroanatomy, and found differences in motivators to learn neuroanatomy between self-selecting "neurophiles" and standard medical students, mainly relating to intrinsic motivation and its role in their lives. More research is needed to further explore these differences and how they might apply to interventions in medical school curricula.

The Career Impact of the National Undergraduate Neuroanatomy Competition.

BACKGROUND: Neurosurgery is a notoriously difficult career to enter and requires medical students to engage in extracurricular activities to demonstrate their commitment to the specialty. The National Undergraduate Neuroanatomy Competition (NUNC) was established in 2013 as a means for students to display this commitment as well as academic ability. METHODS: A bespoke 22-item questionnaire was designed to determine career outcomes and the role of competition attendance in job applications. It was distributed using the SurveyMonkey website to the 87 attendees at the 2013 and 2014 competitions. RESULTS: Responses were received by 40 competitors (response rate, 46.0%). Twenty-four responders (60.0%) intended to pursue a career in either neurosurgery (n = 18) or neurology (n = 6). This included 10 responders (25.0%) who had successfully entered either neurosurgery (n = 9) or neurology (n = 1). The performance of these 10 was significantly better than the other responders (57.0 ± 13.6% vs. 46.5 ± 13.5% [n = 30]; P = 0.036). Seventeen responders (42.5%) either included their attendance at NUNC in a post-Foundation job application or intend to. CONCLUSIONS: The NUNC provides the opportunity for medical students to demonstrate their interest in neurosurgery. It has the potential to be used as a tool for recognizing medical students suitable for neurosurgery training.

Motor vehicle accidents-related maxillofacial injuries: a multicentre and prospective study.

OBJECTIVES: The purpose of this European multicenter prospective study was to obtain more precise information about the demographic characteristics and etiologic/epidemiologic patterns of motor vehicle accidents (MVA)-related maxillofacial fractures. STUDY DESIGN: Of the 3260 patients with maxillofacial fractures admitted within the study period, 326 traumas were caused by MVAs with a male/female ratio of 2.2:1. RESULTS: The maximum incidence was found in Zagreb (Croatia) (18%) and the minimum in Bergen (Norway) (0%). The most frequent mechanisms were car accidents, with 177 cases, followed by motorcycle accidents. The most frequently observed fracture involved the mandible, with 199 fractures, followed by maxillo-zygomatic-orbital (MZO) fractures. CONCLUSIONS: In all the 3 groups (car, motorcycle, and pedestrian), mandibular and MZO fractures were the 2 most frequently observed fractures, with some variations. The importance of analyzing MVA-related facial injuries and their features and characteristics should be stressed.

The National Undergraduate Neuroanatomy Competition: Lessons Learned from Partnering with Students to Innovate Undergraduate Neuroanatomy Education.

Undergraduates often perceive neuroscience to be a challenging discipline. As the scope of neuroscience continues to expand, it is important to provide undergraduates with sufficient opportunities to develop their knowledge and skills with the aim of encouraging the future generation of basic and clinical neuroscientists. Through our experience of developing the National Undergraduate Neuroanatomy Competition (NUNC), we have accrued an extensive volume of performance data and subjective insight into the delivery of undergraduate neuroanatomy education, which has the potential to inform how to better engage students within this field. More broadly, our group has implemented a technology enhanced learning platform alongside a peer-assisted teaching program. These achieve the dual purpose of compensating for the reduction in dedicated neuroanatomy teaching hours and encouraging undergraduates to develop an interest in the neurosciences. Here, we consider how improving the learning experience at an undergraduate level encourages further engagement in the neurosciences and the importance of this within the wider neuroscience community.

The Efficacy of Frontline Near-Peer Teaching in a Modern Medical Curriculum.

Within medical education a reduction in curriculum time for subjects, such as anatomy puts pressure on educators to ensure the same learning outcomes are conveyed in less time. This has the potential to impact negatively on student experience. Near-peer teaching (NPT) is often praised as an effective revision tool, but its use as a frontline teaching resource remains unreported. The study explores the potential for NPT to promote delivery of learning outcomes and maximize student experience within a neuroanatomy module for second year medical students. The study occurred in three educational settings, (1) frontline NPT of cranial nerves, (2) revision session NPT of cranial nerves, and (3) NPT alongside faculty staff in laboratory-based neuroanatomy practical exercises. For the first and second components, knowledge was measured using a pre- and post-session test and student perception was ascertained with a questionnaire. For the third component, student perception was assessed with an end-of-module survey. The results show that overall, NPT was well received by learners. A significant knowledge gain was seen between the pre- and post-session test of the frontline NPT session. The study presents evidence in favor of using NPTs to supplement the delivery of learning outcomes in a time and resource constrained curriculum. In particular, for the effective delivery of frontline material. Anat Sci Educ 0: 1-9. © 2018 American Association of Anatomists.

The benefits of being a near-peer teacher.

BACKGROUND: Near-peer teaching is used in anatomy education because of its benefits to the learner, teacher and faculty members. Despite the range of reports focusing on the learner, the advantages for the teacher, which are thought to include communication skills, subject knowledge and employability, are only beginning to be explored. METHOD: A questionnaire was distributed to the teachers involved in anatomy near-peer teaching at the University of Southampton and Brighton and Sussex Medical School (BSMS). This questionnaire was designed using a rating scale of 0-10 to assess teacher perspectives on their level of knowledge, teaching skills and enjoyment of teaching. Free-text responses determined the teachers' motivation and perceived benefits from the teaching. RESULTS: Twenty-eight questionnaires were gathered (54.9% response rate), including 20 from Southampton and eight from BSMS. Long-term knowledge retention and better understanding of the material were rated 8.1 and 7.9 out of 10, respectively. Eight responses were from currently practising doctors, who rated how much they now use their teaching skills as doctors as 8.9 out of 10. Of the eight doctors, seven gained points for their foundation programme applications as a direct result of near-peer teaching. The most common motivator for engaging in teaching was to improve subject matter knowledge and the most common benefit was improved communication skills. There are numerous advantages to being a near-peer teacher in medical school DISCUSSION: There are numerous advantages to being a near-peer teacher in medical school, which include knowledge improvement, transferrable professional skills and employability. These initial results support the hypothesised benefits to the teachers and provide a foundation for further longitudinal studies.

The National Undergraduate Neuroanatomy Competition: Five years of educating, inspiring and motivating our future neurologists and neurosurgeons

Neurological conditions are common so a knowledge of neuroanatomy is necessary for junior doctors. Additionally, some students have a particular interest in neuroscience. However, little time is dedicated to neuroanatomy in the medical curriculum, and many students struggle with neuroanatomy. The National Undergraduate Neuroanatomy Competition (NUNC) aims to support the development of neuroanatomical knowledge among medical students and promote interest in neurosciences. Students who attended the NUNC completed a series of neuroanatomy-based examinations and a questionnaire investigating aspects of neuroanatomy teaching and resources at their home university. 387 students attended the NUNC between 2013 and 2017, of which 382 had a complete data set (response rate 98.7%). Male students significantly outperformed female students (p<0.0001) and clinical students outperformed pre-clinical students (p<0.05). Best answered questions were on the spine (average score 53.9%), and the most poorly answered questions were on the vasculature (average score 44.7%). Students felt that the neuroanatomy teaching, time spent on neuroanatomy and dissection/prosection resources were all reasonable (6-7/10) at their home institution. Elearning resources were rated more poorly (5.4/10). We conclude that the NUNC gives students the opportunity to enhance their neuroanatomical knowledge and gives keen students the chance to develop their interest

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Ten considerations for implementing effective and sustainable near-peer teaching in clinical anatomy education.

This article was migrated. The article was marked as recommended. Near-peer teaching (NPT) is becoming increasing popular in medical education. The rationale and benefits of introducing such programs have been well documented and are usually described in terms of their advantages to the teacher, students and faculty. As a team that have successfully introduced two NPT anatomy programs in the last six years at the University of Southampton, we have taken a largely evidenced based approach in offering 10 considerations to ensure the implementation of a sustainable and effective NPT program in anatomical sciences. We have highlighted important aspects of NPT that will help maximise the benefit of such programs and emphasised particular areas where careful thought is necessary. We conclude that to safeguard sustainability and consistency of any given NPT program, faculty and student partnership is required, as is the maintenance of quality control and evaluative techniques.

Investigating the effect of distance between the teacher and learner on the student perception of a neuroanatomical near-peer teaching programme.

PURPOSE: Near-peer teaching (NPT) is a highly valuable resource for the education of medical undergraduates with benefits to the students, teachers themselves, and the faculty. To maximise the effectiveness of such teaching programmes, the aim of this study was to determine how the student learning experience, and underpinning social and cognitive congruencies changes as the learner-teacher distance increases. METHODS: Second-year medical students at the University of Southampton participated in a series of neuroanatomy, extra-curricular revision sessions taught by the third-, fourth-, and fifth-year medical students and junior doctors. The students completed a validated questionnaire after the session rating various aspects of the teaching. RESULTS: Although all teachers delivered sessions that we rated highly with a mean perceived gain in knowledge of 18 % amongst all students, it was found that the third- and fourth-year medical students delivered a session that was rated significantly better than the fifth-year students and junior doctors across all, but one areas of feedback. CONCLUSIONS: We believe that these findings may be explained by the diminishing social and cognitive congruencies shared between learner and teacher with increasing distance. From our results, we hypothesise that graduation is an important threshold, where there is a significant drop in congruencies between the learner and teacher, therefore, having a significant impact on the perception of the NPT session.

Can medical students accurately predict their learning? A study comparing perceived and actual performance in neuroanatomy.

It is important that clinicians are able to adequately assess their level of knowledge and competence in order to be safe practitioners of medicine. The medical literature contains numerous examples of poor self-assessment accuracy amongst medical students over a range of subjects however this ability in neuroanatomy has yet to be observed. Second year medical students attending neuroanatomy revision sessions at the University of Southampton and the competitors of the National Undergraduate Neuroanatomy Competition were asked to rate their level of knowledge in neuroanatomy. The responses from the former group were compared to performance on a ten item multiple choice question examination and the latter group were compared to their performance within the competition. In both cohorts, self-assessments of perceived level of knowledge correlated weakly to their performance in their respective objective knowledge assessments (r = 0.30 and r = 0.44). Within the NUNC, this correlation improved when students were instead asked to rate their performance on a specific examination within the competition (spotter, rS = 0.68; MCQ, rS = 0.58). Despite its inherent difficulty, medical student self-assessment accuracy in neuroanatomy is comparable to other subjects within the medical curriculum. Anat Sci Educ 9: 488-495. © 2016 American Association of Anatomists.

Near peer teaching in medical curricula: integrating student teachers in pathology tutorials.

INTRODUCTION: Due to increased cognitive and social congruence with their tutees, near peer teachers (NPTs) may be capable of more effectively delivering course material. This study examines NPTs as pathology tutors alongside more traditional teachers (e.g., consultants and registrars) to explore their acceptability, effectiveness, and years of 'distance' between tutors and tutees. METHOD: In total, 240 first- and second-year undergraduate medical students were taught set material in a pathology tutorial setting by NPTs (fourth-year medical students), registrars, or consultants. Learners were then asked to provide feedback using a 15-item, Likert-type scale. RESULTS: On 11 of the 15 items, there were no significant differences in students' median ratings. However, NPTs were perceived to be significantly more approachable than consultants, more aware of learning outcomes, more receptive to student input, and more invested in exam success. Compared with second-year students, first-year students showed a preference towards registrar tutors in terms of perceived gain of knowledge and use of time. In contrast, second-year students showed a preference towards NPTs, who provided more perceived knowledge gain and investment in exam success. No significant differences were found regarding consultant tutors. DISCUSSION: Perhaps due to increased congruence with tutees, NPTs show promise as tutors within medical curricula. This provides advantages not only to tutees, but also to tutors - who may gain vital teaching experience and offer an effective supplement to 'traditional' faculty educators.

European Maxillofacial Trauma (EURMAT) in children: a multicenter and prospective study.

OBJECTIVE: The aim of this study is to present and discuss the results of a European multicentre prospective study about pediatric maxillofacial trauma epidemiology during a year. STUDY DESIGN: The following data were recorded: gender, age, etiology, site of fracture, date of injury. Of the 3396 patients with maxillofacial fractures admitted within the study period, 114 (3.3%) were children aged 15 years and younger, with a male/female ratio of 2.6:1. Mean age was 10.9 years. Most patients (63%) were aged 11-15 years. RESULTS: The most frequent cause of injury was fall (36 patients). Sport injuries and assaults were almost limited to the oldest group, whereas falls were more uniformly distributed in the 3 groups. The most frequently observed fracture involved the mandible with 47 fractures. In particular, 18 condylar fractures were recorded, followed by 12 body fractures. CONCLUSIONS: Falls can be acknowledged as the most important cause of facial trauma during the first years of life. The high incidence of sport accidents after 10 years may be a reason to increase the use of mouthguards and other protective equipment. Finally, the mandible (and in particular the condyle) was confirmed as the most frequent fracture site.

Assault-related maxillofacial injuries: the results from the European Maxillofacial Trauma (EURMAT) multicenter and prospective collaboration.

OBJECTIVE: The aim of this study is to present and discuss the demographic characteristics and patterns of assault-related maxillofacial fractures as reported by a European multicenter prospective study. STUDY DESIGN: Demographic and injury data were recorded for each patient who was a victim of an assault. RESULTS: Assaults represented the most frequent etiology of maxillofacial trauma with an overall rate of 39% and the values ranging between 60.8% (Kiev, Ukraine) and 15.4% (Bergen, Norway). The most frequent mechanisms of assault-related maxillofacial fractures were fists in 730 cases, followed by kicks and fists. The most frequently observed fracture involved the mandible (814 fractures), followed by orbito-zygomatic-maxillary complex fractures and orbital fractures. CONCLUSIONS: Our data confirmed the strong possibility that patients with maxillofacial fractures may be victims of physical aggression. The crucial role of alcohol in assault-related fractures was also confirmed by our study.

European Maxillofacial Trauma (EURMAT) project: a multicentre and prospective study.

The purpose of this study was to analyse the demographics, causes and characteristics of maxillofacial fractures managed at several European departments of oral and maxillofacial surgery over one year. The following data were recorded: gender, age, aetiology, site of facial fractures, facial injury severity score, timing of intervention, length of hospital stay. Data for a total of 3396 patients (2655 males and 741 females) with 4155 fractures were recorded. The mean age differed from country to country, ranging between 29.9 and 43.9 years. Overall, the most frequent cause of injury was assault, which accounted for the injuries of 1309 patients; assaults and falls alternated as the most important aetiological factor in the various centres. The most frequently observed fracture involved the mandible with 1743 fractures, followed by orbital-zygomatic-maxillary (OZM) fractures. Condylar fractures were the most commonly observed mandibular fracture. The results of the EURMAT collaboration confirm the changing trend in maxillofacial trauma epidemiology in Europe, with trauma cases caused by assaults and falls now outnumbering those due to road traffic accidents. The progressive ageing of the European population, in addition to strict road and work legislation may have been responsible for this change. Men are still the most frequent victims of maxillofacial injuries.