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).

Widespread Horizontal Connections Arising from Layer 5/6 Border Inverted Cells in Rabbit Visual Cortex.

Herein we describe the inverted cells [defined as those projection neurons having a major dendritic shaft abpially oriented (Bueno-López et al., Eur. J. Neurosci., 3, 415, 1991)] originating a unique set of cortical connections characterized by extraordinarily widespread horizontal distribution. Single and multiple injections of wheatgerm agglutinin - horseradish peroxidase were made in areas 17 and 18 and the resulting retrograde labelling in the cortex was analysed. The findings were assessed in independent control experiments in which Fluoro-Gold was used as retrograde tracer. Following single injections in area 17 several separate patches of labelled cells comprising layers 2 - 6 were consistently found in area 18. In addition to these associational cells a number of labelled cells appeared at the layer 5/6 border but were distributed over most of the tangential extent of the visual occipital cortex. This widespread pattern was particularly striking in brains after multiple injections. In these brains a conspicuous band of labelled cells at the 5/6 border radiated from the injection sites, making up an apparently continuous horizontal sheet that intersected the striate - extrastriate boundary and merged with the patches of labelled cells in area 18 and beyond. Most of the cells in the 5/6 border band were inverted cells (82%; n=2081). Injections in area 18 failed to produce such a widespread set of labelled cells in area 17. The functional significance of these connections furnished by the 5/6 border inverted cells remains to be determined, but their distribution would allow for convergent/divergent binding interactions both intra-areally (within area 17) and inter-areally (from area 18 to area 17).

Targets and Laminar Distribution of Projection Neurons with 'Inverted' Morphology in Rabbit Cortex.

This study examines the axonal projections of so-called inverted pyramids and other neurons with their major dendritic shaft oriented in the direction of the white matter ('inverted cells') in the adult rabbit cortex. Single injections of horseradish peroxidase wheat germ agglutinin were made into cortical or subcortical sites. The resulting retrograde labelling in the cortex was analysed and the distribution across areas and layers of inverted cells contributing to each of these projections was estimated. In addition, the radial distribution of inverted cells was independently determined from rapid Golgi-impregnated and Nissl-stained material. All three procedures revealed that inverted cells lay overwhelmingly in infragranular layers, but congregated at the border between layers 5 and 6. Inverted cells, identified by retrograde labelling, seldom furnished non-telencephalic centres; in contrast, these cells constituted a major source for the projections to the ipsi- or the contralateral cortex, the claustrum or the nucleus caudatus. In general, each set of inverted cells (when defined by its specific destination as a group) was located below the typically oriented cells whose axons were aimed at the same target. Thus, the inverted cells of the rabbit cortex are characterized not only by their unique morphology and their corticocortical, corticoclaustral and corticostriatal projections, but also by their distinctive radial locations. These findings suggest that inverted cells, even though possibly composed of different cell types, are a specific class of projection neurons.

Neuroepithelial origin of the insular and endopiriform parts of the claustrum.

The lateral and ventral pallia have been proposed as the source of neurons for the insular and endopiriform claustra, respectively. However, this correlation is controversial. Here, we analysed this relationship by labelling radial glia in coronal slices of the telencephalon of paraformaldehyde-fixed rabbit embryos (E18-E28) and newborn rabbits with an anti-vimentin antibody or with the fluorescent dye DiI. The radial glia that crossed the claustrum was anchored to the neuroepithelium of the lateral ventricular angle (LVA) at all ages studied. The LVA was deep at E18, but it subsequently become shallower, because of the apposition of the portion of its walls proximal to the vertex of the LVA. At E18, the radial glia that crossed most of the insular claustrum extended from the lateral wall of the LVA (presumptive lateral pallium), and the radial glia that crossed either the most ventral part of the insular claustrum or the endopiriform claustrum proceeded from the medial wall of the LVA (presumptive ventral pallium). These results suggest that although the endopiriform claustrum originates from the ventral pallium, the insular claustrum originates from both the lateral and the ventral pallial portions.

Assessment in anatomy

From an educational perspective, a very important problem is that of assessment, for establishing competency and as selection criterion for different professional purposes. Among the issues to be addressed are the methods of assessment and/or the type of tests, the range of scores, or the definition of honour degrees. The methods of assessment comprise such different forms such as the spotter examination, short or long essay questions, short answer questions, true-false questions, single best answer questions, multiple choice questions, extended match questions, or several forms of oral approaches such as viva voce examinations.Knowledge about this is important when assessing different educational objectives; assessing educational objectives from the cognitive domain will need different assessment instruments than assessing educational objectives from the psychomotor domain or even the affective domain.There is no golden rule, which type of assessment instrument or format will be the best in measuring certain educational objectives; but one has to respect that there is no assessment instrument, which is capable to assess educational objectives from all domains of educational objectives.Whereas the first two or three levels of progress can be assessed by well-structured written examinations such as multiple choice questions, or multiple answer questions, other and higher level progresses need other instruments, such as a thesis, or direct observation.This is no issue at all in assessment tools, where the students are required to select the appropriate answer from a given set of choices, as in true false questions, MCQ, EMQ, etc. The standard setting is done in these cases by the selection of the true answer

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Practical teaching of preclinical anatomy

We illustrate here why today practical teaching in preclinical anatomy is important and why the use of human cadavers is still essential for learning human anatomy by taking two examples. We explain why it is important for a student to be able to dissect and learn anatomy by exploratory anatomy. Several alternatives are discussed and modern teaching tools are illustrated with on-line and computer-based resources, anatomical models, reconstructions and radiographic images that could supplement the traditional dissection courses. Newer techniques such as anatomical body painting, projections, ultrasound or living anatomy may help in the understanding of topographical anatomy. We underline the authenticity that comes from using human tissue and consider the strengths and limitations of different teaching tools. Here we discuss also how far one should go in teaching anatomical variations in preclinical teaching. In Europe there is no consensus regarding anatomical teaching, and each institution has its own curriculum. It would be helpful to set up an anatomical data bank with images and PowerPoint slides that could be used in teaching programs. Here the Trans-European Pedagogic Anatomical Research Group (TEPARG) for Europe and the International Federation of Associations of Anatomists (IFAA) at an international level could play an essential role

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The underside of the cerebral cortex: layer V/VI spiny inverted neurons.

This paper presents an account of past and current research on spiny inverted neurons--alternatively also known as 'inverted pyramidal neurons'--in rats, rabbits and cats. In our laboratory, we have studied these cells with a battery of techniques suited for light and electron microscopy, including Nissl staining, Golgi impregnation, dye intracellular filling and axon retrograde track-tracing. Our results show that spiny inverted neurons make up less than 8.5 and 5.5% of all cortical neurons in the primary and secondary rabbit visual cortex, respectively. Infragranular spiny inverted neurons constitute 15 and 8.5% of infragranular neurons in the same animal and areas. Spiny inverted neurons congregate at layers V-VI in all studied species. Studies have also revealed that spiny inverted neurons are excitatory neurons which furnish axons for various cortico-cortical, cortico-claustral and cortico-striatal projections, but not for non-telencephalic centres such as the lateral and medial geniculate nuclei, the colliculi or the pons. As a group, each subset of inverted cells contributing to a given projection is located below the pyramidal neurons whose axons furnish the same centre. Spiny inverted neurons are particularly conspicuous as a source of the backward cortico-cortical projection to primary visual cortex and from this to the claustrum. Indeed, they constitute up to 82% of the infragranular cells that furnish these projections. Spiny inverted neurons may be classified into three subtypes according to the point of origin of the axon on the cell: the somatic basal pole which faces the cortical outer surface, the somatic flank and the reverse apical dendrite. As seen with electron microscopy, the axon initial segments of these subtypes are distinct from one another, not only in length and thickness, but also in the number of received synaptic boutons. All of these anatomical features together may support a synaptic-input integration which is peculiar to spiny inverted neurons. In this way, two differently qualified streams of axonal output may coexist in a projection which arises from a particular infragranular point within a given cortical area; one stream would be furnished by the typical pyramidal neurons, whereas spiny inverted neurons would constitute the other source of distinct information flow.