Student characteristics associated with interpersonal skills in medical consultations.

BACKGROUND: The quality of medical care depends on effective physician-patient communication. Interpersonal skills can be improved through teaching, but the determinants are poorly understood. We therefore assessed the factors associated with the interpersonal skills of medical students during simulated medical consultations. METHODS: We conducted a cross-sectional study of fourth-year medical students participating in simulated consultations with standardized patients. Each video-recorded medical consultation was independently assessed by two raters, using a cross-cultural adaptation of the Four Habits Coding Scheme (4-HCS) into French. We then collected information on demographics and education-related characteristics. The relationship between the overall 4-HCS score and student characteristics was modeled using univariable and multivariable linear regression. RESULTS: Our analytical sample included 165 medical students for analysis. The factors significantly associated with 4-HCS score were gender (ß = - 4.8, p = 0.011) and completion of an international clinical placement (ß = 6.2, p = 0.002) or a research laboratory clerkship (ß = 6.5, p = 0.005). Education-related characteristics, multiple-choice examinations in the first to third preclinical years, and number of medicine or surgery clerkships were not significantly associated with 4-HCS score. CONCLUSIONS: Undergraduate students with higher level of interpersonal skills during video-recorded medical consultations with standardized patients are more likely to be female, to have completed international clinical placement as part of the ERASMUS exchange program or research laboratory clerkship.

Does continuous wound infiltration enhance baseline intravenous multimodal analgesia after posterior spinal fusion surgery? A randomized, double-blinded, placebo-controlled study.

PURPOSE: There has been a growing interest in continuous local anaesthetic wound infiltration as a non-opioid technique for postoperative pain relief. The impact of this modality on baseline analgesia after spinal fusion surgery has however been inconclusive. We tested whether continuous wound infiltration with ropivacaine can enhance postoperative analgesia compared to a baseline intravenous multimodal analgesia protocol after spinal fusion surgery. METHODS: In this randomized, double-blinded, placebo-controlled study, a multiholed 19-gauge catheter was placed at the end of the surgical procedure through the wound to permit the continuous administration (8 ml/h) of ropivacaine 0.2 % (ropivacaine group; n = 19 patients) or saline (control group; n = 20 patients) during the first 48 postoperative hours (H48). Both groups received intraoperative low-dose ketamine, a combination of acetaminophen, non-steroidal anti-inflammatory drug, and nefopam over the same postoperative period, and morphine delivered by a patient-controlled analgesia (PCA) device. RESULTS: Morphine consumption was comparable between the two groups both at H48, 38 mg (26:52) (median, 25th:75th percentile) (control group) versus 43 mg (19:74) (ropivacaine group), and at H24, 18 mg (16:22) versus 22 mg (9:35) respectively. Pain scores at rest and during mobilization, quality of postoperative sleep, and morphine-related side effects were comparable between the two groups at H24 and H48. CONCLUSION: Our findings indicate that no additional analgesia was provided with continuous wound infiltration of ropivacaine compared to a baseline intravenous multimodal analgesia protocol after spinal fusion surgery. TRIAL REGISTRATION: Clinicaltrials.gov #NCT01743794.

Contribution of embryology in the understanding of cervical venous system anatomy within and around the transverse foramen: a review of the classical literature.

Anatomic arrangement of venous system within the transverse foramen is a controversial topic among authors. Precise knowledge of this arrangement is necessary in imaging where vertebral artery dissection is suspected, as well as in surgical approaches of cervical spine. This knowledge objective cannot be achieved without a prerequisite knowledge of primitive venous system. We present here an update on the development of the transverse foramen venous system through a literature review. Our review of the classical literature aimed at synthesis of available related embryological knowledge and relating this synthesis to cervical vertebrae anatomy. Our findings with regard to different primitive descriptions were consistent and often complementary across the studies. The description has varied from a single vertebral vein to a single vein divided at certain areas, or even to a confluence of venous plexus. In this manner, the embryonic knowledge for instance on venous system can help us to better understand the segmental development of vertebral veins and their plexus arrangement. Furthermore, the cranial-caudal embryology, in particular of the nervous system, conveys the initial plexiform arrangement of vertebral veins, which ends into a single venous trunk joining the subclavian vein.

Text-to-movie authoring of anatomy lessons.

There is a need for a simple yet comprehensive tool to produce and edit pedagogical anatomy video courses, given the widespread usage of multimedia and 3D content in anatomy instruction. Anatomy teachers have minimal control over the present anatomical content generation pipeline. In this research, we provide an authoring tool for instructors that takes text written in the Anatomy Storyboard Language (ASL), a novel domain-specific language (DSL) and produces an animated video. ASL is a formal language that allows users to describe video shots as individual sentences while referencing anatomic structures from a large-scale ontology linked to 3D models. We describe an authoring tool that translates anatomy lessons written in ASL to finite state machines, which are then used to automatically generate 3D animation with the Unity 3D game engine. The proposed text-to-movie authoring tool was evaluated by four anatomy professors to create short lessons on the knee. Preliminary results demonstrate the ease of use and effectiveness of the tool for quickly drafting narrated video lessons in realistic medical anatomy teaching scenarios.

Successful Training of Patients to Intervene in Health Education and Clinical Research at Grenoble Patient School.

The primary goal of patient and public involvement (PPI) in healthcare is to improve individual and population health outcomes. This study reports on the successful training of patients to be involved in patient education as peers and clinical research at Grenoble Patients' School (GPS). GPS was founded by patients as an independent association to train patients to the above objectives tasks. The training team was multi-professional and included expert PPI who were part of the professional team. Medical faculty members and 45 patients, 59% females, 52 ± 6.4 years old, trained between 2016 and 2017, showed high satisfaction at the end of the training courses. Almost all the trained patients were involved as peer educators and 4 were involved in clinical research projects at different stages under the guidance of medical teams. Patient involvement at GPS provided strong benefits to trainees and had some impact on education and obtaining research grants. The outcome of this patient training program resulted in the creation of a Patients' Department within the Medical and Pharmacy Schools at the Université Grenoble Alpes in 2020, https://medecine.univ-grenoble-alpes.fr/departements/departement-universitaire-des-patients/.

Translating the Foundational Model of Anatomy into French using knowledge-based and lexical methods.

BACKGROUND: The Foundational Model of Anatomy (FMA) is the reference ontology regarding human anatomy. FMA vocabulary was integrated into the Health Multi Terminological Portal (HMTP) developed by CISMeF based on the CISMeF Information System which also includes 26 other terminologies and controlled vocabularies, mainly in French. However, FMA is primarily in English. In this context, the translation of FMA English terms into French could also be useful for searching and indexing French anatomy resources. Various studies have investigated automatic methods to assist the translation of medical terminologies or create multilingual medical vocabularies. The goal of this study was to facilitate the translation of FMA vocabulary into French. METHODS: We compare two types of approaches to translate the FMA terms into French. The first one is UMLS-based on the conceptual information of the UMLS metathesaurus. The second method is lexically-based on several Natural Language Processing (NLP) tools. RESULTS: The UMLS-based approach produced a translation of 3,661 FMA terms into French whereas the lexical approach produced a translation of 3,129 FMA terms into French. A qualitative evaluation was made on 100 FMA terms translated by each method. For the UMLS-based approach, among the 100 translations, 52% were manually rated as "very good" and only 7% translations as "bad". For the lexical approach, among the 100 translations, 47% were rated as "very good" and 20% translations as "bad". CONCLUSIONS: Overall, a low rate of translations were demonstrated by the two methods. The two approaches permitted us to semi-automatically translate 3,776 FMA terms from English into French, this was to added to the existing 10,844 French FMA terms in the HMTP (4,436 FMA French terms and 6,408 FMA terms manually translated).

Assessing decision-making in education of restorative and prosthetic dentistry: a pilot study.

PURPOSE: To evaluate whether a concordance assessment (CA) software application is able to assess decision-making in restorative and prosthetic dentistry. MATERIALS AND METHODS: Vignettes representing 10 different clinical situations were integrated into a software application. Each vignette included 3D digital models and a short case, as well as 5 therapeutic options rated on a 4-point Likert scale (-2 = strongly contraindicated; -1 = contraindicated; +1 = indicated; +2 = strongly indicated). A panel of 15 dental educators (9 educators from the prosthetic department [PD] and 6 from the conservative department [CD]) had to evaluate the indication of each of the 5 therapies for the 10 vignettes. RESULTS: This pilot questionnaire showed good internal consistency on most therapies (Cronbach's α = 0.86), with the exception of more recently introduced therapies (overlay/veneerlay and endocrown). On a maximum score out of 100, the average of CD educators (79.2 ± 3.2) was not significantly different (P = .73) from that of a PD educator (77.8 ± 3.5). Scores ranged from 66.8 to 89.6. Analysis of the expert panel's responses also reported mostly (34/50) a distribution of responses that was characteristic of CA and uncertain situations. CONCLUSION: The present software application was able to reproduce and assess decision-making in dentistry with satisfying internal consistency of educators.

OntoSIDES: Ontology-based student progress monitoring on the national evaluation system of French Medical Schools.

We introduce OntoSIDES, the core of an ontology-based learning management system in Medicine, in which the educational content, the traces of students' activities and the correction of exams are linked and related to items of an official reference program in a unified RDF data model. OntoSIDES is an RDF knowledge base comprised of a lightweight domain ontology that serves as a pivot high-level vocabulary of the query interface with users, and of a dataset made of factual statements relating individual entities to classes and properties of the ontology. Thanks to an automatic mapping-based data materialization and rule-based data saturation, OntoSIDES contains around 8 millions triples to date, and provides an integrated access to useful information for student progress monitoring, using a powerful query language (namely SPARQL) allowing users to express their specific needs of data exploration and analysis. Since we do not expect end-users to master the raw syntax of SPARQL and to express directly complex queries in SPARQL, we have designed a set of parametrized queries that users can instantiate through a user-friendly interface.

Miming neurological syndromes improves medical student's long-term retention and delayed recall of neurology.

Basic examination and diagnostic skills in neurology are important for every graduating medical student. However, a majority of medical students consider neurology as complex and difficult to master. We evaluate the impact a learner-friendly, innovative simulation-based training programme has on long-term retention and delayed recall of neurological semiology amongst third-year medical students from the University Pierre et Marie Curie in Paris, France. The 2013 class received standard teaching in neurological semiology. The 2015 class who received the same standard teaching in neurological semiology were also invited to voluntarily participate in The Move, a mime-based role-play training programme of neurological semiology. During the Move, students were trained to simulate a patient with a neurological syndrome or the physician examining the patient. Students were evaluated with an assessment thirty months after their neurological rotation, including 15 questions to evaluate long-term retention of neurological semiology, and 10 to test background knowledge in general semiology. The semiology test was performed by 366/377 students from the 2013 class (standard education group) and by 272/391 students from the 2015 class, among which 186 participated in The Move (The Move group) and 86 did not (standard education group). The mean neurological semiology score was higher in the 2015 class compared to the 2013 class (p = 0.007) and remained so after adjustment for the general semiology performance (p = 0.003). The adjusted mean neurological semiology score was 1.21/15 points higher [95% CI 0.66, 1.75] in The Move group compared to the standard education group, corresponding to a 14% better ranking. The Move programme improves medical student's long-term retention and delayed recall of neurological semiology. This learner-friendly interactive teaching may in turn enhance clinical proficiency of future physicians in neurological semiology.

Make Gestures to Learn: Reproducing Gestures Improves the Learning of Anatomical Knowledge More than Just Seeing Gestures.

Manual gestures can facilitate problem solving but also language or conceptual learning. Both seeing and making the gestures during learning seem to be beneficial. However, the stronger activation of the motor system in the second case should provide supplementary cues to consolidate and re-enact the mental traces created during learning. We tested this hypothesis in the context of anatomy learning by naïve adult participants. Anatomy is a challenging topic to learn and is of specific interest for research on embodied learning, as the learning content can be directly linked to learners' body. Two groups of participants were asked to look at a video lecture on the forearm anatomy. The video included a model making gestures related to the content of the lecture. Both groups see the gestures but only one also imitate the model. Tests of knowledge were run just after learning and few days later. The results revealed that imitating gestures improves the recall of structures names and their localization on a diagram. This effect was however significant only in long-term assessments. This suggests that: (1) the integration of motor actions and knowledge may require sleep; (2) a specific activation of the motor system during learning may improve the consolidation and/or the retrieval of memories.

Brain-shift compensation using intraoperative ultrasound and constraint-based biomechanical simulation.

PURPOSE: During brain tumor surgery, planning and guidance are based on preoperative images which do not account for brain-shift. However, this deformation is a major source of error in image-guided neurosurgery and affects the accuracy of the procedure. In this paper, we present a constraint-based biomechanical simulation method to compensate for craniotomy-induced brain-shift that integrates the deformations of the blood vessels and cortical surface, using a single intraoperative ultrasound acquisition. METHODS: Prior to surgery, a patient-specific biomechanical model is built from preoperative images, accounting for the vascular tree in the tumor region and brain soft tissues. Intraoperatively, a navigated ultrasound acquisition is performed directly in contact with the organ. Doppler and B-mode images are recorded simultaneously, enabling the extraction of the blood vessels and probe footprint, respectively. A constraint-based simulation is then executed to register the pre- and intraoperative vascular trees as well as the cortical surface with the probe footprint. Finally, preoperative images are updated to provide the surgeon with images corresponding to the current brain shape for navigation. RESULTS: The robustness of our method is first assessed using sparse and noisy synthetic data. In addition, quantitative results for five clinical cases are provided, first using landmarks set on blood vessels, then based on anatomical structures delineated in medical images. The average distances between paired vessels landmarks ranged from 3.51 to 7.32 (in mm) before compensation. With our method, on average 67% of the brain-shift is corrected (range [1.26; 2.33]) against 57% using one of the closest existing works (range [1.71; 2.84]). Finally, our method is proven to be fully compatible with a surgical workflow in terms of execution times and user interactions. CONCLUSION: In this paper, a new constraint-based biomechanical simulation method is proposed to compensate for craniotomy-induced brain-shift. While being efficient to correct this deformation, the method is fully integrable in a clinical process.

Neuroanatomical affiliation visualization-interface system.

A number of knowledge management systems have been developed to allow users to have access to large quantity of neuroanatomical data. The advent of three-dimensional (3D) visualization techniques allows users to interact with complex 3D object. In order to better understand the structural and functional organization of the brain, we present Neuroanatomical Affiliations Visualization-Interface System (NAVIS) as the original software to see brain structures and neuroanatomical affiliations in 3D. This version of NAVIS has made use of the fifth edition of "The Rat Brain in Stereotaxic coordinates" (Paxinos and Watson, 2005). The NAVIS development environment was based on the scripting language name Python, using visualization toolkit (VTK) as 3D-library and wxPython for the graphic user interface. The following manuscript is focused on the nucleus of the solitary tract (Sol) and the set of affiliated structures in the brain to illustrate the functionality of NAVIS. The nucleus of the Sol is the primary relay center of visceral and taste information, and consists of 14 distinct subnuclei that differ in cytoarchitecture, chemoarchitecture, connections, and function. In the present study, neuroanatomical projection data of the rat Sol were collected from selected literature in PubMed since 1975. Forty-nine identified projection data of Sol were inserted in NAVIS. The standard XML format used as an input for affiliation data allows NAVIS to update data online and/or allows users to manually change or update affiliation data. NAVIS can be extended to nuclei other than Sol.

My Corporis Fabrica Embryo: An ontology-based 3D spatio-temporal modeling of human embryo development.

BACKGROUND: Embryology is a complex morphologic discipline involving a set of entangled mechanisms, sometime difficult to understand and to visualize. Recent computer based techniques ranging from geometrical to physically based modeling are used to assist the visualization and the simulation of virtual humans for numerous domains such as surgical simulation and learning. On the other side, the ontology-based approach applied to knowledge representation is more and more successfully adopted in the life-science domains to formalize biological entities and phenomena, thanks to a declarative approach for expressing and reasoning over symbolic information. 3D models and ontologies are two complementary ways to describe biological entities that remain largely separated. Indeed, while many ontologies providing a unified formalization of anatomy and embryology exist, they remain only descriptive and make the access to anatomical content of complex 3D embryology models and simulations difficult. RESULTS: In this work, we present a novel ontology describing the development of the human embryology deforming 3D models. Beyond describing how organs and structures are composed, our ontology integrates a procedural description of their 3D representations, temporal deformation and relations with respect to their developments. We also created inferences rules to express complex connections between entities. It results in a unified description of both the knowledge of the organs deformation and their 3D representations enabling to visualize dynamically the embryo deformation during the Carnegie stages. Through a simplified ontology, containing representative entities which are linked to spatial position and temporal process information, we illustrate the added-value of such a declarative approach for interactive simulation and visualization of 3D embryos. CONCLUSIONS: Combining ontologies and 3D models enables a declarative description of different embryological models that capture the complexity of human developmental anatomy. Visualizing embryos with 3D geometric models and their animated deformations perhaps paves the way towards some kind of hypothesis-driven application. These can also be used to assist the learning process of this complex knowledge. AVAILABILITY: http://www.mycorporisfabrica.org/.

My Corporis Fabrica: an ontology-based tool for reasoning and querying on complex anatomical models.

BACKGROUND: Multiple models of anatomy have been developed independently and for different purposes. In particular, 3D graphical models are specially useful for visualizing the different organs composing the human body, while ontologies such as FMA (Foundational Model of Anatomy) are symbolic models that provide a unified formal description of anatomy. Despite its comprehensive content concerning the anatomical structures, the lack of formal descriptions of anatomical functions in FMA limits its usage in many applications. In addition, the absence of connection between 3D models and anatomical ontologies makes it difficult and time-consuming to set up and access to the anatomical content of complex 3D objects. RESULTS: First, we provide a new ontology of anatomy called My Corporis Fabrica (MyCF), which conforms to FMA but extends it by making explicit how anatomical structures are composed, how they contribute to functions, and also how they can be related to 3D complex objects. Second, we have equipped MyCF with automatic reasoning capabilities that enable model checking and complex queries answering. We illustrate the added-value of such a declarative approach for interactive simulation and visualization as well as for teaching applications. CONCLUSIONS: The novel vision of ontologies that we have developed in this paper enables a declarative assembly of different models to obtain composed models guaranteed to be anatomically valid while capturing the complexity of human anatomy. The main interest of this approach is its declarativity that makes possible for domain experts to enrich the knowledge base at any moment through simple editors without having to change the algorithmic machinery. This provides MyCF software environment a flexibility to process and add semantics on purpose for various applications that incorporate not only symbolic information but also 3D geometric models representing anatomical entities as well as other symbolic information like the anatomical functions.

The precerebellar linear nucleus in the mouse defined by connections, immunohistochemistry, and gene expression.

The linear nucleus (Li) is a prominent cell group in the caudal hindbrain, which was first described in a study of cerebellar afferents in the rat by [Watson, C.R.R., Switzer, R.C. III, 1978. Trigeminal projections to cerebellar tactile areas in the rat origin mainly from N. interpolaris and N. principalis. Neurosci. Lett. 10, 77-82.]. It was named for its elongated appearance in transverse sections. Since this original description in the rat, reference to the nucleus seems to have been largely absent from experimental studies of mammalian precerebellar nuclei. We therefore set out to define the cytoarchitecture, cerebellar connections, and molecular characteristics of Li in the mouse. In coronal Nissl sections at the level of the rostral inferior olive, it consists of two parallel bands of cells joined at their dorsal apex by a further band of cells, making the shape of the Greek capital letter pi. Our three-dimensional reconstruction demonstrated that the nucleus is continuous with the lateral reticular nucleus (LRt) and that the ambiguus nucleus sits inside the arch of Li. Cerebellar horseradish peroxidase injections confirmed that the cells of Li project to cerebellum. We have shown that Li cells express Atoh1 and Wnt1 lineage markers that are known to label the rhombic lip derived precerebellar nuclei. We have examined the relationship of Li cells to a number of molecular markers, and have found that many of the cells express a nonphosphorylated epitope in neurofilament H (SMI 32), a feature they share with the LRt. The mouse Li therefore appears to be a rostrodorsal extension of the LRt.

Cervical venous organization in the transverse foramen.

The most widely accepted description of venous anatomy in the transverse foramen involves the presence of one or two veins running along and parallel to the external side of the vertebral artery. For most surgeons, the vertebral artery is surrounded by a rete of veins which is continous with the wide sinusoids which surround the thecal sac (internal vertebral venous plexus). The goal of this study was to ascertain the exact structure of the venous system in the transverse canal by micro dissection and histology. Six spinal segments (C1 to C7) removed from cadavers embalmed using 5% diluted formalin or not and studied with or without injection of colored latex after bilateral catheterization of the internal jugular vein, vertebral vein, common carotid artery, and vertebral artery. An anatomical study was performed by optical microscopy. After fixation and decalcification, tissue specimens were stained using hematoxylin-eosin-safran (HES) and immunocytochemical markers including CD43, CD31, and desmine (specific for vascular endothelium). Findings showed that venous blood in the transverse canal flows through a space formed by the periosteum. There was no evidence of a vein inside the transverse canal. The periosteum spans the space between the transverse processes and gives off fibrous leaflets to the artery thus forming a compartmentalized space lined with vascular endothelium around the artery. The venous system in the transverse canal presents itself as a sinus similar to the intracranial sinus structure.