A survey of teaching undergraduate neuroanatomy in the United Kingdom and Ireland.

BACKGROUND: Medical students' perception of neuroanatomy as a challenging topic has implications for referrals and interaction with specialists in the clinical neurosciences. Given plans to introduce a standardised Medical Licensing Assessment by 2023, it is important to understand the current framework of neuroanatomy education. This study aims to describe how neuroanatomy is taught and assessed in the UK and Ireland. METHODS: A structured questionnaire capturing data about the timing, methods, materials, assessment and content of the 2019/2020 neuroanatomy curriculum in the UK and Ireland medical schools. RESULTS: We received 24/34 responses. Lectures (96%) were the most widely used teaching method, followed by prosection (80%), e-learning (75%), tutorials/seminars (67%), problem-based learning (50%), case-based learning (38%), and dissection (30%). The mean amount of core neuroanatomy teaching was 29.3 hours. The most common formats of assessing neuroanatomical knowledge were multiple-choice exams, spot tests, and objective structured clinical exams. Only 37.5% schools required demonstration of core clinical competency relating to neuroanatomy. CONCLUSIONS: Our survey demonstrates variability in how undergraduate neuroanatomy is taught and assessed across the UK and Ireland. There is a role for development and standardisation of national undergraduate neuroanatomy curricula in order to improve confidence and attainment.

Subtalar joint middle facet agenesis: a case report and literature review.

Articular facet morphology plays a fundamental role in subtalar joint biomechanics and stability, and likely influences the development of hindfoot osteoarthritis. While multiple anatomical studies have shown wide variation in articular facet configuration, the clinico-radiological findings are rarely presented. We illustrate a case of bilateral subtalar joint middle facet agenesis in a 45-year-old woman, which was missed despite several presentations. We demonstrate the imaging findings to enable clinicians to distinguish this from the more common middle facet coalition. We summarise the developmental anatomy and discuss the potential implications on biomechanical function. Recognition of middle facet agenesis within the complex subtalar joint is important to prevent misdiagnosis and unnecessary surgery.

Sternocleidomastoid innervation from an aberrant nerve arising from the hypoglossal nerve: a prospective study of 160 neck dissections.

BACKGROUND: Anatomical variants of the spinal root of the accessory nerve and cervical plexus are well known but other variants are exceptionally rare. METHODS: A prospective study of 160 selective neck dissections was undertaken following an index case, where a presumed C1 nerve (travelling with the hypoglossal nerve) was found to innervate sternocleidomastoid (SCM). A search was subsequently made for this variant while not compromising the neck dissection surgery itself. Eight cases could not be included due to metastatic disease precluding safe dissection in this area. A nerve stimulator was used to confirm the motor supply to SCM. RESULTS: This nerve variant was found in 4/160 necks (2.5 %). In all cases, it originated directly from the hypoglossal nerve and stimulation resulted in isolated SCM contraction. No accessory nerve anomalies were found. CONCLUSION: This finding adds to the knowledge of variants in this area. Meticulous dissection and preservation of all nerves, where possible, is important for optimising functional outcomes following surgery.

A brief history of topographical anatomy.

This brief history of topographical anatomy begins with Egyptian medical papyri and the works known collectively as the Greco-Arabian canon, the time line then moves on to the excitement of discovery that characterised the Renaissance, the increasing regulatory and legislative frameworks introduced in the 18th and 19th centuries, and ends with a consideration of the impact of technology that epitomises the period from the late 19th century to the present day. This paper is based on a lecture I gave at the Winter Meeting of the Anatomical Society in Cambridge in December 2015, when I was awarded the Anatomical Society Medal.

Communication of the anterior branch of the great auricular nerve with the marginal mandibular nerve: A prospective study of 25 neck dissections.

The great auricular nerve originates from the cervical plexus (C2, 3) and supplies sensation to the lower part of the pinna and the skin overlying the angle of the mandible. We have previously reported an unusual anatomical variant where the anterior division of the great auricular nerve passed into the submandibular triangle and was joined on its deep surface by the marginal mandibular division of the facial nerve. We now report a prospective study of 25 neck dissections in which a meticulous search for this variant resulted in the same communication between the great auricular nerve and the marginal mandibular division of the facial nerve being found in one further patient (an incidence of 2/25 patients in our series). Although communications between the transverse cervical nerve and the cervical branch of the facial nerve are well known, we have found that the marginal mandibular nerve can also be joined by the cervical plexus. This may have clinical implications during operations on the neck, particularly as stimulation of a communicating nerve of the cervical plexus might result in depression of the lip, and could potentially cause the operating surgeon to think that it was a branch of the facial nerve. We think that this finding merits a cadaveric study to evaluate the relation more fully.

New focus on anatomy for surgical trainees.

The demise of anatomy teaching in the undergraduate medical curriculum has inevitably reduced the general level of applied anatomical knowledge displayed by junior doctors. Initiatives such as the European Working Time Directive have exacerbated the problem by reducing trainees' opportunities to acquire appropriate anatomical knowledge and clinical skills through workplace training. Medical Schools and postgraduate Colleges and Schools of Surgery must work together to design and deliver quality-assured courses in core and non-core anatomy, that cross the undergraduate/postgraduate interface. All medical students should learn a core syllabus of anatomy, agreed by a panel of clinicians and anatomists but delivered according to the pedagogic style favoured by individual Medical Schools. This core will define the anatomy, that all F1 doctors should know, particularly the anatomy associated with clinical procedures: it will be assessed across all years of the undergraduate medical programme. Medical Schools should also offer modules in non-core surgical and/or radiological anatomy, some of which may be designed and delivered in partnership with Colleges of Surgery and Radiology: these modules would be particularly attractive to students contemplating a career in surgery or interventional radiology, but would not be offered exclusively to this cohort. At present, the inadequate anatomical knowledge of Foundation doctors must be addressed by ensuring that early postgraduate training programmes include explicit, formal teaching in anatomy, for example, the Core Surgical Anatomy course currently being piloted at the Royal College of Surgeons of England.

Great auricular communication with the marginal mandibular nerve - a previously unreported anatomical variant.

The great auricular nerve that originates from the cervical plexus and supplies sensation to the lower part of the auricle and the skin overlying the angle of the mandible has no motor component. During an elective neck dissection for a squamous cell carcinoma of the tongue, we found that the anterior division of the great auricular nerve divided, with a long branch that passed into the submandibular triangle anterior and superficial to the facial vein, and was joined on its deep surface by the marginal mandibular division of the facial nerve. Although anatomical variants of other branches of the cervical plexus have been described, this is, to our knowledge, the first time a communication between the great auricular nerve and a branch of the facial nerve has been reported outside the parotid gland.