Essential anatomy for core clerkships: A clinical perspective.

Clerkships are defining experiences for medical students in which students integrate basic science knowledge with clinical information as they gain experience in diagnosing and treating patients in a variety of clinical settings. Among the basic sciences, there is broad agreement that anatomy is foundational for medical practice. Unfortunately, there are longstanding concerns that student knowledge of anatomy is below the expectations of clerkship directors and clinical faculty. Most allopathic medical schools require eight "core" clerkships: internal medicine (IM), pediatrics (PD), general surgery (GS), obstetrics and gynecology (OB), psychiatry (PS), family medicine (FM), neurology (NU), and emergency medicine (EM). A targeted needs assessment was conducted to determine the anatomy considered important for each core clerkship based on the perspective of clinicians teaching in those clerkships. A total of 525 clinical faculty were surveyed at 24 United States allopathic medical schools. Participants rated 97 anatomical structure groups across all body regions on a 1-4 Likert-type scale (1 = not important, 4 = essential). Non-parametric ANOVAs determined if differences existed between clerkships. Combining all responses, 91% of anatomical structure groups were classified as essential or more important. Clinicians in FM, EM, and GS rated anatomical structures in most body regions significantly higher than at least one other clerkship (p = 0.006). This study provides an evidence-base of anatomy content that should be considered important for each core clerkship and may assist in the development and/or revision of preclinical curricula to support the clinical training of medical students.

Experimental Modal Analysis of an In-situ Clavicle.

Clavicle fractures are widespread, and the understanding of their mechanism of occurrence via dynamic loading is important for prevention and design of protection systems. The proposed work will find the natural frequencies and mode shapes of the human clavicles in-situ, by employing experimental modal analysis (EMA) techniques on cadaver clavicles. The clavicle response to impact depends on mechanical energy transmission to the bone and requires an understanding of bone modal characteristics (natural frequencies and mode shapes), as well as the frequency content of the impact force. These dynamic forces include blunt trauma (sport injury or gun stock impact) or falls (i.e. motorcycle accidents) and exhibit a wide frequency spectrum. Clavicle modes are not well understood, and while researchers performed whole body or individual clavicle EMA, no in-situ EMA has been reported. Since an in-situ clavicle features its natural boundary conditions, mode estimation via EMA was more accurate than one performed for an isolated clavicle.The clavicle EMA used instrumented excitation sources (i.e. impact hammer) and sensors (i.e. triaxial accelerometers). The accelerometer responses gathered at several locations along the cadaver clavicle bone and the exciting force was recorded and through time-frequency transformations, the natural frequencies and mode shapes were identified. Mode shape visualization was performed in ModalView software. While material properties of cadaver clavicles may be influenced by embalming, the results, which include natural frequencies, modes and damping constants, would be more relevant than those obtained for isolated clavicles. These results would be used to design protection systems, define global material properties, and calibrate existing analytical models.

Family physicians delivering babies: what do obstetricians think?

OBJECTIVE: This study assesses the attitudes of obstetricians about family physicians delivering babies. METHODS: We performed a two-stage mail survey of physicians who self-reported their specialty as obstetrics- gynecology in the 2001 South Carolina Directory of Licensed Physicians. After excluding physicians who retired or moved, a response rate of 65% was obtained. RESULTS: Fewer than half of the respondents (45%) supported family physicians providing pregnancy care. Obstetricians in favor of family physicians providing pregnancy care were more likely to work near a family physician who delivered babies, less likely to have been sued in the last 5 years, and more likely to be over age 60. Practice location (rural versus urban) did not predict support for family physicians participating in pregnancy care. Those obstetricians who supported family physicians participating in pregnancy care were comfortable with family physicians managing a wide range of common complications. CONCLUSIONS: Since fewer than half of obstetricians believe that family physicians should offer pregnancy care, family physicians may experience difficulty finding appropriate backup. Because older obstetricians were most likely to support family physicians, the retirement of these individuals from practice may create a problem for family physicians seeking obstetrical backup.

Gross anatomy videos: student satisfaction, usage, and effect on student performance in a condensed curriculum.

Anatomy educators are being tasked with delivering the same quantity and quality of material in the face of fewer classroom and laboratory hours. As a result they have turned to computer-aided instruction (CAI) to supplement and augment curriculum delivery. Research on the satisfaction and use of anatomy videos, a form of CAI, on examination performance continues to grow. The purpose of this study was to describe the usage and effect on examination scores of a series of locally produced anatomy videos after an 11% curriculum reduction. First-year medical students (n = 40) were given access to the videos and the prior year's students (n = 40) were used as historical controls. There was no significant difference in demographics between the two groups. The survey response rate was 85% (n = 34) in the experimental group. The students found the videos to be highly satisfying (median = 5 on a five-point Likert scale, interquartile range = 1) and used them on average 1.55 times/week (SD ± 0.77). Availability of the videos did have a statistically significant effect (4% improvement) on the final laboratory examination (p = 0.039). This suggests that the videos were a well-received form of CAI that may be useful in bridging the gap created by a reduction in gross anatomy course contact hours.