The Benefits and Challenges of Clinical Work-based Surface Anatomy Learning Among Preclinical Medical Students

@#Knowledge on surface anatomy enables medical students and graduates to locate anatomical structures exteriorly, improve their clinical and procedural skills and interpret ultrasonographic and radiographic images. Hence, a standard surface anatomy knowledge is essential for attainment of clinical skill competency. Nevertheless, there is lack of attention given on surface anatomy in the medical curriculum as it is usually delivered didactically or during selfstudy by the students. Owing to limitations in cadaveric dissection in many institutions, lecture-based instruction, e-learning materials, living anatomy models, radiological imaging and anatomy software are used in teaching surface anatomy; however, none of these methods proved to be effective over the others. Furthermore, some of these teaching resources lack clinical relevancy, possibly impeding students’ appreciation on learning surface anatomy. Hence, integrating clinical input during surface anatomy teaching by involving patients in an actual clinical environment is pertinent. This article demonstrates the benefits and challenges of teaching surface anatomy in the clinical setting to medical students and highlights the need to design an evidence-based framework of work-based surface anatomy learning.

The teaching of surface anatomy by body painting / Enseñanza de anatomía de superficie mediante la pintura corporal

The present project on learning surface anatomy through the body painting method was undertaken because anatomical knowledge supports medical practice. The appropriate anatomical training of the doctor depends on surface anatomy. We considered the renovation of teaching strategies and didactic resources to optimize the overall teaching- learning process. 189 first-year medical students, enrolled in the Trunk and Splanchnology course at the University of Cádiz (Spain) participated in this study. Students were divided into 5 groups each of 38-41 students. The students were asked to complete a satisfaction questionnaire supplied to each participant through an on-line platform. On the basis of the results, we recommend the body painting method as an alternative tool for learning surface and clinical anatomy.

El presente proyecto sobre el aprendizaje de la anatomía de superficie a través del método de pintura corporal se realizó debido a que el conocimiento anatómico apoya la práctica médica. El entrenamiento anatómico apropiado del médico depende de la anatomía de superficie. Consideramos la renovación de las estrategias de enseñanza y los recursos didácticos para optimizar el proceso general de enseñanza-aprendizaje. De este estudio participaron 189 estudiantes de primer año de medicina, matriculados en el curso de Troncal y Splanchnology en la Universidad de Cádiz (España). Los estudiantes fueron divididos en 5 grupos, cada uno de 38-41 estudiantes. Se les pidió a los estudiantes que completaran un cuestionario de satisfacción proporcionado a cada participante a través de una plataforma en línea. Sobre la base de los resultados, recomendamos el método de pintura corporal como una herramienta alternativa para el aprendizaje de la anatomía de superficie y clínica.

Supratentorial Dissection of the Human Brain for Neuroscientists.

Background: Recent clinical advancements, including brain imaging or target specific procedures, have increased the demand for a more advanced understanding of the structure of the brain. The need for a more sophisticated, functionally relevant understanding the structure of the brain has resulted in a surge of neuroanatomy dissection courses, including gross neuroanatomical observation, cross-sectioning, blunt dissection and various fiber dissection techniques. Methods: Sixteen (16) adult, formalin fixed cerebral hemispheres were included in this study. Surface anatomy, blunt dissection of the lateral ventricles, and cross-sectioning of the anterior portion of the hemisphere, was performed on all specimens. Results: A detailed, but simplified, protocol consisting of seven steps is proposed for the study of the supratentorial anatomy of the human brain. The first two steps promote an appreciation of the predominate structural pattern of the surface of the brain. Four distinct, consecutive dissection steps are recommended for the dissection of the ventricular system. Horizontal cross-sectioning of the anterior portion of the hemisphere is described in five sub-steps. Conclusion: Dissection methods described provides an appreciation of the predominate structural pattern of the surface of the brain, in relation to the deep the structures. This appreciation is gained through the step-by-step dissection of the ventricular system and cross-sections. In addition to understanding the surface-to-deep relationships, the hands-on practical study of the anatomy of brain as described herein, allows the observer to gain a true three-dimensional structural understanding of the human brain.

Salient Features of the Maasai Foot: Analysis of 1,096 Maasai Subjects

BACKGROUND: The Maasai are the most widely known African ethnic group located in Kenya and northern Tanzania. Most spend their days either barefoot or in their traditional shoes made of car tires. Although they walk long distances of up to sixty kilometers a day, they do not suffer from any foot ailments. Little is known about their foot structure and gait. The goal of this investigation was to characterize various aspects of Maasai foot in standing and walking. METHODS: Foot length, calf circumference, hindfoot alignment, step length, cadence, and walking velocity were obtained from 1,096 adult Maasai people (545 males and 551 females; mean age, 40.28 +/- 14.69 years; age range, 16 to 65 years). All included subjects were from rural areas, where the primary terrain was sandy soil, who spend most of their lifetime barefoot, walking. They all denied any medical history or previous symptoms related to foot problems. A trained clinician scanned all feet for deformities. Static (standing) and dynamic (walking) Harris mat footprints were taken to determine the distribution of forefoot pressure patterns during walking. RESULTS: The average foot length was 250.14 +/- 18.12 mm (range, 210 to 295 mm) and calf circumference was 32.50 +/- 3.22 cm (range, 25 to 41 cm). The mean hindfoot alignment was 6.21degrees +/- 1.55degrees of valgus. Sixty-four subjects (5.84%) had bilateral flat-shaped feet with a low medial longitudinal arch that exactly matched the broad pattern of their static footprints. Step length, cadence, and walking velocity were 426.45 +/- 88.73 cm (range, 200 to 690 cm), 94.35 steps/min (range, 72 to 111 steps/min), and 40.16 +/- 8.36 m/min (range, 18.20 to 63.36 m/min), respectively. A total of 83.39% subjects showed unilateral or bilateral deformities of multiple toes regardless of age. The most frequent deformity was clawing (98.79%) of which the highest incidence occurred with the fifth toe (93.23%). Dynamic footprints showed even pressure patterns throughout the forefoot (64.87%), followed by lateral forefoot pressure concentration patterns (21.81%). CONCLUSIONS: Our study shows the distinct parameters that provide more insight into the Maasai foot.

Is the Spinous Process of T7 Usually at the Same Level as the Inferior Tips of the Scapulae?

OBJECTIVE: Appropriate placement of thoracic epidural catheter provides an adequate postoperative analgesia in chest and upper abdominal surgery. Usually, when thoracic epidural puncture is performed, both scapular lower tips and the thoracic (T)7 spinous process is assumed to be at the same horizontal level. The aim of this study is to identify the thoracic epidural puncture in the sitting position, with the neck flexed and arms crossed, may change the relationship between the thoracic vertebrae and the scapular lower tips. METHODS: One hundred patients with postoperative patient controlled epidural analgesia using thoracic epidural catheters were enrolled. It is presumed that the both scapular lower tips and T7 spinous process is at the equal level when performing thoracic epidural puncture. The actual insertion level of the Tuohy needle was examined by radiography when the patient was in the sitting position. RESULTS: Out of 100 patients, there were 62% that were in the same level as the scapular lower tips and T7 spinous process. However, 1% of the patients leveled at T4, 1% at T5, 25% at T6, 18% at T8, and 1% at T9. CONCLUSION: When performing the thoracic epidural puncture under the sitting position, the relationship of the T7 and the scapular lower tips may change. The change of position of scapular lower tips varied among T6.82+/-0.70. Therefore, to be precise, it is advised to utilize C-arm guide when epidural puncture is carried out.

An Analysis of the Surface Anatomical Location of the Posterior-inferior Margin of the Sacroiliac Joint

BACKGROUND: The blind sacroiliac joint (SIJ) block cannot always be performed accurately; it is commonly performed in the office based setting because intraarticular and periarticular injections are effective for SIJ pain. However, knowledge on the surface anatomy of the SIJ is lacking. The purpose of this study was to analyze the surface anatomical location of the posterior-inferior margin of the SIJ. METHODS: After informed consent was obtained, fifty patients undergoing SIJ block in the prone position were examined. The oblique angles where the anterior-inferior margin and the posterior-inferior margin of the SIJ overlap on X-ray were evaluated. In addition, the surface anatomical relationships between the posterior-inferior margin of the SIJ on X-ray and the posterior superior iliac spine (PSIS) and sacral hiatus by palpation were assessed. RESULTS: The oblique angle was 5.4 +/- 2.9degrees. The vertical and transverse distance between the posterior-inferior margin of the SIJ and PSIS were 3.8 +/- 0.8 cm and 0.9 +/- 0.6 cm, respectively. The vertical and transverse distance between the posterior-inferior margin of the SIJ and the midpoint of the sacral hiatus were 3.4 +/- 0.7 cm and 3.9 +/- 0.6 cm, respectively. Only the vertical distance between the posterior-inferior margin of the SIJ and PSIS showed significant difference between the male and the female groups (P = 0.0016). CONCLUSIONS: The measurements in this study can be used as a reference standards for the blind SIJ block.

Applied Anatomy of Pectoralis Major Muscle: Surface Anatomy Related to Female Breast

The most important factor for breast augmentation is to dissect the accurate size of implantation pockets. This study was performed to investigate the anatomical association of the pectoralis major muscle(PMM) with the female breast shape for improving the success rate of mammoplasty. This study included 60 women(120 breasts) in their twenties to thirties who were imaged by CT between September 2006 and December 2007. On reconstructed 3D CT images, 6 points in the area of the PMM were selected as fiducial points, and the PMM contour and the correlation of the PMM with the nipple were analyzed using the imaginary lines connecting individual points. As the volume increased, the lateral and inferior borders of the PMM moved to the superomedial side from the nipple. As the ptosis degree increased, the density became lower, and the lateral and inferior borders of the PMM moved to the superomedial side of the nipple. However, there was no significant correlation between age and PMM contour. The results of this study suggest that the PMM contour may change according to the volume, ptosis and density of the breast. This study can provide objective information for breast surgery, thereby increasing the success rate of mammoplasty.

Description of the Surface Findings with Use of the Revised Korean Surface Anatomical Terms / 대한법의학회지

Forensic medicine doctors in NISI(National Institute of Scientific Investigation) have traditionally used handed-down or old anatomical terms when they put into words the external findings of dead body. And we have had no any traditional rule or accepted guide relevant to the description about the surface anatomy, especially in terms of our practice of forensic pathology and medicine. Korean association of anatomists has taken the head to revise the old anatomy terms mostly occupied with the old Japanese and banal Chinese types, and we have come to see the Hangeul anatomy terms. These new Hangeul anatomy terms are now used by younger forensic pathologists, newcomer forensic doctors, and present medical students. Present more experienced and older pathologists, however, still use the old terms. It is, therefore, no wonder that investigators, policemen, attorneys, judges and even laymen coming in contact with our autopsy reports might be confused with the terms expressed in that official and publicly trusted documents. We felt that it is time for appropriate guideline about describing the surface anatomy to emerge with the viewpoint of forensic medicine. So we explained and depicted what to designate the region which an external finding lies in and how to use the surface anatomy terms.

Suggestion of Safer and Easier Technique of Suprascapular Nerve Block based on Cadaver Study

OBJECTIVE: To suggest a safer and easier technique of suprascapular nerve block by assessing anatomical relationship of the suprascapular notch from a view point of surface anatomy. METHOD: Fourteen shoulders of seven cadavers were dissected in prone position. The scapular notch was exposed and the articular branch of suprascapular nerve was observed. The length and depth of spine, height and relative position of scapular notch were measured for all of the specimen. RESULTS: The length of the spine was 11.45+/-0.72 cm. The injection point was measured as relative position of scapular notch on the spine. The ratio between distance from medial border of the spine to injection point and from the injection point to posterior angle of acromion was 1.89+/-0.2: 1. The depth of the spine, which was defined as the shortest vertical distance from the injection point to the scapula was 2.69+/-0.43 cm, and the vertical distance from this contact point to the base of the scapular notch, e.g. the height of the scapular notch, was 1.18+/-0.1 cm. CONCLUSION: We expect we could perform suprascapular nerve block easily and safely with suggested surface landmarks and measured data in this study.

Positioning of Lumbar Facet Joints by Analysis of Surface Anatomy in Korean Adults

OBJECTIVE: To determine the Korean adult standard of mean length and depth from spinous process which is palpable landmark of back to each facet joint. METHOD: The horizontal line was made between the posterior end of each facet joint, and the rectangular line was made on the horizontal line at the level of spinous process, respectively. We measured the length from the point of intersection to the posterior end of each facet joint (SFL), and the depth from the tip of spinous process to the point of intersection (SFD). All parameters were measured in 30 volunteers (Exp. 1) using computed tomography and in 30 cadavers (Exp. 2). RESULTS: The lower lumbar spine revealed the longer SFL (p0.05). There was no correlation with height and weight, either (r<0.04). CONCLUSION: We measured the standard for SFL and SFD in Korean. We suggest that these results will be useful in clinical practice including blind approach of spinal intervention to the facet joints.

The Application of Surface Anatomy Scanning / 实用放射学杂志

Objective To discuss the application of surface anatomy scanning in the department of cerebral surgery. Methods 24 cases were examined by surface anatomy scanning.These included 5 normal cases,10 gliomas,4 metastasis tumors,3 meningiomas,1 cavernous hemangioma and 1 cerebral infarction.Results 5 normal cases with surface anatomy scanning showed excellent visualization of the sulci and gyri on the surface of the brain.In 19 cases with cortical or subcortical lesions,14 cases showed the relationship between the lesion and the brain surface structures well.5 cases could not displayed because of server edema around the lesion.Conclusion The brain surface anatomy scanning is useful for the localization of cortical and subcortical pathology,for the diagnosis of the disease of sulci and gyri,can partly replace the navigation.

A shorter human anatomy teaching program: less expensive but effective

The principal change proposed in the teaching of gross anatomy is the inclusion of prosection as a part of the teaching program in coordination with dissection, demonstrations and study of anatomical and x-ray platesGreater emphasis on surface anatomy is also recommendedAs regards cadaver dissection, two suggestions are discussed: 1. Curtailment of the exposure of insignificant details to make dissection less time-consuming and to focus the attention of the dissector to the more important parts and structures2. Early dissection of the extremities to forestall excessive dehydration and hardening of these parts of the body. (Summary)