Student evaluation of a Learning Enhancement in Anatomy Program (LEAP) during the COVID-19 pandemic: A retrospective study

Background and Objective@#The pandemic acted as an accelerator for the development of online teaching formats in anatomy and histology worldwide. The authors introduce a bridging program that reinforces the knowledge and understanding of gross and correlative anatomy and histology acquired in a virtual environment in preparation for its future clinical application. The study aims to evaluate the Learning Enhancement in Anatomy Program (LEAP) conducted among first-year medical students at the College of Medicine, University of the Philippines Manila. @*Methods@#This descriptive cross-sectional study aims to determine the initial experience of implementing a learning enhancement program and assess areas for its improvement. An internally validated questionnaire was given to students after the program to gauge students’ reactions (Kirkpatrick Level 1 evaluation). Pre- and post-tests were administered to evaluate knowledge acquisition (Kirkpatrick Level 2 evaluation). Short-term behavioral peer evaluation (Kirkpatrick Level 3 evaluation) was also instituted. @*Results@#One hundred fifty-two (152) students participated in the study. General reactions from students to the LEAP were consistently positive, with a steady majority of the students rating ‘5’ or a ‘Strongly Agree’ to positive statements regarding the program. Higher ratings for more traditional teaching methods, such as cadavers, formalinized specimens, and bones, compared to virtual systems were apparent. However, inter-student variation in preference for teaching modalities was observed. All stations of the LEAP were evaluated satisfactorily, with most gross anatomy stations rated higher than histology stations. A significant increase was noted in the total post-test scores compared to pre-test scores. This improvement in test scores was observed in the anatomy and histology subcategories and in six of the seven organ system modules. Perceived behavioral outcomes were also generally positive. @*Conclusion@#The LEAP is a worthwhile endeavor, garnering overwhelmingly positive reactions and a significant improvement in test scores. Future studies are necessary to fine-tune teaching and training in a blended learning environment.

Evaluation of modified thiel soft-embalmed cadavers as a novel teaching model for musculoskeletal ultrasound and anatomy among rehabilitation medicine residents

Objective@#This study aimed to determine the perceptions of rehabilitation medicine resident trainees on using modified Thiel soft-embalmed cadavers as a learning tool in acquiring knowledge on musculoskeletal ultrasound (MSK-UTZ) and anatomy. @*Methods@#This descriptive cross-sectional study used total enumeration to recruit residents in training under the rehabilitation medicine department of a tertiary referral hospital. An online survey tool was self-administered to determine their perceptions on the use of MSK-UTZ on Thiel-embalmed cadavers. Pre- and post-test scores were compared to determine if their knowledge has improved. @*Results@#Fifteen participants were recruited, who answered the pre- and post-test, and the online survey. The mean pre-test score of participants was 5.87 (±1.68), and the mean post-test score was 6.87 (±2.00). There was no statistically significant difference (P = 0.20) using a paired t-test. At an arbitrary passing rate of 70%, only 5/15 participants passed the pre-test while 10/15 passed the post-test. A chi-square test of independence showed that there was no significant association between the number of participants who passed or failed on the pre- and posttest, X2 (1, N = 15) = 3.3, p = .0.068. Most of the perceptions of the participants were positive in terms of the use of modified Thiel soft-embalmed cadavers as a learning tool, its relevance in the training of a rehabilitation medicine resident, and the overall experience on its use. @*Conclusion@#Thiel-embalmed cadavers as a learning tool was well-accepted, having generally positive perceptions from the participants mainly in terms of perceived enhancement of the understanding of the anatomical basis of musculoskeletal ultrasound, perceived improvement in skills in performing musculoskeletal ultrasound, and most even recommended that it be part of their training as rehabilitation medicine residents. In terms of acquiring knowledge on musculoskeletal ultrasound (MSK-UTZ) and anatomy, no significant improvement in knowledge was noted. Further studies with larger sample sizes are recommended to yield more statistically significant improvement in knowledge and to observe trends in the perceptions of participants.

The Department of Anatomy in the University of the Philippines College of Medicine: Dissecting the history

@#The history of the Department of Anatomy of the College of Medicine of the University of the Philippines can be chronicled from its humble beginnings in 1907 to its continued existence through the COVID-19 pandemic. This article briefly describes its historical development, current undertakings, and future directions in relation to its mission and vision.

Low-cost 3D modeling software for generating patient-specific drill guide templates for cervical pedicle screw insertion: An in vitro study

BACKGROUND@#Instrumented posterior cervical spine surgery (IPCSS) can be conducted using screws inserted through the pedicles of the vertebra. A safe IPCSS method uses 3D-printing to produce templates that will serve as drill guides for screw placement.@*OBJECTIVES@#This study describes the generation of 3D-printed drill guides using low-cost general purpose 3D modeling software and the comparison of screw insertion accuracy scores against the traditional landmark method and guides created using commercial grade software.@*METHODS@#Twenty-five (25) subaxial pedicles of five cadaveric spines were selected and scanned using computed tomography (CT). A digital reconstruction of the five cadaveric spines were created based on the CT DICOM data. A low-cost 3D modeling software, Rhinoceros 3D, was utilized for trajectory planning and generation of a patientspecific drill template using the digital reconstruction. The templates were then fabricated in ABS plastic using a fused deposition modeling (FDM) 3D printer. Insertion of cervical pedicle screws on the cadaveric spines was done by an orthopedic resident using the 3D printed guides. Postoperative CT scans were obtained, and placement accuracy of the screws were scored by two assessors utilizing a four-point rating system. Screws in correct placement were scored Grade 0 while misplaced screws with neurovascular damage were given a score of Grade 3.@*RESULTS@#Accuracy scores for the 3D-printed drill guides were 52% for assessor 1 and 44% for assessor 2. For assessor 1, screw placement in C3, C6, and C7 received the highest scores. For assessor 2, the highest scores were achieved in C3 and C7. The hybrid method of Bundoc et al. achieved scores of 94% while 3D printed guides utilizing commercial software like Materialise Mimics, Geomagic Freeform, or UG Imageware achieved scores of 80-100%. The traditional landmark method had scores ranging from 12% to 94% depending on the skill of the surgeon.@*CONCLUSION@#Commercial medical 3D image-based engineering software has high acquisition costs that might be beyond the reach of most institutions. A sub-$1000 general purpose 3D modeling software can be used to create drill templates. Several factors were identified in the design and fabrication of the template that can be addressed to increase accuracy. Trajectory planning can also be improved by automating the process. The researchers recommend further studies in these areas specially in the context of developing 3D printing as a support service for surgical operations in the Philippines.

Minimally invasive spine surgery techniques in the ambulatory setting: Are they safe and effective?

@#<p style="text-align: justify;"><strong>Background:</strong> Minimally invasive spine surgical techniques (MISST) are associated with less intraoperative blood loss, shorter duration of surgery, and less post-operative pain. In the last two decades, MISST have been performed on an outpatient basis in developed countries but it is still performed primarily on an inpatient basis in the Philippines. This study aims to determine the safety and effectiveness of performing MISST in an ambulatory surgical center in the Philippines.</p><p style="text-align: justify;"><strong>Methods:</strong> A retrospective chart review of patients who underwent MISST in an ambulatory surgical center (ASC) in Manila, Philippines, from January 2014 to December 2018 was done. The different types of MISST were identified and analyzed as to patient demographic characteristics, anesthetic perioperative management, outcomes and complications.</p><p style="text-align: justify;"><strong>Results:</strong> Out of 337 patients included in the review, 8 types of MISST were identified. The average patient age was 55.61 years. Majority (98.2%) of the patients were classified as American Society of Anesthesiologists (ASA) physical status I or II. All patients had a statistically significant (p < 0.05) reduction in pain scores. ASC length of stay varied based on the complexity of the procedure ranging from 2.1 to 12.9 hours. There was a 0.89% incidence of surgery-related complications. Majority (94.4%) of the patients were discharged to home. There was no mortality.</p><p style="text-align: justify;"><strong>Conclusion:</strong> Even in a developing country, transitioning MISST from inpatient to the ambulatory setting can be performed with minimal complications and unplanned hospital admissions while still achieving significant pain reduction. The key elements include careful patient selection, close coordination between the anesthesia and spine surgical teams, and provision of multimodal analgesia.</p>

Dimensional Accuracy of 3D-printed Models of the Right First Metacarpal Bones of Cadavers

Background@#The use of 3D printing in medical education, prosthetics, and preoperative planning requires dimensional accuracy of the models compared to the replicated tissues or organs. Objective. To determine the dimensional accuracy of 3D-printed models replicated from metacarpal bones from cadavers. @*Methods@#Fifty-two models were 3D-printed using fused deposition modeling (FDM), stereolithography (SLA), digital light processing (DLP), and binder jetting method from 13 right first metacarpal bones of cadavers from the College of Medicine, University of the Philippines Manila. Six dimensional parameters of the 3D-printed models and their control bones were measured using 0.01 mm calipers — length, midshaft diameter, base width, base height, head width, and head height. Mean measurements were compared using non-inferiority testing and multidimensional scaling.@*Results@#Mean measurements of the 3D-printed models were slightly larger than their control bones (standard deviation range: 1.219-4.264; standard error range, 0.338-1.183). All models were found to be at least 90% accurate and statistically non-inferior compared to control bones. DLP-printed models were the most accurate (base width, 99.62 %) and most similar to their control bone (–0.05, 90% CI –0.34, 0.24). Through multidimensional scaling, DLP-printed models (coordinate = 0.437) were the most similar to the control bone (coordinate = 0.899).@*Conclusion@#The 3D-printed models are dimensionally accurate when compared to bones.