Anatomy education in low-resourced countries: What are challenges and effective and affordable educational strategies? A qualitative study.

PURPOSE: With limited means, resource-deprived countries must find ways to organize education to meet standards. Few reports exist about anatomical education in LLMICs. This study explores how anatomy teaching is sustained in countries with few resources and which affordable educational strategies are applied to uphold quality. METHODS: A mixed-methods study with anatomy teachers from public medical schools in low or lower-middle income countries (LLMICs) in Africa, Asia, Europe, and Latin-American was performed through survey via email combined with semi-structured online interview with teachers, exploring survey results at a deeper level. RESULTS: LLMICs available to be surveyed, 13 and 8 were found to respond to a written survey and oral interview invitation, face significant teaching challenges, primarily due to lack of funds. These are faculty shortages (low salaries and high student-to-teacher ratio) and inadequate infrastructure (internet, electricity, poor classroom conditions). Solutions were associated with didactic strategies (social media, e-learning, image-based learning, applied anatomy), expanding teaching capacity with less qualified and part-time faculty, student-organized education, and self-financing (teaching resources subsidized by teachers and students). Which was triking was teacher commitment despite difficult circumstances. Teachers propose better faculty management, increased anatomy staff recruitment, and collaboration with other institutions. CONCLUSIONS: Anatomical education in LLMIC is forced to adapt to the socio-economic context, rather than to trends in medical education worldwide. These adaptations are supported mainly by the teachers 'commitment.'

Are We Facing the End of Gross Anatomy Teaching as We Have Known It for Centuries?

The status of anatomy education in undergraduate medical education has dramatically changed over the course of the past century. From the most important and time-consuming component of the preclinical program, anatomy education has reduced in size and status, and yielded in curricular space to accommodate other disciplines and topics. Meanwhile, radiology has become more prominent, as a means to visualize anatomy, not only in clinical care but also in education. For this perspective paper, the authors, all with backgrounds in anatomy, radiology and/or medical education, conducted structured conversations with several academic colleagues with similar backgrounds, reviewed pertinent literature and analyzed the causes of the historical decline of a knowledge domain of medical education, that nevertheless is widely considered essential for medical students and graduates. After this analysis, the authors propose four ways forward. These directions include systematic peer teaching and development of anatomy education as a scholarly domain, further vertical integration with postgraduate medical education, full integration with radiology education, and capitalizing on educational technology. Schools in several industrialized countries have made steps in these directions, which can be further strengthened. In less affluent countries, and in countries with curricula strongly determined by tradition, these steps are less easy to make. To respond to changes in global health and health care, combined with the inevitable technological progress, and international mobility, we believe all schools will move in these directions, slower or faster.

Approaches of anatomy teaching for seriously resource-deprived countries: A literature review.

Background: Teaching anatomy is an important but expensive part of the medical curriculum, potentially more than many countries can afford. In the search for efficient methods, cost-effectiveness is of utmost importance for such countries. The aim of this contribution is to provide a review of the literature on anatomy teaching methods, evaluating these for feasibility in resource-deprived countries. Methods: A literature review was carried out to identify distinct approaches to anatomy teaching published in the period 2000-2014, using the databases of PubMed, Wiley Online Library, Elsevier, HINARI, Springer, and ERIC. The approaches found were compared against their conceptual, operational, technical, and economic feasibility and Mayer's principles of effective instruction. Results: Our search yielded 432 papers that met the inclusion criteria. We identified 14 methods of teaching anatomy. Based on their conceptual feasibility, dissection and technology enhanced learning approaches appeared to have more benefits than others. Dissection has, besides benefits, many specific drawbacks. Lectures and peer teaching showed better technical and economic feasibility. Educational platforms, radiological imaging, and lectures showed the highest operational feasibility. Dissection and surgery were found to be less feasible with regard to operational, technical, and economic characteristics. Discussion: Based on our findings, the most important recommendations for anatomy teaching in seriously resource-deprived countries include a combination of complementary strategies in 3 different moments, lecturing at the beginning, using virtual learning environment (for self-study), and at the end, using demonstration through prosected specimens and radiological imaging. This provides reasonable insights in anatomy through both dead and living human bodies and their virtual representations.

Does an Additional Online Anatomy Course Improve Performance of Medical Students on Gross Anatomy Examinations?

AIM: An online learning course in anatomy was added to the regular academic anatomy course in the 2nd year of medicine at UNAN-Leon in Nicaragua, using the MOODLE platform. This study aims to determine the learning effect of this course. METHOD: Second-year medical students were randomly allocated to an experimental (N = 25) and control group (N = 50). Only the experimental group had access to the online learning module. We compared the performance of the experimental and the control group on both regular anatomy assessment and an objective structured practical exam (OSPE). Additionally, five focus groups were interviewed to learn about their experiences of the expanded course. RESULTS: Of students in the experimental group 94.1% and 81.6% of students in the control group took the OSPE. The experimental group significantly outperformed the control group (41.1 ± 19.3 points vs. 32.1 ± 23.1 points) on the OSPE. No differences between the two groups were found on the regular anatomy examination. Focus group interviews revealed students' opinions about the online course were generally positive. CONCLUSION: In general, the addition of an online course to the regular course was beneficial. The results of the qualitative evaluation of this intervention provides us with input about how to teach and evaluate the anatomy course and how to further improve the online course to enhance anatomy learning.

Correction to: Does an additional online anatomy course improve performance of medical students on gross anatomy examinations?

[This corrects the article DOI: 10.1007/s40670-019-00751-z.].

Mistranslation and genetic variability: the effect of streptomycin.

Streptomycin is an aminoglycoside antibiotic that acts at the level of protein synthesis. Exposure to sublethal concentrations of this antibiotic increased significantly the number of Arg+ mutants derived from an Escherichia coli argE3 (ochre) rpsL31 (streptomycin-resistant) strain. The vast majority of these mutants appeared on selective minimal medium plates with streptomycin (200 micro g/ml) during stationary phase, after 6-10 days incubation at 37 degrees C. Derivative mutD5 or mutL or mutS mutants, carrying a faulty epsilon subunit of DNA polymerase or a defective mismatch DNA-repair protein, respectively, also showed higher numbers of Arg+ mutants on selective medium with streptomycin than on medium without streptomycin. Interestingly, with these DNA-repair mutants about 50% of the Arg+ mutants generated in the presence of streptomycin appeared during the first 5 days of incubation. These observations suggest that the activities of these fidelity-repair proteins prevent in the parental strain the early appearance of the supernumerary Arg+ mutants on the selective medium with streptomycin. The appearance of Arg+ mutants on the plates with streptomycin was not significantly altered by recA, rpoS or dps mutations. A high percentage of the Arg+ mutants arising in the presence of streptomycin were streptomycin-dependent for growth without arginine (Arg+ St-D). These types of mutants displayed a Ram (for ribosomal ambiguity) phenotype, manifested by increased misreading, assayed by in vitro and in vivo experiments and by leakiness on several selective minimal media. Genetic data indicated that these mutants carry a mutation located at about 74 min of the E.coli map that relieves the high translational fidelity conferred by the rpsL mutation. These studies suggest that the growth-limiting conditions of the assay system used, as well as the presence of streptomycin, which causes an increased production of altered proteins, favours the appearance and growth of compensatory Arg+ mutants.

On the participation of RecB in the induction of mini-Tn10 precise excision in a dnaB thermosensitive mutant.

Precise excision of transposons Tn10 and mini-Tn10 is increased in the dnaB252 thermosensitive mutant of Escherichia coli K12, at the permissive temperature. DNA repair proteins like Pol II, RecF, Ruv and RecA were found to participate, to different extents, in this induced excision event. In this work we report that DNA repair-recombination protein RecBCD has a predominant role in this deletion process. The role of this and other repair proteins in DNA replication of the dnaB mutant in relation to the excision of the transposon is analyzed.

Studies on the expression of regulatory locus sae in Staphylococcus aureus.

Global regulatory locus sae consists of a two-component signal transduction system coded by saeR and saeS genes that upregulates the transcription of several exoproteins. Northern analysis carried out in this study reveals the synthesis at late and post-exponential phases of a cotranscript of saeR and saeS structural genes of about 2.4 kb. This transcript is diminished in the isogenic agr:: tetM mutant. Likewise, transcriptional fusion experiments show that sae expression is downregulated in the agr null mutant. Complementation analyses with plasmids carrying fragments of about 1.2 or 0.2 kbp upstream of saeR-saeS genes, which restore fully or only partially, respectively, the wild-type phenotype to the sae mutant, are in agreement with two initiation start points of transcription revealed by primer extension experiments. This work, as well as previous studies, reveals a complex hierarchical regulatory network involving several loci that control the expression of virulence determinants in S. aureus.

Participation of DNA polymerase II in the increased precise excision of Tn10.

In this work the involvement of polymerase II (Pol II) in the precise excision of Tn10 stimulated by a dnaB252 thermosensitive (Ts) mutant at the permissive temperature, by a uvrD mutant, or by mitomycin C (MMC) or ultraviolet (UV) light treatment, was investigated. A deltapolB::kan mutant showed a significant decrease in the excision of Tn10 induced by the dnaB mutation, or by MMC or UV treatment, indicating the participation of Pol II in this type of deletion process. However, no effect of Pol II was evidenced in the excision of Tn10 stimulated by the uvrD mutation. The effect of the polB mutation on Tn10 precise excision induced by all these treatments was compared to that of mutations in repair-recombination genes recF and recA. The results reveal that the degree of participation of these genes varies depending on the agent that stimulates the deletion event.