The legal and ethical frameworkgoverning Body Donation in Europe - Areview of current practice andrecommendations for good practice

Discussions at the inaugural meeting of aTrans-European Pedagogic Research Group forAnatomical Sciences highlighted the fact thatthere exist considerable variations in the legaland ethical frameworks throughout Europeconcerning body bequests for anatomicalexamination. Such differences appear to reflectcultural and religious variations as well as differentlegal and constitutional frameworks. Forexample, there are different views concerningthe “ownership” of cadavers and concerningthe need (perceived by different societies andnational politicians) for legislation specificallyrelated to anatomical dissection. Furthermore,there are different views concerning the acceptabilityof using unclaimed bodies that have notgiven informed consent. Given that in Europe (AU)

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How much anatomy is enough?

Innovations in undergraduate medical education, such as integration of disciplines and problem based learning, have given rise to concerns about students' knowledge of anatomy. This article originated from several studies investigating the knowledge of anatomy of students at the eight Dutch medical schools. The studies showed that undergraduate students uniformly perceived deficiencies in their anatomical knowledge when they started clinical training regardless of their school's didactic approach. A study assessing students' actual knowledge of clinical anatomy revealed no relationship between students' knowledge and the school's didactic approach. Test failure rates based on absolute standards set by different groups of experts were indicative of unsatisfactory levels of anatomical knowledge, although standards differed markedly between the groups of experts. Good test performance by students seems to be related to total teaching time for anatomy, teaching in clinical context, and revisiting anatomy topics in the course of the curriculum. These factors appeared to outweigh the effects of disciplinary integration or whether the curriculum was problem-based or traditional.

Do students have sufficient knowledge of clinical anatomy?

INTRODUCTION: Comparisons of anatomy knowledge levels of students from various curricula show either no differences or small differences to the detriment of innovative schools. To pass judgement on the general level of students' anatomy knowledge, we need an absolute standard. The purpose of this study was to compare students' levels of anatomy knowledge as measured by a case-based anatomy test with standards set by different groups of experts. METHODS: A modified Angoff procedure was used to establish an absolute standard against which the students' results could be evaluated. Four panels of 9 anatomists, 7 clinicians, 9 recent graduates and 9 Year 4 students, respectively, judged 107 items of an anatomy test. The students' results on these items were compared with the standards obtained by the panels. RESULTS: If the standard established by the panel of Year 4 students was used, 64% of the students would fail the test. The standards established by the anatomists, clinicians and recent graduates would yield failure rates of 42%, 58% and 26%, respectively. CONCLUSION: According to the panels' standards, many students did not know enough about anatomy. The high expectations that the Year 4 students appeared to have of their peers may contribute to students' uncertainty about their level of anatomy knowledge.

Does problem-based learning lead to deficiencies in basic science knowledge? An empirical case on anatomy.

INTRODUCTION: Problem-based learning (PBL) is supposed to enhance the integration of basic and clinical sciences. In a non-integrative curriculum, these disciplines are generally taught in separate courses. Problem-based learning students perceive deficiencies in their knowledge of basic sciences, particularly in important areas such as anatomy. Outcome studies on PBL show controversial results, sometimes indicating that medical students at PBL schools have less knowledge of basic sciences than do their colleagues at more traditional medical schools. We aimed to identify differences between PBL and non-PBL students in perceived and actual levels of knowledge of anatomy. METHODS: Samples of Year 4 students in all eight medical schools in the Netherlands completed a questionnaire on perceived knowledge and took part in a computerised anatomy test consisting of both clinically contextualised items and items without context. RESULTS: Problem-based learning students were found to have the same perceived level of anatomy knowledge as students at other medical schools. Differences in actual levels of knowledge were found between schools. No significant effects on knowledge levels were found for PBL schools versus non-PBL schools. CONCLUSION: The results of this study show that PBL does not result in a lower level of anatomy knowledge than more traditional educational approaches. It remains to be ascertained whether the levels students attain are adequate. Subjects for further study are the desired level of anatomy knowledge at the end of undergraduate medical education and the effectiveness of basic science learning within a clinical context and with repetition over the course of the curriculum.

The effect of footrests on sitting balance in paraplegic subjects.

OBJECTIVE: To test the hypothesis that footrests contribute to active control of sitting balance. DESIGN: Cross-sectional group study. SETTING: Rehabilitation center. PARTICIPANTS: Ten persons with complete low thoracic (T9-12) spinal cord injury (SCI), 10 persons with complete lumbar (L1-5) SCI, and 10 matched able-bodied controls. INTERVENTION: An elastically suspended footrest. MAIN OUTCOME MEASURES: Reaching distance, time needed to perform a bimanual forward-reaching movement, center of pressure displacement, and muscle activity. RESULTS: Controls performed the forward-reaching movement slower and with less forward acceleration of the center of mass (COM) in the chair with the elastic footrest. Furthermore, they revealed a typical change in muscle activity patterns when the solid footrest was replaced by the elastic one. Persons with SCI performed the forward-reaching movement equally fast in both footrest conditions, but those with lumbar SCI showed less forward acceleration of the COM, whereas persons with thoracic SCI revealed more forward acceleration of the COM in the chair with the elastic footrest. Muscle activity patterns in persons with SCI did not indicate alternative muscle use through possible compensations or reflex activity. CONCLUSIONS: Regarding wheelchair design, footrest condition does not seem to affect the range in which manual activities of daily living can be performed, but it does affect how they are performed.