Living and post-mortem CT scans in the gross anatomy lab: A study investigating differences in first-year medical students' exam performance and perceptions.

Basic competency in radiological imaging is essential for physicians to identify and manage diseases. An optimal place in which to include imaging in the medical curriculum is during anatomy as students can correlate the 3D anatomy from their body donors with the 2D cross-sectional anatomy. The goal of this project was to enhance first-year medical students' knowledge of cross-sectional imaging in the gross anatomy lab and to investigate whether there are benefits to learning cross sectional imaging via scans from body donors versus living individuals. Student participant performance was evaluated on laboratory practical examinations, CT image questions and spatial anatomical knowledge in the thorax and abdomen sections of gross anatomy. Students learned the cross-sectional imaging during dissections where they accessed the images relevant to their study on Pacsbin, a web-based Digital Imaging and Communication in Medicine viewer, via iPads. Results showed no statistically significant differences in practical examination scores, spatial anatomical knowledge, or identification of anatomical structures on CT image questions between participants who learned from images on body donors versus living individuals. In a questionnaire given at the end of the course, participants cited that the CT images improved their anatomical and imaging knowledge and that they felt better prepared to use imaging software and interpret diagnostic imaging results upon entering clerkships. While there were no differences in academic performance between the groups, positive outcomes regarding student perceptions of anatomical and imaging knowledge and preparedness for use of imaging software were identified in this study.

Virtual peer teaching in the gross anatomy lab: a format of peer teaching and learning during the COVID-19 pandemic.

Background: Peer teaching is a powerful educational tool utilized in medical school curricula. Previously, first year medical students taught their peers about the gross anatomical structures they had dissected in the anatomy lab. While this strategy provided an opportunity for students to learn from one another, there were unintended outcomes including difficulty engaging all students. Considering these observations, along with needing to limit student numbers in the lab due to the coronavirus disease 2019 (COVID-19) pandemic, a strategy was developed where students could conduct their anatomy peer teaching in a virtual environment. The goal was to establish an effective and efficient means for students to teach and learn from one another virtually. Methods: Students, working in groups of four, were tasked to: 1) Find and label 4-5 assigned structures on cadaver-based images; 2) Provide a rationale for labeling; 3) Discuss something relevant about the structure; 4) Prepare a 5-minute video presentation of steps 1-3; and 5) Review and provide meaningful feedback on another group's presentation. Student performance on virtual peer teaching assignments was evaluated using a structured rubric and grades were weighted based on two separate faculty assessments.  Student feedback was obtained via discussions with the course director, a semi-structured 1-hour virtual focus interview and from course evaluation data. Results: While students performed well on these assignments, feedback from students indicated several drawbacks such as excess time editing their videos, concerns about the validity of information provided by their peers, and the timing of peer teaching to be non-conducive to learning. Conclusions: Although the students viewed the virtual peer teaching negatively, we were successful in developing a platform in which students participated more equally in peer teaching. Recommendations to those considering this platform include careful consideration of timing of peer teaching activities and faculty feedback as well as technology used.

Engineering approaches for investigating tumor angiogenesis: exploiting the role of the extracellular matrix.

A major paradigm shift in cancer research is the emergence of multidisciplinary approaches to investigate complex cell behaviors, to elucidate regulatory mechanisms and to identify therapeutic targets. Recently, efforts are focused on the engineering of complex in vitro models, which more accurately recapitulate the growth and progression of cancer. These strategies have proven vital for investigating and targeting the events that control tumor angiogenesis. In this review, we explore how the emerging engineering approaches are being used to unlock the complex mechanisms regulating tumor angiogenesis. Emphasis is placed on models using natural and synthetic biomaterials to generate scaffolds mimicking the extracellular matrix, which is known to play a critical role in angiogenesis. While the models presented in this review are revolutionary, improvements are still necessary and concepts for advancing and perfecting engineering approaches for modeling tumor angiogenesis are proposed. Overall, the marriage between disparate scientific fields is expected to yield significant improvements in our understanding and treatment of cancer.

Breast cancer cell-derived matrix supports vascular morphogenesis.

The extracellular matrix (ECM), important for maintaining tissue homeostasis, is abnormally expressed in mammary tumors and additionally plays a crucial role in angiogenesis. We hypothesize that breast cancer cells (BCCs) deposit ECM that supports unique patterns of vascular morphogenesis of endothelial cells (ECs). Evaluation of ECM expression revealed that a nontumorigenic cell line (MCF10A), a tumorigenic cell line (MCF7), and a metastatic cell line (MDA-MB-231) express collagens I and IV, fibronectin, and laminin, with tenascin-C limited to MCF10A and MCF7. The amount of ECM deposited by BCCs was found to be higher in MCF10A compared with MCF7 and MDA231, with all ECM differing in their gross structure but similar in mean fiber diameter. Nonetheless, deposition of ECM from BCC lines was overall difficult to detect and insufficient to support capillary-like structure (CLS) formation of ECs. Therefore, a coculture approach was undertaken in which individual BCC lines were cocultured with fibroblasts. Variation in abundance of deposited ECM, deposition of ECM proteins, such as absent collagen I deposition from MDA231-fibroblast cocultures, and fibril organization was found. Deposited ECM from fibroblasts and each coculture supported rapid CLS formation of ECs. Evaluation of capillary properties revealed that CLS grown on ECM deposited from MDA231-fibroblast cocultures possessed significantly larger lumen diameters, occupied the greatest percentage of area, expressed the highest levels of von Willebrand factor, and expressed the greatest amount of E-selectin, which was upregulated independent of exposure to TNF-α. To our knowledge, this is the first study to report tumor cell ECM-mediated differences in vascular capillary features, and thus offers the framework for future investigations interrogating the role of the tumor ECM in supporting vascular morphogenesis.