Considering a core curriculum for DSDs and gender identities-It is complicated.

In reading the published letter to the editor by Drs Venkatesh and Morris, they raise a number of points concerning educating students about developmental embryology, along with clinical (and presumably legal) considerations concerning individuals with DSDs or gender. Its publication is timely, given the recent debates in the wider medical community, and in public, following the publication of the Cass report, and the "WPATH files" (by Michael Shellenberger). While typical developmental embryology, and examples of variations, should rightly be included within the undergraduate curriculum (and has traditionally been taught pre-clinically by anatomists), establishing the extent to which diagnosis and management of DSDs and gender dysphoria should be included within modern undergraduate curricula is surely more appropriate for our specialist Clinical Colleagues to determine.

Exploring Visualisation for Embryology Education: A Twenty-First-Century Perspective.

Embryology and congenital malformations play a key role in multiple medical specialties including obstetrics and paediatrics. The process of learning clinical embryology involves two basic principles; firstly, understanding time-sensitive morphological changes that happen in the developing embryo and, secondly, appreciating the clinical implications of congenital conditions when development varies from the norm. Visualising the sequence of dynamic events in embryonic development is likely to be challenging for students, as these processes occur not only in three dimensions but also in the fourth dimensions of time. Consequently, features identified at any one timepoint can subsequently undergo morphological transitions into distinct structures or may degenerate and disappear. When studying embryology, learners face significant challenges in understanding complex, multiple and simultaneous events which are likely to increase student cognitive load. Moreover, the embryology content is very nonlinear. This nonlinear content presentation makes embryology teaching challenging for educators. Embryology is typically taught in large groups, via didactic lecture presentations that incorporate two-dimensional diagrams or foetal ultrasound images. This approach is limited by incomplete or insufficient visualisation and lack of interactivity.It is recommended that the focus of embryology teaching should instill an understanding of embryological processes and emphasise conceptualising the potential congenital conditions that can occur, linking pre-clinical and clinical disciplines together. A variety of teaching methods within case-based and problem-based curricula are commonly used to teach embryology. Additional and supplementary resources including animations and videos are also typically utilised to demonstrate complex embryological processes such as septation, rotation and folding.We propose that there is a need for embryology teaching in the twenty-first century to evolve. This is particularly required in terms of appropriate visualisation resources and teaching methodologies which can ensure embryology learning is relevant to real-world scenarios. Here we explore embryology teaching resources and methodologies and review existing evidence-based studies on their implementation and impact on student learning. In doing so, we aim to inform and support the practice of embryology educators and the learning of their students.

On the importance of integrating comparative anatomy and One Health perspectives in anatomy education.

As a result of many factors, including climate change, unrestricted population growth, widespread deforestation and intensive agriculture, a new pattern of diseases in humans is emerging. With increasing encroachment by human societies into wild domains, the interfaces between human and animal ecosystems are gradually eroding. Such changes have led to zoonoses, vector-borne diseases, infectious diseases and, most importantly, the emergence of antimicrobial-resistant microbial strains as challenges for human health. Now would seem to be an opportune time to revisit old concepts of health and redefine some of these in the light of emerging challenges. The One Health concept addresses some of the demands of modern medical education by providing a holistic approach to explaining diseases that result from a complex set of interactions between humans, environment and animals, rather than just an amalgamation of isolated signs and symptoms. An added advantage is that the scope of One Health concepts has now expanded to include genetic diseases due to advancements in omics technology. Inspired by such ideas, a symposium was organised as part of the 19th International Federation of Associations of Anatomists (IFAA) Congress (August 2019) to investigate the scope of One Health concepts and comparative anatomy in contemporary medical education. Speakers with expertise in both human and veterinary anatomy participated in the symposium and provided examples where these two disciplines, which have so far evolved largely independent of each other, can collaborate for mutual benefit. Finally, the speakers identified some key concepts of One Health that should be prioritised and discussed the diverse opportunities available to integrate these priorities into a broader perspective that would attempt to explain and manage diseases within the scopes of human and veterinary medicine.

Physician Associate Students' Experience of Anatomy Dissection.

The role of physician assistant/associate (PA) has expanded from its inception in the United States over 50 years ago, to European countries including Ireland. While there is an increasing body of evidence exploring the role and training of PAs in clinical settings, there is a scarcity of research exploring PA students' perspectives in relation to their experience of anatomy dissection, or how these experiences may contribute to the development of their core professional identity. Students in the first two cohorts of PA Program at the Royal College of Surgeons in Ireland program were invited to interviews which solicited them to reflect and report on their own experiences of anatomical dissection during their course. Participants' responses were analyzed using a thematic inductive approach; common themes and patterns were organized into a hierarchical structure, which generated the final framework of themes. Ten participants took part in the study; only one had previous personal experience of dissection, while two further participants had some familiarity with prosected specimens. The first theme concerned the participants' expectation of anatomical dissection, with sub-themes of preconceptions, smell, and emotions. The second theme involves discussion of coping strategies that the participants used, including talking, viewing the cadaver as their first patient, and naming (or not naming) the cadaver. The third theme includes how the participants' talked about respect and compassion in the dissection room, development of team working skills, and awareness of bereavement and organ donation. A number of recommendations were also made for the experience and orientation of future students in such a program.

The anatomical society core embryology syllabus for undergraduate medicine.

A modified Delphi methodology was used to develop a consensus regarding a series of learning outcome statements to act as the foundation of an undergraduate medical core embryology syllabus. A Delphi panel was formed by recruiting stakeholders with experience in leading undergraduate teaching of medical students. The panel (n = 18), including anatomists, embryologists and practising clinicians, were nominated by members of Council and/or the Education Committee of the Anatomical Society. Following development of an a priori set of learning outcome statements (n = 62) by the authors, panel members were asked in the first of a two-stage process to 'accept', 'reject' or 'modify' each learning outcome, to propose additional outcomes if desired. In the second stage, the panel was asked to either accept or reject 16 statements which had either been modified, or had failed to reach consensus, during the first Delphi round. Overall, 61 of 62 learning outcome statements, each linked to examples of clinical conditions to provide context, achieved an 80% level of agreement following the modified Delphi process and were therefore deemed accepted for inclusion within the syllabus. The proposed syllabus allows for flexibility within individual curricula, while still prioritising and focusing on the core level of knowledge of embryological processes by presenting the essential elements to all newly qualified doctors, regardless of their subsequent chosen specialty.

Learning Cardiac Embryology-Which Resources Do Students Use, and Why?

With increasing class sizes, small group activities for learning embryology are present in few institutions. How then do students supplement their lectures in order to ask and answer questions, or delve into concepts in detail? Arguably, animations and videos are ideal for visualizing four-dimensional anatomy, but how do students find and filter these? First-year medical students were surveyed with respect to the cardiac embryology component of their course and asked their opinions regarding the clinical relevance of this content and the resources they used to enhance learning. Students indicated that they considered cardiac embryology to be of relevance to clinical practice and that videos are a useful resource in helping them to learn this material. However, when seeking videos or resources, it emerged that students tended to Google information in preference to accessing online resources (or textbooks) specifically recommended by their instructor, despite students' recognition that "accuracy of information" was paramount when choosing what resource to use. While all students seemed reluctant to contact a staff member with questions, those with less proficiency in English were less likely to approach faculty for assistance. While acknowledging students as adult learners, self-regulated learning skills do not develop automatically and the development of these skills should be viewed as a "shared responsibility" between students and staff. Likewise, students also need to be taught critical appraisal of learning resources, especially in the complex online environment, with design of their bespoke institutional virtual learning environment facilitating easy identification and access of recommended resources.

Undergraduate Medical Students' Usage and Perceptions of Anatomical Case-Based Learning: Comparison of Facilitated Small Group Discussions and eLearning Resources.

While case-based discussions can empower students to apply knowledge to contextual clinical situations, scheduling these activities is a challenge in crowded curricula. Case-based eLearning activities, derived from existing cases discussed within anatomy small group tutorials, were created incorporating principles such as interactivity, reinforcement, and feedback. Over half of the students accessed one or more of these online cases, with 18% accessing all eight online cases provided. Access increased as the semester progressed, particularly just before summative examinations, implying students used these primarily as revision aides. Students rated both formats highly, but favored the online format with regard to enjoyment (P = 0.048), learning (P = 0.101), and feedback (P = 0.086). However, more students discussed these cases in small group tutorials within the anatomy dissecting room than completed them online (122 vs. 67) and themes emerging from free text comments included a desire to have more time dedicated to these cases during small group tutorials, and an appreciation for the opportunity for discussion with staff and learning through doing. Additionally, native English speakers rated the anatomy room discussions significantly higher in all aspects than non-native English speakers, suggesting that non-native speakers may be hesitant or reluctant to fully participate in front of peers. While online case-based learning activities are a useful adjunct to anatomy teaching, particularly for revision, assumptions that "digital natives" have an innate preference for digital resources require critical evaluation, as students still place a high value on opportunities for discussion with staff during their studies.

Evaluation of MCQs from MOOCs for common item writing flaws.

OBJECTIVE: There is a dearth of research into the quality of assessments based on Multiple Choice Question (MCQ) items in Massive Open Online Courses (MOOCs). This dataset was generated to determine whether MCQ item writing flaws existed in a selection of MOOC assessments, and to evaluate their prevalence if so. Hence, researchers reviewed MCQs from a sample of MOOCs, using an evaluation protocol derived from the medical health education literature, which has an extensive evidence-base with regard to writing quality MCQ items. DATA DESCRIPTION: This dataset was collated from MCQ items in 18 MOOCs in the areas of medical health education, life sciences and computer science. Two researchers critically reviewed 204 questions using an evidence-based evaluation protocol. In the data presented, 50% of the MCQs (112) have one or more item writing flaw, while 28% of MCQs (57) contain two or more flaws. Thus, a majority of the MCQs in the dataset violate item-writing guidelines, which mirrors findings of previous research that examined rates of flaws in MCQs in traditional formal educational contexts.

Laparoscopically assisted reversal of Hartmann's procedure revisited.

Reversal of Hartmann's procedure is a major operation, associated with substantial morbidity and mortality. In light of this, many patients elect not to undergo reversal (44-49%). In recent years, enthusiasm for laparoscopic reversal of Hartmann's procedure has increased, with the outcomes of many series suggesting that it has a reduced morbidity and mortality compared with the open procedure. We present our initial experience of four cases of laparoscopically assisted reversal of Hartmann's procedure and review the literature on this technique. Laparoscopic reversal was successful in all but one case. Literature review shows reduced postoperative hospital stay compared with the traditional, open approach and suggests that laparoscopic reversal is associated with lower morbidity and mortality rates. Laparoscopic reversal of Hartmann's procedure is feasible with potential advantages for the patient.