Form and Function: Learning Anatomy Using Ultrasound.

Ultrasound (US) is increasingly used across medical specialities as a diagnostic tool and medical faculties are therefore further incorporating imaging into their programmes. Using US within undergraduate instruction has several benefits. US, as a learning instrument, may strengthen existing anatomical knowledge and improve visual understanding of anatomy. The cost-effectiveness, as well as portability of the US, makes it a valuable means to add to traditional anatomy teaching modalities. Furthermore, students have an opportunity to develop skills in interpreting US images and this may add a different element to the learning of anatomy. This study aimed to explore undergraduate clinical anatomy students' perceptions of the use of US as an add-on to cadaveric dissection. Students were invited to participate in virtual focus group discussions. Three virtual focus group discussions were conducted, and 11 participants volunteered to take part. Thematic analysis of the data generated six themes. These are described as the study of living anatomy, learning cross-sectional anatomy, enhanced relevance of anatomy learning, increased interest in anatomy, instructional design, and the affective and technical experience of using US. The results suggest that it is feasible and advantageous to implement US sessions as an add-on to the teaching of anatomy during practical dissection sessions of clinical anatomy students. The use of innovative technologies such as US enhances the interest of students and allows them to develop dexterity and competencies in their learning process. Supplementary Information: The online version contains supplementary material available at 10.1007/s40670-023-01806-y.

Student-Perceived Value on the Use of Clay Modelling in Undergraduate Clinical Anatomy.

Clay modelling is increasingly used as an anatomy teaching method to supplement practical dissection sessions. The use of clay modelling is an active, tactile learning tool utilized to improve student engagement and enhance students' understanding of anatomical relationships in human anatomy. Furthermore, not only does clay modelling engage more senses in the learning process, but it was also found that there are educational advantages to the group interactions that are associated with the construction process to further collaborative learning.The aim of the study was to explore the effect of building anatomical clay models on students' awareness and understanding of their own thought processes as well as to explore whether clay modelling promoted collaborative learning. This cross-sectional study entailed the use of clay modelling and reflective practice to promote metacognition in third-year BSc students (n = 10), at the University of Stellenbosch's (SU) Division of Clinical Anatomy. The third-year BSc students were asked to build anatomical clay models (in groups), complete a reflective assignment and an evaluation form as part of their assessment of the Applied Anatomy module. The reflective assignment was based on Gibb's reflective cycle. The inclusion of such an assignment would trigger students to reflect upon their learning experiences and thus promote their metacognition.Ten (10) BSc students volunteered to take part in the study. A mixed method approach was followed; the reflective assignments were qualitatively analyzed, while the evaluation forms were quantitatively (statistically) analyzed. Data obtained from the online evaluation forms indicated agreeable responses confirming that the clay modelling was a valuable learning tool. However, the participants preferred cadaveric dissection instead of clay modelling to learn anatomy. Furthermore, three themes became prominent from the thematic analysis of the reflective assignments, namely, (1) Advantages of clay modelling, (2) Challenges of clay modelling, and (3) Suggestions for future practice.The research suggests that the inclusion of hands-on clay modelling in the undergraduate clinical anatomy is a valuable learning tool. The participants perceived that it enhanced their anatomical knowledge and improved collaborative learning.

Applying empathic communication skills in clinical practice: Medical students' experiences.

BACKGROUND: Studies have demonstrated that empathic communication improves patient outcomes and helps doctors to deliver accurate symptom reports and diagnoses. These benefits emphasise the need for medical students to apply empathic communication skills during their interactions with patients. Focussed empathic communication skill workshops were introduced into the undergraduate medical students' training at the Faculty of Medicine and Health Sciences, Stellenbosch University, South Africa. This study aimed to explore students' perceptions of applying these empathic communication skills during their clinical practice. We were interested in determining the factors that might influence the development of empathic communication skills. The findings could help curriculum developers to optimise these workshops for inclusion in a formal medical curriculum. METHODS: This study followed a qualitative, descriptive enquiry, exploring the perceptions of medical students through focus-group discussions. The students (N = 18) were selected using convenience sampling techniques. Recordings were transcribed, and the data were thematically analysed. RESULTS: The two main themes identified relate to the students and the clinical learning environment. The students valued the knowledge and skills they acquired. However, feelings of emotional vulnerability, a lack of language proficiency and inadequate role modelling were highlighted as challenges when applying empathic communication during clinical practice. CONCLUSION: The students reported positively on the workshops as these improved both their patient and personal interactions. However, for students to develop these skills further for clinical practice, they need more intentional and supervised opportunities to practise, reflect and receive constructive feedback. These learning opportunities could help medical schools deliver graduates who can competently communicate with their patients in an empathic manner.

Supervision interactions and student learning: how supervision can influence learning.

Background/Introduction: Supervision interactions are a central part of clinical education. The researcher explored and described the intricate construction of supervision interactions to better understand the influence thereof on student learning. Objectives: The aim of this study was to explore how Clinical Educators and physiotherapy students use supervision interactions toward student learning during clinical education. The perceptions and experiences of Clinical Educators and physiotherapy students were explored and described. Methodology: This study followed a qualitative research approach. The data were obtained by the researcher through semi-structured individual interviews with six students and four Clinical Educators. Themes were identified through thematic analysis. Results: Three themes that contributed to the construction of supervision interactions were developed as contextual, personal and relational elements. The consideration of these elements in supervision interactions influenced student learning and future relationships with patients. Conclusion: The emotionally attuned, effective leadership and management by Clinical Educators are fundamental in the construction of supervision interactions. Contextual, relational and personal elements should be considered in the construction of supervision interactions. Faculty should provide appropriate support to Clinical Educators, students and placements.

Exploring perspectives on health professions education scholarship units from sub-Saharan Africa.

INTRODUCTION: There has been a marked increase in institutional structures developed to support health professions education scholarship recently. These health professions education scholarship units (HPESUs) engage in a diverse range of activities. Previous work provided insight into factors that influence the functioning of such units, but data from European, Asian, Latin American, and African contexts was absent, potentially leading to a single world-view informing international standards for HPESUs. This aim of this study was to explore perspectives from sub-Saharan Africa (SSA) in response to this omission. METHODS: Situated within an interpretivist paradigm, the research team conducted semi-structured interviews with nine HPESU leaders in SSA, exploring how participants experienced and understood the functioning of their units. Despite efforts to have representation from across the region, most participants were from South Africa. The researchers analysed data thematically using the theory of institutional logics as an analytical frame. RESULTS: Several aspects of the HPESUs aligned with the previously identified logics of academic research, service and teaching; and of a cohesive education continuum. By contrast, leaders described financial sustainability as a more prominent logic than financial accountability. DISCUSSION: The similarities identified in this study may reflect isomorphism-a process which sees institutions within a similar field becoming more alike, particularly as newer institutions seek to acquire legitimacy within that field. An important caveat, however, is that isomorphism tends to occur across similar institutional contexts, which was not the case in this study. Understanding these differences is key as these HPESUs move to foster scholarship that can respond to the region's unique context.

Perceptions of physiotherapy clinical educators' dual roles as mentors and assessors: Influence on teaching-learning relationships.

BACKGROUND: Central to clinical education is the teaching-learning (T-L) relationship that evolves between the clinical educator (CE) and the student. Within this T-L relationship, CEs may be expected to fulfil dual roles as mentors and assessors of students. Challenges for both parties may arise when CEs take on these different roles. OBJECTIVES: The goal of this study was to ascertain how CEs perceived the influence of their dual roles as mentors and assessors on their T-L relationships with physiotherapy students. METHOD: Individual interviews were semi-structured with nine CEs during this qualitative descriptive study at the Division of Physiotherapy, Faculty of Medicine and Health Sciences, Stellenbosch University. A content analysis followed to analyse the data obtained. An iterative process, aimed to understand the phenomena under study, was conducted via an interpretive approach in context. This revealed main themes that were identified and refined. RESULTS: Clinical educators experienced challenges when their role changed from being a mentor to that of assessor. These challenges affected the learning of students, as they influenced the T-L relationship. Clinical educators experienced ambiguities regarding their dual roles and, as a result, their expectations were often not fulfilled. CONCLUSION: Students' learning processes were negatively affected by the changing roles of CEs, who acted as mentors and later as assessors of clinical competence during the students' clinical rotations. The positioning theory was offered as a framework to resolve the challenges created by the dual roles and to manage expectations between CEs and students. The T-L encounters could be enhanced if students and CEs aligned themselves to a learning-centred paradigm where the focus was on learning and where the needs of the diverse students and the expectations of CEs were balanced. Further research should explore how a workshop with role play, demonstrating to CEs in practice how to reposition themselves, would impact the relationships between both parties. CLINICAL IMPLICATIONS: It is essential to ensure a positive T-L relationship between a CE and a student as this will improve the quality of learning in the clinical environment and, therefore, directly influence student's patient management. Implementing faculty development programmes to address this, should be further explored. KEYWORDS: physiotherapy; clinical education; teaching-learning relationship; learning-centred; dual roles.

Transformative learning as pedagogy for the health professions: a scoping review.

CONTEXT: Transformative learning (TL) has been described as learning that challenges established perspectives, leading to new ways of being in the world. As a learning theory it has resonated with educators globally, including those in the health professions. Described as a complex metatheory, TL has evolved over time, eliciting divergent interpretations of the construct. This scoping review provides a comprehensive synthesis of how TL is currently represented in the health professions education literature, including how it influences curricular activities, to inform its future application in the field. METHODS: Arksey and O'Malley's six-step framework was adopted to review the period from 2006 to May 2018. A total of 10 bibliographic databases were searched, generating 1532 potential studies. After several rounds of review, first of abstracts and then of full texts, 99 studies were mapped by two independent reviewers onto the internally developed data extraction sheet. Descriptive information about included studies was aggregated. Discursive data were subjected to content analysis. RESULTS: A mix of conceptual and empirical research papers, which used a range of qualitative methodologies, were included. Studies from the USA, the UK and Australia were most prevalent. Insights relating to how opportunities for TL were created, how it manifests and influences behaviour, as well as how it is experienced, demonstrated much congruency. Conceptions of TL were seen to be clustered around the work of key theorists. CONCLUSIONS: The training of health professionals often takes place in unfamiliar settings where students are encouraged to be active participants in providing care. This increases the opportunity for exposure to learning experiences that are potentially transformative, allowing for a pedagogy of uncertainty that acknowledges the complexity of the world we live in and questions what we believe we know about it. TL provides educators in the health professions with a theoretical lens through which they can view such student learning.

Physiotherapy students' perceptions of the dual role of the clinical educator as mentor and assessor: Influence on the teaching-learning relationship.

BACKGROUND: Clinical education is widely considered to be the cornerstone of health care professionals' education. Clinical educators (CEs) fulfil many roles and act as both mentors and assessors in the learning process of students' undergraduate health care professions education. However, changing from being a mentor to being an assessor may present particular challenges for both the CE and the students. OBJECTIVE: To explore students' perceptions of how the dual role of a CE as mentor and assessor influenced the teaching-learning (T-L) relationship. METHOD: A qualitative descriptive study, involving seven individual semi-structured interviews and two focus group discussions, was conducted with students in the Division of Physiotherapy, Stellenbosch University. A contextualised interpretive content analysis was used to analyse the data. By following an iterative process, themes were identified and categories were reviewed and refined. RESULTS: Challenges were experienced when CEs had to act and change as both mentors and assessors to the needs of the students. This influenced the T-L relationship and consequently impacted the learning of students. The expectations of students and CEs were often not fulfilled. Contradictions were disclosed regarding the dual role of CEs. CONCLUSION: The findings of the study, grounded in the perceptions and experiences of students on the dual role of the CE, are highlighted. It is important to consider the challenges that the students face in order to minimise any negative effects these challenges could have on students' learning processes.

Refraction effects in soft x-ray multilayer blazed gratings.

A 2500 lines/mm Multilayer Blazed Grating (MBG) optimized for the soft x-ray wavelength range was fabricated and tested. The grating coated with a W/B4C multilayer demonstrated a record diffraction efficiency in the 2nd blazed diffraction order in the energy range from 500 to 1200 eV. Detailed investigation of the diffraction properties of the grating demonstrated that the diffraction efficiency of high groove density MBGs is not limited by the normal shadowing effects that limits grazing incidence x-ray grating performance. Refraction effects inherent in asymmetrical Bragg diffraction were experimentally confirmed for MBGs. The refraction affects the blazing properties of the MBGs and results in a shift of the resonance wavelength of the gratings and broadening or narrowing of the grating bandwidth depending on diffraction geometry. The true blaze angle of the MBGs is defined by both the real structure of the multilayer stack and by asymmetrical refraction effects. Refraction effects can be used as a powerful tool in providing highly efficient suppression of high order harmonics.

Branched isomeric 1,2,3-triazolium-based ionic liquids: new insight into structure-property relationships.

A series of four isomeric 1,2,3-triazolium-based ionic liquids (ILs) with vary degree of branching were synthesized and characterized to investigate the effect of ion branching on thermal and physical properties of the resulting IL. It was found that increased branching led to a higher ionicity and higher viscosity. The thermal properties were also altered significantly and spectral changes in the near edge X-ray absorption fine structure (NEXAFS) spectra show that branching affects intermolecular interaction. While the ionicity and viscosity varying linearly with branching, the MDSC and NEXAFS measurements show that the cation shape has a stronger influence on the melting temperature and absorptive properties than the number of branched alkyl substituents.

Modified bibenzimidazole ligands as spectator ligands in photoactive molecular functional Ru-polypyridine units? Implications from spectroscopy.

The photophysical properties of Ruthenium-bipyridine complexes bearing a bibenzimidazole ligand were investigated. The nitrogens on the bibenzimidazole-ligand were protected, by adding either a phenylene group or a 1,2-ethandiyl group, to remove the photophysical dependence of the complex on the protonation state of the bibenzimidazole ligand. This protection results in the bibenzimidazole ligand contributing to the MLCT transition, which is experimentally evidenced by (resonance) Raman scattering in concert with DFT calculations for a detailed mode assignment in the (resonance) Raman spectra.

High resolution protein localization using soft X-ray microscopy.

Soft X-ray microscopes can be used to examine whole, hydrated cells up to 10 microm thick and produce images approaching 30 nm resolution. Since cells are imaged in the X-ray transmissive "water window", where organic material absorbs approximately an order of magnitude more strongly than water, chemical contrast enhancement agents are not required to view the distribution of cellular structures. Although living specimens cannot be examined, cells can be rapidly frozen at a precise moment in time and examined in a cryostage, revealing information that most closely approximates that in live cells. In this study, we used a transmission X-ray microscope at photon energies just below the oxygen edge (lambda = 2.4 nm) to examine rapidly frozen mouse 3T3 cells and obtained excellent cellular morphology at better than 50 nm lateral resolution. These specimens are extremely stable, enabling multiple exposures with virtually no detectable damage to cell structures. We also show that silver-enhanced, immunogold labelling can be used to localize both cytoplasmic and nuclear proteins in whole, hydrated mammary epithelial cells at better than 50 nm resolution. The future use of X-ray tomography, along with improved zone plate lenses, will enable collection of better resolution (approaching 30 nm), three-dimensional information on the distribution of proteins in cells.

Automatic image acquisition, calibration and montage assembly for biological X-ray microscopy.

We describe a system for the automatic acquisition and processing of digital images in a high-resolution X-ray microscope, including the formation of large-field high-resolution image montages. A computer-controlled sample positioning stage provides approximate coordinates for each high-resolution subimage. Individual subimages are corrected to compensate for time-varying, non-uniform illumination and CCD-related artefacts. They are then automatically assembled into a montage. The montage assembly algorithm is designed to use the overlap between each subimage and multiple neighbours to improve the performance of the registration step and the fidelity of the result. This is accomplished by explicit use of recorded stage positions, optimized ordering of subimage insertion, and registration of subimages to the developing montage. Using this procedure registration errors are below the resolution limit of the microscope (43 nm). The image produced is a seamless, large-field montage at full resolution, assembled automatically without human intervention. Beyond this, it is also an accurate X-ray transmission map that allows the quantitative measurement of anatomical and chemical features of the sample. Applying these tools to a biological problem, we have conducted the largest X-ray microscopical study to date.

High resolution transmission soft X-ray microscopy of deterioration products developed in large concrete dams

In concrete structures, the reaction of certain siliceous aggregates with the highly alkaline concrete pore solution produces an alkali-silicate gel that can absorb water and expand. This reaction can lead to expansion, cracking, increased permeability, and decreased strength of the concrete. Massive concrete structures, such as dams, are particularly susceptible to the damage caused by the alkali-silica reaction because of the availability of water and because massive gravity dams usually do not contain steel reinforcement to restrain the expansion. Both the cement hydration products and alkali-silica reaction products are extremely sensitive to humidity. Consequently, characterization techniques that require high vacuum or drying, as many existing techniques do, are not particularly appropriate for the study of the alkali-silica reaction because artefacts are introduced. Environmental scanning electron micrographs and scanning electron micrographs with energy dispersive X-ray analysis results demonstrate the effect of drying on the morphology and chemical composition of the alkali-silicate reaction gel. Thus, the impetus for this research was the need to observe and characterize the alkali-silica reaction and its gel product on a microscopic level in a wet environment (i.e. without introducing artefacts due to drying). Only soft X-ray transmission microscopy provides the required high spatial resolution needed to observe the reaction process in situ. The alkali-silica reaction can be observed over time, in a wet condition, and at normal pressures, features unavailable with most other high resolution techniques. Soft X-rays also reveal information on the internal structure of the sample. The purpose of this paper is to present research, obtained using transmission soft X-ray microscopy, on the effect of concrete pore solution cations, namely sodium and calcium, on the product formed as a result of alkali attack. Alkali-silicate reaction (ASR) gel was obtained from the FURNAS Dam in Minas Gerais, Brazil. Images of the ASR gel in sodium hydroxide indicated dissolution and repolymerization of the silicate into a less dense form, demonstrating the expansive nature of the gel when exposed to alkalis. In the calcium hydroxide solution, ASR gel, silica fume, and chemical grade silica gel each reacted with the calcium ions in solution to produce a calcium silicate hydrate precursor with a lathlike, branching morphology. The distinctive spherulitic microstructure formed during this reaction was identified as the 'sheaf of wheat' morphology, previously described in the literature. In addition, the development of the sheaf of wheat morphology was documented over time. These results suggest that of the cations studied in this investigation, it is the alkalis in concrete pore solution that produce the expansive ASR gel, while reaction with calcium ions does not result in expansion or damage to the concrete structure. More broadly, these results demonstrate the advantage of transmission soft X-ray microscopy for the study of the alkali-silica reaction, indicating the value of this technique for further studies in concrete technology.

Imaging of humic substance macromolecular structures in water and soils

Humic substances (HSs) are the natural organic polyelectrolytes formed from the biochemical weathering of plant and animal remains. Their macromolecular structure and chemistry determine their role in biogeochemical processes. In situ spectromicroscopic evidence showed that the HS macromolecular structures (size and shape) vary as a function of HS origin (soil versus fluvial), solution chemistry, and the associated mineralogy. The HSs do not simply form coils in acidic or strong electrolyte solutions and elongated structures in dilute alkaline solutions. The macromolecular structural changes of HSs are likely to modify contaminant solubility, biotransformation, and the carbon cycle in soils and sediments.

X-ray microscopic visualization of specific labeling of adhesive molecule CD36 and cytoadherence by Plasmodium falciparum infected erythrocytes.

We investigated the cytoadherence of Plasmodium falciparum infected erythrocytes to target cells that express CD36 by soft x-ray microscopy. Using immunogold beads enhanced with silver, we localized CD36 on the surface of intact melanoma cells and throughout Triton extracted melanoma cells. We examined the orientation of parasites within erythrocytes that bound to target cells, and the interactions between the red cell membrane and the target cell, and we confirmed that fibrillar structures on the surface of melanoma and endothelial cells can be involved in the association between infected erythrocytes and melanoma cells or endothelial cells.

Resolution determination in X-ray microscopy: an analysis of the effects of partial coherence and illumination spectrum.

Determining the resolution of a zone plate X-ray microscope is a complicated issue, depending on many factors in addition to the quality of the optic. These include the degree of coherence of the illumination, the illumination spectrum, and the nature of the resolution test object. In this paper, we examine closely how the degree of coherence of the illumination affects the resolution as measured with three typical test patterns. In addition, we determine the extent to which the illumination spectrum affects the resolution. We compare X-ray microscope test images to numerical simulations as a function of coherence and illumination spectrum. We are able to conclude that in these experiments, the resolution of the X-ray microscope is 41 nm, or 40% discrepancy is due to aberrations in the objective zone plate lens.

Intracellular structures of normal and aberrant Plasmodium falciparum malaria parasites imaged by soft x-ray microscopy.

Soft x-ray microscopy is a novel approach for investigation of intracellular organisms and subcellular structures with high spatial resolution. We used x-ray microscopy to investigate structural development of Plasmodium falciparum malaria parasites in normal and genetically abnormal erythrocytes and in infected erythrocytes treated with cysteine protease inhibitors. Investigations in normal red blood cells enabled us to recognize anomalies in parasite structures resulting from growth under unfavorable conditions. X-ray microscopy facilitated detection of newly elaborated structures in the cytosol of fixed, unstained, intact erythrocytes, redistribution of mass (carbon) in infected erythrocytes, and aberrant parasite morphology. In cysteine protease inhibitor-treated, infected erythrocytes, high concentrations of material were detected in abnormal digestive vacuoles and aggregated at the parasite plasma membrane. We have demonstrated that an abnormal host erythrocyte skeleton affects structural development of parasites and that this aberrant development can be detected in the following generation when parasites from protein 4.1-deficient red blood cells infect normal erythrocytes. This work extends our current understanding of the relationship between the host erythrocyte membrane and the intraerythrocytic malaria parasite by demonstrating for the first time that constituents of the erythrocyte membrane play a role in normal parasite structural development.