Do we really need cadavers anymore to learn anatomy in undergraduate medicine?

With the availability of numerous adjuncts or alternatives to learning anatomy other than cadavers (medical imaging, models, body painting, interactive media, virtual reality) and the costs of maintaining cadaver laboratories, it was considered timely to have a mature debate about the need for cadavers in the teaching of undergraduate medicine. This may be particularly pertinent given the exponential growth in medical knowledge in other disciplines, which gives them valid justification for time in already busy medical curricula. In this symposium, the pros and cons of cadaver use in modern medical curricula were debated and audience participation encouraged.

Categorizing the distribution of the saphenous nerve in relation to the great saphenous vein.

Saphenous donor site neuralgia is a cause of morbidity post-coronary artery bypass surgery. Saphenous nerve damage during harvesting of the great saphenous vein is thought to be responsible. We dissected 37 cadaveric lower limbs from the knee fold to the dorsal venous arches, to study the spatial relations of the saphenous nerve and great saphenous vein to identify its distribution within the leg. Distribution of the saphenous nerve was categorized into Type A, where the nerve traveled inferiorly and split into an anterior and posterior branch during its course between the knee fold and medial malleolus, Type B, where the nerve traveled anterior to the vein with a small caliber branch traveling posteriorly at the proximal end, Type C where two main branches originated at the knee fold, one anterior to and one posterior to the vein. Overall the vein and nerve crossed in 27 out of the 37 cases (73%), occurring between 5 and 29 cm from the malleolus (60% occurred between 16 and 26 cm). In 32 (86%) of cases, the distal part of the nerve and vein were tightly adhered to each other within a common sheath. The length of adherence ranged from 3 to 26 cm with an average of 14 cm. The saphenous nerve is highly vulnerable during harvesting of the great saphenous vein due to its close relationship and crossing branches. Knowledge of the distribution categories of the nerve can help guide the surgeon to avoid damaging nerve branches during harvesting.

Can medical students teach? A near-peer-led teaching program for year 1 students.

The General Medical Council states that United Kingdom graduates must function effectively as educators. There is a growing body of evidence showing that medical students can be included as teachers within a medical curriculum. Our aim was to design and implement a near-peer-led teaching program in an undergraduate medical curriculum and assess its acceptability among year 1 students. Students received six tutorials focusing on aspects of cardiac, respiratory, and blood physiology. Tutorials ran alongside standard module teaching. Students were taught in groups of ~30 students/group, and an active teaching approach was used in sessions where possible. Using anonymous evaluations, student feedback was collected for the program overall and for each tutorial. The program was voluntary and open to all first-year students, and 94 (of 138) medical students from year 1 at Brighton and Sussex Medical School were recruited to the study. The tutorial program was popular among students and was well attended throughout. Individual tutorial and overall program quantitative and qualitative feedback showed that students found the tutorials very useful in consolidating material taught within the module. Students found the small group and active teaching style of the near-peer tutors very useful to facilitating their learning experience. The end-of-module written examination scores suggest that the tutorials may have had a positive effect on student outcome compared with previous student attainment. In conclusion, the present study shows that a near-peer tutorial program can be successfully integrated into a teaching curriculum. The feedback demonstrates that year 1 students are both receptive and find the additional teaching of benefit.

Radial nerve contribution to brachialis in the UK Caucasian population: position is predictable based on surface landmarks.

The midline of the brachialis muscle is now regarded by many surgeons as an internervous plane, between the musculocutaneous nerve supply to the medial portion and a radial nerve contribution to the lateral portion, a principle applied in anterior approaches to the humerus. The radial nerve to brachialis has been described previously in East Asian specimens (Ip and Chang, 1968, Anat Rec 162:363-371; Mahakkanukrauh and Somsarp, 2002, Clin Anat 15:206-209). We sought to investigate the occurrence and character of this nerve in the UK Caucasian population. Dissection of the musculocutaneous nerve and radial nerve was carried out in Caucasian cadaveric arms (n = 42). The radial nerve was dissected from the spiral groove to the lateral epicondyle. Where a branch to brachialis was encountered, its course and level of origin relative to the length of the arm were noted. The musculocutaneous nerve innervated the brachialis in all specimens. Upon investigation 67% of specimens were found to have a radial nerve branch to brachialis. Sixty-one percent of these branches went straight into the muscle, 13% descended, and 26% recurred. The level of origin of the radial nerve branch to brachialis was at a mean of 23% of the distance between the lateral epicondyle and the acromion (n = 31, range 17-37%, SD = 5.3). In three specimens, two branches were observed. A radial nerve contribution to the innervation of the brachialis was present in 67% of UK Caucasian cadavers, which is less than that noted by others in East Asian specimens. The level of the origin of these branches is predictable based on surface landmarks. This fact may be of use during humeral surgery.

Craniofacial development: the tissue and molecular interactions that control development of the head.

The molecular cascades that control craniofacial development have until recently been little understood. The paucity of data that exists has in part been due to the complexity of the head, which is the most intricate regions of the body. However, the generation of mouse mutants and the identification of gene mutations that cause human craniofacial syndromes, together with classical embryological approaches in other species, have given significant insight into how the head develops. These studies have emphasized how unique the head actually is, with each individual part governed by a distinct set of signalling interactions, again demonstrating the complexity of this region of the body. This review discussed the tissue and molecular interactions that control each region of the head. The processes that control neural tube closure together with correct development of the skull, midline patterning, neural crest generation and migration, outgrowth, patterning, and differentiation of the facial primordia and the branchial arches are thus discussed. Defects in these processes result in a number of human syndromes such as exencephaly, holoprosencephaly, musculoskeletal dysplasias, first arch syndromes such as Riegers and Treacher-Collins syndrome, and neural crest dysplasias such as DiGeorge syndrome. Our current knowledge of the genes responsible for these human syndromes together with how the head develops, is rapidly advancing so that we will soon understand the complex set of molecular and tissue interactions that build a head.