Pedagogical principles used by anatomy teachers to facilitate the teaching and learning of anatomy to physiotherapy undergraduates in the United Kingdom.

The teaching of anatomy for physiotherapy differs from other health professions, and yet there is lack of guidance for the best practice in the literature, especially within the United Kingdom (UK). The present study aimed to provide the most effective pedagogical guidance for teaching a typical anatomy curriculum for a three-year BSc Physiotherapy degree program within the UK. The research design used a constructivist grounded theory where semi-structured interviews were conducted with eight registered physiotherapists teaching anatomy to undergraduate physiotherapy students within the UK. The study generated 72,292 words of qualitative data that were thematically analyzed using Saldaña's coding techniques until data saturation was reached. The results had three main components: a pedagogical backdrop composed of five pedagogical issues, pedagogical approaches with its three sub-components and pedagogical timings of phases of when anatomical teaching was conducted across the three undergraduate physiotherapy degree programs. The cognitive load theory (CLT) best explained the results through five main pedagogical principles: spiral curriculum strategies, visual anatomical imagery, kinesthetic anatomical skills, strategies for teaching clinical physiotherapy anatomy, and using anatomical principles for metacognition. The study proposes a new modified version of CLT which acknowledges that newly acquired knowledge is fragile in novice learners, who have limited long-term memory capacities, and subsequently require regular revisitations, and also acknowledges kinesthetic input and germane cognitive load metacognition strategies. The study recommends appointing anatomy theme leads to take responsibility for the spiral curriculum approach across the 3 years and to introduce explicit anatomy teaching during the later clinical years.

A proposed anatomy syllabus for entry-level physiotherapists in the United Kingdom: A modified Delphi methodology by physiotherapists who teach anatomy.

The ever-increasing scope of physiotherapy practice is raising questions on what anatomical knowledge and skills ought to be taught within qualifying physiotherapy degree programmes in the United Kingdom (UK). The aim of the study was to create core anatomical knowledge and skills learning objectives to inform knowledge and skills for entry-level physiotherapists in the UK. A two phased modified Delphi methodology created a consensual anatomy curriculum. A Research-Team-Expert-Panel of four physiotherapists who teach anatomy proposed Anatomy Learning Objectives (Anat-LOs) and accompanying clinical rationales relevant for newly qualified entry-level physiotherapists. A Teacher-Expert-Panel of nine physiotherapists who taught anatomy to physiotherapy students in the UK reviewed Anat-LOs in two consecutive Delphi Rounds, and rated and commented on each Anat-LO. After each Delphi Round, the Research-Team-Expert-Panel reviewed the ratings and comments from the Teacher-Expert-Panel and banked Anat-LOs that passed the 85% acceptance threshold. There were 182 banked Anat-LOs that spanned all eight areas: Introductory Concepts, Principles and Basic Histology; Head and Neck; Thorax; Abdomen, Pelvis and Perineum; Upper Limb; Lower Limb; Spine; and Neuroanatomy regions/systems. The Anat-LOs develop both anatomical knowledge and key anatomical skills, such as palpation and conducting manual tests on model patients. A first ever core anatomy curriculum for entry-level physiotherapists has been created for entry-level physiotherapists, typically Band-5 NHS physiotherapists, and takes an integrated learning approach. The anatomy curriculum brings clarity to students, teachers, clinical supervisors and future employers on the expected anatomical standards for entry-level physiotherapists.

The reliance on unclaimed cadavers for anatomical teaching by medical schools in Africa.

The study of gross Anatomy through the use of cadaveric dissections in medical schools is an essential part of the comprehensive learning of human Anatomy, and unsurprisingly, 90% of the surveyed medical schools in Africa used cadaveric dissections. Donated cadavers now make up 80% of the total cadavers in North American medical schools and all the cadavers used for dissection in the United Kingdom are donated. Because the sources of cadavers used in Africa are not clearly known, a questionnaire to gather information on cadavers used at medical schools was designed from the relevant literature and was sent by electronic mail to 123 Anatomy lecturers in 23 African countries (48 medical schools). Fourteen lecturers from 14 medical schools in ten countries responded to the questionnaires. The results indicate that, in most countries, the cadavers are unclaimed bodies from the hospitals and prisons, and the bodies of dead bandits. In South Africa and Zimbabwe, the donations are mostly from the white community, and medical school in the Islamic country of Libya is importing cadavers from India. The lack of knowledge about body donation programes and firmly held cultural and religious burial traditions may explain the lack of bequests from black communities. The use of unclaimed bodies may disproportionally affect people who were homeless and poor, criminals, people with fewer social links, and social outcasts. The Anatomy lecturers felt that there should be broader national awareness programes for body donations, although the benefits of this could take decades to materialize.

A mental hook for learning the three-dimensional anatomy of the sphenoid bone: an angelic resemblance.

The sphenoid bone seems to resemble a biblical angel. The angel had six wings, and used two to cover the eyes (lesser wings with optic canal representing the eyes), two to fly (greater wings), and two (broad lateral pterygoid plates) to cover the feet (medial pterygoid plates with hamulus). This illustration may help surgical trainees to conceptualise and understand the clinical implications of this wide-ranging bone.

The frequency of absence of palmaris longus in a South African population of mixed race.

The palmaris longus (PL) is a weak flexor of the wrist that may be harvested as a tendon graft and used in surgical procedures for reconstructive purposes. The PL is congenitally absent in 15% of the worldwide population. However, the frequency of absence varies considerably among different population groups, being as high as 63.9% in the Turkish population and as low as 3% in the black population in the Republic of Congo. In this study, South African persons of mixed race (n = 201) were assessed by two anatomists for the presence of the PL tendon using three clinical tests, namely the Traditional Test, Mishra's Test II, and the Gangata Test. The most reliable of the three tests used was determined using Kendall's coefficient of concordance. Of the total number of subjects used, 11.5% had absence (either bilaterally or unilaterally) of the PL tendon. There was a 5.5% bilateral absence of the PL. The study revealed that the PL tendon may present in six different patterns according to the clinical assessment tests applied, the presence or absence of the PL alongside the flexor capi radialis, and the degree of prominence of PL, if present. Using the Kendall's coefficient of concordance, the Mishra's Test II, and the Gangata Test, both involving abduction of the thumb, were found to be most effective in revealing the PL. The frequency of absence of the PL in South Africans of mixed race has been determined.

The contribution of the palmaris longus muscle to the strength of thumb abduction.

The palmaris longus muscle (PLM) is described as a weak flexor of the wrist and a tensor of the palmar aponeurosis, but not a thumb abductor. The PLM is believed to aid thumb abduction through its insertion onto the thenar eminence. Two groups, both right hand dominant, were selected from 1,200 sampled participants. The first group comprised of 38 subjects with unilateral presence of the PLM and was used to determine the strength of thumb abduction. The second group comprised of 30 subjects, with bilateral presence of the PLM, and it was used to calculate the effects of hand dominance. A significant number of subjects with bilateral absence of the PLM were observed and undocumented. Using a dynamometer in subjects with unilateral presence of the PLM, the force of thumb abduction was significantly greater on the hand with a PLM than the one without it (P = 0.014), irrespective of hand dominance. In the second sample with bilateral PLM, thumb abduction on the dominant hand was 10% stronger than on the nondominant hand and was similar to the universally accepted average of 10% increase in grip strength of the dominant hand. Thus, 10% was deducted from all the dominant hands, and the force of thumb abduction remained greater on the hand with PLM than the hand without it (P = 0.049). The results of this study demonstrated the PLM to be involved in thumb abduction, and the authors therefore recommend that this action of the muscle be universally accepted by anatomists and hand surgeons.

The clinical surface anatomy anomalies of the palmaris longus muscle in the Black African population of Zimbabwe and a proposed new testing technique.

The presence of the palmaris longus muscle (PLM) is highly variable. Rates of absence vary from 0.6% in the Korean population to as high as 63.9% in the Turkish population. The tendon of PLM may be absent on one or both forearms, may have duplicated tendons on one forearm or may be laterally shifted to the extent that the tendon of the PLM lies superficial to that of flexor carpi radialis muscle. Among Black American populations, in which there is usually mixed ancestry, rates of absence are 3.5%. Only two studies have been performed on Black African populations: in Republic of Congo and Uganda, and each showed widely differing rates of absence of 3.0% and 14.6%, respectively. In this study, a total of 890 Black Zimbabwean subjects in Harare aged between 8 and 13 years, were examined for clinical surface anatomy anomalies of the tendon of PLM. The results showed that the tendon of the PLM was absent unilaterally in 0.9% of the population, and bilaterally absent in 0.6% with an overall rate of absence of 1.5%. Other variations noted were a laterally shifted PLM in 1.1% of subjects and duplicated tendons on one forearm, which was the least prevalent anomaly, in 0.2% of subjects. The author proposes a new technique to test the tendon of PLM, which combines resisted thumb abduction and resisted wrist flexion. The proposed technique capitalizes on the role of the PLM as an important abductor of the thumb.

An innovative approach to supplement the teaching of the spatial gross anatomy relationships of muscles to undergraduates in health sciences.

Satisfactory assessment of the musculoskeletal disorders in patients by health professionals, followed by diagnosis, treatment, and referral require a good understanding of spatial and three-dimensional (S&3D) anatomy of musculature. Meanwhile, the importance and impact of S&3D learning has been underscored. A novel method to promote S&3D skills in the learning of the musculature of the upper and lower limb was developed, and subsequently evaluated among 120 first-year Physiotherapy and Occupational Therapy undergraduate students at the University of Cape Town. Outlines of human muscles were mapped onto A4 papers, digitalized into a 22-page electronic document, labeled with anatomical details, and printed out. Each student was given a copy to cut out the diagrams and paste them correctly onto adult skeletons using Prestik, in what was called the muscle cut-out exercise (MCOE), just prior to each dissection practical. A questionnaire evaluating the MCOE was developed and 56 students responded. The students "strongly agreed" that the MCOE was useful in teaching them the spatial perspective of the human musculature. Forty-nine percent of the students felt that the size of the diagrams did not always match the skeletons due to variable sizes of the skeletons and 27% suggested the use of color as a means of enhancing the diagrams. The MCOE is a low-cost, enjoyable, time-efficient, easily reproducible, and hands-on practical learning experience.