Consolidation Carnival: A Case-Based Approach to Reviewing Musculoskeletal Anatomy in an Undergraduate Medical Curriculum.

Introduction: Recent changes in undergraduate medical curricula have resulted in time constraints that are particularly challenging, especially when students must learn large blocks of musculoskeletal anatomy content. Consequently, students have resorted to rote memorization to cope, which counteracts our established collaborative self-directed learning model. Methods: For a 6-week musculoskeletal anatomy course, two structured case-based review sessions are described, each following the completion of two five-hour lab sessions, two on the upper extremities and two on the lower extremities. These largely self-directed review sessions consisted of 6 students rotating through 7 to 8 stations every 10 minutes where clinical cases with follow-up questions were projected on large screens. The students were expected to work collaboratively to solve the cases utilizing the prosected specimens provided and discuss the accompanying answers at the end of each case. Results: Ninety-four per cent of the students who participated in this study agreed that the case-based review sessions provided a helpful overview of musculoskeletal anatomy content. Student performance on the open-ended, case-based musculoskeletal examination questions showed no significant difference in performance on shoulder, hand, hip, thigh, and leg questions. There was, however, a statistically significant decrease in the students' scores on a forearm question in 2021 compared to 2019. Conclusion: This paper describes our integrated, collaborative musculoskeletal course, including case-based review sessions, which was positively received by students as having value in reviewing the musculoskeletal content though it was not found to improve examination performance.

Integration of physiology in a curriculum on human structure: a snapshot of the cardiovascular block.

With the gradual shift from discipline-based to competency-based medical education, the integrated curriculum has become a popular model for connecting basic science and clinical content in undergraduate medical education. Despite its popularity, there are concerns that important physiological concepts are not adequately addressed. We describe the spiral integration of physiology content in the 5-week Cardiovascular block of our Homeostasis course at the Zucker School of Medicine. We also describe our approach to incorporating physiology into an integrated, constructed response, short-answer assessment format. Our approach to spiral integration consists of rotating lab stations that highlight the distinction between normal and abnormal states, linked with appropriate clinical interventions. Physiology is at the core of integration in any curriculum and the basis of all applied fields of medicine, hence our approach is that teaching structural relationships would not be valuable without consideration of its functions, which can then be utilized in discussion of clinical presentations, imaging, and relevant pathologies. Likewise, our integrated assessments require the students to compose their answers to the questions from scratch, which creates a shift in mode of students' preparation from rote memorizations to more cognitive processing that enhances critical thinking.

Tissue plasminogen activator for acute ischemic stroke: a New York city emergency medicine perspective.

Nationally, only 2-3% of patients with acute ischemic stroke (AIS) currently receive tissue plasminogen activator (TPA). To better understand the reasons, we investigated the practice patterns, level of familiarity and acceptance of TPA for AIS among emergency physicians in New York City (NYC). Fifty-seven 911-receiving hospital emergency department directors were surveyed regarding TPA use. Of those responding, 37% had never used TPA to treat AIS. Lack of neurological support was reported by 33%. Departments with formal protocols were more likely to use TPA for AIS. In conclusion, there is considerable variation in the practice, knowledge, and attitudes regarding the use of TPA for AIS in NYC emergency departments. Improved educational efforts and institutional support may be necessary to ensure the appropriate use of TPA by emergency physicians.

Simultaneous open and closed dislocations of adjacent metacarpophalangeal joints: a case report.

Metacarpophalangeal joint (MCP) dislocations are uncommon, and when open are often complex, requiring surgical intervention for reduction. A 38-year-old man presented to the Emergency Department (ED) with simultaneous open and closed dorsal dislocations of adjacent MCP joints of the index and long fingers that were successfully treated by closed reduction in the ED. Injuries to the MCP joint can severely affect hand function when treatment is delayed and, thus, it is an accepted principle that definitive treatment should be achieved as quickly as possible for optimal functional outcome. In the case of dorsal dislocations of the MCP joints, aggressive ED intervention followed by brief immobilization and early hand therapy referral may result in dramatic clinical improvement for the patient without the need for surgery.