Basic surgical training 1: Postgraduate surgical examinations in UK and Ireland

This report is concerned with the place of the basic medical sciences, and particularly of anatomy, in the training of surgeons in the UK and Ireland. It reviews the present arrangements and their perceived shortcomings and outlines the proposals for a new 2-year program of Basic Surgical Training drawn up by the four Royal Colleges of Surgery in the UK and Ireland. The new proposals severely restrict the time available to surgical trainees for study of anatomy, exposure to which has already been drastically curtailed in the undergraduate medical course. Although it is intended by the Royal Colleges that specialized anatomy appropriate to the various surgical specialties will be examined during Higher Surgical Training, the author contends that anatomy as it applies to all aspects of surgery must be learned and examined thoroughly during Basic Surgical Training. Examination by MCQs alone is not enough: there is a need for practical assessment in the final assessment at the end of Basic Surgical Training, and this should involve anatomists as well as surgeons. Surgical skills are built upon anatomical knowledge, the study and examination of which must not be reduced to a level where it is detrimental to the care of patients. © 1996 Wiley-Liss, Inc.     

Basic surgical training 3: A view from Ireland

This report points to the inadequate knowledge of anatomy shown by recent medical graduates, now reflected in their poor performance in the oral examination in anatomy in Part A of the FRCSI examination. Although it seems likely that the new examination for the Associate Fellowship of RCSI will retain an oral examination in surgical anatomy, the lack of recognition of a demonstratorship in anatomy as part of the Basic Surgical Training program will deter good applicants for these posts, which will in turn further weaken undergraduate teaching of anatomy. © 1996 Wiley-Liss, Inc.     

Basic surgical training 4: American and British scenes compared

This report outlines the surgical residency program in the United States, with special reference to examinations in anatomy. During each of the 5–6 years of the program and in the first part of the surgical board examination, there are written (MCQ) examinations. The final board examination is oral. The anatomic content of each of these examinations is very small. This situation compares unfavorably with that in the UK in the 1940s and 1950s, when the colleges of surgeons demanded a high standard of anatomic knowledge, so that holders of the Fellowship (FRCS) displayed confidence in their diagnostic skills and in the operating room. In the United States today, surgical residents and attending surgeons (British = consultants) alike seldom have a sound overall knowledge of anatomy. They may become proficient in localized regions, but when drawn out of their area of expertise, their anatomic knowledge may be less than expert. It is disappointing to learn that the surgical colleges in the UK and Ireland are making changes in their Basic Surgical Training program that will inevitably result in a decline from their former high standards. © 1996 Wiley-Liss, Inc.     

The role of anatomy demonstrators: A surgical trainees' perspective

Core Surgical Trainees (CST) in the London (UK) Postgraduate School of Surgery receive clinical anatomy teaching in their first year of training, and, in their second year, give 30 sessions of anatomy teaching to medical and other students. This study set out to investigate the role of demonstrators from the perspective of the trainees. A focus group was convened to ascertain trainees' perspectives on demonstrating anatomy and to identify problems and improvement strategies to optimize their ability to enhance students' learning. A questionnaire was formulated and all second‐year CST (n = 186—from two cohorts) in the London Postgraduate School of Surgery were invited. A total of 109 out of 186 trainees completed the questionnaire. A high percentage (98%) of trainees that completed the questionnaire responded that demonstrating was an invaluable part of their training. Sixty‐two per cent responded that anatomy teaching they received in their first year of core surgical training helped them in their teaching role and 80% responded that it helped them prepare for surgical training. The study also revealed the need for improved communication between trainees and the London Postgraduate School of Surgery/Medical Schools/National Health Service Trusts to address issues such as trainees' perceived difficulty in fulfilling their teaching session requirement. The stakeholders have acknowledged and addressed the outcomes to improve the experience for both surgical trainees and students. The results indicate that anatomy demonstrating delivers important benefits to early surgical trainees, in addition to those received by the students that they teach. Clin. Anat. 31:409–416, 2018. © 2017 Wiley Periodicals, Inc.     

Anatomical variations: How do surgical and radiology training programs teach and assess them in their training curricula?

Sound knowledge of anatomy and Anatomical variations plays an integral role in surgical and radiology specialties. This study investigated the current teaching and assessment trends on Anatomical variations in various surgical and radiology specialty training curricula in Canada and Australia. A survey was sent to 122 Program Directors and Chairs of specialty committees in Canada and Directors of Training/Education in Australia of selected surgical and radiology specialties. A total of 80.7% of respondents report that their training curricula include Anatomical variations. The highest rated classes of variations included in the curriculum are arterial (76%), venous (68%), followed by organs (64%). All trainees learn about Anatomical variations from surgeons and radiologists (100%) and via suggested textbooks of the specialty (87.1%). A total of 54.8% report that specialty training curricula do not suggest specific anatomical variation classifications for the trainees to learn, and 16.1% are uncertain if the colleges provide such kind of instruction. Trainees typically communicated findings of variations in case presentations and clinic's meetings. About 32.3% of respondents report that Anatomical variations are not assessed in their training curriculum. About 39.3% of experienced clinicians in the study report they encounter variations on a monthly basis and 25 and 21.4% on a weekly and daily basis, respectively. Surgical and radiology colleges need to investigate for hidden curriculum in their specialty training programs to ensure there are no gaps in knowledge and training related to Anatomical variations. Most educational leaders surveyed believe more teaching on Anatomical variations in the first 4 years of training would benefit resident doctors. Clin. Anat. 28:717–724, 2015. © 2015 Wiley Periodicals, Inc.     

A quality improvement study for medical devices usage in an acute healthcare setting

Abstract

The objectives of this study were, for a large NHS Trust, to (1) Implement a medical devices training information system which connects the medical equipment inventory to the electronic staff record. (2) Monitor the changes in safety-related practice in the Trust after implementation (3) Examine the association between training compliance and Trust-wide adverse incident data for high risk medical devices. (4) Identify possible gaps in training course content from adverse incident data. A new system was made available, showing medical devices training records for staff in each location. Relevant staff members were trained on how to set up courses, record training, adjust training requirements and view reports. Training practice, compliance and adverse incidents for high-risk equipment were monitored over 30?months after implementation. Trends and changes in training practice were analysed. The Trust now has monitoring information on medical devices training available that had previously been absent. Training compliance increased from 23% to 59%. The frequency and severity of adverse incidents remained relatively constant throughout and was not associated with the increased uptake of training Trust-wide. Training gaps were identified. A Trust-wide system for recording medical devices training has provided training assurance. After implementation changes in practice with training have been identified. It was not possible to show a direct association between increased training compliance and reduced medical device-related incidents Trust-wide. There were specific training courses where changes in content could increase the safe use of medical devices.     

Retrospective evaluation of undergraduate medical education by doctors at the end of their residency time in hospitals: Consequences for the anatomical curriculum

Reform of the undergraduate medical curriculum, including the debate on which of its parts or subjects are superfluous, is a topic of interest in many countries. On being examined at the end of their specialization period, doctors were asked to grade the relevance of all subjects in the undergraduate curriculum for training to become a medical doctor. The subjects that gained the highest grades were internal medicine, gross anatomy, physical examination course, physiology, and pharmacology. The five subjects graded least relevant were biomathematics, terminology, social medicine, medical physics, and medical chemistry. More than 80% of the doctors expressed interest in special lectures and courses, e.g., in topographic anatomy at the beginning of their postgraduate training. Retrospective evaluations at the end of residency time are helpful “evidence” to be considered in reforming the medical curriculum, and in particular in defining “core” and “optional” parts of the curriculum. The data show that anatomy is graded as highly relevant in the undergraduate medical curriculum by doctors at the end of their postgraduate training. Anat Rec. 249:431–434, 1997. © 1997 Wiley-Liss, Inc.     

Comparisons between the attitudes of medical and dental students toward the clinical importance of gross anatomy and physiology

Marked changes are occurring within both the medical and dental curricula and new ways of teaching the basic sciences have been devised and traditional methods (e.g., dissection for gross anatomy and of bench‐based animal preparations for physiology) are increasingly no longer the norm. Although there is much anecdotal evidence that students are not in favor of such changes, there is little evidence for this based on quantitative analyses of students' attitudes. Using Thurstone and Chave attitude analyses, we assessed the attitudes of first year medical and dental students at Cardiff University toward gross anatomy and physiology in terms of their perceived clinical importance. In addition, we investigated the appropriateness (“fitness for purpose”) of teaching methodologies used for anatomy and physiology. The hypotheses tested recognized the possibility that medical and dental students differed in their opinions, but that they had a preference to being taught gross anatomy through the use of dissection and had no preference for physiology teaching. It was found that both medical and dental students displayed positive attitudes toward the clinical relevance of gross anatomy and that they preferred to be taught by means of dissection. Although both medical and dental students displayed positives attitudes toward the clinical relevance of physiology, this was greater for the medical students. Both medical and dental students showed a preference for being taught physiology through didactic teaching in small groups but the medical students also appreciated being taught by means of practicals. Overall, this study highlights the expectations that students have for the basic science foundation teaching within their professional training and signals a preference for being taught experientially/practically. Differences were discerned between medical and dental students that might reflect the direct association between systems physiology and pathophysiology and the application of this knowledge within the medical field in comparison to the dental field, which is heavily skill‐based. Clin. Anat. 27:976–987, 2014. © 2014 Wiley Periodicals, Inc.     

带有双侧部分输尿管的猪膀胱模型在宫腔镜培训中的应用

目的　为获得最大程度模拟人类子宫的宫腔镜精细电切培训用模型。 方法　获取带有双侧部分输尿管的猪膀胱,指导学员进行宫腔镜手术技巧的培训（实验组模型）,同期使用传统的培训模型四腔猪心（对照组模型）,考核为双向性,指导教师以考核内容进行打分,学员则填写调查问卷来评价模型。 结果　3站宫腔镜手术模拟培训中,两组模型训练学员的成绩及学员对模型的评价均有统计学差异（P<0.05）,认为膀胱模型膨起度良好,视野清晰,便于辨识解剖结构,能够更逼真模拟宫腔实际操作的困难状况。 结论　猪膀胱因其最大程度模拟人类子宫及其术中实际困难情境,是宫腔镜技术培训的理想模型。     

解剖学手术操作示教在解剖教学第二课堂中的探索

 作为北京协和医学院教学改革的一部分,开设了解剖学手术操作示教的选修课。精心选择临床病例,实行小组教学。课程内容包括师生共同参与集体备课、临床讲座、手术示教或录播、学生实践以及课后总结等。该课程不仅巩固了解剖学内容,还强调了所学知识在临床中的应用及其重要性,同时也培养了学生的学习兴趣和团队合作意识。     

Getting back together after a break‐up: Relationship advice for anatomists and surgeons

The “surgeon‐anatomist” was originally a single individual who self‐pursued knowledge and understanding of anatomy as the foundation for successful surgical outcomes. However, recent advances in medical education have ironically led to the separation of anatomy and surgery. This physical and emotional “divorce” of anatomists and surgeons into separate individuals has created several critical educational issues for medical and surgical educators including a general lack of anatomical knowledge in medical students and misalignment of graduate medical education procedural specialty training with the Accreditation Council of Graduate Medical Education Core Competencies and now the Next Accreditation System. There are numerous opportunities for anatomists and surgeons to work together to improve educational instruction of established difficult anatomical regions, procedural training, or even develop new techniques and procedures. Similarly, anatomists with specialized training in medical education would be invaluable partners to ensure that procedural assessments align with instructional technologies for truly longitudinal curricula that starts at the medical student level, but stops at the patient outcomes of attending surgeons. This mutually beneficial relationship would be similar to multidisciplinary care teams and current surgeon and PhD/EdD partnerships. The restoration of the relationship between anatomists and surgeons would be invaluable to surgical education and remains an exciting research opportunity. Clin. Anat. 28:931–934, 2015. © 2015 Wiley Periodicals, Inc.     

Learning styles of medical students,general surgery residents,and general surgeons: implications for surgical education

Background  

Surgical education is evolving under the dual pressures of an enlarging body of knowledge required during residency and mounting work-hour restrictions. Changes in surgical residency training need to be based on available educational models and research to ensure successful training of surgeons. Experiential learning theory, developed by David Kolb, demonstrates the importance of individual learning styles in improving learning. This study helps elucidate the way in which medical students, surgical residents, and surgical faculty learn.     

COVID-19 modifications to a first year medical human anatomy course: Effects on student performance on summative examinations

The COVID-19 (COVID) pandemic forced changes in how medical curricula are organized and delivered. In addition to disease mitigation strategies, other curricular modifications were required to maintain educational effectiveness and student and faculty safety. While these changes appear to be successful in their primary goal, their effect on learning and other important educational outcomes is less well understood. We describe changes to our anatomy course and describe their effects on summative examination scores. We compared anatomy examination scores from 4 years prior to COVID with scores from the 2 years following COVID mandated changes in an effort to determine the effectiveness of our course modifications. Examination scores for the first of four successive Blocks of instruction following the implementation of curricular changes demonstrated a lower mean score and greater range of scores than for the four pre-COVID years. Pre-COVID and post-COVID scores for Blocks II, III, and IV were comparable. Our results indicate that our changes to the anatomy curriculum did not prevent a performance decline during the first Block of instruction only. However, students were able to successfully adapt to these changes during the remainder of the course. We discuss factors that may have accounted for the Block I performance decline and call attention to changes within the larger curriculum that may have affected student performance.     

Perception of medical students towards the clinical relevance of anatomy

Recent developments worldwide in medical curricula have often led to major cuts in the teaching of human anatomy. Indeed, it is perceived by some that gross (topographical) anatomy has an exaggerated importance in the initial training of doctors. The value of anatomy consequently has frequently been considerably diminished within medical curricula that have reduced factual content. To date, however, there have been no objective studies into the perceived relevance of anatomy to clinical medicine that have aimed to quantify the attitudes of medical students. On the basis of responses to an attitude analysis questionnaire devised according to the precepts of Thurstone and Chave (The Measurement of Attitude: A Psychophysical Method and Some Experiments with a Scale for Measuring Attitude Toward the Church. Chicago, IL: University of Chicago Press, 1951), we investigated the perception of medical students at Cardiff and Paris towards the importance of gross anatomy to clinical medicine. This was undertaken during the early stages of their studies (when they were newly-admitted to university and were about to commence anatomy courses), immediately after finishing their anatomy courses, and later in the final year of medical studies. The results suggest that, even where there might be geopolitical and cultural backgrounds, students at all stages of their medical course share with professional anatomists the view that anatomy is a very important subject for their clinical studies. Thus, contrary to the unquantified beliefs of those who are sceptical about the purpose and value of anatomy in an undergraduate medical curriculum, the students themselves do not appear to share such beliefs.     

Daily medical education for confined students during coronavirus disease 2019 pandemic: A simple videoconference solution

The outbreak of coronavirus disease 2019 caused by severe acute respiratory syndrome coronavirus 2 infection has recently spread globally and is now a pandemic. As a result, university hospitals have had to take unprecedented measures of containment, including asking nonessential staff to stay at home. Medical students practicing in the surgical departments find themselves idle, as nonurgent surgical activity has been canceled, until further notice. Likewise, universities are closed and medical training for students is likely to suffer if teachers do not implement urgent measures to provide continuing education. Thus, we sought to set up a daily medical education procedure for surgical students confined to their homes. We report a simple and free teaching method intended to compensate for the disappearance of daily lessons performed in the surgery department using the Google Hangouts application. This video conference method can be applied to clinical as well as anatomy lessons.     

Evaluation of clinical relevance of problem-oriented teaching in undergraduate anatomy at the University of Pretoria

Problem oriented medical curricula claim to be based on the fact that the clinical sciences facilitate and encourage the understanding of basic sciences. The question was asked whether the correlation of gross anatomy in the Abdomen Block in the new Pretoria medical curriculum, with clinically relevant content (i.e. relevant physical examination, imaging anatomy, clinical procedures, clinical presentations and clinical case studies) facilitates the understanding of human anatomy and enhances the development of the clinical thinking fundamental to clinical practice. The clinical anatomy component of the Abdomen Block (11 weeks duration) in the third year was developed by using standardized patients, cadaver material, skeletons, X-rays, CT scans, MRIs and multimedia programs. Student perceptions were assessed by a Likert scale questionnaire. Most students thought that integrating the physical examination enhanced their understanding of the relevant anatomy (mean 3.55). A substantial number of students thought the clinical anatomy in the block laid a good foundation for imaging anatomy of the abdomen (mean 3.41). The majority of students thought the clinical anatomy laid a good basis for the understanding of surgical procedures relevant to the abdomen (mean 3.63). Students were mostly confident that clinical anatomy enhanced their understanding of clinical presentations (mean 3.68). Although slightly fewer, the majority reckoned that the clinical case studies gave them a better understanding of the relevant anatomy (mean 3.30). It seems evident that the integration of clinically relevant content facilitates and encourages the understanding of anatomy and thus aids in the development of clinical thinking.     

Surgical Observation: An Enhancement To The Student Athletic Trainer's Education

Surgical observation can be a useful learning experience for student athletic trainers, due to the nature of the injuries they are learning to deal with. Anesthesiology, examination under anesthesia, sterile draping techniques, instrument identification, surgical procedures, and anatomy are among the topics that could be addressed during the observation period. A basic set of guidelines and possible points of interest for the student athletic trainer are suggested in this article.     

Teaching anatomy with surgeons' tools: use of the laparoscope in clinical anatomy.

The purpose of this study was to establish the feasibility of laparoscopy in embalmed cadavers to teach abdominal gross anatomy. One cadaver was selected based on body habitus and absence of previous abdominal operations. A standard trocar was used to enter the abdomen at the umbilicus. Two trocars were placed in the left upper quadrant. Pneumoperitoneum was achieved with continuous CO(2) pressure. Liver retraction was achieved percutaneously, exposing the porta hepatis and the gallbladder. The dissection was done with four first-year medical students using standard laparoscopic equipment. Following this, the demonstration was projected over multiple monitors so that all students could participate. Laparoscopic dissection in an embalmed cadaver is feasible and an excellent educational tool for both the medical student and the dissector. The dissector has the opportunity to manipulate laparoscopic tools in a human model closely paralleling operative experience, and the students have an opportunity to learn abdominal anatomy from a clinical perspective. Laparoscopic examination and dissection of fresh cadavers has been used for training surgeons on new procedures such as colon resection, antireflux procedures, and cholecystectomy. There is no report of this same technology used in embalmed cadavers to teach basic anatomy. This approach allows first-year medical students to learn the anatomy while exposing them to the technology currently used in surgical practice, and it affords surgical residents and students additional opportunities to practice laparoscopic skills.     

Integrating applied anatomy in surgical clerkship in a problem-based learning curriculum

Little attention has been given to structured teaching of applied anatomy to senior medical students in problem-based learning (PBL) medical schools. A course named Anatomical Principles in Surgical Practice was introduced at the Arabian Gulf University (AGU) in 2001 for fifth- and sixth-year medical students during their surgical clerkship rotation. The course aims to emphasize, update and integrate applied anatomical concepts that are essential for surgical practice. The course consists of 15 interactive sessions held weekly to ensure topics coincide with the surgical problem-solving sessions. A questionnaire was administered to students completing their surgical rotations (n=131) seeking their perceptions about the new course during the academic years 2001, 2002 and 2003. To measure learning outcome, 70 students were also given pre- and post-tests. Positive responses were given by 85.2% of the students for course arrangement, by 92.0% for course content, by 88.3% for clinical correlation, by 95.2% for level of teaching and by 87.2% for overall judgment. The students mean scores in the post-test (71.7%±11.7) was significantly higher than their mean scores in the pre-test (42.3%±12.6, p<0.001). Students liked the course and reported feeling more confident in correlating anatomy with surgery during their rotations. By extending anatomical teaching into the clerkship phase, a link between basic medical and clinical sciences has been established that further enhances vertical integration within a PBL curriculum in a spiral fashion.     

Clinical implications of nervus intermedius variants in patients with geniculate neuralgia: Let anatomy be the guide

Geniculate neuralgia (GN) is an uncommon, but severe, condition that is characterized by excruciating paroxysmal pain in the seventh cranial nerve's cutaneous distribution of general somatic afferent fibers carried through the nervus intermedius (NI). GN becomes a surgical disease in refractory cases of pain after exhaustive medical management. Surgical intervention in the form of microvascular decompression and nerve sectioning has been investigated with good patient outcomes. Despite this, there are limited guidelines on either technique's appropriateness in specific operative scenarios. In our 30-year experience in GNs surgical management, we have found that a detailed knowledge of the NIs anatomy, variants, and intraoperative surgical anatomic findings are the key to choosing the most appropriate intervention, and may provide the answer to why some patients fail to experience pain relief after surgery. These anatomic variants also may explain why many patients commonly do not experience side effects related to the visceral efferent and special afferent fibers after nerve sectioning.