Objective: To evaluate the 2010 “Anatomy by whole body dissection” course, a 7‐week elective course offered to senior medical students at the University of Sydney at the end of their third year. Design, setting and participants: In the 2010 course, 29 students divided into eight groups carried out whole‐body dissections on eight cadavers over a 34‐day period. Surgical trainees acted as demonstrators, and surgeons and anatomists as supervisors. The students were assessed by practical tests involving the identification of 20 tagged structures in four wet specimens before, during, at the end of, and 1 month after the course. In addition, students were asked to complete an anonymous feedback questionnaire about the course. Main outcome measure: Acquisition of topographical anatomical knowledge, and student feedback on the usefulness of the course. Results: A significant increase in topographical clinical anatomical knowledge was demonstrated among the participants and was maintained in the short term. The median pre‐course assessment score was 8/20 (interquartile range [IQR], 4) and the median post‐course assessment score was 19/20 (IQR, 1). This difference was statistically significant (P < 0.001). All students rated the course as “very good”, and unanimously recommended that the course be available to all students as part of the medical curriculum. Conclusion: Students’ knowledge of anatomy improved significantly between the pre‐course and post‐course assessments, and all students rated the course very favourably. This supports our view that dissection anatomy should be an integral component of medical education.
The application of TBL methodology to teaching human anatomy by dissection enables a large group of students to have small group experiences without a large number of teachers. It results in effective acquisition of topographical anatomical knowledge and appears to provide better acquisition of such knowledge than the previous methods of anatomy teaching to which these students had been exposed.
One hundred and fifty‐three consecutive patients referred to the Royal Prince Alfred Hospital for consideration of gastric bariatric (surgery obesity) were assessed pre‐operatively by the one psychiatrist. with regard to social, psychological and psychiatric factors. Fifty‐one patients (33%) were considcrcd to be uncomplicated from a psychiatric point of view. Eighty‐eight patients (58%) had identifiable psychopathology and 14 patients (9%) were of doubtful motivation. Thirty patients (20%) were rejected from the treatment programme after the initial assessment because of overt psychiatric illness. severe situational stress. insufficient motivation or lack of significant support. Six of these patients after further assessment or after responding to psychiatric treatment were reviewed and found suitable for a bariatric operation. Of the 113 patients who had a bariatric procedure performed, 17 patients (15%) required postoperative psychiatric management. While the need for psychiatric assessment of patients presenting for bariatric surgery is disputed by some, our experience would indicate that careful pre‐operative screening by a liaison psychiatrist, familiar with morbid obesity and its surgical management, is useful in any bariatric surgical programme. Such screening should identify and enable exclusion of the small number of patients who for psychiatric reasons, are poor risk candidates. A number of other patients in whom identifiable psychopathology will be discerned. will require pre‐operative psychiatric management. While such a programme will decrease postoperative psychiatric problems, these will not be eliminated in the morbidly obese, and the assessing liaison psychiatrist will have a valuable role to play in the collaborative postoperative management of such patients.
BackgroundStudents’ motivation provides a powerful tool to maximise learning. The reasons for motivation can be articulated in view of self-determination theory (SDT). This theory proposes that for students to be motivated and hence benefit educationally and professionally from courses, three key elements are needed: autonomy, competence, and relatedness. In this paper we apply SDT theory to consider medical students’ motivation to participate throughout a 2014 optional summer intensive eight week elective anatomy by whole body dissection course. The course was designed and facilitated by surgeons, and required small group, active learning.MethodsAt the end of the course, data were collected from all (24/24) students by means of an open ended survey questionnaire. Framework analysis was used to code and categorise data into themes.ResultsUtilising self-determination theory as a theoretical framework, students’ motivation and experiences of participation in the course were explored. Elements that facilitated students’ motivation included the enthusiasm and expertise of the surgeons, the sense of collegiality and community within the course, the challenges of group activities, and sense of achievement through frequent assessments.ConclusionThe team learning course design, and facilitation by surgeons, provided an enriched learning environment, motivating students to build on their knowledge and apply a surgical context to their learning.
Forty-five of 60 consecutive morbidly obese patients who had a vertical banded gastroplasty carried out by the one surgeon between 1982 and 1988 were assessed by questionnaire at long-term follow-up in 1993. Eighteen patients (40%) had maintained their BMI at close to the lowest achieved levels. Twenty-seven patients (60%) had had a significant rise in BMI, and 14 of these (31%) had gained weight to return close to or above their pre-surgery BMI levels. No reliable predictors of successful long-term weight loss were detected in the pre-operative data. Forty-eight patients (84%) were satisfied with their surgical treatment. Twenty patients (44%) reported improved social life after surgery. Twenty-one patients (46%) reported a similar social life and only four patients (9%) a worse social life. At follow up five patients (12%) reported emotional problems related to their weight loss surgery and two of this group had had psychiatric counseling for depression. Pre-operative psychiatric assessment appeared to have facilitated intervention by the psychiatrist with these patients. Gastric restrictive surgery, however, remains unpredictable in its long-term weight loss effect.
Background: The most investigated target for deep brain stimulation in depression is the subgenual cingulate gyrus (Cg25) which has been shown to be a critical hub for signalling in the condition. Diffusion tensor imaging (DTI) is a form of MR sequence that can visualise white matter connections and potentially aid target selection. Objectives: To assess whether targets selected using DTI to find the area of maximal tract crossover (maximal isotropy) underlying the subgenual cingulum differ significantly in location from those selected using standard T2 sequences. Methods: Fifty-nine non-depressed adult volunteers underwent MR imaging using T1, T2 and DTI sequences of the brain. Each patient had targets selected for both hemispheres using both T2 and DTI sequences. The significance of the differences in coordinates in all three dimensions was tested using the paired t test. Results: There was a significant difference in the mediolateral (x) and dorsoventral (z) coordinates of DTI targets when compared with T2 targets (p < 0.001). Conclusions: Targets within Cg25 selected using DTI are significantly different in location from those selected using T2 sequences and have the potential to enhance treatment outcome by reducing the impact of interindividual variability.
IntroductionAlthough a fading tradition in some institutions, having clinicians teach anatomy by whole-body dissection provides a clinical context to undergraduate and postgraduate medical students, increasing their depth of learning. The reasons for a clinician’s motivation to teach may be articulated in accordance with self-determination theory (SDT). SDT proposes that for individuals to be intrinsically motivated, three key elements are needed: 1) autonomy, 2) competence, and 3) relatedness.Materials and methodsData were collected through semistructured interviews with eight surgeons who were supervisors/facilitators in the anatomy by whole-body dissection course for undergraduate students in the Bachelor of Medicine, Bachelor of Surgery program and postgraduate students in the Master of Surgery program at the University of Sydney. Qualitative analysis methods were used to code and categorize data into themes.ResultsOur study used SDT as a conceptual framework to explore surgeons’ motivation to supervise students in the anatomy by whole-body dissection courses. Elements that facilitated their desire to teach included satisfaction derived from teaching, a sense of achievement in providing students with a clinical context, a strong sense of community within the dissection courses, and a sense of duty to the medical/surgical profession and to patient welfare.ConclusionThe surgeons’ motivation for teaching was largely related to their desire to contribute to the training of the next generation of doctors and surgeons, and ultimately to future patient welfare.
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