The aim of this study was to examine the effectiveness of using students as tutors in a problem-based learning (PBL) medical curriculum. Ninety-one third-year medical students were divided into ten tutorial groups. The groups were randomly allocated into student-led tutorials (SLT) (five groups, n = 44 students) and faculty-led tutorials (FLT) (five groups, n = 47 students). Outcome measurements included assessment of students' performance in tutorials individually and as a group, end-unit examinations scores, assessment of tutoring skills and identifying students' perceptions about peer tutoring. Student tutors were perceived better in providing feedback and in understanding the difficulties students face in tutorials. Tutorial atmosphere, decision-making and support for the group leader were better in SLT compared with FLT groups. Self-assessment of student performance in SLT was not different from FLT. Student scores in the written and practical examinations were comparable in both groups. However, SLT groups found difficulties in analysis of problems presented in the first tutorial session. We conclude that the impact of peer tutoring on student performance in tutorials, group dynamics, and student achievement in examinations is positive overall. However, student tutors require special training before adopting this approach in PBL programs.

A discrete membranous layer, "stratum membranosum", in human subcutaneous tissue is classically described as confined to the lower anterior abdominal wall and perineum and referred to as Scarpa's and Colles' fasciae, respectively. Evidence for its existence elsewhere in the body is scanty and therefore the present study was undertaken. Dissection of six embalmed adult cadavers, along with ultrasound imaging on four living subjects, were carried out to determine the existence, topography, and thickness of the membranous layer of superficial fascia in different regions of the body. In all six cadavers, a continuous layer of fibrous membrane in the superficial fascia was found consistently in all the dissected regions of the body and was also confirmed by ultrasonography. The arrangement and thickness of this membranous layer varied according to body region, body surface, and gender. It was thicker in the lower than in the upper extremity, on the posterior than anterior aspect of the body, and in females than in males. The mean thickness of the membranous layer ranged from 39 to 189 mum, being thickest in the leg and thinnest over the dorsum of the hand. The membranous layer was observed to have two or even three components in regions such as the breast, back, thigh, and arm and was seen to split, forming special compartments around subcutaneous major veins of upper and lower extremities, with fibrous septa extending to attach to the vessel wall. Functionally, the membranous superficial fascia may play a role in the integrity of the skin and support for subcutaneous structures particularly veins, by ensuring their patency. Understanding the topographic anatomy of this fascial layer may help explain body-contour deformities and provide the anatomic basis for surgical correction.

A questionnaire on the emotional and psychological reactions of Arab medical students to the dissecting room (DR) was distributed to 272 students in four successive pre‐clinical and clinical years in the same academic year (1993‐1994) at Sultan Qaboos University (SQU) Medical College; 205 students responded. Varying degrees of fear on first entering the DR was reported by 46%. The most frequent reactions were recurring visual images of cadavers (total 38%) and temporary loss of appetite (total 22.5%). Students' reactions were most commonly elicited by the smell of the DR (total 91%) and by fear of infection (total 62%). The most frequent method of coping with such fears was by rationalization (total 65%). Significant gender differences (P < 0.05) were found concerning all aspects of the DR experience. Female students showed higher levels of fear, reported stronger physical and behavioral reactions, were more disturbed by certain stimuli in the DR, and used certain coping methods more frequently than their male peers. The need for appropriate psychological preparation of students before studying human cadaveric anatomy is discussed. Clin. Anat. 10:272‐278, 1997. © 1997 Wiley‐Liss, Inc.

The incidence and ossification of sesamoid bones in the hands and feet were studied in 922 radiographs (400 hands and 522 feet) in an Arab population from Bahrain, 5-83 years of age and consisting of 549 adults (393 men and 156 women) and 373 children (286 boys and 97 girls). All radiographs of the hand and foot in the adult population showed two sesamoid bones in the thumb metacarpophalangeal (MCP) joint and in the hallucal metatarsophalangeal (MTP) joint, respectively. Only 2.3% and 1.5% of hands showed sesamoids at the MCP joints of the middle and ring fingers respectively compared to a reported incidence of 7.1% for each digit in Caucasians. The incidence of sesamoids in the MTP joints of third and fourth toes (0.6% each) and inferior to the hallucal interphalangeal joint (3.1%) is probably the lowest reported so far in the literature. In the hands, ossification commenced first in the thumb sesamoids, at the age of 10 years in females and 11 years in males and was completed by the age of 13 and 14 years, respectively. In the feet, ossification began first in the hallucal sesamoids at the age of 8 years in females and 9 years in males and was completed by the age of 10 years in both sexes. The incidence and ossification of sesamoids in the hands and feet in the Arab population from Bahrain seem to differ considerably from reports in other populations. The clinical significance of our findings is discussed.

A unilateral three-headed biceps brachii muscle coinciding with an unusual variant of the musculocutaneous nerve was found during routine dissection of a 79-year-old male cadaver. The supernumerary bicipital head originated from the antero-medial surface of the humerus just beyond the insertion of the coracobrachialis, and inserted into the conjoined tendon of biceps brachii. Associated with this muscular variant was a duplicated musculocutaneous nerve. The proximal musculocutaneous nerve conformed to the normal pattern only in its proximal part, and terminated after innervating the coracobrachialis and biceps brachii muscles. The distal musculocutaneous nerve arose from the median nerve in the lower arm, then passed laterally between the supernumerary bicipital head and the brachialis muscles, supplying both and terminating as the lateral cutaneous nerve of the forearm. The supernumerary bicipital head and the accompanying anomaly of the musculocutaneous nerve seem to be unique in literature.

This study compared the self-rated with student-rated teaching styles of PBL tutors. We also examined the relationship between teaching styles of tutors' and students' evaluation of tutor effectiveness in tutorials. The study included 48 tutors and 276 medical students. Tutors, and students' were given a teaching style inventory with a 5-point scale consisting of 21 items that comprise four domains of teaching styles (facilitative, collaborative, suggestive and assertive). In addition, quantitative and qualitative evaluations of tutor effectiveness by students were analyzed. Tutors perceived themselves in the facilitative-collaborative end of the spectrum of styles In contrast, students perceived tutors as less 'facilitative-collaborative' and more 'suggestive-assertive' than tutors self-ratings (p < 0.001). In addition, the difference in perception between students and tutors ratings in the facilitative-collaborative domains was more evident as students progressed in the PBL curriculum. The students' ratings of the effectiveness of tutors correlated more strongly with facilitative-collaborative than with suggestive-assertive domains of teaching styles. However, other tutor attributes such as establishing rapport with students, providing academic help for them and having content expertise were considered important criteria of an effective tutor. We conclude that there is a mismatch between students' and tutors' perceptions about teaching styles of tutor. Tutor attributes other than teaching styles are important determinants of an effective tutor.

In the problem-based learning (PBL) approach to medical education, students are expected to be trained more by applying processes of reasoning than by memorization of facts. In a PBL curriculum, as with others, it is necessary to match the assessment to the learning process. A detailed description of the testing of anatomical teaching-learning outcomes at the Arabian Gulf University (AGU) is presented. In addition to describing the general principles and guidelines as well as the process of continuous assessment, we have given examples of the multiple-choice questions, patient management problems, and objective-structured practical examinations, which compose our end-of-unit examination and test both vertical and horizontal integration of themes. Students have the opportunity to review the examination after publication of the results. We believe that our approach to the assessment of anatomy tests effective integration of factual knowledge with the principles of problem-solving through the different formats of the components of our examinations.

The retromolar foramen (RMF) is a rare anatomical structure situated in the retromolar fossa behind the third molar tooth. When it is present, the foramen is connected with the mandibular canal and is believed to transmit neurovascular structures that provide accessory source to the mandibular molars and the buccal area. Reports from the literature show that the presence of RMF could pose a challenge in complete blockage of the inferior alveolar nerve during mandibular surgeries. We report the incidence of retromolar foramen from ninety-four dry mandibles of south-eastern part of Karnataka State, India. The foramen was observed in 11 mandibles out of 94 included in the study (11.7%). In three mandibles, the foramen was present bilaterally (3.2%) and in three it was on the left side (3.2%) and in five it was on the right side (5.3%). For the first time, we also measured the dimensions of the retromolar area and distance of the foramen from third molar tooth to understand its risks during the surgical extraction of the lower third molar tooth. A thorough review of the literature has also been done to compare the present findings with the studies reported from the various populations.