Practical examinations in anatomy are usually conducted on specimens in the anatomy laboratory (referred to here as the "traditional" method). Recently, we have started to administer similar examinations online using the quiz facility in Moodle™. In this study, we compare student scores between two assessment environments viz. online and traditional environments. We hypothesized that regardless of the examination medium (traditional or online) overall student performance would not be significantly different. For the online medium, radiological images, prosected specimens, and short video clips demonstrating muscle action were first acquired from resources used for teaching during anatomy practical classes. These were optimized for online viewing and then uploaded onto Moodle learning management software. With regards to the traditional format, actual specimens were usually laid out in a circular stream. Identification tags were then attached to specific spots on the specimens and questions asked regarding those identified spots. A cohort of students taking practical examinations in six courses was studied. The courses were divided into three pairs with each pair credit-weight matched. Each pair consisted of a course where the practical examination was conducted online and the other in the traditional format. There was no significant difference in the mean scores within each course pair. In addition, a significant positive correlation between score in traditional and online formats was found. We conclude that mean grades in anatomy practical examination conducted either online or in the traditional format were comparable. These findings should reassure teachers intending to use either format for their practical examinations.

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In most medical schools, summative practical examination in Anatomy usually takes the format of a "steeplechase" ("spotters" or "bell ringers") conducted in the gross anatomy laboratory using cadaveric material and prosected specimens. Recently, we have started to administer similar examinations online using the quiz facility in WebCT™ and Moodle™. This article chronicles how we conceived and developed this method within the peculiar nature of our medical school setting. Over a five year period, practical summative examinations were organized as "steeplechase" online. The online examinations were administered using WebCT™ and later Moodle™ learning management software. Assessment "objects" were created from the materials available for anatomy teaching. These were digital images of cadaveric materials, radiological, and prosected specimens. In addition, short video clips of 30 seconds duration demonstrating muscle action were produced. These objects were optimized for online viewing and then uploaded onto the learning management software. A bank of questions (multiple choice or short answer type) was then created and linked to the assessment objects. These were used in place of the steeplechase in the computer laboratory. This method serves a crucial purpose in places like ours where continuous availability of human cadavers is impossible. Although time consuming initially, once questions are setup online, future retrieval, and administration becomes convenient especially where there are large batches of students. In addition, the online environment offers distinct advantages with regards to image quality, psychometric analysis of the examination and reduction of staff preparation time compared to traditional "steeplechase."

For long, the immune system has been thought of as an effector mechanism reacting to antigenic challenge with defensive responses designed to eliminate 'foreign' material and return to a standby or surveillance mode. However, the recent concept now supported by substantial evidence suggests that immunity is not effector biased but is also a sensory organ and forms part of an integrated homeostatic network. The bidirectional information flow between the neuroendocrine and immune systems functions to maintain and protect the internal homeostasis of the organism. The paradox of this interwined function is that homeostasis may require the neuroendocrine system to work for or against the immune system, as is the case in infection. Potential dangers necessitate activation of the immune system, and such a response may pose risks to the integrity of the host. This occurs when an overly vigorous response may be detrimental and kill the host, as is the case of toxic shock syndrome. Therefore, the constant monitoring role of the neuroendocrine system to control and, when necessary, regulate the function of the immune system is crucial for the homeostatic integrity of the host. This reciprocity of functional need determines the mode of action to determine the context of a perceived threat and the best way to respond. Any breakdown in this two-way communication may manifest itself in problems such as autoimmunity, septic shock, or chronic infection. In this article, we review our current knowledge of circadian rhythm and its relation to the immune response.

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