Lachman, Nirusha

Gross anatomy courses often utilize teaching assistants (TAs) to serve a multifaceted purpose. Qualitative analysis of interviews with gross anatomy TAs reveals seven distinct roles: formal teaching during course lectures, informal teaching during dissection, prosecting a demonstration cadaver, orchestrating regular review sessions, coordinating formative feedback about academic progress and professionalism, tutoring struggling students outside of class time, and supporting students in crisis should the need arise. Analysis also finds that TAs did not anticipate the full scope of their duties prior to undertaking them, and felt particularly unprepared to address issues of student mental health. We report our findings and propose a model for proactively training TAs for their inherently complex role. This work was supported by the Mayo Clinic Department of Anatomy. Grant Funding Source Student/Postdoctoral Travel Award Student Award

Early medical education courses provide opportunities for promoting leadership in future physicians. Our research sought to integrate explicit activities of teamwork and leadership into the first‐year gross anatomy course and assess student leaders through self reflection and team evaluation. Fifty first‐year medical students were assigned to three‐ or four‐member dissection teams with group leaders designated on a rotating basis. Teamwork was emphasized through daily group quizzes, oral patient presentations relating clinical diagnoses to anatomy, and extensive embryology presentations. Group leaders were responsible for leading the dissections after attending daily orientation sessions on the teaching cadaver. Team and self evaluations of group leaders were gathered with weekly electronic surveys. Preliminary results suggest that team leaders rate themselves lower than their teammates do with respect to altruism, accountability and responsibility. One explanation for this discrepancy is decreased self‐awareness of student leaders regarding their own performance. Further research may demonstrate whether increased communication between leaders and team members can improve leaders' awareness of their capabilities. Research support came from the Mayo Clinic Department of Anatomy. Grant Funding Source N/A

Recent curricular redesign at Mayo Medical School integrated radiology into first‐year gross and developmental anatomy. The resulting six‐week (120 contact hours) Human Structure block teaches gross anatomy through dissection, radiologic imaging, and correlation with embryology. To further promote holistic physician‐development, refinement of the Human Structure course has been driven by the six core competencies of the Accreditation Council for Graduate Medical Education (ACGME): patient care, medical knowledge, practice‐based learning, interpersonal skills, professionalism, and systems‐based practice. We report here more than 20 educational interventions built into the Human Structure block that may serve as a model for incorporating the ACGME core competencies into early medical education. The block emphasizes clinically oriented anatomy, invites self‐ and peer‐evaluation, provides daily formative feedback through an audience response system, and employs team‐based learning. The course curriculum includes didactic briefing sessions and roles for students as teachers, leaders, and collaborators. Third‐year medical students serve as teaching assistants, enhancing their own knowledge of anatomy, bettering their skills as medical educators, and facilitating group communication and critiques. This work was supported by the Mayo Clinic Department of Anatomy. Grant Funding Source None

The goal of our study was to evaluate the effectiveness of the audience response system (ARS) as a tool for providing formative feedback to first year medical students. Over a three year period, we collected data from anatomy and histology courses in which students answered clinically oriented multiple choice questions using the ARS. We compared each student's cumulative ARS and final exam scores and we calculated a correlation coefficient between these two values. In addition, we conducted a questionnaire to evaluate the students' perception on ARS. According to our results, students saw ARS as useful for providing feedback on performance with a mean of 3.61 (1‐5 scale). There was a strong positive correlation between ARS and final exam scores. R values for the ARS and NBME Anatomy subject exam was R=.9556; and for the Anatomy/Radiology written exams, R=.9882. Students believed that ARS improved their performance with a mean of 3.94 (1‐5 scale). Students also preferred more frequent ARS quizzes with fewer questions to less frequent sessions with more questions (mean=3.74). In conclusion, students use ARS as a feedback tool and can rely on it as a good predictor of final course performance. We have found that ARS feedback motivates students to seek help from faculty when appropriate. It is user friendly, interacts well with PowerPoint, and is not time consuming for faculty. Grant Funding Source AAA

The quality of healthcare delivery is dependent on collaboration between various professional disciplines. Integrating opportunities for interprofessional learning in medical education programs will prepare future clinicians to be effective members of a multi‐disciplinary care team. We incorporated an ultrasound demonstration of the upper limb into the gross anatomy courses for first year medical (n=53) and physical therapy (n=28) students. Prior to participating in the learning experience, all students took a short individual pre‐test based on clinical concepts regarding the assigned study material. A physical medicine and rehabilitation physician demonstrated the use of ultrasound as a diagnostic and procedural tool for the shoulder and elbow. Following the demonstration, students worked within interprofessional teams (n=14 teams) to review the related anatomy on dissected specimens. At the end of the session, students worked within interprofessional teams to complete a collaborative post‐test. Team scores were compared to the mean individual score within each team using a paired t‐test. Students scored higher on the collaborative post‐test (5.7/6) than on the individual pre‐test (4.2/6), p <0.0001. Results suggest that working in interprofessional teams may enhance understanding and clinical application of anatomy, thereby reinforcing the benefit of an interdisciplinary team approach to patient care.

Recently many medical schools have introduced ultrasound education, with several institutions adopting formal teaching of ultrasound into their anatomy curricula. Additionally, medical schools nationwide have begun to incorporate various forms of interprofessional education (IPE) into their programs to prepare medical students for the teamwork necessary to serve as physicians. The Anatomy course at Mayo Medical School incorporated several IPE sessions with physical therapy students. Since the course is integrated with radiology, ultrasound imaging was recently added to complement static images and visualize living anatomy. Due to the success of prior IPE endeavors in anatomy, a new elective experience for hands‐on ultrasound practice sessions was offered to both medical and physical therapy students. The aim of this study was to assess student perception of elective ultrasound practice sessions as an opportunity for interprofessional peer‐learning. Practice sessions were scheduled once a week for 4 hours and a trained teaching assistant was available during the sessions. Students were encouraged to discuss different techniques and anatomical knowledge based on their respective experiences. A sign‐in sheet was kept to monitor how many students from both groups attended. Students were asked to fill out a survey at the end of 4 weeks to assess perceptions of the interprofessional experience. Preliminary results indicate that students appreciated the diversity of an interprofessional approach to learning ultrasound skills and enjoyed teaching each other anatomy through ultrasound.

Collaborative learning is recognized for its positive impact on student performance. Influence of social networking on evolution of student learning is rooted in construct of collaborative learning theory. Studies have alluded to benefits of informal learning (outside class) with little information evidenced in academic performance. Gross anatomy course at Mayo Clinic uses team based learning approach over 7 weeks. Teams are diversified (eg. cultural background, college attended, gender) while normalized (similar total average pre‐admission scores) to give each team equal footing from which to work. Teams are assigned at start of histology block 8 weeks prior and maintained through anatomy block. Based on premise of collaborative learning, we predicted students who spent more time interacting with classmates outside class contributed to collective knowledge of team and positively influenced team performance. Study aimed to determine if interaction of team members with classmates outside of assigned team impacted academic performance. Students voluntarily completed weekly surveys identifying classmates they had studied with after hours. Group size and duration of academic interaction were analyzed. Data were compared with final team performance for practical and written exams. Data were statistically analyzed and measured in terms of where teams ranked in overall class performance. Preliminarily, teams with 2 or more members who studied with non‐team members outside class showed improvement, with more overall members outside the bottom tertile. Students in bottom tertile studying with students in top tertile in a small group (< 5) > 1 hour outside class showed 5% improvement. Students in the top tertile are more likely to study alone or with students in the same tertile. Students who study with those in lowest tertile tend to have a positive effect on their performance. When students are allowed to choose their own networks, they tend to form mixed networks, in addition to formal teams.

Ultrasound education continues to be integrated into gross anatomy courses in the United States. The team based design of the anatomy course at Mayo Clinic School of Medicine incorporates team‐based ultrasound oriented activities that are formalized through defined course objectives and assessed in the final examination. Providing personal handheld ultrasound devices to first‐year medical students during the gross anatomy course has been the mainstay of ultrasound education for the past three years. Handheld ultrasound devices have been provided to students for limited periods in some medical schools within the United States, but unique to this curriculum, students are assigned devices that can be utilized outside formal class time. This provides unlimited opportunity to apply their understanding of three‐dimensional, living anatomy, while simultaneously promoting student comfort and engagement with advancing ultrasound technology. Student perception related to the use of ultrasound outside of formal curricular time was evaluated on a five point Likert scale. Both quantitative and qualitative analyses were used to interpret the data obtained from this study. A total of three surveys were sent to medical students over a period of twelve months with an average response rate of 58.9%. Students indicated that (1) ultrasound devices at personal disposal during the anatomy course improved understanding of anatomical structures imaged ( mean 3.9, SD=+/− 1.01 ), (2) the handheld ultrasound device was easy to use ( mean 3.9, SD = +/− 0.8), and (3) it would be beneficial if ultrasound was implemented as part of the longitudinal learning experience in medical school ( mean 4.1, SD = +/ − 0.7 ). Students were not convinced that (1) having a personal ultrasound device influenced future choice of medical specialty ( mean 2.8, SD = +/− 1.0 ) and (2) the opportunity augmented coursework in the past three months of medical school at time of taking the survey ( mean 2.7, SD =+/ − 1.25 ). Results of the study indicated that access to personal handheld devices motivated students to use ultrasound devices and that they did so with increasing frequency outside of class time. In addition, students were able to apply and reinforce anatomical concepts by using landmarks to first locate and orientate the anatomic field and then interpret images of underlying structures. The fact that students did not see the value of ultrasound in determining future career choices or relate their learning of ultrasound to subsequent courses should not deter prospective opportunity for use of ultrasound in clinical practice. Basic ultrasound proficiency and an ability to effectively interpret scans are skills that in the long term will significantly decrease the learning curve in the use of technology as a diagnostic tool in future clinical settings. This abstract is from the Experimental Biology 2018 Meeting. There is no full text article associated with this abstract published in The FASEB Journal .

While fundamental principles of anatomy are well‐established in early medical training, continued retention of anatomical knowledge is dependent on value, importability and relevance to surgical practice. As novel reconstructive strategies emerge, surgeons must account for individual patient factors and comorbidities in predicting patient outcome. Mastery of planning requires precise knowledge of local anatomy and reconstructive techniques, warranting reconnection with prior anatomic knowledge. Finding dedicated time to learn anatomy through self‐guided approach, is often challenging in a busy practice and CPD opportunities become a highly valued resource. In recent years, two mainstream professional dermatology societies have provided a platform for delivery of anatomy based clinical sessions. This study aims to assess value of point of care delivery of relevant anatomy and its role in improving perception of surgical confidence amongst procedural dermatologists in a CPD course. Assessment of core knowledge and knowledge gaps was conducted through the American College of Mohs Surgery (ACMS). Objectives were designed by a team of anatomists and clinicians based on a series of challenging cases. Anatomy sessions were offered at a large general session (>300 participants) and a small group hands‐on flap based session (n=20) Key anatomic teaching points relating to danger zones, safe zones and functional impairment were highlighted. Videos of real‐time dissection using a layered approach of targeted anatomy were created and supplemented with 3D‐printed models. For challenging anatomy encountered during Mohs reconstruction, patient defects were re‐created on the cadaver highlighting pertinent anatomy. Qualitative and quantitative analyses were conducting using course review for general session and confidence rating using Likert scale of anatomy based objectives for small group session. While 60–90 minute general session was sufficient for anatomist‐clinician team to facilitate discussion, participants indicated strong desire for increased session time. Videos and high quality photography were seen as outstanding tools for demonstrating anatomy within surgical field. Participants strongly valued anatomist/clinician partnership and relevance of material to everyday practice. Session review data (n=78) indicated session objectives “improved their ability to provide excellent patient care by helping close practice gaps”( 89.74%), helped “identify practice gaps in knowledge, performance and outcomes” (83.33%) and material presented was relevant to their Mohs and dermatologic practice (100%). Within small group session (n=11), only 18% had access to anatomy facility and material, with 100% agreeing/strongly agreeing that anatomy education was critical to their current practice. Analysis of perceived confidence in anatomic knowledge post course showed significant improvement in confidence in identifying, isolating and visualizing relevant anatomical (p<0.05). Positive impact of collaborative teaching of anatomy outside a mainstream academic setting using targeted point of care delivery through the use of technology (video), products of technology (photography and 3D‐printed material) and patient based clinical discussion to improve physician confidence was demonstrated. In era of authentic learning, anatomists share a responsibility for bringing point‐of‐care content for improved patient care. This abstract is from the Experimental Biology 2018 Meeting. There is no full text article associated with this abstract published in The FASEB Journal .

Medical professionalism is a multifaceted concept that includes maintenance of knowledge, interpersonal skills, teamwork, privacy and honesty. While non‐technical skills are often under‐emphasized in the medical student learning environment these skills are directly associated with providing professional medical care. There is an increasing trend however, for basic science courses such as Anatomy to introduce medical students early onto the concept of professionalism and highlight the importance of non‐technical skill development to patient care. To reinforce these competencies as well as develop an authentic curriculum for non‐technical skill development, anatomists and internists at Mayo Clinic, College of Medicine aligned objectives within medical school and residency programs. Strategies were designed to evaluate (1) teamwork, (2) communication and (3) self‐reflection. The aim of this presentation is to demonstrate how each of these core competencies can be promoted in both residency and medical student curricula and how trainee and student progress may be measured by educational approaches within their learning environments. Strategies include the use of a team charter, self‐reflection/reflective diaries and communication exercises that target patients and the multidisciplinary health care team. Through educational design (1) trainee and student's ability to acknowledge self‐limitation and develop critical thinking skills appeared to evolve and (2) trainee and student appreciation of the importance of communication skills when interacting with different groups as well as ability to translate medical/anatomical terminology to lay language were evident. In addition, the use of reflection and team charters promoted understanding team dynamics and facilitation of effective teamwork. The current multi‐disciplinary health care environment places strong emphasis on team‐work, confidentiality of protected health information and the role of communication in preventing medical errors and improving patient outcome. Anatomy courses designed on team‐based approaches with use of body donors provide a useful simulated learning environment. Medical students may be assessed through a variety of activities targeting team‐work, communication skills and clinical reasoning at different levels. Use of reflective exercises assessing team interaction, evolution of critical thinking skills and course challenges have found an important place in the evolving anatomy curriculum. Early exposure to these critical skills helps prepare for clinical rotations where milestones for these skills will need to be reached. This presentation will demonstrate the translational approach in synergizing non‐technical skill development between anatomy and residency curricula. This abstract is from the Experimental Biology 2018 Meeting. There is no full text article associated with this abstract published in The FASEB Journal .