Langley, Natalie R.

ABSTRACTForensic anthropology must embrace standards and credentialing that align with other medicolegal disciplines, such as forensic pathology and forensic odontology. This involves establishing itself more firmly as an essential specialty in the medicolegal system and limiting practice to qualified professionals. Without educational or professional requirements to practice forensic anthropology, the competencies of those involved in medicolegal cases vary, despite the potentially serious legal impact of errors. Negligent work can impede decedent identification or wrongly convict or free a suspect. Erroneous and unprofessional work also misrepresents the field and may deter agencies from utilizing forensic anthropologists. This commentary aims to convey the need to further professionalize forensic anthropology through the standardization of education, qualifications, and practice. Differences between certification and licensure and their implications are discussed. Recent and upcoming developments in the field highlight progress, including the development of a multi‐level certification system and list of core competencies by the American Board of Forensic Anthropology (ABFA). Additionally, the Anthropology subcommittee of the Organization of Scientific Area Committees for forensic science (OSAC) is developing a standard for qualifications in forensic anthropology. These developments emphasize the importance of certification and standardization in education and training for the advancement of forensic anthropology. Standardization efforts such as these will foster a cohesive, respected practice to serve the evolving needs of the medicolegal system.

Background and objectives Few cadaveric studies have evaluated the dye spread with superficial parasternal intercostal plane (SPIP) blocks. In this study, we examined the dye spread of an ultrasound-guided SPIP block in a human cadaveric model with single and double injection techniques. Methods Seven single and four double ultrasound-guided SPIP blocks were performed in seven unembalmed human cadavers using an in-plane approach with the transducer oriented parasagitally 1 cm lateral to the sternum. For the single SPIP, 20 mL of 0.166% methylene blue was injected in the second or third intercostal space into the plane between the Pec major muscle and internal intercostal muscles. For the double SPIP, 10 mL of 0.166% methylene blue was injected in the SPIP at one intercostal space with an additional 10 mL injected in the SPIP two intercostal spaces caudally. The extent of dye spread was documented. Results For all SPIP injections, there was consistent mediolateral spread from the sternum to the mid-clavicular line, with many extending laterally to the anterior axillary line. There was craniocaudal spread to a median of 2 intercostal muscles with a single SPIP and 3 intercostal muscles with a double SPIP. There was a median spread to 1 intercostal nerve for the single SPIP and 1.5 intercostal nerves with the double SPIP. Conclusions The SPIP block demonstrated limited spread in this cadaver study. A single injection of this block may be of limited value and multiple SPIP injections may be needed to have adequate spread for anterior thoracic procedures.

Perceived self‐efficacy influences how one approaches goals, tasks, and challenges, and has been shown to affect motivation and academic behaviors. The ability to accurately assess one's competency and limitations is also a critical skill for physicians. Research has shown that medical students can underestimate their perceived clinical skills compared to observer assessment, but limited research has addressed perceived knowledge specific to anatomy. This study compares student perception and faculty evaluation of academic competency in a gross anatomy course. Additionally, this study revisits whether daily audience response system (ARS) questions is a predictor of academic success, and the impact of near‐peer tutoring on student performance. Data from 51 first year medical students in a 7‐week gross anatomy course were evaluated. At the end of week 3 of the course, students with a cumulate ARS grade below the 70% pass requirement were contacted by faculty with individualized formative feedback on academic performance and presented with opportunities for improvement and formal tutoring. All students irrespective of performance were made aware of opportunities for tutoring. Six near‐peer teaching assistants tutored students who requested help. Mean ARS scores and laboratory practice practical grades were evaluated before and after the students received formative feedback. Students were placed into one of four groups based on two factors: (1) their perceived ability to succeed in the course, and (2) faculty perception of their potential for success. Students in groups 1 and 3 were identified by faculty members as potentially at risk, whereas groups 2 and 4 were viewed as low risk. From the students' perspective, those in groups 1 and 2 self‐identified as needing assistance, whereas groups 3 and 4 felt that they were not at risk of failing the course. Of the 12 students contacted by faculty, 6 (12% of the class) requested a tutor (group 1). Additionally, 11 (21%) students who were not contacted by faculty requested a tutor (group 2). Six (12%) students that were contacted by faculty did not request a tutor (group 3), while 28 (55%) were not contacted by faculty and did not request a tutor (group 4). The averages of daily ARS scores between groups after feedback was significantly greater in group 4 compared to groups 1 and 2 (68% vs 61% and 63%, p=0.04 and 0.04, respectively). In addition, the post faculty feedback practical average scores were significantly higher in group 4 compared to group 1 (67% vs 56%, p=0.04). These data show that in an environment that fosters acceptance of academic support, students are more receptive to receiving and reaching out for help from near‐peer tutors. Formative feedback from ARS scores continue to be a reliable indicator for tracking student performance. Improvement of student performance in final course evaluation may be a positive indicator of success from near‐peer tutoring. Support or Funding Information None

Ultrasound has been used more frequently in the anatomical sciences to reinforce core anatomy concepts in the classroom and introduce commonly applied imaging technologies encountered in a clinical setting. Interprofessional Education (IPE) is being incorporated into health sciences training as a learning model for real world interactions. The primary objective of the current study was to determine the impact of an IPE ultrasound curriculum on students' anatomy and ultrasound knowledge, as well as attitudes towards interprofessional collaboration. We hypothesized that students who participated in an IPE experience would have improved recall of anatomical and ultrasound concepts as well as improved attitudes and perceptions towards IPE when compared to students who did not participate in an IPE session. First year medical students (MD, n = 40) and first year physical therapy students (PT, n = 25) were randomly assigned to PT‐only, MD‐only, or mixed PT‐MD ultrasound instruction groups studying the shoulder. Students were assessed using an anatomy and ultrasound knowledge test and University of the West of England Interprofessional Questionnaire (UWEIPQ) prior to and following the session. The results of this study suggest that while ultrasound instruction significantly improves ultrasound post‐test scores when compared to pre‐test scores regardless of group assignment (PT‐only: p < 0.001; MD‐only: p = 0.007; PT‐MD: p < 0.001), learning in an interprofessional PT‐MD group did not significantly impact knowledge recall of ultrasound concepts when compared to non‐IPE groups. Interestingly, students in PT‐MD groups had significantly higher anatomy post‐test scores when compared to the MD‐only groups (PT‐MD post‐test = 93.2%; MD‐only post‐test = 84.1%; p = 0.041), but not when compared to the PT‐only groups. Additionally, the results of the UWEIPQ are consistent with the impression that students who participate in an IPE experience are more likely to be cognizant of inherent biases in the interactions between different health professionals as well as demonstrate increased confidence in their interprofessional relationships. In conclusion, our study reinforces that IPE programs should quantify knowledge recall in order to assess the effectiveness of a specific program. Furthermore, such endeavors should assess important competencies including communication, teamwork, and interdisciplinary respect that are necessary to succeed in a multidisciplinary health care team. Support or Funding Information Department of Anatomy, Mayo Clinic College of Medicine and Science, Mayo Clinic, Rochester, MN; Social Science and Humanities Research Council, Government of Canada

Introduction The superficial and deep parasternal intercostal plane (DPIP) blocks are two new blocks for thoracic pain. There are limited cadaveric studies evaluating the dye spread with these blocks. In this study, we examined the dye spread of an ultrasound-guided DPIP block in a human cadaveric model. Methods Five ultrasound-guided DPIP blocks were performed in four unembalmed human cadavers using an in-plane approach with a linear transducer oriented in a transverse plane adjacent to the sternum. Twenty milliliters of 0.1% methylene blue were injected between ribs 3 and 4 into the plane deep to the internal intercostal muscles and superficial to the transversus thoracis muscle layer. The chest muscles were dissected, and the extent of dye spread was documented in both cephalocaudal and mediolateral directions. Results The transversus thoracis muscle slips were stained in all cadavers from 4 to 6 levels. Intercostal nerves were dyed in all specimens. Four levels of intercostal nerves were dyed in each specimen with variability in number of levels stained above and below the level of the injection. Conclusions The DPIP block spreads along the tissue plane above the transversus thoracis muscles to multiple levels to dye the intercostal nerves in this cadaver study. This block may be of clinical value for analgesia in anterior thoracic surgical procedures.

Abstract Purpose This scoping review summarises five decades of research on gender bias in subjective performance evaluations of medical trainees. Method A medical librarian searched PubMed, Ovid Embase, Scopus, Web of Science and Cochrane DBSR in June 2020. Two researchers independently reviewed each abstract to determine if it met inclusion criteria (original research article investigating gender bias in subjective medical trainee evaluations by staff). References from selected articles were also reviewed for inclusion. Data were extracted from the articles, and summary statistics were performed. Results A total of 212 abstracts were reviewed, and 32 met criteria. Twenty (62.5%) evaluated residents, and 12 (37.5%) studied medical students. The majority of studies on residents were Internal Medicine ( n = 8, 40.0%) and Surgery ( n = 7, 35.0%). All studies were performed in North America and were either retrospective or observational. Nine (28.0%) were qualitative, and 24 (75.0%) were quantitative. The majority of studies were published in the last decade ( n = 21, 65.6%). Twenty (62.5%) studies documented gender bias, of which 11 (55%) found that males received higher quantitative performance evaluations and 5 (25%) found that females received higher evaluation scores. The remaining 4 (20%) reported gender differences in qualitative evaluations. Conclusions Most studies detected gender bias in subjective performance evaluations of medical trainees, with a majority favouring males. There is a paucity of studies on bias in medical education with a lack of standardised approach to investigating bias.

AbstractThe medicolegal system relies on the ability of experts and non‐experts alike to make judgments about expertise and use those judgments to reach consequential decisions. Given the lack of standard criteria, mandatory certification, or licensure for establishing expertise required to practice forensic anthropology and testify as an expert witness, we sought to understand how individuals assess and identify expertise in forensic anthropology by using a social science tool called the Imitation Game. This tool assesses immersion in a specific area of study via discourse, with the premise that some individuals lacking expertise themselves imitate or attempt to pass as experts. For this project we recruited volunteers with varying expertise in forensic anthropology to participate in interviews which asked questions about the practice and structure of the discipline. Those interviews were transcribed, anonymized, and evaluated by other recruited individuals with varying expertise in forensic anthropology. Results found that judges who were experts in forensic anthropology performed better than non‐expert judges in determining who was not an expert in forensic anthropology based on their anonymized responses; however, nearly half of the non‐experts were still able to pass as experts in forensic anthropology. The difficulties in assessing expertise based on discourse interactions demonstrates the value and need for well‐defined credentials and mandatory certification to practice forensic anthropology. This study demonstrates that accurately identifying expertise in forensic anthropology may be challenging for both experts and non‐experts, especially when relying solely on interactional expertise rather than formal assessments of competency which directly elucidate contributory expertise.

AbstractForensic fractographic features of bone reliably establish crack propagation in perimortem injuries. We investigated if similar fracture surface features characterize postmortem fractures. Experimentally induced peri‐ and postmortem fractures were used to assess if fractographic features vary as bone elasticity decreases during the postmortem interval (PMI). Thirty‐seven unembalmed, defleshed human femoral shafts from males and females aged 33–81 years were fractured at varying PMIs with a drop test frame using a three‐point bending setup and recorded with a high‐speed camera. Vital statistics, cause of death, PMI length, temperature, humidity, collagen percentage, water loss, fracture energy, and fractography scores were recorded for each sample. Results showed that fractographic features associated with perimortem fractures were expressed in PMIs up to 40,600 accumulated degree hours (ADH), or 60 warm weather days. Hackle was the most consistently expressed feature, occurring in all fractures regardless of ADH. The most variable characteristics were wake features (78.4%) and arrest ridges (70.3%). Collagen percentage did not correlate strongly with ADH (r = −0.04, p = 0.81); however, there was a strong significant correlation between ADH and water loss (r = 0.74, p < 0.001). Multinomial logistic regression showed no association between fractographic feature expression and ADH or collagen percentage. In conclusion, forensic fractographic features reliably determine initiation and directionality of crack propagation in experimentally induced PMIs up to 40,600 ADH, demonstrating the utility of this method into the recent postmortem interval. This expression of reliable fractographic features throughout the early PMI intimates these characteristics may not be useful standalone features for discerning peri‐ versus postmortem fractures.