Pawlina, Wojciech

Advanced postgraduate medical education for health‐care professionals is constantly evolving. Understanding facial anatomy and especially its vascular system is crucial when performing soft tissue filler injections to avoid adverse events including tissue loss or irreversible blindness. Standard anatomical resources often fall short of elucidating clinically relevant concepts in more highly specialized areas of interest. A novel dissection approach for demonstrating the anatomy of the lateral orbit was presented at scientific meetings to participants from dermatology, plastic surgery, and general practice. Results from the post‐course online survey (n = 52) were analyzed. The results of the survey reveal a high educational impact and a high clinical relevance of the novel dissection approach. In addition, the majority of respondents (97.7%; n = 51) felt that the exposed anatomical structure of the orbit and face improved their ability to safely perform cosmetic procedures on the face. More experienced respondents who had previously attended at least five cadaveric dissections were more likely to strongly agree that reviewing anatomy through this novel dissection approach increased their confidence in avoiding periorbital vascular danger zones. As minimally invasive outpatient procedures continue to evolve, practicing physicians and mid‐level providers often face the challenge of having to reconcile preexisting anatomical knowledge with new clinical practice. Skills required to navigate high impact anatomy include visualization of structures that form the navigational landscape and avoidance of key danger zones. The novel dissection approach to the lateral orbit reflects the increasing focus on revisiting, reforming, and redesigning anatomy for continuing professional development activities.

In recent years, the use of point of care ultrasound (POCUS) in clinical practice has increased substantially . Many medical schools have introduced ultrasound skills training into their curriculum which starts early in anatomy courses . Few, if any, of these programs assess students’ ultrasound knowledge and skills in a simulated clinical team environment. Anatomy Ultrasound Objective Structural Practical Examination (OSPE) implemented as a part of practical examination provides such an opportunity to asses both traditional and non‐traditional discipline‐independent skills, competencies and attributes. As part of the seven‐week anatomy course at Mayo Clinic Alix School of Medicine, first‐year medical students attended four ultrasound sessions. Each session included a short didactic module followed by hands‐on practice guided by near‐peer teachers. For the final examination, four‐member student teams were required to work collaboratively to perform four different scans during which students interacted with multiple standardized patients and rotated responsibility for obtaining an image, orienting the image, and identifying assigned structures. Students were graded using a rubric and received a team‐score based on tasks associated with individual roles of team members. In addition to ultrasound skills, the nature of their professional interactions with patient, communication skills, and situational awareness were assessed. The average team score was 96%. The students completed a survey at the conclusion of the anatomy course in which they rated the OSPE experience very positively. Team‐based OSPE examination was a clinically relevant and effective mechanism to simultaneously evaluate anatomic knowledge, clinical skills, and non‐traditional discipline‐independent skills that were emphasized during the anatomy course. Support or Funding Information

Active learning has the benefit of being more engaging and interactive, making it more suitable for adult learners who prefer a task/problem centered approach to learning. Implementation of small‐group sessions in the material‐rich course is not always possible and other alternatives that engage learners should be explored. To incorporate active learning strategies, a team learning exercise “Talking Points” (TP), was introduced in a microscopic anatomy sessions for first year medical students. At the beginning of the laboratory period, students were given 5–7 subject‐related basic science/clinical problems and were encouraged to discuss within small “ad hoc” formed teams. Near the end of the laboratory session, these items were discussed by the entire group. This exercise gave the students the opportunity to learn relevant clinical material within small teams and present their findings to other classmates. Many students remarked that TP facilitated their learning of the material, stimulated questions, encouraged peer teaching, and provided a preview of learning strategies for the final examination. The participation and students' performance during TP was not included in the final grade. Incorporation of the TP into the microscopic anatomy curriculum increased students' participation and ended the laboratory session with an enthusiastic conclusion.

Objectives Local anesthetic injection into the interspace between the popliteal artery and the posterior capsule of the knee (IPACK) has the potential to provide motor‐sparing analgesia to the posterior knee after total knee arthroplasty. The primary objective of this cadaveric study was to evaluate injectate spread to relevant anatomic structures with IPACK injection. Methods After receipt of Institutional Review Board Biospecimen Subcommittee approval, IPACK injection was performed on fresh‐frozen cadavers. The popliteal fossa in each specimen was dissected and examined for injectate spread. Results Ten fresh‐frozen cadaver knees were included in the study. Injectate was observed to spread in the popliteal fossa at a mean ± SD of 6.1 ± 0.7 cm in the medial‐lateral dimension and 10.1 ± 3.2 cm in the proximal‐distal dimension. No injectate was noted to be in contact with the proximal segment of the sciatic nerve, but 3 specimens showed injectate spread to the tibial nerve. In 3 specimens, the injectate showed possible contact with the common peroneal nerve. The middle genicular artery was consistently surrounded by injectate. Conclusions This cadaver study of IPACK injection demonstrated spread throughout the popliteal fossa without proximal sciatic involvement. However, the potential for injectate to spread to the tibial or common peroneal nerve was demonstrated. Consistent surrounding of the middle genicular artery with injectate suggests a potential mechanism of analgesia for the IPACK block, due to the predictable relationship between articular sensory nerves and this artery. Further study is needed to determine the ideal site of IPACK injection.