Citations

Medical error is an important cause of patient morbidity/mortality. Disclosing medical errors to patients is an important component of safe practice. There is a growing need to assess the inherent nature of how physicians in training approach such unanticipated outcomes. With limited exposure for medical students to the idea of medical error disclosure, which is an important area of professionalism in medicine, we believe that a reflective writing exercise can be an efficient tool to objectively assess how students acknowledge and address medical errors early in their medical career. Every year, students in the 1 st year gross anatomy course are asked to respond to a scenario in which a medical student's cellular phone conversation with a friend in a public area (i.e. post office) was overheard by a family member of a cadaver donor to Mayo Medical School. Students were asked to write an apology email to the offended party (Mrs. X) as though they were the student who made the mistake. Students were given 48 hours to complete and submit the assignment. We retrospectively reviewed the medical error disclosure assignment of medical students in the first‐year gross anatomy course at Mayo Medical School between 2005 and 2015. An instrument for assessing medical error disclosure, consisting of fifteen items evaluated on Likert scale (1–5, 1 is the lowest and 5 is the highest), was developed. Using this evaluation tool, we assessed the basic elements of medical error disclosure – acknowledgement of error/system failure, expression of regret, awareness of its impact, description of future behavior, and proper tone as an apology letter. Preliminary data from years 2005, 2008, 2011, and 2014 indicated the mean error disclosure scores of 3.49 ± 0.83, 3.32 ± 0.81, 3.29 ± 0.84, and 3.25 ± 0.75, respectively. The word count in those four class years were 246.9 ± 84.0, 236.3 ± 86.4, 211.2 ± 92.3, and 242.3 ± 79.1 words, respectively. The proportion of students who claimed to have spoken with his/her mother was 2 out of 42 (4.7%), 4 out of 49 (8.2%), 0 out of 48 (0%), and 20 out of 51 (39%) students, respectively. Across the four class years, there was a non‐significant but uniform trend of reduced mean error disclosure score over time, while the mean word count did not show a certain pattern. One notable trend over the class years was an increasing attribution to their mother as the person they spoke with, possibly a way to help alleviate Mrs. X's frustration by eliciting empathy. Overall, this efficient, integrated writing exercise serves as a sensitive tool to objectively gauge skills in the basic areas of medical error disclosure in a preclinical anatomy course. Support or Funding Information My sponsor is Dr. Wojciech Pawlina, the senior author of the abstract. Funding will be considered by the Department of Anatomy, Mayo Clinic College of Medicine, Rochester, MN.

While small group learning and team‐based learning (TBL) have become widely accepted modalities in medical education, surprisingly little is known about how medical students interact between and within their learning teams and how dissection teams themselves interact with faculty or teaching assistants (TAs). This study sought to examine: (1) interactions between faculty/TAs and student teams; and (2) student table‐to‐table interactions taking place in the anatomy didactic block at Mayo Medical School. In addition, interactions between students in the same student team and overall team dynamics were examined by faculty. The purpose of this study is to understand dissection group dynamics and how these sets of interactions relate to student academic performance . The amount of time faculty/TAs spent with a group during each teaching session was recorded by students at the end of each session. The number of team‐to‐team interactions were also recorded. These values were then compared to student examination performance. Results from this study indicated that the individual time faculty/TAs spend with teams and the number of table‐to‐table interactions appeared to have no correlation with overall team academic performance. However, faculty assessment of interactions within student teams and overall team dynamics appears to be an accurate predictor of the team's overall academic performance, where groups with well‐defined leadership roles and strong cooperation between team members performed higher than those where this was not present . Support or Funding Information Mayo Clinic College of Medicine Department of Anatomy

Advanced plastic and craniomaxillofacial reconstruction is a multidisciplinary field, requiring communication and accurate planning among various specialists including oncologic surgeons, plastic surgeons, and radiologists. Complex defects may present in pediatric congenital deformities, after trauma or oncologic surgery. Restoration of form and function require precise planning among the various specialists involved and accurate execution of the surgical plan. Often, considerations for bony and soft tissue requirements make the reconstruction more challenging. Virtual surgical planning using computed tomographic imaging, 3D surface imaging technology and computer‐aided design allow the surgeons to perform virtual surgery and generate templates and cutting guides that allow for the precise and expedient recreation of the plan in the operating room. The author presents cases highlighting various reconstructive requirements where virtual planning was used for advanced plastic and craniomaxillofacial reconstruction to achieve precise reconstruction. Support or Funding Information None

AbstractThe 3D stereoscopic technique consists in providing the illusional perception of depth of a given object using two different images mimicking how the right and left eyes capture the object. Both images are slightly different and when overlapped gives a three‐dimensional (3D) experience. Considering the limitations for establishing surgical laboratories and dissections courses in some educational institutions, techniques such as stereoscopy and photogrammetry seem to play an important role in neuroanatomy and neurosurgical education. The aim of this study was to describe how to combine and set up realistic models acquired with photogrammetry scans in 3D stereoscopic projections. Three donors, one dry skull, embalmed brain and head, were scanned using photogrammetry. The software used for displaying the final realistic 3D models (Blender, Amsterdam, the Netherlands) is a free software and allows stereoscopic projection without compromising the interactivity of each model. By default, the model was exported and immediately displayed as a red cyan 3D mode. The 3D projector used in the manuscript required a side‐by‐side 3D mode which was set up with simple commands on the software. The final stereoscopy projection offered depth perception and a visualization in 360° of each donor; this perception was noted especially when visualizing donors with different cavities and fossae. The combination of 3D techniques is of paramount importance for neuroanatomy education. Stereoscopic projections could provide a valuable tool for neuroanatomy instruction directed at clinical trainees and could be especially useful when access to laboratory‐based learning is limited.

AbstractOutflow tract ventricular arrhythmias are the most common type of idiopathic ventricular arrhythmia. A systematic understanding of the outflow tract anatomy improves procedural efficacy and enables electrophysiologists to anticipate and prevent complications. This review emphasizes the three‐dimensional spatial relationships between the ventricular outflow tracts using seven anatomical principles. In turn, each principle is elaborated on from a clinical perspective relevant for the practicing electrophysiologist. The developmental anatomy of the outflow tracts is also discussed and reinforced with a clinical case.

Introduction: Medical education is trending towards an outcome-based curriculum that prepares medical graduates to excel in a rapidly evolving, team-centred healthcare delivery system. The Mayo Medical School (MMS) has recently redesigned its curriculum to introduce early clinical relevance, optimise course integration, provide flexibility and promote active learning. This study aims to evaluate the role that curricular flexibility plays in students’ perceived learning, satisfaction and performance. Materials and Methods: First-year students completed a 5-point Likert scale survey regarding satisfaction with and perceived learning from various components of the flexible curriculum during 2 different academic blocks. Students’ academic performance was assessed by a National Board of Medical Examiners (NBME) Subject Examination after each block. Results: In comparing student-rated satisfaction and perceived learning from didactics versus other curricular components for Block 3 (Pathology and Immunology) and Block 5 (Gross Anatomy and Radiology), students rated didactics higher in all cases in which there was a statistically significant difference in the ratings. There was a statistically significant positive correlation between the amount learned and satisfaction for all curricular components with the exception of Block 5 independent study. During Block 3, only interest in the subject matter correlated positively with the NBME score, while during Block 5, only time spent in class correlated negatively with the NBME score. Conclusions: Although various components of the flexible curriculum do not appear to affect satisfaction and perceived learning, their potential influence on graduate outcomes, in terms of delivering healthcare providers who are patient-centred, creative thinkers and compassionate leaders should not be discounted. Key words: Curriculum reform, Medical curriculum, Outcomes-based education, Student satisfaction

Introduction: Changes in worldwide healthcare delivery require review of current medical school curricula structure to develop learning outcomes that ensures mastery of knowledge and clinical competency. In the last 3 years, Mayo Medical School implemented outcomes-based curriculum to encompass new graduate outcomes. Materials and Methods: Standard courses were replaced by 6-week clinically-integrated didactic blocks separated by student-self selected academic enrichment activities. Gross and microscopic anatomy was integrated with radiology and genetics respectively. Laboratory components include virtual microscopy and anatomical dissection. Students assigned to teams utilise computer portals to share learning experiences. High-resolution computed tomographic (CT) scans of cadavers prior to dissection were made available for correlative learning between the cadaveric material and radiologic images. Results: Students work in teams on assigned presentations that include histology, cell and molecular biology, genetics and genomic using the Nexus Portal, based on DrupalEd, to share their observations, reflections and dissection findings. Conclusions: New generation of medical students are clearly comfortable utilising web-based programmes that maximise their learning potential of conceptually difficult and labor intensive courses. Team-based learning approach emphasising the use of knowledge-sharing computer portals maximises opportunities for students to master their knowledge and improve cognitive skills to ensure clinical competency. Introduction: Changes in worldwide healthcare delivery require review of current medical school curricula structure to develop learning outcomes that ensures mastery of knowledge and clinical competency. In the last 3 years, Mayo Medical School implemented outcomes-based curriculum to encompass new graduate outcomes. Materials and Methods: Standard courses were replaced by 6-week clinically-integrated didactic blocks separated by student-self selected academic enrichment activities. Gross and microscopic anatomy was integrated with radiology and genetics respectively. Laboratory components include virtual microscopy and anatomical dissection. Students assigned to teams utilise computer portals to share learning experiences. High-resolution computed tomographic (CT) scans of cadavers prior to dissection were made available for correlative learning between the cadaveric material and radiologic images. Results: Students work in teams on assigned presentations that include histology, cell and molecular biology, genetics and genomic using the Nexus Portal, based on DrupalEd, to share their observations, reflections and dissection findings. Conclusions: New generation of medical students are clearly comfortable utilising web-based programmes that maximise their learning potential of conceptually difficult and labor intensive courses. Team-based learning approach emphasising the use of knowledge-sharing computer portals maximises opportunities for students to master their knowledge and improve cognitive skills to ensure clinical competency. Ann Acad Med Singapore 2008;37:998-1001 Key words: Clinical competency, E-learning, Educational strategies, Medical wikis, Outcomesbased curriculum, Team-based learning Key words: Clinical competency, E-learning, Educational strategies, Medical wikis, Outcomesbased curriculum, Team-based learning

Background: The number of soft-tissue filler injections performed in the United States is constantly increasing and reflects the high demand for enhanced facial and body attractiveness. The objective of the present study was to measure the viscoelastic properties of soft-tissue fillers when subjected to different testing frequencies. The range of tested frequencies represents clinically different facial areas with more [lips (high frequency)] or less [zygomatic arch (low frequency)] soft-tissue movement. Methods: A total of 35 randomly selected hyaluronic acid–based dermal filler products were tested in an independent laboratory for their values of G′, G″, tan δ, and G* at angular frequencies between 0.1 and 100 radian/second. Results: The results of the objective analyses revealed that the viscoelastic properties of all tested products changed between 0.1 and 100 radian/second angular frequency. Changes in G′ ranged from 48.5 to 3116 percent, representing an increase in their initial elastic modulus, whereas changes in G″ ranged from −53.3 percent (i.e., decrease in G″) to 7741 percent (i.e., increase in G″), indicating both an increase and a decrease in their fluidity, respectively. Conclusions: The increase in G′ would indicate the transition from a “softer” to a “harder” filler, and the observed decrease in G″ would indicate an increase in the filler’s “fluidity.” Changes in the frequency of applied shear forces such as those occurring in the medial versus the lateral face will influence the aesthetic outcome of soft-tissue filler injections.