Dissection Laboratory Research Articles

Effect of 3D‐Printed Models on Cadaveric Dissection in Temporal Bone Training

ObjectiveMastoidectomy is a cornerstone in the surgical management of middle and inner ear diseases. Unfortunately, training is challenged by insufficient access to human cadavers. Three-dimensional (3D) printing of temporal bones could alleviate this problem, but evidence on their educational effectiveness is lacking. It is largely unknown whether training on 3D-printed temporal bones improves mastoidectomy performance, including on cadavers, and how this training compares with virtual reality (VR) simulation. To address this knowledge gap, this study investigated whether training on 3D-printed temporal bones improves cadaveric dissection performance, and it compared this training with the already-established VR simulation.Study DesignProspective cohort study of an educational intervention.SettingTertiary university hospital, cadaver dissection laboratory, and simulation center in Copenhagen, Denmark.MethodsEighteen otorhinolaryngology residents (intervention) attending the national temporal bone dissection course received 3 hours of mastoidectomy training on 3D-printed temporal bones. Posttraining cadaver mastoidectomy performances were rated by 3 experts using a validated assessment tool and compared with those of 66 previous course participants (control) who had received time-equivalent VR training prior to dissection.ResultsThe intervention cohort outperformed the controls during cadaver dissection by 29% (P < .001); their performances were largely similar across training modalities but remained at a modest level (~50% of the maximum score).ConclusionMastoidectomy skills improved from training on 3D-printed temporal bone and seemingly more so than on time-equivalent VR simulation. Importantly, these skills transferred to cadaveric dissection. Training on 3D-printed temporal bones can effectively supplement cadaver training when learning mastoidectomy.

Vidian Canal as a Transcranial Landmark: Anatomy, Technique, and Illustrative Cases.

Objective The vidian nerve can be accessed in transcranial approaches in carefully selected patients to ensure its preservation and to serve as a landmark for sphenoid sinus entry. This report is to review a technique, evaluate it in laboratory settings, and present two illustrative cases. Design The study involves cadaveric dissection and illustrative cases. Setting The study conducted in a cadaveric dissection laboratory. Participants The object of the study is one cadaveric head and two illustrative clinical cases. Main Outcome Measures Two cases using this approach were illustrated, and a cadaver dissection was performed in a step-by-step fashion. Results: The vidian canal can be accessed by drilling the anterolateral triangle. Two illustrated cases were presented; in one, the vidian nerve was used as part of a corridor to access the sphenoid sinus for tumor delivery, and in the other, the technique was used to find and preserve the vidian nerve during transcranial resection. Conclusion Careful identification of the vidian canal in transcranial surgery is a beneficial technique in carefully selected cases which allows identification of the nerve both for its preservation in selected cases and to create the vidian-maxillary corridor for tumor resection. Knowing the anatomy and pneumatization variants is important in the surgical approach.

The Effectiveness of Augmented and Virtual Reality in the Education of Physical Therapy Students

<h3>Research Objectives</h3> To determine the effectiveness of augmented and virtual reality as a teaching modality on doctor of physical therapy students' learning as seen through confidence, recall, retention and application as compared to traditional teaching methods. <h3>Design</h3> Posttest only control group design with retrospective analysis. <h3>Setting</h3> Private secondary institution, doctoral physical therapy (DPT) program, American International College (AIC), Springfield, MA. <h3>Participants</h3> Convenience sample, 297 first year graduate DPT students enrolled in Gross Anatomy, AIC. Control group: 162 (cohorts 2017 & 2018); experimental group: 135 (cohorts 2019 & 2020). <h3>Interventions</h3> "Visible Body" (VB), augmented and virtual reality (VR) software used by experimental group; control group: attended traditional in-person lecture and laboratory classes. <h3>Main Outcome Measures</h3> Objective data scores (three lecture exams, Osteology Practical exam and Dissection lab exam) collected anonymously for each cohort, calculated by the primary course faculty. Subjective data (quantitative and qualitative) assessed through survey. <h3>Results</h3> Exam scores compared for three groups with different levels of exposure to VB (did not use VB (1), optional use VB (2), and required use VB (3)). Analyses (ANOVA and T-Tests) showed statistical significance with the mean performance for Group 1 being significantly lower than Groups 2 and 3. Osteology exam: No significant difference between groups noted. Dissection Exam: Group 3 scored significantly higher than the other groups. Survey data on the students' self-efficacy towards their ability to learn Gross Anatomy with the VB software proved to be statistically significant (95% CI). Researchers were blinded to all scores and surveys. <h3>Conclusions</h3> Positive correlation exists between grades and the use of the VB application, indicating that the use of VR is an effective resource for DPT students in learning Gross Anatomy. Additionally, VB may be an adequate substitute for cadaver lab for dissection, though aspects of quality and understanding of anatomical relationships may be diminished in the use of virtual software alone. Further research to substantiate these results and further analyze the benefits of VR as a superior resource for learning Gross Anatomy amongst DPT programs is necessary. <h3>Author(s) Disclosures</h3> No disclosures/conflicts.

POST-COVID-19 PANDEMIC: HOW SAFE IS CADAVER DISSECTION IN MEDICAL SCHOOLS?

The practice of cadaver dissection is still largely used as a primary way of teaching and learning anatomy in several medical schools globally due to its enormous advantages. Despite the rise in the call for technology integration of virtual teaching into the modern medical education, especially virtual dissection in teaching anatomy, most medical schools prefer the conventional wet laboratory dissections over the new virtual dissections that are emerging. The surge in the creation of medical schools has led to a proportionate rise in demand for cadavers needed for dissection. Nevertheless, using human cadavers for teaching and training roles is embraced with certain ethical uncertainties. The recent emergence of COVID-19 has raised questions on the continuous use of traditional cadaveric dissections, as the cause of the death and safety of the bodies for dissection may not be ascertained before use. This paper recommends the guidelines and protocols to be followed before the use of bodies for dissection, and also proposes the possible integration and use of virtual dissection for anatomy teaching during and after the COVID-19 pandemic.

"Dissection Educational Videos" (DEVs) and their contribution in anatomy education: a students' perspective.

PurposeThe suspension imposed on Universities due to COVID-19 pandemic impeded students’ educational opportunities. Alternative teaching modalities have been used. Substitution of dissection courses on cadavers was a great challenge. Present study investigates students’ view on the efficacy of the “online” pre-recorded “dissection educational videos” (DEVs) in assisting anatomy teaching, aiming to modernize the lectures and reinforce comprehension.MethodsThe adequacy of the “online” anatomy courses and a possible new teaching modality were evaluated by the 2nd year pre-graduate students, employing an online questionnaire.ResultsOne hundred and ninety-six volunteer students participated. Before the pandemic, 78.1% of the students constantly attended the “auditorium-based” lectures and 73% used self-teaching tools (STTs) for a better understanding of anatomy. During pandemic, a slight lower frequency (76%) attended the “online” lectures and a higher frequency (84.2%) used at least one STT. Up to 59.2% of the students disagreed with the permanent replacement of the “auditorium-based” by the “online” lectures, while 62.8% supported the idea of parallel conduction of the lectures. Combined teaching tools were the most preferred resources. 83.2% of the students stated that the dissection labs’ cancellation negatively affected their education, and 75.5% supported the permanent addition of the pre-recorded DEV series in the lectures.ConclusionsCOVID-19 pandemic created the temporary need for pure remote education. During lockdown, the use of STTs has significantly increased. A novel teaching modality (DEV series), presented in the study, can be used both as educational material and as a STT.

A cadaveric analysis of anatomical variations of the anterior belly of the digastric muscle.

The anterior belly of the digastric muscle (ABDM) presents highly variable and frequent anatomical variations. Since the ABDM functions as a landmark for clinical procedures involving the submental region, it is important to have a comprehensive understanding of its variations. In this study, we sought to improve our knowledge of ABDM variations in the ethnically diverse whole-body donor population in Northern California. Specific aims were: (1) to determine the frequency of ABDM and anterior belly (AB) accessory muscle variations in cadavers donated to the UC Davis Body Donation Programme, (2) to classify these variations identified in this population using the previously proposed nomenclatures by Yamada (1935) and Zlabek (1933), and (3) to investigate the innervation and arterial supply to the representative ABDM and AB accessory muscle variations. During the 2018 and 2019 gross anatomy dissection laboratories at the UC Davis School of Medicine, the submental regions of 48 cadavers were examined and classified. Fifteen (31.2%) cadavers presented ABDM and AB accessory muscle variations. These variations were clearly categorised using the morphology of the ABDMs and attachments of the AB accessory muscles. We also identified three previously unreported types of variations, two of which presented the fusion of right and left ABDMs and one presenting an ectopic tubercle beneath the mandibular symphysis to which a pair of AB accessory muscles were attached. Anterior belly of the digastric muscle variations were found in 1 in 3 individuals in the local Northern California population. Knowledge of the prevalence and common patterns of ABDM variations in the general population would be valuable information when an operation or examination is performed in the submental region.

Crashing from cadaver to computer: Covid-driven crisis-mode pedagogy spawns active online substitute for teaching gross anatomy.

In early 2020, the Covid-19 crisis forced medical institutions worldwide to convert quickly to online platforms for content delivery. Although many components of medical education were adaptable to that format, anatomical dissection laboratory lost substantial content in that conversion, including features of active student participation, three-dimensional spatial relationships of structures, and the perception of texture, variation, and scale. The present study aimed to develop and assess online anatomy laboratory sessions that sought to preserve benefits of the dissection experience for first-year medical students. The online teaching package was based on a novel form of active videography that emulates eye movement patterns that occur during processes of visual identification, scene analysis, and learning. Using this video-image library of dissected materials, content was presented through asynchronous narrated laboratory demonstrations and synchronous/active video conference sessions and included a novel, video-based assessment tool. Data were obtained using summative assessments and a final course evaluation. Test scores for the online practical examination were significantly improved over those for previous in-person dissection-based examinations, as evidenced by several measures of performance (Mean: 2015-2019: 82.5%; 2020: 94.9%; P=0.003). Concurrently, didactic test scores were slightly, but not significantly, improved (Mean: 2015-2019: 88.0%; 2020: 89.9%). Student evaluations of online sessions and overall course were highly positive. Results indicated that this innovative online teaching package can provide an effective alternative when in-person dissection laboratory is unavailable. Although this approach consumed considerable faculty time for video editing, further development will include video conference breakout rooms to emulate dissection small-group teamwork.

Anatomy 3.0: Rediscovering Theatrum Anatomicum in the wake of Covid-19.

The Covid‐19 pandemic has challenged medical educators internationally to confront the challenges of adapting their present educational activities to a rapidly evolving digital world. In this article, the authors use anatomy education as proxy to reflect on and remap the past, present, and future of medical education in the face of these disruptions. Inspired by the historical Theatrum Anatomicum (Anatomy 1.0), the authors argue replacing current anatomy dissection laboratory (Anatomy 2.0) with a prototype anatomy studio (Anatomy 3.0). In this studio, anatomists are web‐performers who not only collaborate with other foundational science educators to devise meaningful and interactive content but who also partner with actors, directors, web‐designers, computer engineers, information technologists, and visual artists to master online interactions and processes in order to optimize students' engagement and learning. This anatomy studio also offers students opportunities to create their own online content and thus reposition themselves digitally, a step into developing a new competency of stage presence within medical education. So restructured, Anatomy 3.0 will prepare students with the skills to navigate an emergent era of tele and digital medicine as well as help to foreshadow forthcoming changes in medical education.

In Reply: The Glossopharyngo-Cochlear Triangle-Part II: Case Series Highlighting the Clinical Application to High-Riding Posterior Inferior Cerebellar Artery Aneurysms Exposed Through the Extended Retrosigmoid Approach.

To the Editor: We thank the authors1 of this letter for their comments and insights. We hope this 2-part study successfully described the elucidation and execution of a patient-specific, microsurgical approach using the glossopharyngo-cochlear triangle (GCT) to treat a select subset of posterior inferior cerebellar artery (PICA) aneurysms.2,3 We wholeheartedly agree that 2-part studies—in which part I3 provides an in-depth discussion of the microsurgical anatomy and results of cadaveric dissections and part II2 highlights the clinical utility and the nuances of “real-world” surgical application of the anatomic principles—are “indispensable prerequisite(s).”1 We thank the editorial board of Operative Neurosurgery for continuing to publish and support these important endeavors. We believe that combining these 2 distinct studies into a single manuscript would have truncated and obscured the salient points of both studies, potentially diluting the significance and limiting the educational value and clinical applicability of the findings. Innovation in cerebrovascular and skull base microneurosurgery is driven by applying honed microsurgical techniques and skills to novel clinical scenarios, resulting in improvements in surgical outcomes and patient care. This innovation can be accomplished only by the continued enhancement of our knowledge of microsurgical anatomy; commitment to laboratory dissection, where we can continue to expand our armamentarium and safely push the limits of what is possible; and critical evaluation of our surgical and clinical outcomes. It is through spending time in the anatomy laboratory that we developed the microsurgical skills necessary to safely and efficaciously treat challenging lesions, such as distal PICA aneurysms, despite their proximity to delicate neurovascular structures and their location in deep surgical corridors. We welcome the idea that novel microsurgical approaches may provide an even more efficacious route or technique for treating these challenging lesions; if these new approaches could somehow obviate the need to manipulate the neighboring cranial nerves, all the better. We agree with the authors that such approaches can be devised, and their application critically evaluated, only by 2-part studies such as these. This point further highlights the importance of anatomic laboratory dissections, which are critical to neurosurgical education during residency and fellowship training and beyond. With regard to the definition of a “high-riding PICA aneurysm,” we found a measurement greater than 23 mm above the foramen magnum to be the most straightforward clinically applicable measurement.2,3 However, this is just one of many anatomic clues that can guide approach selection and patient-specific surgical intervention. In our clinical manuscript, in addition to reporting increased distance of the aneurysm from the foramen magnum, we reported how the distances from the internal auditory canal (IAC) and jugular foramen (JF) to the aneurysm differed significantly between typical and high-riding PICA aneurysms.2 High-riding PICA aneurysms had a mean distance below the IAC of 3.7 mm (range 0-6.8 mm) and a mean distance above the JF of 8.2 mm (range 6.9-9.4 mm). In contrast, the control group of typical PICA aneurysms had a mean distance below the IAC of 11.6 mm (range 7.0-18.0 mm) and a mean distance above the JF of 1.9 mm (range −7.3 to 7.3 mm). Identifying an aneurysm's location relative to these anatomic landmarks and using these results as a reference can guide surgical approach planning. These additional measurements can also assist in scenarios where the angle of gantry of the computed tomography angiography prevents direct measurement of distance in a single image slice. An additional solution to this issue can be to measure the distance on consecutive image slices (as was done in the illustrative case described in part I of our study).3 Although measuring on multiple slices may have a minor effect on the calculated distances, it is unlikely that this possible submillimetric difference would drastically affect approach selection. Importantly, much like our philosophy on anatomic triangles used to guide subarachnoid dissection, these measurement guidelines are meant to help predict approach corridors and are not intended to be rigid barriers. We agree that an operative video highlighting this technique would be of clinical interest and would clarify the nuances of the surgical approach and patient selection. Indeed, at the time of this response, we have a narrated video submitted for review, which we hope the authors of this letter and others will find interesting and clinically beneficial.4 Again, we would like to thank the authors1 of this letter for their comments and their thoughtful response. Funding This study did not receive any funding or financial support. Disclosures The authors have no personal, financial, or institutional interest in any of the drugs, materials, or devices described in this article.

Arterial stiffness and carotid distensibility following acute formaldehyde exposure in female adults.

Formaldehyde (FA) is a ubiquitous organic preservative used in several industries and represents an occupational health hazard. Short-term exposure to FA can increase oxidative stress and cause a decrease in conduit vessel function. These decrements in vascular function may extend to the arterial architecture, predisposing individuals to increased risk of cardiovascular disease. The purpose of this study was to investigate the impact of an acute 90-minute FA exposure period (259 ± 95 ppb) on indices of arterial architecture. Arterial stiffness and carotid distensibility as determined by central pressures, augmentation index (AIx), and carotid-femoral pulse wave velocity (cfPWV) (n=13F, 24 ± 1year) as well as carotid stiffness and intima media thickness (IMT) (n = 9F, 23 ± 1year) were assessed prior to (Pre-FA) and immediately following (Post-FA) exposure to FA in human cadaver dissection laboratories. Central pressures and cfPWV (Pre-FA: 5.2 ± 0.8m.s-1, Post-FA: 5.2 ± 1.1m s-1) were unchanged by acute FA exposure (p > 0.05). Carotid stiffness parameters and distension were unchanged by acute FA exposure (p > 0.05), although distensibility (Pre-FA: 33.9 ± 10.5[10-3*kPa-1], Post-FA: 25.9 ± 5.5[10-3*kPa-1], p < 0.05), and IMT (Pre-FA: 0.42 ± 0.05mm, Post-FA: 0.51 ± 0.11mm, p < 0.05) decreased and increased, respectively. Individual Pre- to Post-FA changes in these markers of arterial architecture did not correlate with levels of FA exposure ([FA]: 20-473 ppb) (p > 0.05). Our group previously found vascular function decrements following acute FA exposure in human cadaver laboratories; here we found that carotid distensibility and intima media thickness are altered following FA exposure.

Experience of virtual learning in the times of pandemic and its future perspectives: observations from ‘gynecological oncology’ trainee survey

<h3>Objectives:</h3> In these unprecedented times of COVID-19 pandemic, surgical education and training has been severely disrupted. Surgical skills are prone to decay. Promoting virtual learning and simulation based platforms can expand training opportunities beyond the walls of hospital. Such measures may mitigate the diminished surgical and clinical skills caused by disruption of training. The foreseeable goal should be to build resilient training standards resistant to disruption as one caused by COVID 19. We aimed to study the perceptions of in-training candidates in gynecological oncology in India regarding their present experience of virtual learning and future perspectives to incorporate these training modalities in standard academic curricula. <h3>Methods:</h3> We developed and validated a survey questionnaire using a three member expert team. The survey was administered through a cross-sectional web-based (Google forms) platform to all the trainees in gynecological oncology across India listed in our directory in the first week of August, 2020. Data collected was analysed using Google sheets. Results were expressed as percentages of total responses received excluding unattended responses. Inferences were drawn from the content-specific responses. <h3>Results:</h3> Thirty-seven trainees across the country responded. Majority (97.2%) of the trainees conceded that COVID-19 had significantly impacted their training, of which 78% suggested that hands-on surgical training was the most affected, 15% percieved an impact on academic training and only 7% suggested an impact on clinical trial learning. All respondents were continuing academic training through webinars, online case presentations and tumour boards. None of the responses favoured virtual learning over or equivalent to bedside clinics and face to face interactions. Almost three-fourths (77%) of trainees suggested continuing online platforms in post-COVID times. Presently only 3 of 16 centres from responses received had skill lab and simulation training facilities. Virtual anatomical learning facility was available only in a single centre across the country. Cadaveric dissection (89%) was a preferred choice over simulation modules by in-training candidates to prevent skill decay. Telemedicine clinics were run by 14 of 16 centres in the country but only 54% of trainees were satisfied with telemedicine services. <h3>Conclusions:</h3> Although, a positive response for online teaching modules was recieved among trainees in gynecological oncology in India, face to face learning and bed side clinics were still valued. There was a modest preference for simulation based skill training while cadaveric dissection lab training was overwhelmingly accepted. This could possibly be attributable to unavailability and non-exposure of majority of trainees to simulation based platforms.

University of Toronto's redesigned ophthalmology curriculum and eye dissection lab

ObjectiveTo present a multifaceted approach to ophthalmology undergraduate medical education and to assess the efficacy of an eye dissection laboratory in enhancing medical student learning. DesignCurriculum review, validation, and student feedback evaluations. ParticipantsYear 2 medical students enrolled in the University of Toronto's Doctor of Medicine Program. MethodsStudent feedback evaluations were compiled from the University of Toronto undergraduate medical education student surveys before 2012–2016 and following introduction of the redesigned foundations ophthalmology curriculum at the University of Toronto (2017–2018). Students who participated in the Eye Dissection Lab as part of the newly designed curriculum completed the pre- and postsession satisfaction and overall interest in ophthalmology questionnaires and a knowledge-based test. ResultsAnalysis of 1640 student evaluations demonstrated an increase in ophthalmology curriculum rating following the launch of the foundations ophthalmology curriculum (p = 0.015). Among the 335 students who completed the eye dissection lab, there was a significant increase in the average scores for the satisfaction questionnaire, knowledge-based test, and level of interest in the field of ophthalmology from before and after the session, with improvements in scores noted in 91%, 42%, and 36% of the educational parameters of the participants, respectively (p < 0.001). ConclusionsThe newly designed foundations ophthalmology curriculum and the eye dissection lab at the University of Toronto serve as effective means for enhancing ophthalmology teaching in medical schools across Canada.

Assessment of Ethical Compliance of Handling and Usage of the Human Body in Anatomical Facilities of Ethiopian Medical Schools.

BackgroundHuman anatomy has historically been a cornerstone in medical education and is special in that it uses human remains kept in various anatomical facilities like a morgue, gross anatomy laboratory, or museums for instruction and research. While serving knowledge advancement facilitating clinical practice and research, human cadaver handling, and usage at all levels, such as cadaver sourcing, transportation, storage, preservation, dissection, and final disposal deserves in return the utmost respect. In Ethiopia, even though there is not enough information on when, where, and by whom the first cadaver dissection was conducted, dissection is being conducted in many of its medical schools. Despite ethical necessity surrounding human body usage in every anatomical setting, there is still ethical and legal uncertainty due to several challenging barriers which is severe in developing nations including Ethiopia. The aim of this study is, therefore, to assess ethical practices of handling and usage of the human body to promote, in the near future, formulation and implementation of acceptable, respectful, and ethical guidelines for the anatomy dissection laboratories and related settings in Ethiopia.MethodsA multicentered cross-sectional study was used at selected anatomy facilities of eight Ethiopian medical schools. The collected data through structured questionnaires and checklists were cleaned, preset and entered in to SPSS version 20 for analysis. Internal consistency and reliability were measured by using Cronbach’s alpha.ResultsThe study result showed vivid human body ethical breaches that ranged from lack of power by anatomy unit to oversee the process during sourcing, transportation, embalming, caring, and dissection of cadavers in the anatomy laboratories to student’s mistreatment of cadavers.ConclusionIn addition to lack of compliance due to lack of standard ethical guidelines or policies regarding human body usage, the compliance-based professional development is also nonexistent. The ethical way of body sourcing is through body donation; however, in Ethiopia, anatomy teaching exclusively depends on unclaimed bodies. Using a body for dissection that is solely sourced unethically may generate a negative emotional sense of life for anatomy instructors, technical assistants, morticians, and medical students. We inspire better provision of moral and ethical exercise with the good practice concerning the human body through recognizing the humanity and uniqueness of the deceased person. The results of this study serve as a serious condemnation of practices in Ethiopian anatomy facilities and we urge the Anatomical Society of Ethiopia to play its part in changing the present practices related to ethical and legal uncertainty of the human body usage.

Needs of Young African Neurosurgeons and Residents: A Cross-Sectional Study

Introduction: Africa has many untreated neurosurgical cases due to limited access to safe, affordable, and timely care. In this study, we surveyed young African neurosurgeons and trainees to identify challenges to training and practice.Methods: African trainees and residents were surveyed online by the Young Neurosurgeons Forum from April 25th to November 30th, 2018. The survey link was distributed via social media platforms and through professional society mailing lists. Univariate and bivariate data analyses were run and a P-value < 0.05 was considered to be statistically significant.Results: 112 respondents from 20 countries participated in this study. 98 (87.5%) were male, 63 (56.3%) were from sub-Saharan Africa, and 52 (46.4%) were residents. 39 (34.8%) had regular journal club sessions at their hospital, 100 (89.3%) did not have access to cadaver dissection labs, and 62 (55.4%) had never attended a WFNS-endorsed conference. 67.0% of respondents reported limited research opportunities and 58.9% reported limited education opportunities. Lack of mentorship (P = 0.023, Phi = 0.26), lack of access to journals (P = 0.002, Phi = 0.332), and limited access to conferences (P = 0.019, Phi = 0.369) were associated with the country income category.Conclusion: This survey identified barriers to education, research, and practice among African trainees and young neurosurgeons. The findings of this study should inform future initiatives aimed at reducing the barriers faced by this group.

Enhancing Anatomical Instruction: Impact of a Virtual Canine Anatomy Program on Student Outcomes.

Innovative reforms in medical education will require instructional tools to support these changes and to give students more flexibility in where and how they learn. At Colorado State University, the software program Virtual Canine Anatomy (VCA) was developed to assist student learning both inside and outside the anatomical laboratory. The program includes interactive anatomical photographs of dissected canine cadavers, dissection instructions with accompanying videos and diagrams, radiographs, and three-dimensional models. There is a need to evaluate the effectiveness of instructional tools like VCA so that decisions on pedagogical delivery can be evidence-based. To measure the impact of VCA on student outcomes in a dissection laboratory, this study compared student attitudes, quiz scores, dissection quality and accuracy, and instructor reliance between students with and without access to VCA. Students with VCA needed less time with teaching assistants (P<0.01), asked teaching assistants fewer questions (P=0.04), felt that the dissection was easier (P=0.02), and were in stronger agreement that they had access to adequate resources (P=0.02). No differences were found in the dissection quality or accuracy, quiz scores, or attitudes regarding overall enjoyment of the activity between the two groups. This study shows that VCA increases student independence and can be used to enhance anatomical instruction.

A Layered Approach to Teaching Breathing in Dissection Lab

Introduction A search on the word “breathing” yields over 940 million Google results (2021). Nestor's Breath (2020) has garnered mainstream attention and curiosity. We propose that breathing (via intubation) in a layered fresh tissue dissection can create a more three dimensional understanding of breath when linked to experientials in a movement-based anatomy lab. Literature continues to look at the importance of dissection in tactile learning (Granger 2004). Topp (2014), noted a concern in medically oriented labs in that, “pattern and form are not immediately apparent...” Others have commented that the combination of movement and dissection lab helps to reinforce understanding and retention of concepts in medical school students (Vertel et al., 2020). Methods Review of current dissectors included Gray's Clinical Photographic Dissector (Loukas et al., 2018), Netter (2018) Thiele, Stecco (2015) as well as anatomical models, such as those created through plastination. In addition, the authors’ expertise in dissection and movement was the basis for a 2020 dissection with a group of yoga therapists and related movement and medical professionals. Steps for fresh tissue dissection: 1) tracheotomy was performed, tubing inserted, and lungs inflated with body in first preparation with pectoralis major, pectoralis minor and serratus anterior muscles reflected from the midline to lateral 2) ribs were clipped laterally and reflected from the level of clavicles. Lung inflation shown with the pericardial sac and relationship to ribcage and lungs 3) dissection continued in stages to highlight relationship with the diaphragm 4) discussion continued in breathing lab utilizing various props to demonstrate the role of the diaphragm in breathing, and yoga concepts to represent the movement of air into and out of the system. Reinforcing the idea of breath as shape-change in the cavities was emphasized, with the distinction of shape and volume change in the thoracic cavity, and shape but not volume change in the abdominal cavity (Kaminoff, Matthews, 2007). Results Relational movement was demonstrated at every level of dissection, from the lungs inflated pre-rib cutting, to lungs in situ with muscles and ribs reflected to highlight the relationship of the lungs, diaphragm and pericardium. The combination of a layered cadaver dissection of lung inflation with the addition of breath applications through movement lab was found to have a high rate of participant satisfaction in being able to more fully visualize human breathing. Video footage of both was documented for educational purposes. Typical survey reports included comments such as: “the demonstration changed my ideas about breathing. I can now visualize the connections in a way that book learning alone never accomplished.” Conclusion/Significance Creating a demonstration of breathing in situ at different levels of dissection puts this important function of human life in context for students of all levels, and effective learning of breath can be enhanced through applications like yoga breathing. Student learning in dissection lab, whether in person or virtually requires application to the living body. Context matters. Future investigations could test learning outcomes from the video footage (both dissection and movement labs) in this approach in repeated settings.

Effect of a Three‐Dimensional Anatomy Atlas on Medical Education Under Pandemic Restrictions

IntroductionThe COVID‐19 pandemic posed significant challenges to the instruction of in‐person cadaveric dissection. Compared to previous years, there was a 66% reduction in student lab dissection times for the first‐year medical students (MS1s) at Texas Tech University Health Sciences Center. Complete Anatomy (CA), a three‐dimensional (3D) anatomy atlas, was provided as an additional educational resource to supplement the in person cadaveric dissection labs. The aim of this study is to increase student engagement by producing tailored anatomical modules in CA and to evaluate their effects on students’ stress levels and summative practical exam performance throughout the Clinically Oriented Anatomy (COA) block. We hypothesized that the CA modules would allow current MS1s to perform to the same academic standard as students who did not have these COVID‐19 limitations and reduce their exam stress.MethodsLearning modules were created that displayed 3D anatomical structures corresponding to each of the 27 COA in person dissection labs. The CA modules consisted of content and quizzes that MS1s could access either outside or inside the lab. At the end of each of the three COA units and at the end of the COA block, students were surveyed about their participation and satisfaction with the modules. Students’ performance on module quizzes was compared to their performance on summative practical exams. Additionally, the Class of 2023’s performance in COA was compared to the Class of 2024’s, with the latter taking the block under pandemic restrictions.ResultsThroughout the block, 82%‐95% (unit 1 n=97/102, unit 2 n=67/72, unit 3 n=107/130) of survey respondents reported using the modules as a study aid and 55%‐79% used the modules for all 27 anatomy labs. Additionally, 75%‐87% of MS1s rated the modules as “very useful” or higher on a Likert‐scale survey, with a majority of surveyed students using both the content and quizzes. At the end of the block a second survey showed 74% (n=70/94) of students “strongly agreed” or “agreed” that using the modules reduced their stress, and 80% (n=75/94) “strongly agreed” or “agreed” that modules allowed them to continue their learning outside of the lab. MS1 performance in the COA block was positively correlated with performance on CA quizzes (r=0.46, p<0.0001). Further, there was no significant difference between the 2023 and 2024 MS1 classes in summative practical exam scores for units 1 and 3, as well as in the National Board of Medical Examiners (NBME) exam. However, there was a significant increase in summative practical exam performance in the Class of 2024 for unit 2 (p<0.0001) as compared to the Class of 2023.ConclusionFindings suggest that the CA modules facilitated student engagement in anatomy and positively enhanced their medical education throughout the COA block. Although dissection time and lab access were limited, the CA modules benefitted the students and could have potentially compensated for that lost time.

Dissection‐Based Investigation of Variations in Major Gross Arterial Supply to the Trigeminal Ganglion

Introduction & Objective The trigeminal nerve (CN V) primarily conveys afferent sensory input from the anterolateral aspect of the face and scalp via its three main branches – the ophthalmic nerve (CN V1), maxillary nerve (CN V2), and mandibular nerve (CN V3). The 20,000-35,000 primary afferent pseudounipolar neurons of CN V1-3 converge at the trigeminal ganglion (TG) where the neurons’ cell bodies are positioned. The TG is located in Meckel's cave (cavum trigeminale), an intracranial area along the sphenoid bone deep to the meningeal layer of dura mater just anterior to the petrous apex. Four main arterial sources have been reported to perfuse the TG – the accessory meningeal artery (AMA), a branch of middle meningeal artery (MMA), a branch of internal carotid artery (ICA), and a tentorial branch of the superior cerebellar artery (SCA). The reported rate for each potential arterial supply remains variable. The objective of this study was to identify the arterial source of the TG via human cadaveric dissection and quantify the rate of occurrence. Materials & Methods Right and left trigeminal ganglia were examined on 29 embalmed human cadavers. Origins of gross arterial supply traversing the deep surface of the ganglia were identified and recorded. Arterial supply was photographed (iPad Pro, Apple Inc.) and image color contrast was utilized to aide structure identification (Adobe Photoshop 20.0.9). TG tissue samples including the major vessel(s) were collected, paraffin embedded, sectioned at 5 μm, and stained with hematoxylin and eosin (H&E). Major arteries and normal microvasculature were verified with light microscopy (Zeiss Axioskop, Model 45 14 85) and photographed (AmScope Digital Camera, Model MU1003). Results Blood supply to 28 TG was inconclusive due to compromised vessel integrity from a previous course dissection. Of the remaining 30 TG, 56.6% were supplied by a branch of ICA, 16.7% by AMA, and 10.0% by a branch of MMA. No TG were supplied by the tentorial branch of SCA. Anastomotic connections were discovered between MMA/ICA and AMA/ICA for 10.0% and 6.7% of TG supply, respectively. Three of the five AMAs were noted to course through separate foramen in the basicranium instead of the foramen ovale as expected. H&E histological examination confirmed artery structure and verified expected arteriole and capillary microvasculature throughout the TG. Conclusions & Significance In both exclusive and anastomotic form, the majority of TG arterial supply originated from the ICA. Supply from the AMA, MMA, and SCA occurred less often but still merit significance. The results of this study reflect known rates of TG arterial supply. Gross imaging from this study may supply medical educators with new resources to facilitate TG dissection in gross dissection laboratories and may also provide diagnosticians and cardiovascular surgeons with better understanding of TG arterial supply variations that could benefit diagnosis, surgical approaches, and outcomes. In case of blockage, stenosis, or ligation, anastomotic supply would provide anatomical insurance to the TG but warrants further study.

Case Report: An Encapsulated Mass of the Gluteal Region Found During Cadaveric Dissection

We describe a large, encapsulated mass containing friable tissue – likely a partially healed hematoma or abscess – in the right gluteal region of a 93-year-old female cadaver, which potentially caused impaired function of the ipsilateral tensor fasciae latae. We first observed this mass between the right gluteus medius and gluteus minimus muscles during dissection lab for the Physical Therapy DPT students. This structure was roughly circular (~11 cm in maximum width) and completely encapsulated by dense connective tissue. Since the inferior aspect appeared to pass through the sciatic foramen, we hypothesized that this was caused by a sciatic hernia. However, this was rejected based on the later dissection of the abdominal and pelvic cavities. None of the structures that can potentially cause a sciatic hernia – colon, ovaries, uterine tube, ureter – were protruding through the sciatic foramen. Additionally, dissection of the gluteal region revealed that the dense connective tissue covering the mass was not passing through the sciatic foramen, rather it was adhered to the ilium near the greater sciatic notch. Dissection of the structure itself showed that its margins were limited to the borders of the gluteus medius and it was composed of two layers of dense connective tissue with clear fluid between them. The outer layer of connective tissue had the appearance of thickened intermuscular fascia. Within the second layer, completely encapsulated, was friable tissue. This suite of characteristics is consistent with a partially healed intermuscular hematoma or abscess, but the pathologic diagnoses of this mass cannot be confirmed without histologic evaluation. Intermuscular hematomas and abscesses in the gluteal region can be caused by traumatic damage to the superior gluteal artery, trigger point injections, and hip arthroplasty. A plausible side effect of this mass lesion is compromised function of the superior gluteal nerve and artery. The tensor fasciae latae on the right side was 9.6% shorter and 13.4% lower in mass than on the left side. There was symmetry and no evidence of degeneration to the gluteus medius and gluteus minimus muscles, so it is possible that there was only a disruption to the innervation or blood supply to the ipsilateral tensor fasciae latae.

Shifts in Digital Resources Usage for Gross Anatomy Education During Covid‐19

INTRODUCTION/OBJECTIVE:Covid‐19 has led to sudden changes to gross anatomy education when traditional dissection‐based laboratories had to shift towards virtual modalities due to physical distancing and remote learning requirements. The purpose of this study was to determine how the use of digital teaching resources in gross anatomy education changed from before to during Covid‐19.MATERIAL/METHODS:Data were obtained from an IRB‐approved survey distributed to professional associations and listservs targeting anatomy educators from June to November 2020. Respondents were asked to select the digital resources they used before and during Covid‐19. Data were analyzed during the early and latter parts of the pandemic as May‐August (T1) and August‐December (T2), as well as overall (T3). T2 data were classified into five categories: 2D illustrations, dissection media, interactive software, in‐house, and open access. Total usage for each timepoint, the proportions of digital resources, and the 5 categories before and during Covid‐19 were compared using McNemar's test with alpha<5%. Data are presented as percent increase (+value) or decrease (‐value).RESULTS:60 and 208 responses were received for T1 and T2, respectively. The total number of digital resources used for anatomy education increased from before to during COVID‐19 as seen in the data analysis from T1 (+47%), T2 (+41%), and T3 (+43%) (P≤0.003). In T1, the use of BlueLink (+122%) and Complete Anatomy (+140%) software increased (P<0.04), while Acland's Anatomy (+68%), Anatomy.TV (+1300%), Complete Anatomy (+89%), and BlueLink (+148%) increased in T2 (P≤0.03). During T3, the usage of Acland's Anatomy (+60%), Anatomy.TV (+750%), Complete Anatomy (+102%), BlueLink (+143%), and VisibleBody (+100%) increased (P≤0.03). All other digital resources did not change (P>0.05). When data for T2 were categorized, dissection media (+44%), interactive software (+87%), and open‐access (+100%) content increased (P≤0.008), while 2D illustrations (‐3%) and in‐house content (‐23%) decreased (P>0.05).CONCLUSIONS:This study demonstrates sustained increases in digital resource usage for gross anatomy education during Covid‐19. This was particularly pronounced for interactive software, open access resources and dissection media that allowed educators to mimic features of a dissection lab.SIGNIFICANCE:These rapid shifts in both commercial and free digital resources are likely to drive innovation in anatomy education for years to come. It remains unknown if the current findings are transient Covid‐19‐related changes or if they will persist long‐term.