Anatomical sciences curricula have been under constant reform over the years, with many countries having to reduce course hours while trying to preserve laboratory time. In Mexico, schools have ...historically been autonomous and unregulated, and data regarding structure and methods are still lacking. A national survey was sent by the Mexican Society of Anatomy to 110 anatomical sciences educators. The questionnaire consisted of 50 items (open and multiple choice) for gross anatomy, microscopic anatomy, neuroanatomy, and embryology courses in medical schools across Mexico. A clinical approach was the most common course approach in all disciplines. Contact course hours and laboratory hours were higher in Mexican anatomy education compared to other countries, with the highest reported contact hours for embryology (133.4 ± 44.1) and histology (125 ± 33.2). There were similar contact hours to other countries for gross anatomy (228.5 ± 60.5). Neuroanatomy course hours (43.9 ± 13.1) were less than reported by the United States and similar to Saudi Arabia and higher than the United Kingdom. Dissection and microscopy with histological slides predominate as the most common laboratory activities. Traditional methods prevail in most of the courses in Mexico and only a few educators have implemented innovative and technological tools. Implementation of new methods, approaches, and curricular changes are needed to enhance anatomical sciences education in Mexico.
Most guidelines fail to specify patient positioning during central venous catheterization. The objective was to determine the effects of head‐down tilt (Trendelenburg position) and head rotation on ...the internal jugular vein (IJV). A prospective, observational, longitudinal, and descriptive study using healthy adult volunteers, of both sexes, was performed. The change in position and cross‐sectional areas (CSA) of the right IJV and common carotid artery (CA) were measured by ultrasonography during Trendelenburg position (TP) (0°, 5°, 10°, and 15°) and contralateral head‐rotation (HR) (0°, 45°, and 90°) for a total of 12 positions. The neutral supine position was first, randomizing the other 11 positions, with 5‐min rest intervals in between. Vital signs and symptoms were recorded. A total of 54 volunteers were recruited between the ages of 21 and 32, of which 30 were men. Any degree of TP or HR significantly increased the CSA. The largest area obtained was 1.78 cm2 with a TP15HR90 which did not have a statistical difference with TP10HR45 1.59 cm2. A HR90 tended to displace the IJV medially, overlaying the CA. Any degree of TP or HR will significantly increase CSA or the right IJV. A 5° to 10° TP is recommended when the patient's condition allows it, with a 45° HR, without significantly displacing the IJV anterior to the CCA.
Near‐peer teaching has been widely implemented in medical schools and the benefits for the near‐peer teachers (NPTs), the students, and the institution have been well documented. However, NPT ...training methods and perceptions of such have been limited. A four‐year clinical anatomy and surgical training program was established (est. 2019) as part of the continuous training timeline for NPTs (n > 60 total) formation at the Universidad Autónoma de Nuevo León, in Mexico. The program provides various training courses for the NPTs according to their hierarchy, including teaching skills, professional development, psychosocial aspects, and career objectives. A “Clinical Anatomy and Surgical Training Diploma” was planned with 12 modules to aid in developing these abilities, along with a higher understanding of clinical anatomy shared by expert clinical specialists, and diverse clinical and surgical skills such as suturing, catheterization, and basic surgical procedures. The program has a completion rate of approximately 15 NPTs/year. All, while creating an environment with a sense of belonging, and facilitating mentorship between fellow NPTs and educators. Near‐peer teachers develop leadership, communication, and teaching skills. The program has provided a constant source of anatomy educators, avoiding any shortage.
Introduction
Central venous catheterization (CVC) is procedure used in hospital settings for patient monitoring, diagnostic, and therapeutic means. The right internal jugular vein (RIJV) is the first ...choice recommended, with ultrasound (US)‐guided as the gold standard. This method is not always available, especially in rural settings or developing countries, and complications are still frequent even under expert hands.
The head‐down tilt (Trendelenburg) position involves elevation of the lower limbs to favor venous return and increase neck veins regurgitation. Evidence is scarce and contradicting regarding the safety of degree of inclination and head rotation.
The objective of this study was to determine the effects of different degrees of Trendelenburg and head rotation on the RIJV and right common carotid artery (RCCA).
Methods
An experimental, longitudinal, prospective, analytical study was performed. Healthy adults of both sexes were recruited to voluntarily participate.
Inclusion criteria: adults between 18 and 29 years of age, with normal vital signs, and a BMI ≤24.9. Those with RIJV pathology, anatomical variations, neck surgeries, COVID, or metabolic diseases were excluded.
Neck US‐imaging was performed, obtaining cross‐sectional area (CSA) measurements of RIJV and RCCA, and their relationship, at the inferior level of the thyroid cartilage. Randomization at Trendelenburg positions of 0°, 5°, 10° and 15° and left head‐rotation of 0°, 45° and 90° in each inclination were performed. Vital signs and oxygen saturation were monitored between each position, as well questioning for discomfort symptoms.
Results
Measurement of the RIJV and RCCA area was performed in 54 healthy participants (30 men), age range 21‐32. RIJV basal CSA was 1.0±0.5mm2 in a supine position (0°) without head rotation (0°). Trendelenburg angle and head‐rotation increased the CSA of the RIJV in a statistically significant way, obtaining the greatest area in a 15° Trendelenburg position and maximum rotation (Table 1). This, in turn, had no statistically significant difference with 10° Trendelenburg and 45° rotation (Table 2).
Conclusions
A 5º, 10º, or 15º Trendelenburg position and contralateral head rotation increase RIJV CSA. Head rotation also changes the location of the vein anterior to the RCCA at maximum rotation, but not significantly at 45º.
Although the greatest area obtained is achieved at the 15º Trendelenburg position with 90º head rotation, this position is uncomfortable and does not have statistical difference with 10º Trendelenburg position with 45 to 90º head rotation, which represents an increase of the initial diameter of 60% of CSA, making it a feasible position.
Although Ultrasound‐guided catheterization is the gold‐standard, Trendelenburg position and 45º head rotation help increase RIJV diameter, to create a safer procedure.
Significance and implications
This study provides anatomical evidence of RIJV changes with Trendelenburg and head rotation. Most international guidelines focus on CVC approach, and fail to mention patient positioning. The publishing of this data will aid with future versions of CVC guidelines.
Anatomy has historically been considered a static science, not research‐lead. Cadaveric anatomy provided an evidence for a more precise anatomy teaching, however, small samples were used for absolute ...truths. Preservation techniques allowed to expand this, yet, research was limited to descriptive and comparative studies. As anatomy teaching evolved from descriptive, to clinically oriented, to evidence‐based, and having a growing role in other sciences, it caused an exponential growth in its’ publications. Anatomical research aided to establish evolutionary and functional databases of variability between populations, sex, and age. However, it’s most important contribution is currently oriented towards patient safety, development of prostheses, technology and surgical materials, improvement of imaging interpretation, and provide evidence of clinical and anatomical implications. Several studies have reported an important percentage of mala praxis and surgical errors can be attributed to a lack of anatomical understanding of the region, consideration of anatomical variations, and alterations due to inflammation, continuing a need for anatomical research.
It is important to note, anatomy journals and publications have changed over time. The longest running journals focus on basic anatomy regarding structure, function, development, and evolution, while the last 3 to 4 decades have birthed journals with an anatomy oriented towards the clinical and surgical applications, with the most exponential growth in education.
Anatomical education is a growing field. New strategies have been implemented over the years to improve students’ learning of anatomy. There have been important technological advancements, providing educators with new teaching tools, both in the classroom and laboratory. Problem‐solving and computer‐based learning. Students’ interest increased, and learning became purposeful. Educational research has not only focused on evaluating the ability for students to learn new information, ease of the technique, and retention of the information, but also the perception of the technique or tool. The lack of bodies available for dissection, rising costs of laboratories, and the cut down of anatomy course hours, have open a wide range of resources for learning anatomy, many made available for free in online platforms.
Technology‐assisted learning is a powerful tool, when purposefully designed, peer‐evaluated, and integrated to support interpersonal interactions, teamwork, and communication skills. An over‐use should be avoided, to truly adhere to the pedagogic objectives. There is a need for evidence‐based education. Teaching should be balanced with tools such as imaging, clinical cases, three‐dimensional printing, virtual and augmented reality, interactive holograms, and others. There is no doubt the millennial generation have emerged technological advancements into their lives and culture, and education must continue to adapt with the demands of new generations.
Anatomical and educational research must be performed purposefully following recommendations and guidelines to obtain the maximum benefit for students and educators.
There are many difficulties a student or educator can present in the anatomy course. Technological advances and availability of new tools have provided alternatives to improve the learning method.
A ...3D model of an orbit and ocular globe (OG) was designed and 3D printed. It consisted of a roof, floor, medial and lateral walls, and a posterior wall. The superior and inferior orbital fissures were represented, as well as the common tendinous ring (Zinn's) and the optic canal from which a cylindrical axis extends in a 45° angle, representing the optic nerve (ON). At the end of this axis, a sphere an enarthrosis sphere simulates the OG. The medial wall is parallel to the OG’s axis, while the lateral wall is almost parallel to the ON’s axis. The OG was formed with polygons to allow better perception of the movements. The center of the sphere attached to the ON matches the center of the OG, resulting in the OG rotating without moving within the orbit.
Six holes were made in the OG, in which elastic threads were placed. In the anterior half of the OG, a hole for the superior, inferior, medial and lateral surfaces was made, corresponding to the insertions of the superior rectus (SR), inferior rectus (IR), medial rectus (MR), and lateral recti muscles (LR) respectively. On the lateral surface of the posterior half of the OG, a hole in the superior region was made for the insertion of the superior oblique (SO) and another in the inferior region for the insertion of the inferior oblique (IO). The four rectus muscles originate from the annulus of Zinn, and represented with holes that cross the posterior wall of the orbit in the common tendinous ring at the four points of insertion.
In the medial wall of the orbit, at the superior anterior corner, a trochlea was made, through which the thread representing the SO passes and is anchored to the posterior wall through a hole that is superior to the hole for the SR. On the same wall, but in the interior anterior corner of the orbit, we designed a hole to anchor the thread that represents the IO. The angles between the axes of the oblique muscles, recti muscles, and the axis of the OG were kept as close to reality as possible. In the model, the axis between the recti muscles and the OG’s is 20° (human orbit is 23°) and between the oblique muscles and the OG’s is 70° (human orbit is 51°).
The design allows an internal rotation when tightening the threads that are inserted in the superior half of the OG (SR, SO); if the inferior half are tightened (IR, IO), it causes an external rotation; if the recti are tightened, adduction occurs (except for the LR); if those representing the obliques and the LR are tightened, an abduction occurs; if those inserted in the anterior half of the OG (SR, IR, MR, LR) are tightened, the movement corresponding to its name is produced, and if those inserted in the posterior half are tightened, the movement occurs opposite to what their names indicate (SO, IO).
The model is effective and makes learning easier. Student perception has not been surveyed yet. Future version may improve the angle between the oblique’s and the OG’s axis. Pathological finding can also be exemplified.
Introduction
The tentorial notch is the aperture between the free edges of the tentorium cerebelli. This complex space varies greatly in dimensions; its study could improve the understanding of the ...mechanism of brain injuries. The morphometric analysis of the tentorial notch has been analyzed mainly in cadaveric studies. However, the postmortem effect could have an impact in such measures, varying amongst themselves. The aim of this study was to evaluate the morphometry of tentorial notch by Magnetic Resonance Imaging (MRI) in a Hispanic population.
Methods
A descriptive cross‐sectional study was performed. We analyzed retrospectively 45 MRI in the tentorial notch from asymptomatic patients, age ranging from 18 to 60 years. The images were evaluated intraobservatory by an expert radiologist. We measured: maximum notch width (MNW), the maximum width of the notch in the axial plane; notch length (NL), the length of the tentorial notch from the superoposterior edge of the dorsum sellae to the apex of the notch; interpedunculoclival distance, the distance from the interpeduncular fossa to the superoposterior edge of the dorsum sellae; apicotectal distance, the distance from the tectum in the median plane to a perpendicular line dropped from the apex of the tentorial notch to the cerebellum; cisternal third nerve distance, the distance covered by the cisternal portion of the third cranial nerve; inter‐third nerve angle, the angle between the two third cranial nerves.
Results
According to the quartile of the MNW, we divided the patients into narrow, midrange and wide groups. Also, quartile groups determined by NL were classified as short, midrange and long. The mean and standard deviation of MNW was of 31.42 ± 2.75 mm; NL, 55 ± 4.91 mm. apicotectal distance, 18.85 ± 3.83; interpedunculoclival distance, 21.03 ± 3.24; inter‐third nerve angle, 54.53 ± 7.25; right and left cisternal third nerve distance, 22.75 ± 4.55 and 21.78 ± 4.36 respectively. Statistical differences was identified only between sexes in the MNW.
Conclusion
Morphometric changes in cadaveric models in the tentorial notch and its neurovascular relations may have implications for a better understanding of the mechanisms of brain herniation and traumatic lesions. In addition, this data could improve the anatomical knowledge for neurosurgeons for cranial base surgical approaches. Although this data does not replace the image guidance, it improves the orientation for neurosurgeons.
Significance/implication
Differences in the clinical presentation of some neurological injuries could be related to variations in the space of the tentorial notch and the position of the brainstem. A transtentorial herniation is the movement of the temporal lobe through the tentorial notch. This pathology occurs in vascular disease, tumors, and brain edema. Furthermore, the location of the pressure and the pathological process, the dimensions of the notch could be a factor for the pattern of herniation.
Acquisition of Basic Surgical Skills (BSS) are essential for medical students. The objective was to determine it's fidelity impact.
Using four suturing models (SM) (pigskin, sponge, commercial pad, ...and orange), SM-quality and student-SM interaction were evaluated. After a 1-h class, participants were divided into groups and randomly assigned exercises in SM in 15-min intervals. The experiment included completing three individual simple stitches and a 3-stitch continuous suture in each SM.
Eighty-two medical students participated. Suturing quality was better in pigskin and sponge, which were also the preferred models (p < 0.001). Significant differences in quality between the insertion and exit point, and firmness of knots (p < 0.05) in both simple and continuous sutures, as well as between length and distance in continuous ones (p < 0.001) were identified.
Acquisition and quality of BSS are influenced by the intrinsic characteristics of SM. An adequate degree of resistance, consistency, and elasticity are necessary.
•The majority of medical students suffer from burn out symptoms, with higher prevalence in women.•The increase if family member mortality and economic crisis during the COVID-19 pandemic increased ...the risk of developing burnout.•High emotional exhaustion, cynicism, and low academic effectiveness prevails among medical students.
Background: Overwhelming requirements, a high degree of work, and prolonged exposure to emotionally demanding circumstances in work and life settings can lead to burnout syndrome. The purpose of the study is to assess burnout syndrome and its associated factors among medical students during the COVID-19 pandemic.
Methods: A cross-sectional, prospective, descriptive study was conducted in a Mexican medical school during the last week of the spring semester of 2021 using the Maslach Burnout Inventory-Student Survey (MBI-SS) and an associated factors survey.
Results: Based on the MBI-SS definition, most students (54.2%, n = 332) had burnout symptoms and high emotional exhaustion (79.6%, n = 448), high cynicism (57.3%, n = 351), and low academic effectiveness (36.4%, n = 223). After adjusting the associated factors, a significant correlation between the school year and the presence of burnout was identified (OR 1.127, 95% CI 1.023–1.241, p<0.05). Regarding the current pandemic, the death of a family member by COVID-19 also put students at risk of developing burnout (OR 1.598*, 95% CI 1.080–2.363, p<0.05).
Limitations: The main limitation of this study was the lack of a control group (before the pandemic); therefore, the high prevalence of burnout can only be hypothesized due to the pandemic but cannot be objectively evidenced. A prospective study after the pandemic is needed to resolve this question.
Conclusion: The coronavirus pandemic represents a challenge to the academic and psychological stability of students. It essential to continue assessing burnout levels in medical students and the general population to treat them in time and improve mental health.
Background: The coronavirus pandemic is an international public health emergency without precedence in modern history. It represents a challenge to the academic and psychological stability of ...students due to the changes it can cause in daily life. This study aimed to evaluate the prevalence and level of burnout in medical students caused by the academic and psychological instability that the pandemic represents.
Methods: A cross-sectional prospective study was designed using the Maslach Burnout Inventory-Student Survey (MBI-SS). This evaluated the emotional exhaustion due to study demands, cynicism, and negative self-academic efficacy. This study was based in the school of medicine of the Universidad Autonoma de Nuevo Leon (UANL), in Monterrey, Mexico during the Spring semester 2020.
Results: A total of 154 (93 women and 61 men) first-year medical students participated (response rate 36.4%). Burnout was identified in 14.9% (n=23), and high emotional exhaustion in 53.9% (n=83). Burnout was almost 4 times more likely to develop in men than in women (aOR = 4.8; 95% Confidence Interval=1.7-13.3) when considering age as a covariable in the multivariable model.
Conclusion: Further epidemiological studies of burnout syndrome in medical students are needed, and schools should consider promoting mental health and making programs available for their students to help overcome the emotional and social challenges during the pandemic.
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