Anatomy Scholars Program

Platform Presentation at the 2022 American Association of Clinical Anatomist (AACA) Conference

Abstract:

INTRODUCTION. Stanford’s Division of Clinical Anatomy offered a virtual, week‐long Clinical Anatomy Summer Program (CASP) to pre‐health students, utilizing VR anatomical models accessible via the Engage platform on Oculus Quest headsets as a teaching modality. The first iteration of CASP with VR in 2020 emphasized the need for VR improvements related to connectivity, audio, graphics, and setup instructions, which were applied in 2021. This study aimed to determine if the VR improvements affected the learning experience and evaluate the effectiveness and student perception of VR in teaching anatomy. METHODS. Data was collected from an anonymous Qualtrics survey that utilized 5‐ point Likert scale questions and short answer responses based on the VR experience and analyzed using SPSS. SUMMARY. The survey yielded a response rate of 39% (n = 32). When asked to evaluate the overall VR experience, survey results of 2020 students (Mn = 4) were lower than 2021 students (Mn = 4.28). A Mann‐Whitney test indicated that this difference was not statistically significant, U(N2020 students = 44, N2021 students = 32,) = 291, z = ‐1.151, p = .25. A Chi‐Square Goodness of Fit Test, Χ2 (4, n = 32) = 19.79, p = .0005, rejected our expectations that most of the 2021 students would have negative reactions to VR due to the burnout experienced from virtual learning during the pandemic. 69% of students strongly agreed that VR was a positive learning experience, and 44% specifically mentioned that the 3D visualization of anatomical structures improved their understanding of the lecture material. Almost half the students (48%) indicated mild to moderate nausea. Most students indicated that 30 minute VR sessions would be most effective. CONCLUSIONS. Despite implementing improvements to VR, no significant difference was shown in the perceived learning experience. Students widely viewed VR as a valuable supplement that helped them to better understand the lecture material, and its influence was not affected by the weariness of online learning during the pandemic contrary to our expectations.

Journal Published May 2021

DOI: 10.1177/23742895211013530

The following fictional case is intended as a learning tool within the Pathology Competencies for Medical Education (PCME), a set of national standards for teaching pathology. These are divided into three basic competencies: Disease Mechanisms and Processes, Organ System Pathology, and Diagnostic Medicine and Therapeutic Pathology. For additional information, and a full list of learning objectives for all three competencies, see http://journals.sagepub.com/doi/10.1177/2374289517715040.1.

Journal Published Oct 2019

DOI: 10.1097/PHM.0000000000001218

Abstract

With an aging and growing US population, American healthcare faces an impending physician shortage. This is important for the field of physical medicine and rehabilitation, because physiatrists' skills in managing chronic conditions and functional outcomes are especially relevant to an older population. The present study was designed to better understand the future physical medicine and rehabilitation workforce, by recording and analyzing the quantities of Accreditation Council of Graduate Medical Education-accredited physical medicine and rehabilitation graduate medical education programs and positions between 2001-2002 and 2017-2018. Results indicated that physical medicine and rehabilitation graduate medical education has grown since 2001-2002, especially in subspecialties such as pediatric rehabilitation and sports medicine. However, the growth in physical medicine and rehabilitation residency positions has been three-fold lower than that of total graduate medical education. In addition, subspecialization has become increasingly prevalent, and residency positions have declined relative to the population of older adults. The future identity of physical medicine and rehabilitation will continue to develop as professional and demographic trends shape this important medical specialty.

Journal Published Jan 2018

DOI: 10.1177/2333721418777659

Abstract

It is no secret that the average age of the U.S. population is increasing, and this has special significance for the U.S. health care system. The number of individuals above 65 years old is predicted to increase 55% by 2030, and all the while, there is a looming physician shortage, one especially relevant for Geriatricians. Therefore, current Geriatricians must have objective information to assess the past, present, and future state of this important specialty. However, little literature exists regarding the recent changes in Geriatrics-related graduate medical education programs. In the present study, we use data from the Accreditation Council of Graduate Medical Education, to characterize quantitative trends in Geriatrics graduate medical education between academic years 2001-2002 and 2017-2018. We find that, when Hospice/Palliative Care is excluded, Geriatrics-related graduate medical education programs have grown by just 1.1% when adjusting for population growth. There are 58 fewer total filled Geriatrics and Geriatric Psychiatry positions in 2017-2018 than there were in 2001-2002, a population-adjusted decline of 23.3%. Our results confirm the growing notion that the Geriatrics specialty may need to alter its approach toward professional supply, if it is to meet the growing health care demands of an aging U.S.

Platform Presentation at the 2019 American Association of Clinical Anatomist (AACA) Conference

Anatomical analysis of cardiac defects is essential for a comprehensive understanding of cardiovascular diseases. Wolff-Parkinson White Syndrome (WPWS) is a rare disease affecting 0.68 to 1.7 per 1000. It is characterized by an abnormal electrical pathway in the heart, often causing episodes of elevated heart rate. Most patients with WPWS have otherwise normal cardiac anatomy. Only 9-32% of patients do have associated structural anomalies, almost all of which are either Ebstein anomaly, hypertrophic cardiomyopathy, or transposition of great arteries. However, we present a case with anomalies not previously reported in association with WPWS. RESOURCES. The patient autopsy report was reviewed for morphological descriptions of all cardiac morphologies. DESCRIPTION. We present the autopsy findings of a 10-year old girl who had a history of WPWS. She was in her usual state of health until she developed sudden cardiac arrest at home. Autopsy revealed her heart was above average weight for her age, (190g compared to normal=139g). The right atrial appendage demonstrated aneurysmal change including effacement of pectinate muscles. Non-compaction was present in the inner one-third of the left ventricular wall. This area also demonstrated acute myocardial infarct which correlated with the timing of cardiac arrest. Additionally, the right subclavian artery originated directly from the aortic arch distal to the origin of the left subclavian artery. SIGNIFICANCE. WPWS is a rare defect, and only on rare occasions is it concomitant with ventricular noncompaction or aberrant subclavian origin. It is an especially rare occurrence with atrial appendage aneurysm. This case represents the first reported occurrence of this constellation of findings in association with WPWS. The opportunity to learn how the coexistence of all four defects affects the regional structures of the heart poses a unique ability to understand the association between anatomical aberrations and WPWS.

Poster Presentation at the 2019 American Association of Clinical Anatomist (AACA) Conference

Many infants are born with congenital heart conditions that compromise the blood flow to the lungs via the pulmonary arteries (PA). The use of artificial conduits to circumvent malformations has greatly reduced mortality rates in recent years. However, despite this improvement in overall patient outcome, conduits may become thrombosed and fail, which can lead to reoperation or even death. RESOURCES. Autopsy reports were searched for patients 4 weeks or older who had conduits implanted to aid in the pulmonary artery blood supply. A total of 37 autopsies were reviewed for primary and secondary diagnoses, conduit type, conduit duration, and whether thrombosis was present. DESCRIPTION. Data was analyzed to observe trends and prevalence in conduit types and thrombotic events. The most common heart conditions requiring artificial PA conduits were hypoplastic left heart syndrome (41%) and some form of heterotaxy (22%). The most common conduit types included right ventricle-to-PA conduit (38%) and Glenn shunt (28%). The overall rate of thrombus formation was 54% of which 60% were found in the artificial conduit. SIGNIFICANCE. Blood flow through the pulmonary artery is vital for life. There are many congenital conditions that require the insertion of artificial conduits to provide adequate blood flow through the PA that would otherwise lead to oxygenation deficiencies without the conduit. However, a conduit may result in the formation of a thrombus, often in the shunt itself, which can occlude blood flow and/or dislodge to become an embolus. Thrombosis of PA conduits remains a challenge for patients with a wide range of congenital heart defects regardless of conduit type.

Poster Presentation at the 2019 American Association of Clinical Anatomist (AACA) Conference

Anatomical variations of the epiglottis are rare. Congenital laryngeal anomalies like aplastic, hypoplastic and bifid epiglottides, have been reported, and are often associated with digestive/respiratory complications. However, there are no recorded cases of an epiglottis with focally absent cartilage. The present study describes the histological and pathological characteristics of this rare structure/condition. RESOURCES. This anomaly was discovered incidentally during autopsy. Histologic tissue analysis was performed. DESCRIPTION. A twenty-seven-year-old patient with cystic fibrosis and end-stage lung disease was observed to have an epiglottis with a thin and transparent mid-portion. The histological analysis showed the region lacking elastic cartilage contained bland connective tissue surrounded by normal stratified squamous epithelial layers. The larynx was otherwise normal. The trachea and bronchi contained thick mucus, and the lungs showed classic pathologic changes of cystic fibrosis. SIGNIFICANCE. An epiglottis with focally absent cartilage has not previously been reported. Patients with abnormalities of the epiglottis are expected to have problems with airway, aspiration and feeding, however this was not reported for this patient. While the primary symptoms of cystic fibrosis are classically respiratory/pancreatic abnormalities, other structural abnormalities may occur, such as absent/underdeveloped vas deferens. Similarly, the etiology of this patient's focally absent epiglottic cartilage may be related to cystic fibrosis.

Tech Fair Presentation at the 2018 American Association of Clinical Anatomist (AACA) Conference

Recently, many medical schools have looked for ways to decrease the percentage of pre-clerkship education time in lectures and increase the amount of educational activities with interactive components. One of the ways to achieve this is by engaging in problem-based learning activities in small group formats moderated by faculty members or staff. This case study examined the effectiveness of using Nearpod (nearpod.com) in large lectures with only one instructor to mimic small interactive learning sessions. RESOURCES. Nearpod is a digital teaching tool that facilitates an immersive learning experience by empowering instructors to create interactive lessons. Nearpod has applications for iOS, Android, PC/MAC, and Windows 8 devices, and also works as a web-based platform. DESCRIPTION. Nearpod was incorporated in three required medical school courses in the fall quarter of academic year 2017-2018: Clinical Anatomy, Embryology, and Histology. Prior to the in-class sessions, students had access to new content which helped induce in-class participation by using Nearpod on their own devices. These sessions were led by a single instructor in the main lecture hall projecting questions based on scenarios related to the topic. After the instructor deemed it appropriate, response results were displayed, a brief discussion followed, and the instructor moved on to the next question. Question and response types varied from simple multiple choice questions, polls, open-ended questions, and a 'Draw-It' function, which enabled students to identify structures on radiologic images or virtual histology slides. SIGNIFICANCE. Nearpod can make large-group sessions interactive and may have significant future applications in schools with limited faculty and resources. The variety of question and response types allow the instructor to choose assessments appropriate for the topic being covered, especially for anatomy and other topics with a prominent visual component.

Poster Presentation at the 2018 American Association of Clinical Anatomist (AACA) Conference

Nager acrofacial dysostosis, or Nager syndrome, is a rare condition with less than 100 reported cases and is marked primarily by abnormalities in bone development. Most cases of Nager syndrome are caused by mutations in the SF3B4 gene whose protein product is known to be involved in the bone morphogenetic protein (BMP) pathway. However, less is known about abnormalities beyond the musculoskeletal system in this condition. RESOURCES. We examine the gross, radiologic, and histologic findings from the autopsy of a 22-month old female with Nager syndrome, including both expected and previously unreported findings. DESCRIPTION. The patient was found to have the SF3B4 mutation as well as classic features of Nager syndrome including severe micrognathia, radial hypoplasia, oligodactyly of the hands, clinodactyly of the feet, and shallow-to-absent external acoustic meatuses. However, histologic examination of the ovaries also revealed follicular abnormalities including follicular cysts and developing antral follicles. Such findings are highly unusual in a patient of this age, thus suggesting they may be related to the underlying Nager mutation. SIGNIFICANCE. The SF3B4 protein is known to interact with BMPR1A, which is recruited and phosphorylated by BMPR2 when BMPR2 is bound by one of its ligands. Two such ligands for BMPR2 happen to be Gdf9 and BMP15. Interestingly, while mutations in both alleles for either Gdf9 or BMP15 are known to cause sterility in sheep, those with a single mutant allele are, paradoxically, superovulatory. Therefore, we raise the possibility that haploinsufficiency of SF3B4 has a similar effect on the pathway, resulting in the patient's ovarian histology. While the major features of Nager syndrome involve abnormalities of face and limb development, here we describe a case with atypical ovarian findings which may represent an additional manifestation of the same genetic mutation.

Recent advances in computer technology allow us to image, reconstruct, and interact with anatomical information that had been previously inaccessible. A process of stacking two-dimensional (2D) images to create threedimensional (3D) models is utilized for computed tomography (CT) scan reconstructions. A similar practice has been tried with gross anatomical photographic data. RESOURCES. This innovative project was designed to develop techniques to create 3D microscopic data sets of specific human organs (specimens). Five individually dissected organs: kidney, spleen, eyeball, cerebellum, and a region of the anterior lower limb were harvested from a fresh cadaver donated to Stanford’s Willed Body Program. To preserve shape, structure, and color the specimens were flash frozen in liquid nitrogen and stored in a -80°C freezer to avoid desiccation. The frozen specimens were milled from 20-30 micron units using the cryomacrotome and photographed after each slice was removed. These images were then aligned and reconstructed creating 3D interactive models that can be virtually segmented and dissected. DESCRIPTION. This project focuses on the individual organ structures, providing improved resolution of the organ and its internal structures. SIGNIFICANCE. With the addition of 3D organ models, students are provided with a virtual, hands-on anatomy resource that compliments cadaver labs and histology labs. Similarly, this project demonstrates that this cryomacrotome slicing technique can be effectively used to build libraries of high resolution, 3D data sets of individual organs. Users have the capability of annotating the virtual images and incorporating them into an anatomy/physiology curriculum. This project also illustrates that small animals, such as the frog (pilot specimen), can be similarly imaged, segmented, and used for virtual anatomy/physiology dissections in high school and college anatomy programs.

Tech Fair Presentation at the 2017 American Association of Clinical Anatomist (AACA) Conference

Modern anatomy education consists primarily of cadaveric specimens (dissection and prosections), two-dimensional images (2D), and limited physical and digital 3D models. Often these computer generated and physical 3D models oversimplify anatomical structures, resulting in reduced accuracy and limited functionality. Photogrammetry, a process that uses overlapping photographs to create 3D models, can prove particularly valuable in bridging the gap between 3D models and physical specimens. RESOURCES. This study used photogrammetry with human specimens. Imaging equipment and reconstruction techniques were developed and built by Anatomage, Inc. Data from the high-resolution digital images were compiled and transformed into 3D interactive models. The specimens were donated from the Stanford Willed Body Program and included five prosections, a dissected torso, and a serially dissected unembalmed forearm. DESCRIPTION. This study aims to evaluate the viability of using photogrammetry with human specimens to create accurate and interactive 3D models. SIGNIFICANCE. Embalmed anatomical specimens are valuable resources for understanding anatomy, yet their use is constrained by tissue deterioration, storage space, and finances. Photogrammetry can offer realistic, innovative, and accessible 3D computer models with options for digital manipulation and labeling. This library of virtual models can also supplement students' comprehension with challenging areas of anatomy, as well as the study of abnormal pathologies and atypical morphologies. Easy access and widespread distribution can invite global collaboration through the creation of a modern digital anatomical library. This new generation of digital anatomy technology can enhance the knowledge and understanding of the human body for all students including allied health professionals and biomedical researchers.

Poster Presentation at the 2017 American Association of Clinical Anatomist (AACA) Conference

Two techniques used in rhinoplasty to straighten the lower lateral cartilage (LLC) are lateral crural strut grafts (LCSG) and lateral crural hinged flaps.The LCSGs were harvested and carved from autologous septal cartilage. The purpose of this study was to determine if the techniques significantly straighten the LLC and also to compare the two techniques. METHODS. An external rhinoplasty approach was used on four fresh adult human cadavers to expose the lower lateral cartilages and the septum. Both techniques were done bilaterally on each cadaver(n=8 LLCs). The vestibular mucosa was dissected from the LLCs. Septal cartilage was harvested and the LCSGs were carved measuring 18x4x2 mm. The LCSGs were placed with two mattress sutures of 6-0 Nylon on both sides. The LCSGs were then removed and the hinged flaps were created while keeping a continuous strip of 7mm of LLC. Photos of the LLCs were taken before and after each step, and standardized measurements were performed using GNU Image Manipulation Program (GIMP). SUMMARY. There was a significant difference between the LCSG and the hinged flap (p=0.049) with the LCSG straightening the LLC by an average length of 7.7 degrees more than the hinged flap technique. Both techniques significantly straightened the cartilage compared to the baseline average, with the LCSG straightening the LLC by 19.4 degrees(p=0.002) and the hinged flap straightening the LLC by 11.7 degrees (p=0.003). CONCLUSIONS. The two techniques significantly straightened the LLC with the LCSG increasing the LLC more than the hinged flap.

Poster Presentation at the 2016 American Association of Clinical Anatomist (AACA) Conference

Checklists have recently found their place in many surgical environments, showing outstanding potential in improving patient outcomes. Checklist implementation, however, has in many cases been met with poor compliance. A major reason for this is healthcare provider resistance. The anatomy laboratory offers a model for the surgical setting and is an ideal environment for an introduction to checklists. RESOURCES. A single dissection operations checklist was designed to standardize important pre- and post- dissection operations for any given laboratory period. Checklist items were communication oriented, prompting students to briefly discuss the day's dissection assignment, talk through individual team member roles, and discuss which portions of the dissection might prove especially challenging or dangerous. Additional items concerned safety, cleanliness, and organization of the laboratory instruments and facilities. DESCRIPTION. Students were instructed to complete their checklists at the beginning and end of each dissection period. The checklist was not intended to guide or direct specific dissection procedures. Course teaching assistants were instructed to periodically prompt students to use the checklist, however, checklist completion was not graded. Checklist compliance and user attitude information was gathered throughout the course. SIGNIFICANCE. Other procedurally standardized industries offer valuable guidance in checklist development and implementation. In the aviation industry, beginner pilots are trained to incorporate checklists into their workflow early on. Early exposure to checklists contributes to a culture in which checklists are widely accepted as an integral part of workflow. To achieve this sort of cultural acceptance in surgery, we propose that medical students would benefit from early and repeated exposure to checklists in their anatomical dissection coursework.