Alexandra Louise Webb

Purpose: While nonverbal communication skills (NVCS) are an important contributor to building a clinical alliance, they are often included implicitly rather than explicitly in medical education programs. Ambiguity around if (and how) NVCS are taught, learned or developed limits the flexibility of implementation of NVCS education in medical programs. This gap in understanding is further highlighted by recent pushes toward online learning environments. This study aimed to identify the perceptions of clinical skills tutors, simulated patients, and students around learning NVCS and how that translates to an online context. Methods: A qualitative study was conducted using a series of semi-structured interviews with clinical skills tutors, simulated patients and medical students from an Australian medical program. The resulting data was analyzed using reflective thematic analysis. Results: We classified participant construals of how NVCS are taught and learned into four themes: ‘explicit teaching’, ‘experiential learning’, ‘observational learning’ and the importance of ‘feedback’. In the transition to online learning, the process of learning NVCS through explicit teaching was largely thought to be retained. Experiential and observational learning were retained in limited forms and some elements of feedback were lost. Conclusions: This study has identified new perspectives of stakeholders in teaching and learning NVCS online for use in clinical contexts. Learning NVCS online can be beneficial in preparing students for telehealth consultations. However, a better understanding of how skills used online and in face-to-face environments correspond is required to guide the development of innovative and engaging methods for the teaching and learning of NVCS.

This chapter describes an innovative approach to the cross-disciplinary study of anatomy and art to facilitate visualization of the human body. We draw upon the literature, together with our own experience of designing, delivering and researching a cross-disciplinary art and anatomy course, to indicate the critical elements of the approach that foster students’ visualization of the anatomy of the human body. Visual arts have been linked with anatomy for centuries, but typically biomedical science has existed in a utilitarian relationship with art only used as an aid. In this chapter, we discuss the rationale underpinning a cross-disciplinary anatomy and art course and describe our experience of devising activities and assessment that create a stimulating and mutually beneficial environment for visualizing the experience and physicality of the human body. We describe the structure of the course which integrates art and anatomy to train students in the language of anatomy and visual representation, by engaging them in a process of attempting their own visual communication. The cross-disciplinary nature of our approach creates a unique social environment that offers a supportive environment for exploration and experimentation without fear of failure. Students’ personal growth in resilience, tolerance for uncertainty and creativity prepares them for the inclusion of these values in their career. Keywords Anatomy Art Human body Medicine in the arts Visual arts in medicine Interdisciplinary learning Biomedicine Visual arts

Characterization of the oropharynx, a subdivision of the pharynx between the soft palate and the epiglottis, is limited to simple measurements. Structural changes in the oropharynx in whiplash‐associated disorder (WAD) cohorts have been quantified using two‐dimensional (2D) and three‐dimensional (3D) measures but the results are inconsistent. Statistical shape modelling (SSM) may be a more useful tool for systematically comparing morphometric features between cohorts. This technique has been used to quantify the variability in boney and soft tissue structures, but has not been used to examine a hollow cavity such as the oropharynx. The primary aim of this project was to examine the utility of SSM for comparing the oropharynx between WAD cohorts and control; and WAD severity cohorts. The secondary aim was to determine whether shape is associated with sex, height, weight and neck length. Magnetic resonance (MR) T1‐weighted images were obtained from healthy control (n = 20), acute WAD (n = 14) and chronic WAD (n = 14) participants aged 18–39 years. Demographic, WAD severity (neck disability index) and body morphometry data were collected from each participant. Manual segmentation of the oropharynx was undertaken by blinded researchers between the top of the soft palate and tip of the epiglottis. Digital 3D oropharynx models were constructed from the segmented images and principal component (PC) analysis was performed with the PC weights normalized to z‐scores for consistency. Statistical analyses were undertaken using multivariate linear models. In the first statistical model the independent variable was group (acute WAD, chronic WAD, control); and in the second model the independent variable was WAD severity (recovered/mild, moderate/severe). The covariates for both models included height, weight, average neck length and sex. Shape models were constructed to visualize the effect of perturbing these covariates for each relevant mode. The shape model revealed five modes which explained 90% of the variance: mode 1 explained 59% of the variance and primarily described differences in isometric size of the oropharynx, including elongation; mode 2 (13%) primarily described lateral (width) and AP (depth) dimensions; mode 3 (8%) described retroglossal AP dimension; mode 4 (6%) described lateral dimensions at the retropalatal‐retroglossal junction and mode 5 (4%) described the lateral dimension at the inferior retroglossal region. There was no difference in shape (mode 1 p = 0.52; mode 2 p = 0.96; mode 3 p = 0.07; mode 4 p = 0.54; mode 5 p = 0.74) between control, acute WAD and chronic WAD groups. There were no statistical differences for any mode (mode 1 p = 0.12; mode 2 p = 0.29; mode 3 p = 0.56; mode 4 p = 0.99; mode 5 p = 0.96) between recovered/mild and moderate/severe WAD. Sex was not significant in any of the models but for mode 1 there was a significant association with height (p = 0.007), mode 2 neck length (p = 0.044) and in mode 3 weight (p = 0.027). Although SSM did not detect differences between WAD cohorts, it did detect associations with body morphology indicating that it may be a useful tool for examining differences in the oropharynx.

Knowledge of musculoskeletal anatomy is fundamental to physical therapy education. Although detailed anatomy syllabi have been developed for medical and other health professional students, none are available for training physical therapists. Therefore, the aim of this project was to produce a core musculoskeletal anatomy syllabus specific to physical therapy students, utilizing a modified Delphi approach. An international Delphi panel (n = 53) composed of anatomists and clinicians involved in physical therapy education considered a total of 2193 anatomical items arranged in four categories (musculoskeletal concepts; vertebral column; pectoral girdle and upper limb; pelvic girdle and lower limb). Using specific criteria, items were rated on the basis of whether they were considered essential knowledge for a competent physical therapy student, and were categorized as core, recommended, not recommended or not core. Of the 2193 items, 1700 (77.5%) were rated as core or recommended. For musculoskeletal concepts, 70% (233/332) of items were categorized as core/recommended. Approximately 80% of items in the other three categories were considered core/recommended-vertebral column (355/440), pectoral girdle and upper limb (513/657), and pelvic girdle and lower limb (599/764). This project presents a detailed musculoskeletal anatomy syllabus which may be used within a physical therapy curriculum. A key difference compared to published musculoskeletal anatomy syllabi for medical students is that a greater number of items are considered core/recommended (approximately 80% vs. 50%). These findings will now be considered and deliberated in accordance with the International Federation of Associations of Anatomists modified Delphi approach.

While debate about the use of—and alternatives to—human cadaveric dissection in medical training is robust, little attention has been paid to questions about timing. This study explores the perspectives of medical students and recent graduates with regard to two key questions: when in the degree program do students prefer dissection opportunities and what are the students getting out of participating in dissection? Self‐report survey data from students in preclinical years (n = 105), clinical years (n = 57), and graduates (n = 13) were analyzed. Most (89%) preferred dissection during the preclinical years, with no effect by training year (χ² = 1.98, p = 0.16), previous anatomy (χ² = 3.64, p = 0.31), or dissection (χ² = 3.84, p = 0.26) experience. Three key findings emerged. First, the majority of students prefer to dissect in the preclinical years because they view dissection as important for developing foundation knowledge and delivering an opportunity for consolidation prior to transitioning to primarily clinical studies. In addition, students recognize that it is a time‐consuming activity requiring specialized facilities. Second, three main understandings of the purpose of dissection were reported: depth of learning, learning experience, and real‐world equivalence. Third, these student perspectives of the purpose of dissection are associated with timing preferences for dissection opportunities. The results identify the preclinical phase as the optimal time to strategically integrate dissection into medical training in order to maximize the benefits of this unique learning opportunity for students and minimize its impact upon curricular time.

Neck pain is one of the most common symptoms of cervical spine disease, and segmenting neck muscles to create volumetric measurements may assist clinical diagnosis. While image registration is used to segment medical images, registration is highly challenging for neck muscles due to their tight proximity, shape and size variations among subjects, and similar appearance. These challenges cause conventional multi resolution-based registration methods to be trapped in local minima due to their low degree of freedom geometrical transforms. This paper presents a novel object-constrained hierarchical registration framework for aligning inter-subject neck muscles. First, to handle large scale local minima, the proposed framework uses a coarse registration technique, which optimizes the new edge position difference (EPD) similarity measure, to align large mismatches. Also, a new transformation based on the discrete periodic spline wavelet (DPSW), affine and free-form-deformation (FFD) transformations are exploited. Second, to avoid monotonous nature of using transformations in multiple stages, a fine registration technique is designed for aligning small mismatches. This technique uses a double-pushing system by changing edges in the EPD and switching transformation resolutions. The EPD helps in both coarse and fine techniques to implement object-constrained registration via controlling edges, which is not possible when using traditional similarity measures. Experiments are performed on clinical 3D magnetic resonance imaging (MRI) scans of the neck, with the results showing that the EPD is more effective than the mutual information (MI) and sum of squared difference (SSD) measure in terms of volumetric dice similarity coefficient (DSC). Additionally, the proposed method is compared with the diffeomorphic Demons and SyN state-of-the-art approaches with ablation studies in inter-subject deformable registration. The proposed method achieves better accuracy, robustness and consistency than the reference methods, with an average volumetric DSC of 0.7029 compared to 0.6654 and 0.6606 for the Demons and SyN methods, respectively.

A student's own body provides an often disregarded site of knowledge production and corporeal wisdom. Learning via cognitive processes anchored in physical movement and body awareness, known as embodied learning, may aid students to visualize structures and understand their functions and clinical relevance. Working from an embodied learning perspective, the current article evaluates the use of an offline physical learning tool (Anatomical Glove Learning System; AGLS) for teaching hand anatomy for clinical application in medical students. Two student samples (N₁ = 105; N₂ = 94) used the AGLS in two different ways. In the first sample, the AGLS was compared to a traditional approach using hand bones, models and prosected specimens. Secondly, the AGLS and traditional approach were combined. The evaluation consisted of three outcomes: short‐term learning (post‐test), medium‐term applications (mock‐objective structured clinical examination, MOSCE), and longer‐term assessment (objective structured clinical examination, OSCE). Findings from the first sample indicated no significant differences between the AGLS and traditional laboratory groups on short‐ (F_(1,78) = 0.036, P = 0.849), medium‐ (F_(1,50) = 0.743, P = 0.393), or longer‐term (F_(1,82) = 0.997, P = 0.321) outcomes. In the second sample using the AGLS in combination with a traditional approach was associated with significantly better short‐term post‐test scores (F_(2,174) = 5.98, P = 0.003) than using the AGLS alone, but demonstrated no effect for long‐term OSCE scores. These results suggest an embodied learning experience alone does not appear to be advantageous to student learning, but when combined with other methods for studying anatomy there are learning gains.

Australian and New Zealand universities commenced a new academic year in February/March 2020 largely with “business as usual.” The subsequent Covid‐19 pandemic imposed unexpected disruptions to anatomical educational practice. Rapid change occurred due to government‐imposed physical distancing regulations from March 2020 that increasingly restricted anatomy laboratory teaching practices. Anatomy educators in both these countries were mobilized to adjust their teaching approaches. This study on anatomy education disruption at pandemic onset within Australia and New Zealand adopts a social constructivist lens. The research question was “What are the perceived disruptions and changes made to anatomy education in Australia and New Zealand during the initial period of the Covid‐19 pandemic, as reflected on by anatomy educators?.” Thematic analysis to elucidate “the what and why” of anatomy education was applied to these reflections. About 18 anatomy academics from ten institutions participated in this exercise. The analysis revealed loss of integrated “hands‐on” experiences, and impacts on workload, traditional roles, students, pedagogy, and anatomists' personal educational philosophies. The key opportunities recognized for anatomy education included: enabling synchronous teaching across remote sites, expanding offerings into the remote learning space, and embracing new pedagogies. In managing anatomy education's transition in response to the pandemic, six critical elements were identified: community care, clear communications, clarified expectations, constructive alignment, community of practice, ability to compromise, and adapt and continuity planning. There is no doubt that anatomy education has stepped into a yet unknown future in the island countries of Australia and New Zealand.