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      Evaluating the impact of an integrated multidisciplinary head & neck competency-based anatomy & radiology teaching approach in radiation oncology: a prospective cohort study

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          Abstract

          Background

          Modern radiation oncology demands a thorough understanding of gross and cross-sectional anatomy for diagnostic and therapeutic applications. Complex anatomic sites present challenges for learners and are not well-addressed in traditional postgraduate curricula. A multidisciplinary team (MDT) based head-and-neck gross and radiologic anatomy program for radiation oncology trainees was developed, piloted, and empirically assessed for efficacy and learning outcomes.

          Methods

          Four site-specific MDT head-and-neck seminars were implemented, each involving a MDT delivering didactic and case-based instruction, supplemented by cadaveric presentations. There was no dedicated contouring instruction. Pre- and post-testing were performed to assess knowledge, and ability to apply knowledge to the clinical setting as defined by accuracy of contouring. Paired analyses of knowledge pretests and posttests were performed by Wilcoxon matched-pair signed-rank test.

          Results

          Fifteen post-graduate trainees participated. A statistically significant (p < 0.001) mean absolute improvement of 4.6 points (17.03%) was observed between knowledge pretest and posttest scores. Contouring accuracy was analyzed quantitatively by comparing spatial overlap of participants’ pretest and posttest contours with a gold standard through the dice similarity coefficient. A statistically significant improvement in contouring accuracy was observed for 3 out of 20 anatomical structures. Qualitative and quantitative feedback revealed that participants were more confident at contouring and were enthusiastic towards the seminars.

          Conclusions

          MDT seminars were associated with improved knowledge scores and resident satisfaction; however, increased gross and cross-sectional anatomic knowledge did not translate into improvements in contouring accuracy. Further research should evaluate the impact of hands-on contouring sessions in addition to dedicated instructional sessions to develop competencies.

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          Most cited references16

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          Medical education in the anatomical sciences: the winds of change continue to blow.

          At most institutions, education in the anatomical sciences has undergone several changes over the last decade. To identify the changes that have occurred in gross anatomy, microscopic anatomy, neuroscience/neuroanatomy, and embryology courses, directors of these courses were asked to respond to a survey with questions pertaining to total course hours, hours of lecture, and hours of laboratory, whether the course was part of an integrated program or existed as a stand-alone course, and what type of laboratory experience occurred in the course. These data were compared to data obtained from a similar survey in 2002. Comparison between the data sets suggests several key points some of which include: decreased total hours in gross anatomy and neuroscience/neuroanatomy courses, increased use of virtual microscopy in microscopic anatomy courses, and decreased laboratory hours in embryology courses.
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            Examining the validity of pressure ulcer risk assessment scales: developing and using illustrated patient simulations to collect the data.

            Simulations are of particular advantage in research studies where large samples are necessary to achieve statistical power and the information must be collected under uniform conditions in order to aid interpretation. In the study reported below, simulation was achieved through the use of medical photography accompanied by case studies of the same patients. All information was collected on the same day. The purpose of the study was to determine the validity of the three pressure ulcer risk assessment scales most commonly used in clinical nursing practice in the UK. Each clinical nurse assessed the same four patients using three risk assessment scales and a visual analogue scale designed to capture their own clinical judgement. External validity was assessed by a panel of tissue viability experts who provided independent ratings. Data were obtained from 236 clinical nurses, yielding 941 risk assessments. Experience with this approach to data collection suggests that it requires careful planning. This should include measures to ensure that the simulated information is valid and that all data collectors have been adequately trained and are able to motivate the nurses participating in the study. Providing consideration is given to these issues, the use of simulation can help to collect data that would be difficult to obtain by more conventional means. It is also important to recognize that clinical decisions are de-contextualized in simulations because they are reduced to verbal and visual summaries. The decision to use simulations should thus be taken only if this is acknowledged.
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              Quidne mortui vivos docent? The evolving purpose of human dissection in medical education.

              The dissection experience has evolved over the past 500 years, following broader cutural trends in science and medicine. Through this time each period has recruited human gross anatomic dissection for characteristic purposes. Key variables have been: (1) the motivating philosophies of medicine and science, (2) how well clinical medicine and basic science have been integrated by anatomy, and (3) how explicity thoughts or feelings about death and dying have been addressed in the context of anatomy. The authors are especially interested in the third variable, and suggest that although anatomy is scientifically in decline, dissection is currently enjoying a revival as a vehicle for teaching humanist values in medical school. Changes in the culture of medicine have carried anatomy from a research science, to a training tool, nearly to a hazing ritual, to a vehicle for ethical and moral education. Physicians, scientists, and medical students, as well as observers such as sociologists and writers, have been only intermittently aware of these cultural shifts. Yet anatomic dissection has been remarkably persistent as a feature of medical education-indeed it stands out as the most universal and universally recognizable step in becoming a doctor. This paper attempts to explore and interpret in detail the history of anatomy education, drawing on both subjective commentary and objective data from each period.
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                Author and article information

                Contributors
                Journal
                BMC Med Educ
                BMC Med Educ
                BMC Medical Education
                BioMed Central
                1472-6920
                2014
                26 June 2014
                : 14
                : 124
                Affiliations
                [1 ]Department of Anatomy & Cell Biology, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
                [2 ]Division of Radiation Oncology, Department of Oncology, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
                [3 ]Department of Medical Imaging, London Health Sciences Centre, Victoria Hospital, London, ON, Canada
                [4 ]Department of Otolaryngology - Head and Neck Surgery, London Health Sciences Centre - Victoria Hospital, London, ON, Canada
                [5 ]London Regional Cancer Program, London, ON, Canada
                Article
                1472-6920-14-124
                10.1186/1472-6920-14-124
                4102036
                24969509
                ab2fe22c-d5b3-4dd7-a807-7892f7af5e47
                Copyright © 2014 D’Souza et al.; licensee BioMed Central Ltd.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 10 January 2014
                : 19 June 2014
                Categories
                Research Article

                Education
                anatomy,education,radiotherapy,contouring,head and neck cancer
                Education
                anatomy, education, radiotherapy, contouring, head and neck cancer

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