Medical Science Educator © IAMSE 2013 Volume 23(3) 325

MEDICAL SCIENCE EDUCATOR The Journal of the International Association of Medical Science Educators Med Sci Educ 2013; 23(3): 325-326

INNOVATION

A Model of Integrating Emergency Orthopedics to Anatomy Curriculum for Medical School Students: Hip Joint as an Example of Lower Extremity Course Yehia M.A-H. Marreez Touro University Nevada, Henderson, NV, USA Anatomy courses are in a relatively unique position to provide foundational knowledge in the pre-clinical, undergraduate medical education curriculum that can be applied immediately, and also built upon throughout a clinician’s career. Efficient anatomy integration in the current system-based curriculum without losing some learning quality is inevitable. The current formats of integrating anatomy seem inadequate, as they do not pay enough attention to subject priority and development of hands-on experience in specific areas, such as critical or urgent care, that may require development of early experience. Probably, a favorable way to understand anatomy is to not only integrate clinically relevant and surgical topics, but also select appropriate subjects for simulated hands-on practice in early years’ medical education.1,2 To this end, many appropriate topics in emergency medicine and surgery, trauma, and emergency orthopedic may be a good fit. Emergency orthopedics in particular could be a rich source for simple topics that ideally could be taught in conjunction with anatomy early in the medical education to familiarize medical students with such urgent problems that need appreciation and immediate care. Using hip joint as a model, we designed a sample case-based approach to integrate emergency orthopedics with anatomy. In terms of application, the anatomy of hip joint is generally outlined in a 5-minute traditional lecture-type (didactic) format or

any other convenient method. This introduction, which may act as an orientation to basic anatomy for the students, would be immediately followed by a clinical case-based presentation concerning the “traumatic posterior dislocation of the hip”, a common hip lesion. It is important to use audiovisual or animation technology to help further knowledge of the nature of the case, mechanism of lesion occurrence, and anatomical deformity. Then, the underlying disturbed anatomy of the region and potential risks as a result of the hip dislocation are closely analyzed in an interactive discussion with the students. Emergency intervention to restore normal hip anatomy is reasoned and explained in a context of didactic review of the normal and abnormal hip anatomy. Hands-on practice of the maneuver to restore normal hip functions then can be performed, as described, to enhance problem reasoning and appreciation, using robotic or cadaveric simulation.3,4 The high accuracy and precision of robots could be a valuable aid of simulating hip pathology on a manikin or a cadaver. However, the high costs of such new technology may be a real obstacle. Despite of its inaccuracy and lack of precision, induced hip dislocation in fresh or embalmed cadavers could be an alternative. In such case, tissue flaccidity in fresh cadavers or excessive rigidity in embalmed cadavers may result in imperfect problem appreciation during the manipulative hip reduction. The perfect place to apply such model would be the gross anatomy lab as a workshop place. The prominent idea in this model is to not only learn the anatomy, but also appreciate its clinical value by establishing a direct linkage to common or emergency problems that require training and

Corresponding author: Yehia M.A-H. Marreez, MD, PhD, Department of Basic Medical Sciences, Touro University Nevada, 874 American Pacific Dr., Henderson, NV 89014, USA, Phone: 702-777-4782, Fax: 702-777-1799, email: yehia.marreez@tun.touro.edu

Medical Science Educator © IAMSE 2013 Volume 23(3) 326

immediate hands-on manipulations. Unlike other approaches that use surgeries on cadaveric material to teach anatomy, our approach does not use elective or emergency major surgeries that would fit best in specialty residency program training.2 As a short-term outcome, the application of this model would be expected to associate the student’s intellect with his/her visual and tactile senses towards one problem, which may result in reinforcing the pedagogic objectives. Also, it would eliminate confusion about specific needs for some details in basic science learning and introduce students to clinical work. Hence, this model may minimize redundancy and arduousness in retaining voluminous anatomical information because it involves parallel hands-on application.2,4 As a long-term outcome, this approach may initiate early sense of trust and responsibility of the medical students towards safe practice of medicine. We are planning to start a pilot study to apply this approach on a limited number of randomly selected first-year medical students. The approach will be assessed based on the results of an exam and survey for the participants of this study against an equal number of non-participant students. In conclusion, anatomy is perfectly compatible with orthopedics, emergency medicine, and surgical specialties. Carefully designed integration would move anatomy curriculum to a higher level of interest and clinical significance.

Keywords Integration, anatomy simulation, preclinical practical experience, clinical application to gain foundational knowledge References 1. Johnston AN, McAllister M. Back to the future

with hands-on science: students' perceptions of learning anatomy and physiology. J Nurs Educ. 2008;47(9):417-421.

2. Nutt J, Mehdian R, Parkin I, Dent J, Kellett C. Cadaveric surgery: a novel approach to teaching clinical anatomy. Clin Teach 2012;9(3):148-151.

3. Clegg TE, Roberts CS, Greene JW, Prather BA. Hip dislocations—Epidemiology, treatment, and outcomes. Injury. 2010;41(4):329–334.

4. Sugand K, Abrahams P, Khurana A. The anatomy of anatomy: a review for its modernization. Anat Sci Educ. 2010;3(2):83-93.