Maxillary Melanotic Neuroectodermal Tumor of Infancy
Editors-in-ChiefAsim Kurjak (Croatia)
Frank A Chervenak (USA)
Executive EditorsSanja Kupesic (USA)
Ritsuko K Pooh (Japan)Ivica Zalud (USA)
Co-EditorsKazuo Maeda (Japan)History Ana Bianchi (Uruguay)ObstetricsGiovanni Monni (Italy)Invasive diagnostic procedures Zoltan Papp (Hungary)Prenatal diagnosisEberhard Merz (Germany)3D/4D sonography Veljko Vlaisavljevic (Slovenia)Human reproductionMiroslaw Wielgos (Poland)Education Radu Vladareanu (Romania)GynecologyMilan Stanojevic (Croatia)Neonatology Narendra Malhotra (India)Developing countriesCarmen Comas (Spain)Echocardiography Aris Antsaklis (Greece)Twins
Donald School Journal ofUltrasound in Obstetrics and Gynecology
The Official Journal of the Ian Donald Inter-University School of Medical Ultrasound
Sameer Abdullah (Saudi Arabia)Nelson Aguilar (Colombia)Badreldeen Ahmed (Qatar)Vincenzo D Addario (Italy)Tony Duan (China)Alaa Ebrashy (Egypt)Jadranka Dizdarevic (Bosnia and Herzegovina)Orion Gliozheni (Albania)Alfredo Guzman (Peru)Tze Kin Lau (Hong Kong)Aleksandar Ljubic (Serbia)Abdal-Latif Ashmaig Khalifa (Sudan)Berivoj Miskovic (Croatia)
Oliver Vasilj (Croatia)Anton Mikhailov (Russia)Azen Salim (Indonesia)Cihat Sen (Turkey)Yuriy P Vdovychenko (Ukraine)Liliana Voto (Argentina)Hari Shrestha (Nepal)Alexandra Matias (Portugal)Syed Amir Gilani (Pakistan)Corazon Yabes-Almirante (Philippines)Abdallah Adra (Lebanon)Mohamed S Elmahaishi (Libya)
Fawaz Akhazaleh (Jordan)
Secretary of the JournalJadranka Cerovec
Maxillary Melanotic Neuroectodermal Tumor of Infancy
Three years ago I made a transition to the USA and joined Texas Tech University in El Paso, theinstitution with a famous slogan: "From here it's possible". In 1921 the first President of Texas TechUniversity, American educator, Paul Whitfield Horn stated: "It is a country that lends itself to bigness.It is a country that does not harmonize with things little or narrow or mean. Let our thoughts be bigthoughts and broad thoughts. Let our thinking be in worldwide terms." Indeed, only two years after Icame to this picturesque and exotic place on the borderland, Paul L Foster School of Medicine (PLFSOM)was established as one of the forefront institutions in a shift in medical education.
I feel privileged to share my experience on the role of imaging and ultrasound in Obstetrics andGynecology in medical students' education and explore the opportunity for worldwide collaborationwith medical educators in this field. A significant proportion of illustrations in seventeen articles of thisspecial issue have been previously published in different textbooks and monographs of Jaypee Brothers. They kindly permitpublishing them in our Journal.
The aim of this issue is to demonstrate a few examples as to how PLFSOM is bypassing the standard biomedical sciences infavor of integrated curriculum that teaches the students through a series of clinical presentations, clinical skill activities and caseexample sessions. Instead of taking three semesters of anatomy, two semesters of physiology, microbiology and immunology,one semester of biochemistry, and so on, our students learn the relevant basic science knowledge as it relates to most commonclinical presentations. For example, in reproduction unit twelve most common clinical presentations are comprehensively discussed:amenorrhea, infertility, contraception counseling, menopause, prolapse and pelvic floor relaxation, screening and prevention,vaginal discharge and sexually transmitted disease, abnormal genital tract bleeding, pelvic mass, pelvic pain, pregnancy andcomplications in pregnancy. The relevant basic science information from all the traditional subjects is woven into the instructionrelated to the most common symptoms that obstetrics and gynecology specialists diagnose and treat in their practice. Clinicalpresentations are schematically organized as elegantly illustrated in the article by Dr Patham on integrative diagnostics approachof a patient with abnormal genital tract bleeding. For every clinical presentation inductive reasoning diagnostic process isprovided by an expert clinician. The medical curriculum of PLFSOM is a variant of a Calgary Medical School model, introduced in1995. The curriculum content is loaded to students' laptops and great majority of our curriculum is paperless.
In this context, distance teaching modules are used to foster integration of basic science and clinical science knowledge andinductive reasoning. When computer assisted learning program and series of web-based interactive tutorials were created for ourresidents in June 2009, anonymous survey indicated that all of them (100%) found it was a powerful learning stimulus which hasmade a positive impact on their practice. PLFSOM computer-based learning tutorials in obstetrics and gynecology provide thelearners with numerous ultrasound images, organized according to clinical presentations, expert schemes and algorithms, whichare created to render the learning process irrespective of the learner's location. In our articles Dr Eichbaum and I share ourexperience and thoughts on the role of imaging, distance learning programs and telemedicine in Medical Schools of tomorrow.
In PLFSOM curriculum we have recognized the importance of ultrasound simulation training. As Drs Akins and Ho havepointed out in their article, the portability, affordability and lack of ionization have made ultrasound indispensable in many areas.Being experts in medical simulation, they propose ultrasound simulators should be used in undergraduate, graduate andpostgraduate education to increase the competence of health care providers in using and interpreting the ultrasound studies.
In our Medical School, traditional lectures, computer learning modules, team based and small group learning sessions arecreated to emphasize the importance of imaging from the very first day. The anatomist, Dr Black, uses imaging and ultrasound tohelp students to identify and assess the anatomical structures, and demonstrate the advantages and disadvantages of variousimaging techniques in evaluation of different organs. The embryologist, Dr Beale, has invited international experts to join ourinitiative to use 2-D and 3-D prenatal ultrasound illustrations and videos in teaching normal and abnormal human developmentfrom conception to birth and facilitate knowledge accumulation and retention in embryology. Dr Janssen demonstrates how 2-Dand 3-D color and power Doppler may be efficiently used to provide functional information related to physiology, while DrPiskurich and Dr Subramanya explore the potential of ultrasound imaging in teaching the basic concepts of immunologic andinfectious diseases in pregnancy.
Clinical medical educators, Dr Brower and Dr Zafar elaborate on the use of ultrasound in teaching fetal neuroanatomy andemergency medicine, respectively. In a very interesting clinical vignette, Drs Loaiza and Arroyave present a patient confrontedwith a diagnosis of multiple structural fetal malformations diagnosed by ultrasound. Obstetrics and gynecology has beenenriched by ultrasound, but a physician's rapport with his/her patient will never be replaced. Therefore, while delivering bad newsto your patients, make sure you spend enough time with them explaining the ultrasound findings in details. Ultrasound may also
Marico A da Fonseca, S Thikkurissy et al
be used in teaching pharmacology, as excellently demonstrated by Dr Quest, who proposed ultrasound to be used for longitudinalassessment of drug safety and effectiveness. Finally, in a well-illustrated article Dr Rajkumar provides preliminary data on the useof 2-D and 3-D power Doppler ultrasound in evaluation of mammary gland tumor volumes and vascularity in animal models, andtesting their response to different lines of medication.
We believe that the readers of this issue, dedicated to medical education in the field of obstetrics and gynecology ultrasoundwill find our contributions both useful and stimulant to further enhance their teaching strategy.
Medical educators in sonography are aware that training in obstetrics and gynecology ultrasound requires extensivevisualization and spatial training. Web-based interactive tutorials are perceived by adult learners as a better strategy of assimilatinginformation, because they can be accessed at anytime and from anywhere. This type of distance teaching serves as a great toolfor developing basic skills for images interpretation, facilitates referral and decision making skills and assures better longitudinaland vertical integration of knowledge. Computer assisted learning is applicable in preclinical, clinical and postgraduate settingsaccording to the need of learners of today and tomorrow, who have different learning styles from their predecessors.
According to the decision of the leadership of Ian Donald Inter-University School of Medical Ultrasound in the near futuredistance teaching program will become available for all 50 branches of Ian Donald Inter-University School of Ultrasound.Recognizing the importance of continuous education, Albert Einstein has stated: "Education is what remains after one hasforgotten everything he/she learned in school". Having a free access and link to web-based interactive tutorials and ultrasoundimage library created by prominent ultrasound educators will be like having a group of experts at your fingertips. View it regularlyfor the benefit of your current and future patients and students.
Being recently appointed as an Executive Director for Distance Teaching of Ian Donald Inter-University School of MedicalUltrasound I look forward to working closely with all of you. Please find a w