Attitudes and responses of medical sudents and professional anatomists to dissecting different regions of the body

Although there have been many studies assessing emotional responses of medical students to the dissecting room experience, little is known about whether dissecting particular regions of the human body cause more concern than others. Furthermore, no studies have been conducted on the concerns of professional anatomists. In this study, we assessed the hypothesis that medical students are more concerned about the dissection of the face, the perineum and the extremities of the limbs. We also hypothesized that there are gender differences. For the reactions of a group of professional anatomists from the United States and Europe we hypothesized that they were less concerned than the medical students and showed no differences across the regions of the body. The hypotheses were tested by means of questionnaires distributed to medical students at Cardiff University and at the Descartes Paris University who had recently completed their anatomy courses and to anatomists working at universities in Europe and the USA. Ethical approval for the study was obtained from the ethical committees at the Cardiff School of Biosciences and at Paris and all data was obtained by consent of the respondents and remained confidential. The findings were complex, although the level of concern was low overall. Some regional differences were discerned, particularly concerning the face, the perineum, the hand and the female chest. Anatomists were less concerned than the students and female students and female anatomists showed more concern than their male counterparts. Few differences were discerned however between student respondents who had positive and neutral attitudes to gender “politics” and those who espoused negative views. We recommend that, at the start of an anatomy dissection course, time is spent dealing with sensitive issues (including equality and diversity issues), emotional responses, and matters pertaining to mortality. However, we argue that this should not involve hiding regions of the body, nor overreacting to the natural anxiety of students, since doing either of these things could enhance negative reactions and stifle the progress of the student from being a layperson to a competent healthcare professional. Clin. Anat. 32:253–267, 2019. © 2018 Wiley Periodicals, Inc

Sexism and anatomy, as discerned in textbooks and as perceived by medical students at Cardiff University and University of Paris Descartes

Contemporary textbooks of anatomy and surface anatomy were evaluated to ascertain whether they were gender-neutral. The evidence of this, and previous studies, suggests that, both in terms of imagery and text, many textbooks lack neutrality. To further investigate such matters, we provided second-year medical students studying at Cardiff University (n = 293) and at the Paris Descartes University (n = 142) during the 2011–2012 academic year with a questionnaire inviting them to address the possibility that social/gender factors hinder the dispassionate representation of anatomy. Ethical approval was obtained from both Cardiff and Paris universities. Eighty-six percent of the students at Cardiff and 39% at Paris Descartes responded and provided data for analysis. The hypothesis tested is that medical students perceive a gender bias that is reflected in the books they read and the tuition they receive. Our findings suggest that, while students recognise the importance of gender issues and do not wish to associate with sexism, most are unaware of the possible negative aspects of sexism within anatomy. In this respect, the findings do not support our hypothesis. Nevertheless, we recommended that teachers of anatomy and authors of anatomy textbooks should be aware of the possibility of adverse effects on professional matters relating to equality and diversity issues

The attitudes of European medical students towards the clinical importance of neuroanatomy

The attitudes of medical students towards the clinical importance of neuroanatomy have been little studied. Because it has been reported that medical students find neuroanatomy difficult and can have ‘neurophobia’, here we test the hypothesis that early-stage medical students across Europe have a low regard for neuroanatomy’s clinical relevance. The work was conducted under the auspices of the Trans-European Pedagogic Research Group (TEPARG), with just over 1500 students from 12 European medical schools providing responses to a survey (52% response rate) that assessed their attitudes using Thurstone and Chave methodologies. Regardless of the university surveyed, and of the teaching methods employed for neuroanatomy, our findings were not consistent with our hypothesis. However, the students had a less favourable opinion of neuroanatomy’s importance compared to gross anatomy; although their attitudes were more positive than previously reported for histology and embryology. The extent to which neuroanatomy plays a significant role in the early years of medical education is moot. Nevertheless, we conclude that in addition to newly recruited medical students being informed of the subject’s role in a healthcare profession, we advocate the use of modern imaging technologies to enhance student understanding and motivation and cognisance of the core syllabus for the subject being developed by the International Federation of Associations of Anatomists (IFAA)

Cognitive behaviour therapy plus aerobic exercise training to increase activity in patients with myotonic dystrophy type 1 (DM1) compared to usual care (OPTIMISTIC):Study protocol for randomised controlled trial

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Cognitive behavioural therapy with optional graded exercise therapy in patients with severe fatigue with myotonic dystrophy type 1:a multicentre, single-blind, randomised trial

Background: Myotonic dystrophy type 1 is the most common form of muscular dystrophy in adults and leads to severe fatigue, substantial physical functional impairment, and restricted social participation. In this study, we aimed to determine whether cognitive behavioural therapy optionally combined with graded exercise compared with standard care alone improved the health status of patients with myotonic dystrophy type 1. Methods: We did a multicentre, single-blind, randomised trial, at four neuromuscular referral centres with experience in treating patients with myotonic dystrophy type 1 located in Paris (France), Munich (Germany), Nijmegen (Netherlands), and Newcastle (UK). Eligible participants were patients aged 18 years and older with a confirmed genetic diagnosis of myotonic dystrophy type 1, who were severely fatigued (ie, a score of ≥35 on the checklist-individual strength, subscale fatigue). We randomly assigned participants (1:1) to either cognitive behavioural therapy plus standard care and optional graded exercise or standard care alone. Randomisation was done via a central web-based system, stratified by study site. Cognitive behavioural therapy focused on addressing reduced patient initiative, increasing physical activity, optimising social interaction, regulating sleep–wake patterns, coping with pain, and addressing beliefs about fatigue and myotonic dystrophy type 1. Cognitive behavioural therapy was delivered over a 10-month period in 10–14 sessions. A graded exercise module could be added to cognitive behavioural therapy in Nijmegen and Newcastle. The primary outcome was the 10-month change from baseline in scores on the DM1-Activ-c scale, a measure of capacity for activity and social participation (score range 0–100). Statistical analysis of the primary outcome included all participants for whom data were available, using mixed-effects linear regression models with baseline scores as a covariate. Safety data were presented as descriptives. This trial is registered with ClinicalTrials.gov, number NCT02118779. Findings: Between April 2, 2014, and May 29, 2015, we randomly assigned 255 patients to treatment: 128 to cognitive behavioural therapy plus standard care and 127 to standard care alone. 33 (26%) of 128 assigned to cognitive behavioural therapy also received the graded exercise module. Follow-up continued until Oct 17, 2016. The DM1-Activ-c score increased from a mean (SD) of 61·22 (17·35) points at baseline to 63·92 (17·41) at month 10 in the cognitive behavioural therapy group (adjusted mean difference 1·53, 95% CI −0·14 to 3·20), and decreased from 63·00 (17·35) to 60·79 (18·49) in the standard care group (−2·02, −4·02 to −0·01), with a mean difference between groups of 3·27 points (95% CI 0·93 to 5·62, p=0·007). 244 adverse events occurred in 65 (51%) patients in the cognitive behavioural therapy group and 155 in 63 (50%) patients in the standard care alone group, the most common of which were falls (155 events in 40 [31%] patients in the cognitive behavioural therapy group and 71 in 33 [26%] patients in the standard care alone group). 24 serious adverse events were recorded in 19 (15%) patients in the cognitive behavioural therapy group and 23 in 15 (12%) patients in the standard care alone group, the most common of which were gastrointestinal and cardiac. Interpretation: Cognitive behavioural therapy increased the capacity for activity and social participation in patients with myotonic dystrophy type 1 at 10 months. With no curative treatment and few symptomatic treatments, cognitive behavioural therapy could be considered for use in severely fatigued patients with myotonic dystrophy type 1. Funding: The European Union Seventh Framework Programme

L’adaptation d’un programme thérapeutique dans le cadre d’une maladie neuromusculaire

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Clinique et psychopathologie de la douleur

International audienceLa douleur est un ressenti si universel qu’elle peut paraître banale chez les patients. Pourtant, l’écoute de cette douleur ouvre des perspectives cliniques importantes car elle dit quelque chose du patient, de son rapport au corps, de son histoire et de son contexte. Au-delà du ressenti physique, la psychologie et la psychopathologie sont d’emblée impliquées dans la perception douloureuse, que l’on parle de migraines, de douleurs dorsales, de douleurs de croissance ou du grand âge, etc.Cet ouvrage est écrit par des psychologues et psychiatres experts du domaine de la douleur, issus de pratiques différentes et complémentaires (psychanalytique, cognitivo-comportementale, humaniste et existentielle). Ils y présentent les connaissances nécessaires pour déployer une écoute, une évaluation psychologique et un suivi clinique des patients douloureux chroniques afin d’aller vers des accompagnements thérapeutiques adaptés et efficaces.Un ouvrage traitant d'une situation en santé : la douleur, qui touche près d’un patient sur trois et qui motive plus de la moitié des consultations médicales

Éléments de comorbidité: Chapitre 5

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Personnalité et douleur: Chapitre 6

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