Teaching is one of the core components of the professional identity of a physician. During this week, we will re-introduce you to the world of health professions education, discussing the science behind learning and teaching, using the help of some frameworks. We will also briefly review how curricula are developed.
Accordions
(Toggles are preferred, but I’m using both terms here.) See also the Advanced Tabs widget.
When to use an Accordion/Toggle or a Tabs widget? It’s a judgement call.
If the header is very long, use the Accordion/Toggle.
If you want to use icons and they aren’t included in the Advanced Tabs icon, do it manually using Accordion/Toggle.
I used these in the Gross Anatomy book. There’s an en space between the icon and the titles. They’re mostly Pacific blue, but I took advantage if there were easy opportunities to include color (it also drew attention to them in what was otherwise a pretty consistent/repetitive list).
The empty bladder (rarely the case in the living body) is shaped like an inverted pyramid, and its anatomic parts are described in its empty state. The actual position and shape of the bladder vary according to the amount of urine it contains and the age of the person.
Superior surface (dome of the bladder) is covered by peritoneum. The other surfaces of the bladder are subperitoneal.
Posterior surface is called the base or fundus of the bladder.
Apex of bladder: Connects the bladder to the anterior abdominal wall via a fibrous cord called the median umbilical ligament (urachus).
Neck of bladder: Points inferior. This is where urine leaves the bladder and enters the urethra. In the male, the neck rests on the prostate and is fused to it.
Figure 20.3 NETTER, ATLAS OF HUMAN ANATOMY, PLATE 313.
The mucosa of the empty bladder is folded and loose, except in an area at the base called the trigone, where it is smooth and firmly tacked down to the underlying muscle.
The trigone is defined by three orifices = two internal ureteric orifices and the internal urethral orifice. The trigone is at the base of the bladder.
The trigone may be elevated in males = this is called the uvula of the bladder. It can become quite prominent in older males when the underlying prostate enlarges.
The smooth muscle in the bladder wall is called the detrusor (Latin = “to drive away”). It contracts to squeeze out the urine. The detrusor is the juicer!In the neck, smooth muscle forms the involuntary internal urethral sphincter.
Ureterovesical junction (UVJ): The ureters pass through the wall of the bladder at an oblique angle. This is the intramural part of the ureter. As the bladder fills and distends, the intramural part closes to prevent backflow of urine from bladder into ureter. This valve mechanism doesn’t work so well in children because the intramural part of the ureter is short and there is not enough bladder musculature. Reflux of urine is a common cause of urinary tract infections in kids.
A rest-and-digest function, regulated by parasympathetic innervation. It is under voluntary control but may occur asa reflex involving the micturition center in the brainstem, as in children not “toilet-trained” or when one has an intense fight-fright-flight emergency response.
As the bladder fills, stretch receptors communicate fullness to the brain, causing reflex contraction of the detrusor muscle and relaxation of the internal urethral sphincter.
This reflex can be overcome by contraction of the voluntary external urethral sphincter in the deep perineal pouch (if you are toilet trained!), preventing flow of urine in the urethra.
Conscious relaxation of the pelvic diaphragm and external urethral sphincter allows urine to flow. When you can’t relax (as in a crowded public restroom), tense muscles and sympathetic closure of the internal urethral sphincter results in an unfortunate inability to micturate.
This site has a nice description of neural control of micturation.
Superior rectal artery (from inferior mesenteric) and middle rectal artery (from internal iliac).
Venous drainage: A submucosal rectal venous plexus drains to the superior rectal vein (portal drainage) and middle rectalveins (systemic drainage = IVC).
Sympathetic: From upper lumbar segments of spinal cord to pelvic plexus via the hypogastric nerves—this is vasomotor,but may also relax smooth muscle to inhibit peristalsis and constrict the internal anal sphincter.
Parasympathetic: From pelvic splanchnic nerves—stimulates peristalsis; relaxes internal anal sphincter.
Afferent: Carry information concerning stretch and fullness to the sacral spinal cord via pelvic splanchnic nerves. Most of the rectum is below the pelvic pain line, so pain is referred to sacral dermatomes and is poorly localized in the pelvic region.
The rectum fills slowly during the day, the feces being delivered by peristalsis in the descending and sigmoid colons.
The urge to defecate is initiated by mucosal receptors in the ampulla. This induces the relaxation of the internal anal sphincter (smooth muscle) and increases rectal peristalsis.
Reflex stimulation of the external anal sphincter (skeletal muscle) resists the pressure produced by peristalsis—maintaining fecal continence.
Relaxation of the voluntary sphincter and puborectalis muscle and initiation of the Valsalva maneuver (“bearing down”) with continued peristaltic activity empties the rectum.
Figure 20.24 GRAY’S ANATOMY FOR STUDENTS, FIGURE 5.47.
This can be confusing, since anatomists and urologists use different terms, and they are often mixed and matched. The passage of the urethra and ejaculatory ducts through the prostate divides it into anatomic lobes and clinical zones.
Anterior lobe (isthmus) is anterior to the urethra—also known as the fibromuscular zone. There is no glandular tissue here.
Left and right lobes are lateral to the urethra and meet posteriorly in a shallow groove. These lobes together constitute the peripheral zone, the posterior portion of which is palpated in a rectal exam. This zone is the most common location of prostate cancer.
Median lobe is the tissue surrounding the ejaculatory ducts. Also called the central zone.
The transitional zone is sandwiched between the three zones just described. It encircles the urethra in the core of the prostate, below the bladder. This is the region affected by benign hyperplasia.
Figure 20.14 GRAY’S ANATOMY FOR STUDENTS, FIGURE 5.54.
The typical orientation of the uterus is described as anteflexed and anteverted. Flexion refers to orientation of the uterine body with respect to the uterine cervix. Version refers to the orientation of the entire uterus compared to the vagina.
When anteflexed, the body of the uterus is bent anteriorly upon the cervix.
When anteverted, the entire uterus is tilted forward on the vaginal canal—the uterus and vagina thus have a profile shaped like the number “7” in a lateral view.
Parametrium: Outermost, composed of visceral pelvic fascia.
Myometrium: Middle layer, thick smooth muscle, branches of the uterine vessels are in this layer.
Endometrium: Inner layer, mucous membrane with uterine glands.Undergoes monthly renewal and degeneration—being cyclically prepared by hormones for implantation of the embryo.
Faux Advanced Tabs widget/faux button with drop-down
Use this if there’s only a single entry (rather than the Advanced Tabs widget)—this one is accessible, but using the Advanced Tabs widget with only one entry is not accessible.
This widget should also be used in place of the Advanced Tabs widget if the page will be used on phones. (Doing it as a toggle rather than accordion is a better UX experience.)
Numbered list toggle used in Virtual Public Health.
PRECEDE (Predisposing, Reinforcing, and Enabling Constructs in Educational Diagnosis and Evaluation): Focuses on planning by identifying desired outcomes and working backward to determine strategies.
PROCEED (Policy, Regulatory, and Organizational Constructs in Educational and Environmental Development): Focuses on implementation and evaluation of interventions.
Used in Gross Anatomy, EKG, Global Health, and Virtual Neurology. It’s a judgement call re having it open on page load; same re putting the tabs on top or on the side. Use icons only if it can be done for all of the tabs. Otherwise, see Accordions/Toggles.
See also the faux Advanced Tabs widget under Accordions
Faux Advanced Tabs widget: Use this when you’re designing something for the phone. (The Advanced Tabs widget isn’t ideal for a very narrow screen. This faux A.T. widget simulates it but is a better user experience on a phone.)
Skolnik, Richard. Global Health 101. Jones & Bartlett Learning, LLC, 2019. ProQuest Ebook Central.
For students interested in Global Health who would like additional references on the field, here are some references and organizations of interest that are not specifically linked to individual modules in the course:
In many ways, Dr. Paul Farmer popularized the field of global health and provided an example to a generation of what can be done to address inequality. This biography provides a excellent anchor to the life and work of Paul Farmer, which may be helpful as an ‘overview’ in addition to reading some of Dr. Farmer’s publications.
A professional organization for universities around the world engaged in addressing global health challenges. Opportunities for students and trainees to be on working groups, present at conferences, and connect to other institutions involved in global health. There are several free educational programs available.
Reasoning without Resources. For students who plan to participate in direct patient care in an international and low/low-middle income country, consider reviewing some of the case studies in Reasoning without Resources as an introduction to how you might need to adjust your clinical approach in areas without the diagnostic and therapeutic interventions you are used to.
An interesting examination of many of the common cultural experiences and friction that arise when Westerners are living/working in African through the lens of economic structure and its relation to human behavior.
Causes/etiologies
Category/Classification/Pathophysiology
Clinical Guidelines
Diagnosis
Definition
Demographics
Differential
Differential
Imaging
Location
Medication
prognosis
Signs and symptoms/clinical presentation
Testing/Physical exam
Treatment/management
Workup/H&P
Enhance user experience with Advanced Tabs, allowing seamless content navigation. Organize information efficiently while keeping the interface clean and interactive. Perfect for FAQs, product details, or multi-section content.
Skin (Integument)
Thoracic cage
Muscles
An organ consisting of an outer layer called the epidermis and a tough connective tissue layer beneath it called the dermis.
The skeletal elements underlying the thoracic body wall consisting of ribs, costal cartilages, the sternum, and thoracic vertebrae.
Paravertebral muscles: As the name implies, these are located adjacent to the vertebral column in the back. We won’t be discussing them much in this course, but you should be aware of them, as they form an easily palpable longitudinal mass alongside the vertebral column.
Body wall muscles: Three layers in both thoracic and abdominal regions:
In addition to the general gender analysis questions, key legal and rights-based subject areas to consider are:
Cost-effectiveness analysis
Property and inheritance rights
Health indicators and metrics (e.g., Healthy people targets)
Age of legal marriage
Employment opportunities
Policies for preventing and responding to GBV
Legal recognition of significant relationships (e.g., same-sex partnerships, customary or informal marriages)
Ability to protest and appeal wrongs and discriminatory practices
Laws restricting discrimination and violence against LGBT people
Discrimination and criminalization of LGBT individuals and behavior
In addition to the general gender analysis questions, the difference in women’s and men’s capacity for power and decision-making in the following areas should be considered:
Indian rural pregnant women wearing medical masks due to illness, dizziness. Healthy pregnancy concept.
Household affairs
Use of personal economic resources, including income
Type of employment
Political participation: Voting, running for office, and legislating
Entering into legally binding contracts
Open, free socializing
Resources
Salivary glands: Secrete saliva into the oral cavity.
Liver
Gall bladder: Stores bile. Connected to the liver and duodenum by bile ducts.
Pancreas: Has both exocrine and endocrine functions. Snuggled up within the concavity (“C”) of the duodenum and connected to it by one (or two) pancreatic duct(s).
Book Widgets iFrame
See also examples under Icon Boxes.
Carousel
Used on the Anatomy of a Case Report page. I used a gray rule around the whole thing to visually unite the highlighted image and the thumbnails below.
This could be a good choice in place of the Slides widget (see the Case Studies example below)—Carousel images can be clicked to enlarge.
Case studies
Ideally, the words Case Studies would be in crimson, like it (usually) is in on CBL covers.
Slides widget for cases
See also the Carousel widget for different functionality that would still look cohesive to the reader.
Case Study: Sam
Sam is a 45-year-old who presents to inquire about their breast cancer risk and when to begin mammography. She has no known family history of breast or ovarian cancer. Menarche was at age 13. Her first child was born when she was 27, and she was briefly on hormonal birth control for three years at age 20. She drinks alchohol 2–3 times a week, usually one glass of wine per sitting. She denies radiation exposure. Her BMI is 34.
Sam Pre-Question
Which risk factors does Sam have that may increase her risk of breast cancer?
a. Age, family history, age at menarche.
b. Radiation exposure, age at first child, and hormonal contraception.
c. Gender, hormonal contraception, BMI.
d. Family history, age at first child, alcohol use.
Sam Pre-Question
According to the U.S. Preventative Task Force, which of the of these screening tools is evidence based to reduce death from breast cancer?
a. Breast self-exam.
b. Screening mammography.
c. Breast ultrasound.
d. Clinical breast exam by provider.
Sam Pre-Question
According to the U.S. Preventative Task Force, when should Sam begin screening mammography, and how often should she be screened?
a. Now, every year.
b. Age 50, every other year.
c. Now, every other year.
d. Should have started at age 40, every year.
Flip Box widget for case
(from Virtual Neurology) Case Study: Mitch—Unresponsive at a bus stop
Tap the image to view the case.
Case Study: Steve
A 55-year-old man comes to see you for recent onset of right-sided headaches which he refers to as “migraines.” He has some nausea with his headaches. He has no other symptoms with the headaches.
Another case option from Virtual Neurology (for longer, multi-paragraph cases)
Tap the arrow to view the case.
A 78-year-old male with a history of metastatic lung cancer, migraines, DVT, DM, HTN, and hyperlipidemia presented to the ED yesterday with new onset aphasia. His wife reports that, at dinner time last night, he was confused, not making sense, smacking his lips, and trying to eat dog food.
In the ED, the patient was not oriented to person, place, or time. He was stringing words together that did not make sense and did not follow commands. NIH Stroke Scale was 8. Bilateral LE extremity strength is 4/5. Overnight, he had urinary incontinence.
This morning, the patient’s aphasia has resolved, and he is oriented 4. He states that he vaguely remembers not being able to speak and thinks that he may have intermittently lost consciousness. Neurological exam shows 5/5 motor strength and intact sensation. He is currently taking Atorvastatin, Metformin, and Warfarin. Labs show hyponatremia of 130. Head CT and CT angio was unremarkable. MRI is pending. Patient refuses treatment for his lung cancer and wanted to stay at home with his family rather than pursue hospice care.
Question
Which of the following is the most likely diagnosis?
Digital Accessibility: Long text description for images
Use long text when the image is complex or when the description requires more detail and needs to be longer than 150 characters.
Provide a detailed description of the image, including trends, relationships, and key data points.
Use tables or lists to present structured information if necessary.
Link to the long description from the image or nearby text, so give the widget a CSS ID (under the Advanced tab in the widget).
[insert 2-word descriptive caption] Text description
[insert content]
Filterable gallery
Important landmarks for a good BPD:
Midline should be straight and equidistance between both sides of the cranium
Fetal skull should have a symmetric oval shape
Cavum septum pelludicem should be visible anteriorly
Thalamus should be visible
Cerebellum should not be visible
Measurement is made from the outer skull table to the inner skull table (“leading edge to leading edge”) (see Biometry for details).
Good ultrasound image for measurement of BPD and head circumference
The cephalic index is the Biparietal Diameter divided by the Occipto-Frontal Diameter times 100. The normal range for cephalic index is 70–86.
In some instances, the head is very elongated, making the BPD inaccurate. This is called dolicocephaly. Dolicocephaly is often associated with breech presentation or oligohydramnios (for example, in renal agenesis). In these circumstances, the HC is a more accurate predictor of EGA than the BPD.
Conversely, a very rounded head (relatively short OFD) is termed brachycephalic.
Example of dolicocephaly
Goals
See Learning Goals.
Gross Anatomy Style Guide
I’ve worked all of the widgets from that page into this one. Let me know if there are any questions about how/where they are used.
Hero images
Add a vector-based image as a Featured Image (in WordPress, size 1200px x 628px) if it is going on the main textbook LP. The same image should be used in the hero.
If it is going on a sub-LP, it does not need a featured image.
Use JPG for featured image and PNG (transparent background) for hero image.
Use the term ‘learning goals’ (lowercase) rather than objectives . . . unless it is a full year 4 course (such as Global Health).
Point students to objectives on E.Flo MD using the icon widget below. We want to avoid having objectives on the Learning site because E.Flo MD is the source of truth and we don’t want to risk two sets of information that don’t match.
We used the red bullets in LMH, but we’re moving away from that because it’s tedious to create each line one by one, and it looks dorky if the line is more than two long.
sample 1
sample 2
We use this in the Dissector:
Goals
Identify the boundaries and contents of the axilla.
Learn the architecture of the brachial plexus.
Identify the muscles, nerves, and vessels of the arm.
Lists (Alternatives to bulleted lists)
See also Tables, Icon List
1
The outer layer is the visceral layer of serous pericardium or the epicardium, a serous membrane. It contains a variable amount of fatty tissue deep to the mesothelium.
2
The thickest portion of the heart is the middle layer, the myocardium. This layer consists of cardiac muscle tissue.
3
The smooth, inner layer of the heart is the endocardium. It is continuous with the endothelium, the simple squamous epithelium lining the blood vessels that enter and leave the heart.
A period of three calendar months. Clinicians divide the gestation period into three trimesters. The most dramatic and critical stages of development occur during the 1st trimester.
Fetus is the term used to describe the developing human after the completion of the embryonic period. The fetal period therefore is between the ninth week and birth.
While this knowledge check is “open book,” the best way to learn is to practice spaced-repetition “free recall,” so try to answer these without looking.
I want to thank you for your beautiful work on the Microaggressions module. It’s BEAUTIFUL! The faculty I work with in IPE were blown away. Thank you for creating such an interactive module for students.
A period of three calendar months. Clinicians divide the gestation period into three trimesters. The most dramatic and critical stages of development occur during the 1st trimester.
Using the estimated day of fertilization as the reference point. Gestation lasts 38 weeks. In our discussions, we will use fertilization age when describing development.
The first eight weeks of development. This is a busy time with the most striking advances in development. All of the body’s organ systems have formed by the end of the embryonic period. This period is of most interest to us as we study gross anatomy.
Fetus is the term used to describe the developing human after the completion of the embryonic period. The fetal period therefore is between the ninth week and birth.
This is a faux timeline, since the formatting for the text on the real Timeline one gets wonky.
