A Core Syllabus for the Teaching of Gross Anatomy of the Thorax to Medical Students

This is an Open Access document downloaded from ORCA, Cardiff University's institutional repository: http://orca.cf.ac.uk/128413/ This is the author’s version of a work that was submitted to / accepted for publication. Citation for final published version: Moxham, Bernard J., Stephens, Shiby, Sharma, Deepak and Loukas, Marios 2020. A core syllabus for the teaching of gross anatomy of the thorax to medical students. Clinical Anatomy 33 (2) , pp. 300-315. 10.1002/ca.23522 file Publishers page: http://dx.doi.org/10.1002/ca.23522 <http://dx.doi.org/10.1002/ca.23522> Please note: Changes made as a result of publishing processes such as copy-editing, formatting and page numbers may not be reflected in this version. For the definitive version of this publication, please refer to the published source. You are advised to consult the publisher’s version if you wish to cite this paper. This version is being made available in accordance with publisher policies. See http://orca.cf.ac.uk/policies.html for usage policies. Copyright and moral rights for publications made available in ORCA are retained by the copyright holders. Clinical Anatomy (2019) MEDICAL AND DENTAL EDUCATION A Core Syllabus for the Teaching of Gross Anatomy of the Thorax to Medical Students 1,2 1 2 BERNARD J. MOXHAM , * SHIBY STEPHENS, DEEPAK SHARMA, AND MARIOS LOUKAS 2 1Cardiff School of Biosciences, Cardiff University, Museum Avenue, Cardiff, CF10 3AX, Wales, United Kingdom 2St George’s University, Grenada, West Indies Discussion is ongoing concerning the need to ensure the clinical relevance of the biomedical sciences. However, clinical relevance within health care courses pre- supposes that there is internationally agreed core material to be taught and learned. For anatomy, by the initial use of Delphi Panels that comprise anatomists, scientists, and clinicians, the International Federation of Associations of Anatomists (IFAAs) is developing internationally accepted core syllabuses for all anatomical sciences disciplines in the health care professions. In this article, the deliberations of a Delphi Panel for the teaching of thoracic anatomy in the medical curriculum are presented, prior to their publication on the IFAA’s website. To develop the syllabus further, it is required that anatomical societies, as well as individual anatomists and clinicians, comment upon, elaborate, and amend this draft recommended syllabus. The aim is to set internationally recognized standards and thus to provide guidelines concerning the knowledge of the human thorax expected of graduating medical professionals. Such information should be borne in mind by those involved in the development of medical courses. Clin. Anat. 00:000–000, 2019. © 2019 Wiley Periodicals, Inc. Key words: medical education; gross anatomy; thorax; core syllabus; Delphi Panel INTRODUCTION (e.g., Patel and Moxham, 2006, 2008; Moxham and Plaisant, 2006; Moxham and Moxham, 2007; Pabst, Controversy persists concerning the development 2009; Kerby et al., 2011; Moxham et al., 2016). of medical curricula and the role of the anatomical Globally, the range and variety of medical curricula sciences within them. Drake et al. (2002, 2009, have changed markedly from the traditional model 2014) and McBride and Drake (2018) have con- of 2 or 3 years “preclinical studies” followed by 2 or ducted a series of surveys of medical schools in the 3yearsof “clinical studies” to systems-based inte- United States showing that the time devoted to grated curricula. This has led to the significant teaching gross anatomy has declined from an aver- decreases in the amount of time devoted to gross age of approximately 170 hr in 2002 to 130 hr in anatomy and the subject is nowadays taught less as 2018. It was also reported that this compares with a stand-alone course but more often within approximately 350 hr in the 1950s. While 130 hr may seem a significant amount of time, in the con- text of the entire medical course, this corresponds *Correspondence to: Bernard J. Moxham, Cardiff School of Bio- sciences, Cardiff University, Museum Avenue, Cardiff CF10 3AX, merely with 3 full weeks of anatomy tuition in a year Wales, United Kingdom. E-mail: [email protected] or 2% of the entire course. These changes are occurring despite anatomists, medical students and Received 5 November 2019; Accepted 15 November 2019 laypersons opining that gross anatomy is crucial and Published online 00 Month 2019 in Wiley Online Library fundamental for medical education and training (wileyonlinelibrary.com). DOI: 10.1002/ca.23522 © 2019 Wiley Periodicals, Inc. 2 Moxham et al. TABLE 1. [Color table can be viewed at wileyonlinelibrary.com] Not Topic Core Recommended recommended Not core General topics Location and general functions Regions of the thorax Size and shape of thorax Surface anatomy of the thorax Auscultatory points for heart valves Counting of ribs Outline of the heart Outline of pleura Apex beat The skin of the thorax Cutaneous innervation of thorax (dermatomes) Vasculature of the skin Lymphatic drainage of the skin Superficial and deep fascia of the thorax Clavipectoral fascia Deltopectoral triangle The breast Position of the breast on thorax in relation to the ribs Position of the nipple and areola on thorax Functions Development of the breasts Shape and size Axillary tail Fascial relationships of breast Submammary space Subareolar muscle Glands of the nipple and areola Montgomery’s tubercles Lobes and ducts of the breast Suspensory ligaments Arterial supply of the breast Venous drainage of the breast Lymphatic drainage of the breast Innervation of the breast Accessory breast tissue Accessory nipples Changes with pregnancy and lactation Changes with age The male breast Milk line Cooper’s ligament Retromammary space horizontally and/or vertically integrated medical recognized core syllabuses for the anatomical courses, or even as optional (elective) courses sciences. (see Moxham and Pais, 2016; McBride and There have recently been worthy attempts to Drake, 2018). develop core syllabuses for gross anatomy in general Adopting different approaches for teaching gross (Leonard et al., 2000; Griffioen et al., 1999; anatomy can be beneficial if they accord with an McHanwell et al., 2007; Orsbon et al., 2014; Smith understanding of medical students’ different et al., 2016a, 2016b; Connolly et al., 2018; Finn learning styles. On the other hand, care must be et al., 2018). Most have been concerned with devising taken to ensure that diversity does not lead to a learning outcomes and not with listing core topics. lack of consistency, reliability, and transparency in Alternatively, more “specialized” core syllabuses for medical education that renders great diversity in the anatomical sciences concerned with core topics standards from medical school to medical school. have been published through the auspices of the IFAA Such concerns would not be so problematic if exam- for head and neck anatomy (Tubbs et al., 2014; ination procedures and practices existed that Tubbs and Paulk, 2015), for neuroanatomy (Moxham ensured uniform standards both nationally and et al., 2015), for embryology and teratology (Fakoya internationally and if there were internationally et al., 2017), for the musculoskeletal system Thorax Core Syllabus 3 TABLE 2. [Color table can be viewed at wileyonlinelibrary.com] Not Topic Core Recommended recommended Not core Thoracic walls Size and shape of thoracic walls Osseous structures comprising thoracic walls Sternum Size, location, and orientation Bony composition Shape and location of manubrium Suprasternal (jugular) notch of manubrium Clavicular notches of manubrium Notches for first and second ribs on manubrium The sternoclavicular joint Interclavicular ligaments The first and second sternocostal joints The manubriosternal joint Plane of Louis and relationship of structures there Sternebrae of body of sternum Size, shape, and location of body of sternum Sternal foramen Notches for second to seventh ribs of body of sternum Xiphoid process (shape size and location) Xiphisternal joint Notch for seventh rib on xiphoid process Muscle attachments to the sternum Pectoral m. Sternocleidomastoid m. Sternothyroid m. Sternohyoid m. Transversus thoracis External intercostals (membrane) Rectus abdominalis External and internal oblique ms. Attachment of linea alba Diaphragmatic attachments Movements of sternum during respiration Vascular supply of sternum Innervation of the sternum Development and ossification of sternum The clavicle Size Shape Location and orientation Infraclavicular fossa and boundaries Side determination Functions Bony composition Gender differences Nutrient foramina Sternal part and sternoclavicular joint Acromial part and acromioclavicular joint Muscle attachments to the clavicle Sternocleidomastoid m Pectoralis major Trapezius Deltoid Sternohyoid Subclavius (inferior groove for subclavius) Attachment of costoclavicular ligament (conoid tubercle and trapezoid line) Relationship with brachial plexus Vascular impressions Development and ossification of clavicle 4 Moxham et al. TABLE 3. [Color table can be viewed at wileyonlinelibrary.com] Not Topic Core Recommended recommended Not core The ribs (costae) Number of ribs Sizes of ribs True, false, and floating ribs Side determination Bony composition of the ribs Movements of ribs during respiration Vasculature of the ribs Innervation of the ribs Development and ossification of ribs Features of a typical rib Shaft Head Neck and tubercle Anterior end and costal cartilage Costal groove Impressions Articulations

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