Richard L Drake

Cleveland Clinic

Human Anatomy

Residents and clinical faculty members play a crucial role in the education of medical students. Typically, these individuals are known for their role in teaching these students purely in the clinical setting; however, they also have a role in the basic science curriculum as well. One of the most obvious areas is in gross anatomy teaching sessions,...

Embalmed cadavers have and continue to be widely used in anatomy education at most medical schools. However, in a program developed at the Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, students learn anatomy from unembalmed/fresh cadavers that more closely resemble the living body. Additionally, they are taught by...

Curricular reform is causing many directors of anatomy courses to move in new directions and become innovators. During this process it is important to remember three basic guidelines (match curriculum or philosophy of education of institution; complement the faculty involved in the teaching; fit the type of students that will participate) and five...

Background: Facial allotransplantation including the temporo-mandibular joints (TMJ) may improve the functional outcomes in face transplant candidates who have lost or damaged this joint. Methods: Linear and angular measurements were taken in hundred dry skulls and mandibles, and in hundred 3D-reconstructed facial CT-scans, to determine the vari...

Background Masculinization of the face is a common finding in facelift patients. It is attributed to deflation and decent of the midface-jowls coupled with skin laxity. Fullness is evident lateral to the jowl in small percentage due to prominent buccal fat pad. Objectives To examine the anatomy of the buccal fat pad, triangulate the prominent BFP...

Background: Hand transplantation in patients with severe upper extremity burns can be associated with an increased risk of exposure of vessels, tendons and nerves because of extensive skin and soft tissue deficit. This study evaluated how to reliably transfer additional extended skin flaps with a standard hand allograft. Methods: Twenty-five upp...

Purpose: To elucidate the mechanisms underlying nasolacrimal air regurgitation (AR) in the setting of continuous positive airway pressure therapy. Methods: Twelve nasolacrimal systems of 6 fresh female human cadavers were evaluated individually for AR using continuous positive airway pressure therapy before any nasolacrimal procedure. Cadavers w...

The drivers for curricular change in medical education such as the addition of innovative approaches to teaching, inclusion of technology and adoption of different assessment methods are gaining momentum. In an effort to understand how these changes are impacting and being implemented in gross anatomy, microscopic anatomy, neuroanatomy/neuroscience...

Objective There is limited information on the potential danger to the vascularity of the femoral head during surgical dislocation of the hip using the direct lateral approach. The objective of this study was to investigate the topographical anatomy of the medial femoral circumflex artery (MFCA), the primary source of blood supply to the femoral hea...

Background: Candidates for multivisceral transplantation present with complex defects often beyond traditional reconstructive options. In this study, the authors describe a dissection technique for a total abdominal wall vascularized composite flap. In addition, the authors suggest a classification system for complex abdominal wall defects. Metho...

Learning objectives: After studying this article, the participant should be able to: 1. Define the anatomy of the lower eyelid tarsoligamentous framework and the related periorbital retaining ligaments, and cite their surgical relevance. 2. Perform a systematic functional and aesthetic evaluation of the lower eyelid focusing on the lid-cheek junct...

Background: When modifying a curriculum to accommodate changes in the methods of subject matter presentation or fit within a shortened time frame, student retention of knowledge remains an important issue. Aim: This study evaluates medical student retention of anatomical knowledge as they matriculate through an anatomy curriculum where the instruct...

Internal mammary artery perforator (IMAP)-based fasciocutaneous flaps have recently gained popularity in sternal wound reconstruction due to their decreased donor site morbidity. However, patients with significant macromastia or who are obese present a challenge when using these flaps due to their anatomy and associated comorbid conditions. Despite...

Curricular reform is causing many directors of anatomy courses to move in new directions and become innovators. During this process it’s important to remember three basic guidelines (match curriculum or philosophy of education of institution; complement the faculty involved in the teaching; fit the type of students that will participate) and five g...

Background Neurostimulation of the hypoglossal nerve has shown promising results in the treatment of obstructive sleep apnea. This anatomic study describes the detailed topography of the hypoglossal nerve's motor points as a premise for super-selective neurostimulation in order to optimize results and minimize the risk of complications related to m...

The education of future health care professionals must involve activities where interprofessional collaboration and the functioning of interdisciplinary teams are the goals and not the exceptions. This type of interprofessional education (IPE) will benefit students as they will be better able to communicate with and mobilize the skills of other hea...

Unilateral vocal fold paralysis can be treated with surgical medialization with a carved silastic implant. One challenge to this approach is anticipating the dimensions of the implant for adequate medialization. The purpose of this study was to develop a predictive model for implant design based on a patient's unique laryngeal anatomy and consideri...

An in-depth understanding of the nuances of facial anatomy is the best means of preventing complications during facelift surgery. An appreciation of the operative details is complicated not only by the complexity of the anatomy but also by the variability in the nomenclature used. The authors have attempted to clarify these issues by detailing the...

Embalmed cadavers have and continue to be widely used in anatomy education at most medical schools. However, in a program developed at the Cleveland Clinic Lerner College of Medicine of Case Western Reserve University students learn anatomy from unembalmed/fresh cadavers that more closely resemble the living body. Additionally, they are taught by r...

Residents and clinical faculty members can play a crucial role in the education of medical students. Typically, these individuals are known for their role in teaching these students purely in the clinical setting; however, they also have a role in the basic science curriculum as well. One of the most obvious areas is in gross anatomy teaching sessi...

Accurate clinical or pretreatment stage classification of lung cancer leads to optimal treatment outcomes and improved prognostication. Such classification requires an accurate assessment of the clinical extent of regional lymph node metastasis. Consistent and reproducible regional lymph node designations facilitate reliable assessment of the clini...

Curricular changes continue at United States medical schools and directors of gross anatomy, microscopic anatomy, neuroscience/neuroanatomy, and embryology courses continue to adjust and modify their offerings. Developing and supplying data related to current trends in anatomical sciences education is important if informed decisions are going to be...

Background: The great auricular nerve (GAN) is the most commonly injured nerve during facelift surgery. Although rare, injury can result in long-term sequelae. Objectives: Previous reports have described the nerve's location at the midbelly of the sternocleidomastoid muscle (SCM) or at its emergence from underneath the SCM. The purpose of our study...

Improving professional attitudes and behaviors requires critical self reflection. Research on reflection is necessary to understand professionalism among medical students. The aims of this prospective validation study at the Mayo Medical School and Cleveland Clinic Lerner College of Medicine were: (1) to develop and validate a new instrument for me...

During the last decade of the 20th century and the first decade of the 21st century, curricular reform has been a popular theme. In fact, reform on the current scale has not occurred since the early 1900s, when Abraham Flexner released his landmark report 'Medical Education in the United States and Canada'. His report, suggesting major changes in h...

Over the past decade significant curricular changes have altered medical student education related to the anatomical sciences. The purpose of this study was to measure retention of anatomical knowledge as student's progress through medical school. The anatomy program at the Cleveland Clinic Lerner College of Medicine is unique not only in its prese...

Since the American Association of Anatomists (AAA) published its last survey in 2009, related to the status of courses in Gross Anatomy, Microscopic Anatomy, Neuroscience and Embryology, significant curricular changes have occurred. In this session, data obtained in the 2012 AAA Education Course Survey will be discussed. Survey items queried course...

During the past two decades, anatomy instruction has changed due to curricular reforms in medical schools. Reduction in total hours of anatomy course and cadaver dissection, as well as shifts towards an integrated curricula has raised questions whether changes have had a negative impact on the students’ knowledge of anatomy. Our purpose was to inve...

Anatomy instruction has evolved over the past two decades as many medical schools have undergone various types of curricular reform. To provide empirical evidence about whether or not curricular changes impact the acquisition and retention of anatomy knowledge, this study investigated the effect of variation in gross anatomy course hours, curricula...

Top ocean predators have evolved multiple solutions to the challenges of feeding in the water. At the largest scale, rorqual whales (Balaenopteridae) engulf and filter prey-laden water by lunge feeding, a strategy that is unique among vertebrates. Lunge feeding is facilitated by several morphological specializations, including bilaterally separate...

An ostomy is an opening in the abdominal wall to which a portion of the gastrointestinal tract is attached. Its purpose is to provide a pathway for digested material to leave the body when the normal pathway is blocked due to a variety of situations. It can involve a part of the small intestine, i.e. an ileostomy, or a part of the large intestine,...

Healthcare providers in all areas and levels of education depend on their knowledge of anatomy for daily practice. As educators, we are challenged with teaching the anatomical sciences in creative, integrated ways and often within a condensed time frame. This article describes the organization of a clinical anatomy course with a peer taught unembal...

Residents routinely make significant contributions to the education of medical students. However, little attention has been paid to rewarding these individuals for their involvement in these academic activities. This report describes a program that rewards resident teachers with an academic appointment as a Clinical Instructor. The residents partic...

Medical students at the Cleveland Clinic Lerner College of Medicine of Case Western Reserve University receive instruction from a resident at the cadaver during their anatomy course. As discussed by McBride and Drake in this issue of ASE, residents teaching in the anatomy course at his institution who satisfy specific requirements qualify for an ac...

At most institutions, education in the anatomical sciences has undergone several changes over the last decade. To identify the changes that have occurred in gross anatomy, microscopic anatomy, neuroscience/neuroanatomy, and embryology courses, directors of these courses were asked to respond to a survey with questions pertaining to total course hou...

Simulation! The deans talk about its use in medical education regularly. But how can it be used to teach the basic sciences to first- and second-year medical students? This article will help answer that question by providing information about various types of simulation activities being used in medical education and examples of their application to...

There is just not enough time! Current course surveys show that the amount of class time available for Gross Anatomy, Embryology, Microscopic Anatomy and Neuroanatomy continues to decrease. This has a big impact on courses that spend a significant amount of time in the laboratory, like Gross Anatomy. What am I going to do? I have to look at differe...

To measure the pressure in the temporal and central aspects of the chiasm simultaneously during compression of the optic chiasm from below with an expanding simulated tumor. Experimental study. Craniotomies were performed on 5 unfixed cadaveric specimens ranging in age from 49 to 89 years, and the optic chiasm was exposed. After a pediatric gauge F...

Fewer and fewer programs are training graduate students and postdoctoral fellows in the classical anatomical disciplines. Nonetheless, there remains a need at all levels of clinical and basic science education for skilled instructors of anatomy, histology, and embryology. Two sessions at the 2006 annual meeting of the American Association of Anatom...

The objective was to explain the anatomic basis of a longitudinal cleft of increased signal in the iliopsoas tendon seen on hip MR arthrograms. A prospective review of 20 MR hip arthrograms was performed using standard and fat-suppressed T1-weighted images to establish whether or not the cleft was composed of fatty tissue and to define the anatomy...

Extensor tendon irritation and attritional tendon ruptures are potentially serious complications after open reduction and internal fixation of distal radius fractures. These complications are well recognized after dorsal plating of distal radii; and these are now being reported after errant screw placement during volar fixed-angle plating. Intraope...

The establishment of The Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, whose first class entered in 2004, provided a unique opportunity to design an anatomy program that, from all indications, is effective, time efficient, and clinically relevant in the context of a nonlecture, problem-based, organ-systems-oriented...

Directors of courses in the basic anatomical sciences in allopathic and osteopathic medical schools in the United States were surveyed regarding the present composition of their courses. Results indicate the majority of gross anatomy courses are in the range of 126 to 200 total course hours, and that laboratory dissection is a key component of thes...

The curriculum for first year medical students at the University of Cincinnati has changed. Beginning in the fall of 1998, material in the first year was presented in an Integrated Educational Program. The goal of this program was to provide students with an understanding of the normal structure, function, and development of the human body. The pur...

The curriculum for first year medical students at the University of Cincinnati has changed. Beginning in the fall of 1998, material in the first year was presented in an Integrated Educational Program. The goal of this program was to provide students with an understanding of the normal structure, function, and development of the human body, The pur...

How we educate students in the first two years of medical school is changing at many institutions. Effective medical education should be viewed as a continuum, integration of the basic sciences and clinical medicine should occur throughout the curriculum, and self-directed, life-long learning should be emphasized. Curricular revision may be appropr...

Intensively treating type I diabetics with continuous subcutaneous insulin infusions or multiple daily insulin injections to normalize mean blood glucose concentrations significantly reduces the onset of secondary diabetic complications when compared to conventionally treated diabetics. Our studies focused on characterizing hepatic enzyme expressio...

How we educate students in the first two years of medical school is changing at many institutions. Effective medical education should be viewed as a continuum, integration of the basic sciences and clinical medicine should occur throughout the curriculum, and self-directed, life-long learning should be emphasized. Curricular revision may be appropr...

During the 1860s and '70s, more than a decade before the development of French Impressionism, Italy produced a group of avant-garde artists whose fervently nationalist paintings anticipated some of Impressionism's theoretical concerns. These artists were called "Macchiaioli" because they based their technique on a quickly rendered "macchia," or ske...

Maternal malnutrition late in pregnancy results in the reduced storage of fetal hepatic glycogen in the final days of gestation and an accentuation of normal birth-related hypoglycemia. It was of interest to determine whether or not low glycogen levels resulted when maternal malnutrition disrupted the normal ontogeny of fetal hepatic glycogen synth...

Glycogen and the enzymes involved in hepatic carbohydrate metabolism have a heterogeneous distribution throughout the parenchyma of the liver. Although the precise lobular localization for many of these enzymes has been determined, information on the distribution and content of glycogen synthase (GS) has not been published. These studies were under...

Chronic administration of phenobarbital, an anticonvulsant drug, or rifampicin, an antituberculous drug, alters hepatocyte ultrastructure by inducing the proliferation of smooth endoplasmic reticulum (SER) and changes in glycogen content. While these generalized effects are important, the lobular location of hepatocytes must be considered since per...