The first four levels of Bloom's taxonomy were used to create quiz questions designed to assess student learning of the gross anatomy, histology, and physiology of the gastrointestinal (GI) system. Information on GI histology and physiology was presented to separate samples of medical, dental, and podiatry students in computer based tutorials where the information from the two disciplines was presented either separately or in an integrated fashion. All students were taught GI gross anatomy prior to this study by course faculty as part of the required curriculum of their respective program. Student responses to the quiz questions were analyzed to assess both the validity of Bloom's cumulative hierarchy and the effectiveness of an integrated curriculum. No statistically significant differences were found between quiz scores from students who received the integrated tutorial and from those who received the separate tutorials. Multiple regression analyses provided partial support for a cumulative hierarchy where scores on the lower levels of Bloom's taxonomy predicted scores on higher levels. Notably, in the majority of regression analyses, the comprehension score was the key foundational predictor for application and analysis scores. This study supports the suggestion that educators increase the number of comprehension level questions, even at the expense of knowledge level questions, in course assessments both to evaluate lower order cognitive skills and also as a predictor of success on questions requiring application and analysis levels of the higher order cognitive skills of Bloom's taxonomy. Anat Sci Educ 11: 433-444. © 2018 American Association of Anatomists.

Rationale Knowledge of the relationship of the dorsal scapular artery (DSA) with the brachial plexus is limited. Objective We report a case of a variant DSA path, and revisit DSA origins and underinvestigated relationship with the plexus in cadavers. Methods The DSA was examined in a male patient and 106 cadavers. Results In the case, we observed an unusual DSA compressing the lower plexus trunk, that resulted in intermittent radiating pain and paresthesia. In the cadavers, the DSA originated most commonly from the subclavian artery (71%), with 35% from the thyrocervical trunk. Nine sides of eight cadavers (seven females) had two DSA branches per side, with one branch from each origin. The most typical DSA path was a subclavian artery origin before passing between upper and middle brachial plexus trunks (40% of DSAs), versus between middle and lower trunks (23%), or inferior (4%) or superior to the plexus (1%). Following a thyrocervical trunk origin, the DSA passed most frequently superior to the plexus (23%), versus between middle and lower trunks (6%) or upper and middle trunks (4%). Bilateral symmetry in origin and path through the brachial plexus was observed in 13 of 35 females (37%) and 6 of 17 males (35%), with the most common bilateral finding of a subclavian artery origin and a path between upper and middle trunks (17%). Conclusion Variability in the relationship between DSA and trunks of the brachial plexus has surgical and clinical implications, such as diagnosis of thoracic outlet syndrome.

The success of biventricular pacing procedures is at least partially related to the ability to implant leads into the heart. Lead placement into the coronary sinus can be particularly challenging because of variations in the coronary venous anatomy. We examined the anatomy of the coronary sinus and the Thebesian valve. Forty-three (22 male, 21 female) embalmed adult cadavers were used to determine the internal diameter of the coronary sinus ostium, the presence of a membranous or fenestrated Thebesian valve, and the percent occlusion of the coronary sinus ostium by the Thebesian valve, if present. An 8-French (F) guiding catheter was used to simulate coronary sinus cannulation. The average internal diameter of the coronary sinus ostium was 11.44 ± 3.21 mm. A Thebesian valve was present in 74 % of the cadavers, and the majority (84 %) of those valves were membranous. In the presence of a Thebesian valve, the opening at the ostium was reduced to 7.47 ± 2.69 mm. The percent occlusion of the coronary sinus ostium by the Thebesian valve varied from 8.26 to 100 %. The average cannulation distance (length of catheter travel into the coronary sinus from the coronary sinus ostium) was 69 ± 18 mm. Statistical analyses revealed no gender differences in the measurement data for either the coronary sinus or Thebesian valve. The most common presentation is a membranous Thebesian valve. Most frequently, the percent occlusion ranged between 41 and 50 %. The cannulation distance was greater in males than in females.