Monthly Archives: March 2022

Most people spend about a third of their entire life asleep but for many, the activity isnt as natural or comforting as it could be.

Up to 70 million adults in the US have a disorder that disrupts their sleep, according to the American Sleep Association, resulting in about $16 billion in medical costs each year. Insomnia is the most common problem, affecting 1 in 3 adults at some point in their lives, and 1 in 10 chronically. Poor sleep has been linked to a variety of health problems, including type 2 diabetes, heart failure, high blood pressure, depression, obesity, a compromised immune system, and low sex drive.

If you can relate to the struggle, you might want to consider trying one medication-free approach: listening to music.

Decades of research suggest that many kinds of music can help people fall asleep faster and improve overall sleep quality. A 2018 online survey of 615 adults published in the journal PLOS One found that 62% reported occasionally listening to music at night to help them sleep, 35% used it at least once a week, and 4% used it every night. (The researchers noted their sample may not be representative of the general population.)

We tried our own (decidedly unscientific) Twitter poll to see how many people use music to help them snooze. Overall, 28% (among 218 respondents) use it regularly, while about 12% said they tried it but it didnt work for them.

If listening to music before bed sounds like an appealing way to doze off, there are professionals music therapists who can help you use this technique successfully.

Music therapy and its research in sleep is gaining traction as a novel, culturally sensitive, cost-effective, and safe intervention, Joanne Loewy, a music therapist and founding director of the Louis Armstrong Center of Music and Medicine at Mount Sinai Beth Israel in New York, told BuzzFeed News. Our brain likes predictability and thrives on patterning. So, with music and music therapy, we have special ways of addressing sleep by helping people induce a relaxation response.

While music probably wont replace doctor-prescribed medication or therapies for sleep problems, you dont need to have a sleep disorder or be musically inclined to try it for better sleep.

Listening to music throughout the day can often help people feel good and distract them from stressors that can contribute to anxiety or depression. Turns out, the same is true at nighttime, and music can help some people fall asleep faster and have better-quality sleep.

According to one 2012 study published in the International Journal of Nursing Studies, 25 adults with chronic insomnia who tuned into soothing music for 45 minutes before bed over four days had improved overall rest, shortened stage two sleep (a lighter stage in non-REM sleep), and prolonged REM sleep compared to a control group who didnt listen to music. REM sleep is associated with dreams and deeper slumber, which is critical for cognitive function, memory, emotional processing, and learning.

A 2014 study published in the Journal of Alternative and Complementary Medicine had a similar finding among young adults with long sleep latency, meaning they took an average of 10 minutes or longer to fall asleep.

Part of the reason listening to music can help you sleep is that it can lower the stress hormone cortisol, release pleasure and satisfaction neurotransmitters such as dopamine, and nudge your nervous system from fight or flight to rest and digest mode, according to Dr. Michael Jaffee, director of the Neurology Sleep Clinic at the University of Florida.

Whats more, your breathing and heart rates can synchronize to music over time. This phenomenon, called entrainment, encourages relaxation. Jaffee told BuzzFeed News that much of the music that improves sleep quality generally plays at about 60 to 80 beats per minute, which is close to an adult's normal resting heart rate of about 60 to 100 beats per minute. (Music has also been shown to have this effect on premature infants, improving their feeding behaviors and sucking patterns.)

Listening to music before bed can distract you from other noises like outside traffic, too, similar to white noise machines. Unlike music, however, white noise (think whirring fans or radio static) emits consistent and simultaneous sounds at the same frequencies that can drown out more intermittent and distracting background noises. Sleep researchers often consider nature sounds like rain or waterfalls to be white noise, as well.

White noise is not as well studied as music for sleep, but the former can be more beneficial for some people because its consistency may be less of a distraction than music, according to Thomas Dickson, a musicologist who works in the Empirical Musicology Laboratory at the University of New South Wales in Australia. However, white noise could be less of a helpful sleeping tool for people who find it boring, he added.

The genres of music that help people sleep vary widely. (Dickson said his research has found anything from classical to ambient music to pop and folk songs can work.) You should try whatever type of music you think works for you, but it may be best to choose tunes that have a lower pitch, dont encourage dancing, have a smooth sound, and don't have lyrics.

And youll want to avoid wearing headphones while you sleep, Jaffee said, because they could cause hearing damage or headaches; they could also prevent you from hearing any safety alarms or problems in your home.

Instead, experts recommend playing music on a speaker with an automatic timer so it doesnt play all night long. With that said, tuning into your music might be difficult if you share a bed with someone who finds it annoying. Some negotiating with your partner may be necessary.

Just remember you have to be patient, Dickson warns. Generally, studies show it takes about three to four weeks of consistent listening at bedtime, at the same time every night, for music to improve sleep quality.

Jaffee recommends first listening to music during the day to see if it sparks relaxation and joy that might help you sleep at night. (Avoid music that triggers strong emotional reactions, which can be counterproductive to relaxation.)

Volume matters too. Aim for anything under 50 decibels (about as loud as a quiet refrigerator or moderate rainfall), Dickson said, or just start with a volume thats as quietly as comfortably possible.

Here are some general healthy sleep habits you should follow:

Keep in mind that any random music may or may not do the trick for you. Popular sleep and relaxation apps like Calm, Headspace, and BetterSleep may be a better option; they offer prerecorded music or allow you to create your own sound clips.

For an even more custom approach, music therapists can select or create tunes and protocols that meet your specific needs.

Music therapists are trained in psychology, medicine, and music and work as independent clinicians alongside doctors, psychologists, audiologists, social workers, and behavioral health specialists, to name a few.

For years, they have used music in places like hospitals and nursing homes to soothe adults with dementia, improve communication abilities in children with autism, and reduce pain among hospitalized patients.

Music therapists also treat people who still have trouble sleeping despite medication or cognitive behavioral therapy, which helps people change how they think about sleep and develop healthy bedtime habits.

Anyone can call and make an appointment with a music therapist to address sleep problems, but people are most often referred to the professionals by other doctors such as psychiatrists, said Loewy, the New Yorkbased music therapist.

In the beginning, a music therapist will prescribe helpful sleep habits, Loewy said, like avoiding food at least a couple of hours before bed. Other sessions address why you cant sleep, your childhood, lifetime traumas, bedtime habits, and general likes and dislikes when it comes to different sounds and instruments. The result: They can create custom-made tunes or playlists just for you.

Using a sleep music sedation protocol she developed, Loewy starts by playing music or songs that are familiar or induce feelings of safety in people. Next, she removes any lyrics, if patients want, and changes the meter (beats and bars). Then she may implement instrumental sounds and rework pitch, harmony, and melody to match and enhance the persons breathing.

The final composition is a unique yet simple collection of sounds thats predictable, repetitive, and comforting, which is what the brain is looking for to relax, Loewy said. After several real-time listening sessions in a clinical setting to see how patients react to the music, she then may prescribe playlists for at-home listening beginning half an hour before sleep.

For some, these playlists may last 15 to 20 minutes, but for others with severe anxiety, for example, they may last about 40 minutes, Loewy said.

Still, there is no formula for music therapy sessions or treatments, including how long each visit lasts; treatment plans can range from three months to five years. It just depends on a persons unique circumstances, she said. A 60-year-old whos worried because her son recently lost a job, for instance, may need longer sessions than a 25-year-old dealing with a noisy upstairs neighbor.

While sleep apps can help some people, Loewy is not a fan.

I believe in individual assessment because apps assume that people like a certain kind of music, which tends to be generic and misses culture and transition of tempo. I don't find them very relaxing, Loewy said. Compared to what music therapists provide, its like the difference between going to a diner and going to a real French restaurant.

There are currently 9,712 board-certified music therapists, a spokesperson for the Certification Board for Music Therapists told BuzzFeed News. Of that number, 9,129 work in the US.

A 2019 survey conducted by the American Music Therapy Association found more than 1 million people received music therapy services in 2018, according to responses from nearly 3,000 professionals. However, its unclear how many people receive music therapy for sleep issues, specifically.

The survey also found the average rate for individual music therapy sessions across the US is $77 per hour; group sessions are about $88 per hour.

Depending on where you live, music therapy is a reimbursable service through Medicare or Medicaid. Some private insurance companies like Blue Cross Blue Shield, United Healthcare, Cigna, and Aetna will pay for the service, the AMTA says. Generally, music therapy, like other types, is reimbursable when its preapproved and deemed medically or behaviorally necessary to reach the individual patient's treatment goals, according to the association.

The service can also be reimbursed via other sources, including grants, private pay, workers compensation, and state departments.

About 31% of AMTAs survey respondents said their music therapy sessions were covered by either government funding or a third-party health insurance. You can find a music therapist through the AMTA or CBMT.

Music at night isnt everyones groove and thats OK.

BuzzFeeds own Twitter poll found about 61% of respondents said they cant listen to music at night. Some said they run their TV on a timer, listen to the radio instead, or scroll on social media until they doze off.

Its probably because music can be both beneficially and detrimentally distractive, Dickson said. Anecdotally, I've heard from some musicians that they find music too distracting for sleep, and maybe this is because they intellectualize the music instead of relaxing to it.

A 2021 study published in the journal Psychological Science found that people who listen to music more often (particularly popular or catchy songs, either during the day or before bed) are more likely to catch earworms when a song or tune plays over and over in your mind at night. This was associated with greater difficulty falling asleep, more nighttime awakenings, and more time spent in lighter stages of sleep among the approximately 250 study participants who either answered survey questions or slept in a sleep clinic.

The researchers from Baylor University in Texas said their results suggest our brains process music while we sleep, and that listening to familiar music before bed may not be in our best interest.

But fear not, Loewy said. Theres really no specific person or group of people that should avoid using music as a sleep aid. If youre interested, she suggests seeking a professionals help if you feel you need it. And if it doesnt work, there are other treatment options.

Here's a technique that could help a lot of people, but in many cases needs to be individualized or tailored to the individual based on their unique tastes and preferences, Jaffee said. Music as a sleep aid shares commonality, but at the same time with that individuality, speaks to who we are as people.

See the article here:

Music Can Improve Your Sleep, And There Are Therapists Who Can Guide You - BuzzFeed News

Global Alternative and Complementary Medicine Market Research Report Along with Leading Players, Revenue, Production Techniques, Business Overview, Forecasted to 2027

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Global Alternative and Complementary Medicine Market Future Scope, Facts, Competitor Analysis & Price Analysis (2022-2028) : Nordic Naturals, The...

New Delhi: Every year, thousands of Indians with medical degrees from foreign universities appear for the Foreign Medical Graduate Exam (FMGE) a screening test conducted by the National Board of Examination (NBE) and mandated by the National Medical Commission (previously Medical Council of India) to qualify for practise in their own country.

On an average, less than 20 per cent of them are able to clear it, according to NBE data.

Foreign medical graduates from countries like Russia, Ukraine, China, the Philippines, Bangladesh and Nepal, among others, are allowed to practise in India only after they have cleared the FMGE. However, MBBS graduates from the US, UK, Australia, Canada and New Zealand do not need to take the exam.

In 2019, 25.79 per cent of foreign graduates cleared the FMGE, while the percentage was 14.68 in 2020 and 23.83 in 2021. The figures in years preceding 2019 were even lower.

So, what do the nearly 80 per cent graduates do after failing to clear this test? While some give up on their dream to pursue medicine and adopt a different career path, others cling to it, especially since there is no cap on the number of attempts for the biannual FMGE.

ThePrint caught up with some foreign medical graduates who spoke on condition of anonymity as they signed a non-disclosure agreement with the NBE while applying for the FMGE.

Also Read: Students Ukraine nightmare triggers furore over medical fees in Bihar, Nitish cant do much

A 32-year-old from Mumbai, who completed her MBBS (Bachelor of Medicine and Bachelor of Surgery) degree in Russias Ryazan oblast around eight years ago, said she could not clear the FMGE despite 10 attempts. She is now pursuing hospital management at an institute in Mumbai.

I am studying hospital management, but I have not given up on my dream to practise medicine. I appeared for the FMGE yet again this year and am waiting for the results, she told ThePrint.

She also claimed that there were errors in the question paper this year and that questions worth 12 marks were wrong, for which students should have been awarded marks. The students have now petitioned the NBE regarding the same.

Asked why she chose to pursue medicine from a university in Russia, she said that while she was mulling over where to apply, she was told that the institute is one of the best in that country.

Its been many years so I dont remember the exact fee that I paid, but it was definitely less than what I would have paid in a private medical college in India, so I went for it, she added.

Asked if the exam had become any easier for her after 10 attempts, she said: The syllabus of FMGE is not fixedthey can ask anything and not just from the UG level, but the PG level as well. No matter how much we study, it just seems impossible to crack and not just because its tough, but also because there is no transparency about this exam.

A candidate cannot apply for revaluation, rechecking, or get the answer sheetall this makes it more difficult for us, she added.

Another medical graduate, who completed her MBBS from a university in Shandong, China, four years ago, attempts the FMGE exam every year but has not had success so far.

Speaking to ThePrint, she said she decided not to divert energy into anything else and has been solely focusing on preparing for her next shot at the exam.

My score has improved every time in the last four attempts. I believe I will be able to clear the exam this time, added the 27-year-old Noida resident.

She also spoke about the lack of a defined syllabus: No books are prescribed to us by NBE, there is no defined syllabus that we can refer to while preparing for the exam. All this makes the exam more difficult for us.

However, not everyone is able to retain their interest in the profession after many failed attempts at clearing the exam. A 35-year-old businessman from Jind, Haryana, is one such example.

After attempting the FMGE five times following an MBBS degree from a university in the Russian capital Moscow in 2014, he finally gave up the idea of being a doctor three years ago. He now handles his familys business of manufacturing perfumes.

My father wanted me to be a doctor and sent me to Russia because I could not qualify for a medical seat in India. I tried a lot to clear the screening test and get a licence to practise medicine, but could not succeed. Hence, I decided to give up on it and join my family business instead of wasting more time, he told ThePrint.

Some consultants ThePrint spoke to also said that most people are left with no choice but to take up alternative professions after repeated failed attempts at clearing the exam.

Vineet Tiwari, who runs a consultancy in Delhi that helps students choose a medical college and prepare their application, said: These foreign graduates cannot practise in India but they can practise in the country they studied from. Those who have the means and connections, get internships in China, Russia, and then start practising there. This was, however, only possible pre-pandemic.

Others who are not able to get such opportunities would either take up an alternative career path or work at a clinic where licensed professionals are not required, in remote areas, villages or small towns, he added.

Neeraj Chaurasiya, another consultant based in Noida, said many graduates keep trying repeatedly to clear the exam.

Most people make repeated attempts to clear the exam but those who cannot clear it take up related careers if they have to stay in India. Those who can, go to countries where they can practise medicine, he further said.

Former NBE executive director Dr Vipin Batra said the idea of a screening exam came up around 1998-99, when what was earlier a diplomatic window the government would nominate students for PG medical education in the erstwhile USSR and then CIS (Commonwealth of Independent States) countries gradually became a commercial venture with more and more colleges in the region opening their doors to Indian students.

The demand-supply mismatch in medical education has always been a problem for India. Initially, medical education in the USSR was part of a diplomatic exchange programme when the government would nominate [students]. In 1998, the MCI for the first time passed a resolution derecognising foreign medical graduates, Dr Batra told ThePrint.

But that received a setback and the Pokhran nuclear test happened in 1998 and Russia was the only country standing with India through the sanctions. There was a lot of diplomatic pressure against derecognising degrees from a country that stood with India in those times, so finally, in 2001, a middle path was devised. This was the screening test, he said.

However, the test was met with some opposition. Some medical graduates moved the Supreme Court seeking an order to limit the ambit of questions asked to just clinical subjects. The apex court, in its verdict, allowed some relaxations, including removal of the cap on number of attempts allowed.

The first FMGE happened in 2004 March and it has been happening for the last 16 years. But new international players came into the picture in the millennium decade and countries like China and Philippines also opened their doors to Indian students. Currently, we send as many students to study medicine in China as to the erstwhile CIS countries. The Philippines has an advantage because it is English-speaking, he added.

Doctors who have experience working with foreign medical graduates, however, claim that even those who clear the screening test are often found wanting in clinical and practical skills.

There are times we encounter graduates who cannot even put a cannula on a patient, a senior doctor from Delhis Indraprastha Apollo Hospital told ThePrint.

There is a reason that the examination is so tough, and India is not the only country requiring foreign graduates to clear a screening test, say experts.

Former Kerala chief secretary Dr Vishwas Mehta, who dealt with medical education during his stint as joint secretary in the Union health ministry, told ThePrint: I have been to medical colleges in Armenia, Georgia and Russia. There is no entrance test and the fees are reasonable so a lot of people end up there. But there are very strict laws, so students are never allowed to touch a patient, so they often do not know how to put a catheter or injection or even do a delivery.

The standards are very different. Also, there is no reciprocal arrangement with these countries for recognising their degrees. Even the US required medical graduates going from India to appear for the USMLE (United States Medical Licensing Examination).

(Edited by Gitanjali Das)

Also Read: Ticket out of despair: How agents fuel the boom in Indians wanting to study medicine abroad

See original here:

80% foreign medical graduates fail India's licence exam. Here's what they end up doing instead - ThePrint

Introduction: The teaching of human anatomy, a medical subject that relies heavily on live teaching, teacher-student interactivity, and visuospatial skills, has suffered tremendously since the COVID-19 pandemic mandated the shutting down of medical institutions. The medical education fraternity was compelled to replace the traditional teaching method of hands-on cadaveric dissections (HOCDs) with online education to overcome this new challenge, but it came at the cost of reduced student engagement and lesser spatial orientation.

Method: In this cross-sectional, questionnaire-based study, we designed anovel online dissection courseon lower limb anatomy and collected student feedback on the same fromconsenting Phase I Bachelor of Medicine, Bachelor of Surgery (MBBS) students of Symbiosis Medical College for Women, Pune, India. The course design consisted of three different modes: a live Zoom session using a handheld camera phone, a pre-recorded video dissection uploaded on the institute learning management system, and a Powerpoint presentation with high-resolution photographs of each dissected layer; and the feedback intended to find outwhat works best for the students. Overall feedback regarding their preferences in terms of presentation design, use of background music in pre-recorded videos, and overall learning experience was also collected. Thecourse consisted of six two-hour teaching sessions. The first three sessions each used a different mode of teaching, repeating the same pattern in the next three sessions. The first mode of teaching implemented was a live Zoom session where instructors used a hand-held cell phone camera to show specimens that had been dissected a day prior. The second mode involved a pre-recorded video showing step-by-step dissection performed by the instructor which was then uploaded on the Institute Learning Management System. Of the two pre-recorded videos, background music consisting of a low-volume instrumental track was added to the second video. The third mode utilized Powerpoint presentations containing high-resolution photographs of each dissected layer on a separate slide along with labeling. The presentations were shown to the students over a Zoom call. A Google Form (GF) questionnaire was created after validation by subject experts to gather the students feedback on the teaching and learning of anatomy via these sessions. The GF responses were collected and analyzed using Microsoft Excel.

Results: 41.7% of students recommended the use of a combination of all three modes in the same session, while 36.7% favored pre-recorded videos. 86.7% of students said that a good quality presentation design helps in keeping them engaged and only23%of students favored the use of background music for increasing their ability to concentrate. 63.3% of students found the learning experience highly satisfactory.

Conclusion: Although virtual dissection teaching methods may not be able to completely replace HOCDs, a well-planned online dissection course incorporating multiple modes of online dissections with an emphasis on good quality presentation design and frequent teacher-student interactivity can provide a strong impetus for learning in the absence of live teaching methods.

Human anatomy is one of the basic sciences that is taught in themedical curriculum worldwide [1,2]. For many years this subject has been taught using traditional teaching methods such as didactic lectures, demonstrations, small group discussions, and cadaveric dissections. With pedagogical evolution, anatomical education started witnessing the ingraining of newer, creative teaching methods which incorporated computer-assisted learning [3]. Online educational content delivered through websites such as YouTube has been shown to augment students learning experiences [4]. The inclination towards such teaching tools was further accentuated after restrictions on the live classroom teaching setup due to the 2020 COVID-19 pandemic [5]. Distance education became the new norm and replacing old school methods with newer modalities like streaming video platforms, web conferencing tools, and much recently, virtual anatomy atlas software, was no longer just an evolutionary trend but an absolute necessity [6,7]. Furthermore, the incorporation of learning management systems such as Google Classroom [8] and Moodle [9,10] in medical education has made it possible to facilitate the teaching and learning of this complex subject in an orderly manner, in spite of the physical distance. Two important drawbacks are to be considered in this new wave of teaching, however: the first being the lack of live face-to-face interaction [11,12], the second a deprivation of visuospatial learning that is a hallmark feature of anatomy learning, especially in hands-on cadaveric dissections (HOCDs) [13]. The understanding of visual and spatial relationships amongst structures offered by HOCDs has always made this method an integral, irreplaceable part of anatomy teaching and learning[14]. The inability to conduct such sessions during institutional lockdowns is a matter of concern for anatomy education [15,16]. Students perspectives on the very same matter have been studied in recent times [17,18]. In March 2020, Diaz et al. ran an online anatomy practical course consisting of 20 pre-recorded videos of prosected cadaveric specimens with a positive response and statistically significant rise in academic scores [19]. Since then, various other methods have been used such as virtual dissection tables, dissection audio-visual resources (DAVR), and dissection educational videos (DEVs) [20-24]. In spite of multiple studies focussing on student feedback on online anatomy education, no studies have collected feedback by comparing multiple modes of online dissection within the same course. Whether the touch-and-feel based learning of HOCDs can ever be replaced by virtual dissections remains an issue of debate, but an effort to keep an online dissection session as real as possible can be done in todays times, thanks to the availability of enhanced digital audio-video creation technology. In this study, the authors have attempted to understand students perspectives on a novel online lower limb dissection course that they designed and deliveredduring the pandemic. The course encompasses various possible modes of online dissection teaching. Factors such as preferred mode of lecture delivery, presentation design, the scope for background music in online sessions, and overall learning experience have been considered.

This was aquestionnaire-based study exploring students perspectives on a novel online dissection course on lower limb anatomy. The course was a part of the online anatomy curriculum of a Phase I MBBS batch at Symbiosis Medical College for Women, Pune. It was mentioned in the student consent form that the feedback will be collected anonymously for purposes of medical education research and curricular development. Sixty students gave consent and were included in the study. Before collecting the data, the study plan was proposed to the Institute Research Committee at Symbiosis Medical College for Women and the approval number received was SMCW/IRC/Fac Res/52/2022. As per Table 4.2, Serial Number 1 of the National Ethical Guidelines for Biomedical and Health Research involving Human Participants of the Indian Council of Medical Research, New Delhi, studies involving comparison of instructional techniques, curricula, or classroom management methods are exempted from Ethical Committee review.

The course consisted of six two-hour teaching sessions, conducted for the entire batch. Three sessions were conducted initially, each one using a different mode of teaching (Tables 1, 2). The same pattern was repeated for the next three sessions.

Live Zoom Session Over the Cellphone

In this mode, the dissection was done a day prior by the instructor. The prosected specimen was then shown over a live Zoom session by two teachers. One teacher held the cellphone (Redmi Note 9 Pro Max; Xiaomi, Beijing, China) whose camera was used to show the specimen while the other teacher taught with the use of forceps for pointing and grasping the necessary structures. Students had the liberty to interrupt the teacher in the middle of the session by unmuting themselves and asking questions, whenever needed. The total duration of the session was two hours.

Pre-recorded Videos Uploaded on Institutes Learning Management System

In this mode, the dissection was done a day prior by the instructor. The entire video was first recorded using the high-definition DJI Osmo Pocket Handheld 12 MP camera (DJI, Shenzhen, China). The video consisted of a moving camera format with close-ups on certain structures as well as a fixed camera format when the concerned regional anatomy was summarized. The video was then edited using LumaFusion for iPad and exported with the specifications of 1920 x 1080 pixels at 30 frames per second.During the editing, while the parts of the video wherein the instructor is teaching were kept at normal speed, the parts of the video where the instructor is dissecting in real-time were sped up significantly. This way, the unnecessary length of dissection time was shortened, yet various layers of the dissection were demonstrated step-by-step to the viewers. Of the two videos (Table 2, Numbers 2 and 5), each of 40 minutes duration, that were produced with this method, an instrumental track in low volume was added as background music in the second video. Both of these videos were further divided into two halves of 20 minutes duration. Thus, two 20 minute videos were shown to the students in each session. Both the sessions started with the instructor navigating the students through the LMS in a 10-minute online briefing over Zoom call. The students were then given 30 minutes to watch the first part of the video on their respective devices. This was followed by a 30-minute live interactive Question and Answer (Q&A) session over Zoom call. The students then watched the second part of the video over the next 30 minutes, again on their respective devices, followed by yet another live question and answer session over the same Zoom call. The total duration of the session was two hours.

PowerPoint Presentation

In this mode, dissection was done a day prior by the instructor, and high-resolution photographs were taken using a Canon DSLR PowerShot SX70 HS camera (Canon, Tokyo, Japan). The presentation consisted of a step-by-step dissection with the photograph of each dissected layer on a separate slide along with labeling. The presentation was screen-shared live over the videoconferencing application Zoom. Students had the liberty to interrupt the teacher in the middle of the session by unmuting themselves and asking questions, whenever needed. The total duration of the session was two hours.

A Google Form (GF) questionnaire was created to gather the students feedback on the teaching and learning of anatomy in these sessions. It had three sections. The first section consisted of consent. It was mentioned here that the feedback will be used anonymously for purposes of research and improved delivery of online anatomical education in the future. The second section consisted of feedback on lower limb dissection sessions in relation to student preferences on the mode of teaching, the effect of presentation design and annotations on students ability to stay focussed, and students' perception of the use of background music in pre-recorded dissection videos. The third section collected overall feedback on the session regarding parameters such as speed of lecture, degree of repetition of information, level of teacher-student interaction in the session, comprehensibility of the topic taught, and overall quality of the students learning experience. After thorough validation by subject experts, this questionnaire was distributed toPhase I MBBS students of Symbiosis Medical College for Women, Pune. The students not willing to participate in the study were given the opportunity to withdraw from the study.

The GF responses were collected and analyzed using Microsoft Excel. An ascending Likert scale was used to assessstudents' comprehension of the taught topics and overall learning experience. This data was visuallyrepresented as bar charts. Pie charts were used to represent thestudent responses on preferred session mode, perception of design and annotation use in PowerPoint presentations, and student views on the use of background music in pre-recorded videos.

The results showed that 53.3% of students rated comprehension of the topics taught as a 4 on a 5-point ascending Likert scale. Similarly, 63.3% of students found the overall learning experience highly satisfactory (Figures 1, 2).

In terms of mode of lecture delivery, 41.7% of students recommended that the instructor use a combination of all three modes in the same lecture. 36.7% of students preferred the PR videos, 15% preferred the live ZS, and 6.6% preferred a PPT (Figure 3).

56.7% of participants rated the PowerPoint presentation design as a 4 on a 5-point ascending Likert scale. 86.7% of students opined that the quality of presentation design directly correlates with their ability to stay focused during the lecture. 95% of students said that the annotations helped enhance their understanding of the presentation content (Figures 4, 5, 6).

Out of two PR videos used in the study, the background music was added to the second one. The research attempted to assess how this affected student engagement (Figure 7).

Forty-five percent of students were indifferent to the usage of background music in the dissection videos and perceived no effect on their engagement with the video. 23.3% thought that the music increased engagement, whereas 31.7% considered it as an unnecessary distraction.

The present study aimed atunderstanding student preferences in online dissection sessions on lower limb anatomy with the objective of improving curricular design for future online learning sessions based on the feedback collected. The course incorporated three modes of online dissections: live Zoom sessions, pre-recorded videos of dissection, and PowerPoint presentations of the dissected specimens.

Most students suggested that the instructor incorporate a combination of all modes in the same online session (Figure 3). However, if they had to choose one, 36.7% of students favored pre-recorded videos. In a similar study by Choi-Lundberg et al. on the effectiveness of using DAVR as a preliminary mode of learning dissection, the authors reported that implementing DAVR resulted in higher scores among undergraduate medical students. A positive correlation was noted between scores and the number and total time of DAVR viewed [22]. PPTs were the least preferred modes of teaching online dissection. The following factors could be responsible for greater student preference for PR videos:

Control of Video Playback

Students could pause, replay, speed up or slow down the pre-recorded videos on their own devices. This gave them the liberty to focus on different parts of the dissection as per their understanding. The live videos had the teacher progressing at a fixed pace, with no option to pause or replay. The PPTs had static images which might have failed to capture visuospatial intricacies, leading to low preference. Fidalgo et al. conducted a similar study to assess the use of alternative learning methods among students in which students clearly preferred a video format over PPTs. However, they concluded that the most beneficial way to aid most students learning would be to administer a combination of different alternative teaching methods [25].

Elimination of Internet Bandwidth Issues

A major drawback of the live ZS could be the reduced video quality, audio delay, and buffering experienced due to server overload. These problems do not arise while viewing pre-recorded content. In a similar study by John et al. [26], nearly 60% of students preferred PR videos over live videos due to this very reason.

Reduced Dissection Time

The parts of the PR video where the teacher was dissecting in real-time were sped up in order to reduce the length of dissection time.However, while demonstrating the various layers and structures, the video speed was brought back to normal. Not only was this the closest imitation of an actual HOCD, but it also allowed the students to focus on important anatomical structures better.

More Teacher-Student Interaction

Two slots of 30 minutes each were allotted purely for interactive Q&A sessions over Zoom call after watching the first and second parts of the PR videos. In the live ZS as well as the PPT modes, students had to unmute and interrupt the teacher to ask questions. This might have prevented students from asking a lot of questions. A study by Nolan et al. on a neuroanatomy course suggests that sessions focusing on student interaction yield better attendance as opposed to traditional didactic lecture-taking methods [27]. A large-scale study took students perceptions of 73 teaching courses into consideration with respect to the course design. It was found that feedback from instructors and active discussion were the two most important factors that improved students perceptions of a course [28]. Although the live ZS allowed for immediate resolution of doubts, this came at the cost of affecting the teachers flow of thought, which might have led to hesitation from the students' side.

Two factors, namely design of the PPT and use of annotations were favored by students for increasing focus and comprehension (Figures 4, 5, 6). Modern educators need to put more effort into the design of PPTs and actively annotate on the slide being displayed to improve student appeal and engagement.

Angel et al. reported that background music can have significant effects on cognitive performance. Using fast-tempo music and standardized test batteries, Angel et al. demonstrated that background music increased spatial and linguistic processing skills [29]. Evidently, the development of these skills among students is of utmost importance to facilitate their learning. Fassbender et al. established that using background music while delivering lectures to students can result in a significantly higher recall of facts [30]. In a similar vein, the authors wanted to find out how medical students would react to the presence of background music while studying a complex subject like anatomy. Student opinions were mixed, with 23% of students finding the background music as a necessary aid to improve engagement (Figure 7).Further studies are needed to analyze the effects of using different types of music in online medical lectures.

In summary, online dissection sessions need to be designed by incorporating a healthy mix of the flexibility provided by high-quality pre-recorded videos, the interaction provided via live Zoom sessions, and a well-designed PPT with generous use of annotations to give students a wholesome anatomy learning experience. Forthcoming studies need to assess the merits of such a combination. This study has one limitation. Only the inferior extremity was dissected as a part of this study. Teaching other parts, especially those having smaller anatomical structures and needing finer dissection need to be conducted to further explore the student preferences on the various possible modes for teaching anatomical dissections online.

Although virtual dissection teaching methods may not be able to completely replace HOCDs, these results indicate that they can provide a strong impetus for learning in the absence of HOCDs. What needs to be kept in mind however is the incorporation of multiple modes within the same session to increase student engagement. The use of pre-recorded videos covering the most important parts of online dissection sessions enables the students to revisit the more complex concepts that they might miss while learning across the screen in the absence of a face-to-face give and take. It also eliminates the distraction and disengagement that arises due to internet bandwidth problems in the live video conferencing sessions. Maintaining a high level of teacher-student interaction by deliberately dividing longer online sessions into smaller subdivisions with frequent question-answer exchanges is pivotal to encourage student participation. Lastly, while the use of superior quality design and aggressive annotation in online presentations attracts students attention, the use of background music and its implications needs to be studied in more detail considering several factors such as the volume, tempo, genre, and other musical parameters that could influence student attention.

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A Novel Online Dissection Course on Lower Limb Anatomy During the COVID-19 Pandemic - Cureus