Introduction: Spatial ability has been defined as a skill in representing, transforming, generating and recalling symbolic, non-linguistic information. Two distinct human spatial abilities have been identified: visualization and orientation. A sex difference in spatial abilities favouring male has been documented. A pattern of negative effects with increasing age on spatial abilities has also been demonstrated. Spatial abilities have been correlated to anatomy knowledge assessment using practical examination, three-dimensional synthesis from two-dimensional views, drawing of views, and cross-sections in a systematic review. Spatial abilities have also been correlated to technical skills performance in beginners and intermediate learners in a systematic review. The objective of this study was to conduct a systematic review of the interrelationship between spatial abilities, anatomy knowledge and technical skills. Methods: Search criteria included ‘spatial abilities’, ‘anatomy knowledge’ and ‘technical skills’. Keywords related to these criteria were identified. A literature search was done up to November 9, 2018 in Scopus and in several medical and educational databases on Ovid and EBSCOhost platforms. A bank of citations was obtained and was reviewed independently by two investigators. Citations related to abstracts, literature reviews, theses and books were excluded. Articles related to retained citations were obtained and a final list of articles was established. Methods relating spatial abilities testing, anatomy knowledge assessment and technical skills performance were identified. Results: A series of 385 titles and abstracts was obtained. After duplicates were removed and selection criteria applied, 11 articles were retained, fully reviewed, and subsequently excluded with reasons. Conclusion: No eligible articles were found in a systematic review of the interrelationship between spatial abilities, anatomy knowledge and technical skills. The outcome of future studies could help to further understand the cognitive process involved in learning a technical skill in Emergency Medicine.

Background: The widening scope of cognitive therapy models and strategies poses a challenge for designing cognitive therapy training. What are the core skills to be learned? What do learners view as important to learn and what are the skills and knowledge they focus on? Aims: The present study describes the perceptions of CT trainees of both what is important and what is difficult to learn. We also analyse what the trainees focus on when evaluating their professional learning. In addition, we report on changes in self-assessed skills during the training. Method: Quantitative and qualitative data were collected after 2 years of training (n = 39) in three programmes and after the entire 4-year training in four programmes (n = 53). Results: Significant progress was reported in all domains of therapist skills, most clearly in cognitive and constructivist strategies. The trainees practised most those skills they considered important to be learned and, consequently, they also attained a higher level of mastery in these skills. The trainees’ learning orientation and foci of self-reflections remained relatively unchanged. They focused on technical and conceptual skills and knowledge, whereas interpersonal skills were peripheral in their self-reflection. Conclusions: Pedagogical and theoretical implications of the findings are discussed.

Children with innocent murmurs are often referred to a paediatric cardiologist for diagnosis. The most common murmurs of early childhood are the so-called Still's murmurs, followed by ejection murmurs across the pulmonary or aortic vessels, and the venous hum. There also exists a high coincidence of murmurs with the presence of tendinous structures traversing the cavity of the left ventricle. In this report, we describe 6 patients who presented to our outpatient clinic with cardiac murmurs. None of them had abnormalities on the clinical examination, electrocardiographic, or echocardiographic investigation. They presented a similar murmur that was also audible over the back. On closer examination of the aorta with cross-sectional echocardiography, we discovered echogenic, tendinous structures crossing the lumen of the descending aorta or the aortic arch. Whilst we are not yet able to prove that the cords produced the innocent murmurs, the association is highly suggestive.