James Pickering is an Associate Professor and works in the Division of Anatomy, School of Medicine, University of Leeds. James undertakes research in Anatomy education.
Research Items (31)
Massive open online courses (MOOCs) are a novel and emerging mode of online learning. They offer the advantages of online learning and provide content including short video lectures, digital readings, interactive assignments, discussion fora, and quizzes. Besides stand-alone use, universities are also trying to integrate MOOC content into the regular curriculum creating blended learning programs. In this 12 tips article, we aim to provide guidelines for readers to integrate MOOC content from their own or from other institutions into regular classroom teaching based on the literature and our own experiences. We provide advice on how to select the right content, how to assess its quality and usefulness, and how to actually create a blend within your existing course.
- Mar 2019
Over the last few years Anatomical Sciences Education has published a number of articles documenting the use of social media platforms in anatomy education (Jaffar, 2014; Barry et al., 2016; Hennessy et al., 2016; Pickering and Bickerdike, 2017). As a collective group of authors responsible for contributing to some of this literature, we have recently noticed a significant change in the way our students are engaging with these platforms. For example, the Twitter hashtag associated with the Neuroanatomy and Head and Neck module (#NLM2soton) at the University of Southampton, as discussed by Hennessy et al. This article is protected by copyright. All rights reserved.
With the availability of numerous adjuncts or alternatives to learning anatomy other than cadavers (medical imaging, models, body painting, interactive media, virtual reality) and the costs of maintaining cadaver laboratories, it was considered timely to have a mature debate about the need for cadavers in the teaching of undergraduate medicine. This may be particularly pertinent given the exponential growth in medical knowledge in other disciplines, which gives them valid justification for time in already busy medical curricula. In this symposium, the pros and cons of cadaver use in modern medical curricula were debated and audience participation encouraged.
- May 2018
Anatomy curricula are becoming increasingly populated with blended learning resources, which utilize the increasing availability of educational technology. The educational literature postulates that the use of technology can support students in achieving greater learning outcomes by increasing engagement. This study attempts to investigate the dimensions of student engagement with technology‐enhanced learning (TEL) resources as part of a medical program's anatomy curriculum using exploratory factor analysis. A 25‐item five‐point Likert‐based survey was administered to 192 first‐year medical students, with three emergent factors discerned: satisfaction, goal setting and planning, and physical interaction. The three factors closely aligned with the existing literature and therefore additional nonparametric analysis was conducted that explored the levels of engagement across three custom‐made anatomy TEL resources, including: (1) anatomy drawing screencasts; (2) an eBook; and (3) a massive open online course (MOOC). Usage data indicated that the most popular resource to be accessed across the cohort was the anatomy drawing screencasts via YouTube, with the MOOC being used least. Moreover, some evidence suggests that those students who utilized the MOOC were more engaged. Generally, however, no correlations were observed between the levels of engagement and TEL resource usage or assessment outcomes. The results from this study provide a clear insight into how students engage with TEL resources, but do not reveal any relationship between levels of engagement, usage, and assessment outcomes. Anat Sci Educ 00: 000–000. © 2018 American Association of Anatomists.
Whether ultrasound (US) should be incorporated into a medical undergraduate curriculum remains a matter of debate within the medical education arena. There are clear potential benefits to its early introduction particularly with respect to the study of living anatomy and physiology in addition to the learning of clinical skills and procedures required for the graduate clinical practice. However, this needs to be balanced against what is perceived as an added value in addition to financial and time constraints which may potentially lead to the sacrifice of other aspects of the curriculum. Several medical schools have already reported their experiences of teaching US either as a standalone course or as a fully integrated vertical curriculum. This article describes and discusses the initial experience of a UK medical school that has taken the steps to develop its own pragmatic vertical US curriculum based on clinical endpoints with the intent of using US to enhance the learning experience of students and equipping them with the skills required for the safe practice as a junior doctor.
- Dec 2017
Anatomy education is at the forefront of integrating innovative technologies into its curricula. However, despite this rise in technology numerous authors have commented on the shortfall in efficacy studies to assess the impact such technology-enhanced learning (TEL) resources have on learning. To assess the range of evaluation approaches to TEL across anatomy education, a systematic review was conducted using MEDLINE, the Educational Resources Information Centre (ERIC), Scopus, and Google Scholar, with a total of 3,345 articles retrieved. Following the PRISMA method for reporting items, 153 articles were identified and reviewed against a published framework—the technology-enhanced learning evaluation model (TELEM). The model allowed published reports to be categorized according to evaluations at the level of (1) learner satisfaction, (2) learning gain, (3) learner impact, and (4) institutional impact. The results of this systematic review reveal that most evaluation studies into TEL within anatomy curricula were based on learner satisfaction, followed by module or course learning outcomes. Randomized controlled studies assessing learning gain with a specific TEL resource were in a minority, with no studies reporting a comprehensive assessment on the overall impact of introducing a specific TEL resource (e.g., return on investment). This systematic review has provided clear evidence that anatomy education is engaged in evaluating the impact of TEL resources on student education, although it remains at a level that fails to provide comprehensive causative evidence. Anat Sci Educ. © 2017 American Association of Anatomists.
Objective: To determine the microarchitecture of the cervix using high-resolution diffusion tensor (DT) magnetic resonance imaging (MRI). Design: Cross-sectional study. Setting: Leeds, UK. Sample: Women undergoing hysterectomy for benign pathology. Methods: Ex-vivo DT-MRI measurements were obtained using a 9.4-T Bruker nuclear magnetic resonance (NMR) spectrometer on seven fixed human cervices obtained at hysterectomy. A deterministic fibre-tracking algorithm was used to indirectly visualise underlying fibre organisation. Inter-regional differences in tissue structure were sought using quantitative measurements of diffusion. Main outcome measure: The identification of an occlusive structure in the region corresponding to the internal cervical os. Results: Fibre tracking demonstrated two regions: an outer circular and inner longitudinal layer. The total circumferential tract volume (TV) was greatest in the proximal region of the cervix (TV: proximal, 271 ± 198 mm3 ; middle, 186 ± 119 mm3 ; distal, 38 ± 36 mm3 ). Fractional anisotropy (FA) and apparent diffusion coefficient (ADC) measurements were significantly different between regions in all samples (P < 0.0005), indicating greater tract density and organisation towards the internal os. Conclusion: Fibre tracking infers a system of dense, well-defined, encircling fibres in the proximal region of the cervix, corresponding to the location of the internal os. These findings may provide evidence of specific anatomic microarchitecture within the cervix able to resist intrauterine forces associated with pregnancy. Tweetable abstract: Diffusion-tensor MRI derived tractography identified well-defined encircling fibres at the internal os.
Recent changes in anatomy education have seen the introduction of flipped classrooms as a replacement to the traditional didactic lecture. This approach utilizes the increasing availability of digital technology to create learning resources that can be accessed prior to attending class, with face-to-face sessions then becoming more student-centered via discussion, collaborative learning and problem-solving activities. Although this approach may appear intuitive, this viewpoint commentary presents a counter opinion and highlights a simple alternative that utilizes evidence-based active learning approaches as part of the traditional lecture. The active lecture takes the traditional lecture, and (1) ensures the lecture content is relevant and has clear objectives, (2) contains lecture material that is designed according to the latest evidence-base, (3) complements it with additional supplementary material, (4) creates space to check prior understanding and knowledge levels, and (5) utilizes suitable technology to facilitate continual engagement and interaction. This article is protected by copyright. All rights reserved.
Recent changes in anatomy education have seen the introduction of flipped classrooms as a replacement to the traditional didactic lecture. This approach utilizes the increasing availability of digital technology to create learning resources that can be accessed prior to attending class, with face-to-face sessions then becoming more student-centered via discussion, collaborative learning and problem-solving activities. Although this approach may appear intuitive, this viewpoint commentary presents a counter opinion and highlights a simple alternative that utilizes evidence-based active learning approaches as part of the traditional lecture. The active lecture takes the traditional lecture, and (1) ensures the lecture content is relevant and has clear objectives, (2) contains lecture material that is designed according to the latest evidence-base, (3) complements it with additional supplementary material, (4) creates space to check prior understanding and knowledge levels, and (5) utilizes suitable technology to facilitate continual engagement and interaction.
Medical student engagement is a constant topic of conversation between all faculty members seeking to explore varied approaches to student support. Although considerable work has been undertaken to explore the various domains of engagement, generally it still remains a poor proxy for learning. This personal perspective seeks to highlight how cognitive engagement might be viewed as the key domain in which students must operate. Only when students have become masters of their current knowledge base and what it is they are required to know as part of their course, can they make behavioural decisions to support their learning.
Technology-enhanced learning is now almost ubiquitous across all healthcare curricula. From social media, through eBooks to virtual reality, technology is having an increasingly important role in supporting students to reach the desired learning objectives. However, while it is common to find reports on these interventions in the literature, there remains a paucity of meaningful evaluation on the actual impact these novel and innovative approaches to education have on student learning. This commentary pushes forward the need to continually evaluate the role of technology with healthcare curricula.
- May 2017
Massive open online courses (MOOCs) are a novel mode of online learning. They are typically based on higher education courses and can attract a high number of learners, often in the thousands. They are distinct from on-campus education and deliver the learning objectives through a series of short videos, recommended readings and discussion fora, alongside automated assessments. Within medical education the role of MOOCs remains unclear, with recent proposals including continuing professional development, interprofessional education or integration into campus-based blended learning curricula. In this twelve tips article, we aim to provide a framework for readers to use when developing, delivering and evaluating a MOOC within medical education based on the literature and our own experience. Practical advice is provided on how to design the appropriate curriculum, engage with learners on the platform, select suitable assessments, and comprehensively evaluate the impact of your course.
Massive open online courses (MOOCs) remain a novel and under-evaluated learning tool within anatomical and medical education. This study aimed to provide valuable information by using an anatomy MOOC to investigate the demographic profile, patterns of engagement and self-perceived benefits to healthcare professionals. A 21-item survey aimed at healthcare professionals was embedded into the Exploring Anatomy: The Human Abdomen MOOC, in April 2016. The course attracted 2711 individual learners with 94 of these completing the survey, and 79 of those confirming they worked full- or part-time as healthcare professionals. Variations in use across healthcare profession (allied healthcare professional, nurse or doctor) were explored using a Fisher’s exact test to calculate significance across demographic, motivation and engagement items; one-way ANOVA was used to compare self-perceived benefits. Survey data revealed that 53.2% were allied healthcare professionals, 35.4% nurses and 11.4% doctors. Across all professions, the main motivation for enrolling was to learn new things in relation to their clinical practice, with a majority following the prescribed course pathway and utilising core, and clinically relevant, material. The main benefits were in relation to improving anatomy knowledge, which enabled better support for patients. This exploratory study assessing engagement and self-perceived benefits of an anatomy MOOC has shown a high level of ordered involvement, with some indicators suggesting possible benefits to patients by enhancing the subject knowledge of those enrolled. It is suggested that this type of learning tool should be further explored as an approach to continuing professional, and interprofessional, education.
- Jan 2017
- 37th Annual Meeting of the Society for Maternal Fetal Medicine: The Pregnancy Meeting
The use of technology-enhanced learning (TEL) resources is now a common tool across a variety of healthcare programs. Despite this popular approach to curriculum delivery there remains a paucity in empirical evidence that quantifies the change in learning gain. The aim of the study was to measure the changes in learning gain observed with anatomy drawing screencasts in comparison to a traditional paper-based resource. Learning gain is a widely used term to describe the tangible changes in learning outcomes that have been achieved after a specific intervention. In regard to this study, a cohort of Year 2 medical students voluntarily participated and were randomly assigned to either a screencast or textbook group to compare changes in learning gain across resource type. Using a pre-test/post-test protocol, and a range of statistical analyses, the learning gain was calculated at three test points: immediate post-test, 1-week post-test and 4-week post-test. Results at all test points revealed a significant increase in learning gain and large effect sizes for the screencast group compared to the textbook group. Possible reasons behind the difference in learning gain are explored by comparing the instructional design of both resources. Strengths and weaknesses of the study design are also considered. This work adds to the growing area of research that supports the effective design of TEL resources which are complimentary to the cognitive theory of multimedia learning in order to achieve both an effective and efficient learning resource for anatomical education.
The use of Facebook to support students is an emerging area of educational research. This study explored how a Facebook Page could support Year 2 medical (MBChB) students in preparation for summative anatomy assessments and alleviate test anxiety. Overall, Facebook analytics revealed that in total 49 (19.8% of entire cohort) students posted a comment in preparation for either the first (33 students) or second (34) summative anatomy assessments. 18 students commented in preparation for both. In total, 155 comments were posted, with 83 for the first and 72 for the second. Of the 83 comments, 45 related to checking anatomical information, 30 were requiring assessment information and 8 wanted general course information. For the second assessment this was 52, 14 and 6, respectively. Student perceptions on usage, and impact on learning and assessment preparation were obtained via a five-point Likert-style questionnaire, with 119 students confirming they accessed the Page. Generally, students believed the Page was an effective way to support their learning, and provided information which supported their preparation with increases in perceived confidence and reductions in anxiety. There was no difference between gender, except for males who appeared to be significantly less likely to ask a question as they may be perceived to lack knowledge (P < 0.05). This study suggests that Facebook can play an important role in supporting students in preparation for anatomy assessments.
- Jul 2016
Background: The use of technology within education has now crossed the Rubicon; student expectations, the increasing availability of both hardware and software and the push to fully blended learning environments mean that educational institutions cannot afford to turn their backs on technology-enhanced learning (TEL). The ability to meaningfully evaluate the impact of TEL resources nevertheless remains problematic. Aims: This paper aims to establish a robust means of evaluating individual resources and meaningfully measure their impact upon learning within the context of the program in which they are used. Methods: Based upon the experience of developing and evaluating a range of mobile and desktop based TEL resources, this paper outlines a new four-stage evaluation process, taking into account learner satisfaction, learner gain, and the impact of a resource on both the individual and the institution in which it has been adapted. Results: A new multi-level model of TEL resource evaluation is proposed, which includes a preliminary evaluation of need, learner satisfaction and gain, learner impact and institutional impact. Each of these levels are discussed in detail, and in relation to existing TEL evaluation frameworks. Conclusions: This paper details a holistic, meaningful evaluation model for individual TEL resources within the specific context in which they are used. It is proposed that this model is adopted to ensure that TEL resources are evaluated in a more meaningful and robust manner than is currently undertaken.
- Jun 2016
Massive open online courses (MOOCs) are designed as stand-alone courses which can be accessed by any learner around the globe with only an internet-enabled electronic device required. Although much research has focused on the enrolment and demographics of MOOCs, their impact on undergraduate campus-based students is still unclear. This article explores the impact of integrating an anatomy MOOC in to the anatomy curriculum of a year 1 medical degree program at the University of Leeds, United Kingdom. The course did not replace any teaching that was already being delivered, and was used to supplement this teaching to support the students' consolidation and revision. Analysis of student feedback indicates a high level of usage, with evidence to suggest that female learners may have approached the course in a more personalized manner. Although the video based resources and quizzes were greatly appreciated as learning tools, significant evidence suggests the students did not engage, or were inclined to engage, with the discussion fora. Furthermore, a significant majority of students did not want the MOOC to replace the existing teaching they received. Given the feedback provided, this research suggests that although the student population believe there to be value in having access to MOOC material, their role as replacements to campus-based teaching is not supported. Details regarding the enrolment and engagement of the general public with the MOOC during the two runs are also documented, with the suggestion that graduates employed in the healthcare sector were the primary users of the course. Anat Sci Educ. © 2016 American Association of Anatomists.
The structure of the cervix is integral to the maintenance of pregnancy, keeping the developing baby in utero and forming a barrier to the ascent of microorganisms from the vagina. Weakness of the cervix may lead to deficiency of this barrier and is associated with subsequent preterm birth. The underlying cause of this structural weakness is poorly understood. In this paper we review the structure and function of the cervix before and during pregnancy. The causes of mechanical failure of the cervix during pregnancy are described, with a specific focus on the internal cervical os. We highlight the role of the internal cervical os in causing preterm birth and discuss research techniques that may provide further insight into its function during pregnancy. It is hoped that clinical translation of this knowledge will enable the early and appropriate identification of women who will benefit from strategies to reinforce the internal os and so reduce the incidence of preterm birth.
- Aug 2014
The traditional lecture remains an essential method of disseminating information to medical students. However, due to the constant development of the modern medical curriculum many institutions are embracing novel means for delivering the core anatomy syllabus. Using mobile media devices is one such way, enabling students to access core material at a time and place that suits their specific learning style. This study has examined the effect of five anatomy drawing screencasts that replicate the popular anatomy drawing element of a lecture. These resources were uploaded to the University's Virtual Learning Environment for student access. Usage data and an end of module questionnaire were used to assess the impact of the screencasts on student education. The data revealed a high level of usage that varied in both the time of day and day of the week, with the number of downloads dramatically increasing towards the end of the module when the assessment was approaching. The student group found the additional resources extremely useful in consolidating information and revision, with many commenting on their preference to the screencasts compared to the more traditional approaches to learning. Scrutinizing the screencasts in relation to cognitive load theory and the cognitive theory of multimedia learning indicates a high correlation with an evidence-based approach to designing learning resources. Overall the screencasts have been a well-received enhancement that supports the student learning and has been shown to promote flexible learning. Anat Sci Educ. © 2014 American Association of Anatomists.
External laryngeal nerve (ELN) palsy and recurrent laryngeal nerve (RLN) palsy remain two of the major complications that can result from a thyroidectomy procedure. Two landmarks have been used to help identify these nerves in surgery, Joll’s triangle, and Simon’s triangle. The former is said to contain the ELN and its borders are made up of the superior border of the thyroid gland, the midline, and the retracted strap muscles in surgery. The latter is said to enclose the RLN and is made up of the common carotid artery lat- erally, the tracheo-esophageal groove medially and the inferior thy- roid artery superiorly. The study aims to assess the usefulness and reliability of these landmarks. The necks of three cadavers were dissected to reveal the triangles and their associated nerves. The triangles were identified in all three cadavers. Simon’s triangle con- sistently contained the RLN, although the area demarcated was very large in one case. Joll’s triangle did not always contain the ELN, but did contain similar looking structures, such as the vessels supplying cricothyroid muscle, that could be mistaken for the ELN. The triangle was also very large compared to the structure it intended to point out. Simon’s triangle was a useful, consistent landmark. Joll’s triangle did not always contain the nerve and was too large to be of significant use.
- Jan 2014
Neuroanatomy teaching at the University of Leeds includes the examination of isolated brains by students working in small groups. This requires the prosected brains to exhibit all 12 pairs of cranial nerves. Traditional methods of removing the brain from the skull involve elevating the frontal lobes and cutting each cranial nerve as the brain is reflected posteriorly. This can leave a substantial length of each nerve attached to the skull base rather than to the removed brain. We have found a posterior approach more successful. In this study, five adult heads were disarticulated at the level of the thyroid cartilage and placed, prone, in a head stand. A wedge of bone from the occipital region was removed before the cerebellum and brainstem were elevated to visualize the cranial nerves associated with the medulla oblongata, cerebellopontine angle and mesencephalic-pontine junction prior to cutting them as close to the skull as possible. Five brains were successfully removed from the skull, each having a full complement of cranial nerves of good length attached to them. This approach significantly increases the length and number of cranial nerves remaining attached to the brain, which supports student education. For integration into head and neck dissection courses, careful consideration will be required to ensure the necks are suitably dissected and to decide whether the cranial nerves are best left attached to the skull base or brain. Clin. Anat., 2013. © 2013 Wiley Periodicals, Inc.
- Aug 2011
The transversus abdominis plane (TAP) block is a new technique for providing analgesia to the anterior abdominal wall. There is ongoing debate regarding access point for TAP block. The aim of this cadaveric study was to compare the spread of 40 mL of dye using three different approaches to TAP: subcostal , via the mid-axillary and via the lumbar triangle of Petit (LTOP). Injection of black dye into the TAP was performed for each hemi-abdominal wall of 13 embalmed human cadavers by using 3 different access points: subcostal (9 hemi-abdomens), mid-axillary (9) and LTOP (8). This was followed by dissection to determine the extent of dye spread and nerve involvement in the dye injection. The shapes of the dye were traced onto clear plastic, which was then photographed. These digital photographs were loaded into the mathematical software programme Matlab, and the outline of the dye spread was digitised using a piecewise cubic spline, enabling the shapes to be plotted on a graph and the areas to be calculated. The area of the dye spread for subcostal, mid-axillary and LTOP was 85.1 (T7-L1), 58.9 (T10-L1) and 77.9 cm² (T10-L1), respectively. There was statistically significant difference between area of dye spread between subcostal and mid-axillary approach (p<0.01). This dye injection study in a cadaver model indicates that subcostal approach is associated with a larger area of spread of dye than the mid-axillary approach. Dye injected through subcostal, mid-axillary and LTOP approaches demonstrated different nerve involvement.
- Jun 2011
Background: Transversus abdominis plane (TAP) block is a recently described regional anaesthesia technique that provides analgesia for the abdominal wall. Three access points for injection have been described: via the lumbar triangle of Petit (LTOP), via the midaxillary line and via the subcostal region (SC). This study aimed to investigate the spread of dye following injection via all 3 sites with a large volume injectate. Materials and Methods: 24 hemiabdomens were injected with 40 mL 25% black food dye: 8 via the LTOP) 4 via the MAL, 4 via the SC. Dissection was performed to reveal the extent of nerve involvement and dye spread. Results: Variation in the size and shape of the LTOP was found between cadavers. Mean areas of dye spread (range of nerve involvement) in the remaining 16 hemiabdomens for LTOP, MAL and SC were 77.9 cm2 (T10-ilioinguinal), 50.3 cm2 (T10-ilioinguinal) and 91.3 cm2 (T7-ilioinguinal) respectively. Communications were seen between nerves within the TAP in one dissection. Dye staining was seen to involve nerves outside the TAP. Conclusion: Subcostal injection gives more superior dye spread, with a greater area and awider range of nerve involvement. This should perhaps be the preferred injection site, and could have broader indications.
Changes in skeletal muscle volume induce localized sarcoplasmic reticulum (SR) Ca(2+) release (LCR) events, which are sustained for many minutes, suggesting a possible signaling role in plasticity or pathology. However, the mechanism by which cell volume influences SR Ca(2+) release is uncertain. In the present study, rat flexor digitorum brevis fibers were superfused with isoosmotic Tyrode's solution before exposure to either hyperosmotic (404 mOsm) or hypoosmotic (254 mOsm) solutions, and the effects on cell volume, membrane potential (E(m)), and intracellular Ca(2+) ([Ca(2+)](i)) were determined. To allow comparison with previous studies, solutions were made hyperosmotic by the addition of sugars or divalent cations, or they were made hypoosmotic by reducing [NaCl](o). All hyperosmotic solutions induced a sustained decrease in cell volume, which was accompanied by membrane depolarization (by 14-18 mV; n = 40) and SR Ca(2+) release. However, sugar solutions caused a global increase in [Ca(2+)](i), whereas solutions made hyperosmotic by the addition of divalent cations only induced LCR. Decreasing osmolarity induced an increase in cell volume and a negative shift in E(m) (by 15.04 +/- 1.85 mV; n = 8), whereas [Ca(2+)](i) was unaffected. However, on return to the isoosmotic solution, restoration of cell volume and E(m) was associated with LCR. Both global and localized SR Ca(2+) release were abolished by the dihydropyridine receptor inhibitor nifedipine by sustained depolarization of the sarcolemmal or by the addition of the ryanodine receptor 1 inhibitor tetracaine. Inhibitors of the Na-K-2Cl (NKCC) cotransporter markedly inhibited the depolarization associated with hyperosmotic shrinkage and the associated SR Ca(2+) release. These findings suggest (1) that the depolarization that accompanies a decrease in cell volume is the primary event leading to SR Ca(2+) release, and (2) that volume-dependent regulation of the NKCC cotransporter contributes to the observed changes in E(m). The differing effects of the osmotic agents can be explained by the screening of fixed charges by divalent ions.
- Feb 2009
Rat flexor digitorum brevis (FDB) fibres were superfused with isoosmotic Tyrode's solution before exposure to either hyperosmotic (405 mOsm) or hypoosmotic (254 mOsm) solutions, and the effects on cell volume, membrane potential (Em) and intracellular Ca2+ ([Ca2+]i) determined. Solutions were made hyperosmotic by addition of sugars or divalent cations, and hypoosmotic by reducing [NaCl]o. Under control conditions, FDB fibres typically exhibited a low resting Em of -60.1 ± 2.91, n=67. All hyperosmotic solutions induced a sustained decrease in cell volume, membrane depolarisation (by ∼14-18 mV, n=40) and SR Ca2+ release. However, sugar solutions caused a pronounced increase in global [Ca2+]i, while solutions made hyperosmotic by addition of divalent cations induced only LCR. Decreasing osmolarity caused an increase in cell volume and membrane hyperpolarisation (15.04 ± 1.85 mV, n=8), while [Ca2+]I was unaffected. However, on return to the isoosmotic solution, restoration of cell volume and Em was accompanied by LCR. With all protocols, SR Ca2+ release was markedly inhibited by the RyR1 inhibitor tetracaine or the dihydropyridine receptor (DHPR) inhibitor nifedipine. Inhibition of sarcolemmal Cl− channels with 9-anthracene carboxylic acid (9-AC) or the Na/K/2Cl (NKCC) co-transporter with furosemide, both induced a marked hyperpolarisation of Em to -79.2 ± 3.7 mV (n=8) and -89.2 ± 1.7 mV (n=17), respectively. In the presence of furosemide, the depolarisation associated with hyperosmotic shrinkage was reduced by 48.3 ± 2.3 % (n=7). These findings suggest that (i) tonic activation of the NKCC co-transporter and consequent effects on [Cl]i underlie the low resting Em in FDB fibres and (ii) the initiation of LCR that accompanies a decrease in cell is caused by membrane depolarisation, which may be linked to increased activity of the NKCC co-transporter.