Shadowing: Plastic Surgery


After multiple shifts with plastic surgeons in the OR they take over after mastectomies or other cancers are removed.  They are called to the Emergency room to evaluate superficial , I appreciate not only their physical skill, but the variety of their patients trauma.  In clinic, they see those hoping for cosmetic fixes (closing a diastasis between the rectus muscles) and those needing long-term wound care from paralysis.  They also work on the damage caused by gunshots (sometimes while the patient is under police guard).


In clinic the residents and medical students do a first pass with each patient, then the attending joins them to finish up.  Though a slow process, the teaching that occurs is obvious.  One particular case highlighted the need for remembering or reviewing anatomy.  The patient, a woman in her early thirties, went to the emergency department on the weekend.  She claims to have grabbed the wrong end of a “butter-knife” in order to cut some cake.  The cuts on her dominant right hand were located at the metacarophalangeal joints of fingers four and five.  After her wounds were cleaned she was asked to move each digit.  The pinkie finger would not comply.  The residents opened the skin wider to confirm the flexor tendons were intact.  While they saw and pulled on one, getting the appropriate response, at this site the superficialis divides and hides.  Though they stitched her up and expected all would be well in a week, at clinic the attending took one look at the straight finger and suggested surgery to repair a cut tendon.  The residents did no harm, and learned to be a bit more thorough even when called in on such a small injury.

Summer Travels, part 2

Physics in action.
Physics in action.

Here’s a fun scientific thought for you.  A beer can (or soda can) one-third full of liquid will stand on its indented angle.  The new fad in several microbreweries is to have glasses shaped like beer cans because it’s familiar to hold and can stand on this angle.  Try it next time.

HAPS President-elect Tom Lehman reporting in, still traveling through the United States this summer in search of inner peace and balance, while also seeking out family, friends, bike trails, golf courses, and (of course) microbreweries.  During weeks 3-6 of my 10-week summer trip, I drove from western Washington to central Minnesota.  I didn’t run into many HAPSters during this part of the trip, but I did get to let my mind wander on a number of topics.

One topic is traditions.  I visited several of my high school classmates this summer for our 30th class reunion in Fort Benton, Montana (“The Birthplace of Montana”).  The town has created an annual tradition – Summer Celebration – where all of the class reunions are held the weekend before the 4th of July, surrounded by art shows, 5K run, town parade, golf tourney, fireworks over the Missouri River, and a street dance.  It’s one of the best weekends that you could ever experience in small town Americana.

A slice of Americana.
I’m a Big Sky boy at heart.

Small towns and big cities have their shares of traditions, but so do educational environments.  We’ve experienced traditions of lab designs (e.g., dissection, microscopy), lecture modes (e.g.,PowerPoints, case studies), and course designs (face-to-face, online, hybrid).  However, there are always new ideas coming up that may become traditions on their own.  Murray Jensen is a leading HAPSter in field of POGIL (we had a very impressive seminar on this topic at the Vegas conference this summer).  Our list-serv and even this blog have lit up with discussions of “flipping classes”.  It’s rewarding to build new traditions while keeping an eye on current traditions.  That’s one of the best things about HAPS to me; how we’re so excited about new ideas and how they can benefit our students.

Remember to exercise your body as well as your mind.
Remember to exercise your body as well as your mind.

As I’ve traveled across the upper stretch of the US, I’ve thought about seminars and workshops from the HAPS conference.  I’ve become excited about how I can incorporate these ideas into my current curriculum, fueled by beautiful scenery and exercised-induced endorphins.  This is so much better than stewing in my office.

As I head southward from Minnesota to Missouri, I leave you with this thought.  Exercise your mind this summer.  See what traditions you enjoy in your class, what traditions you can lose, and what traditions you can start.  You might be surprised where the thoughts take you.Let your mind wander.

Let your mind wander.

6- Being BRAVE

The "Bad Hair Day" Horse. Source:
You record flipped lectures even on bad hair days.

As educators, we are used to being vulnerable.  We stand in front of crowds (and sometimes very big crowds) of humans and explain what we know.  We guide the ship, so to speak, and if we make mistakes, they are usually very public.  I have visceral memories of teaching my first classes at the college level, back when I thought all college professors were all-knowing geniuses.  I remember the horror and fear I felt that my students might find out that I was just trying to pretend to be an all-knowing genius.  I was terrified of the questions I couldn’t answer and hid my insecurities beneath a carefully crafted lecture that left little time for spontaneity.  After a couple years of teaching at the college level, NO ONE thought I was an all-knowing genius….so I could relax. And then I decided to start recording flipped lectures.

Recording video lectures requires a different kind of vulnerability, and it can be very intimidating.  It really is awkward to make videos of  yourself, for all the world to see.  I can still remember sitting in my office before recording my first video lecture in late August 2012, rehearsing my introduction for the 47th time and feeling like all I REALLY wanted to do was throw up.  I definitely found myself regretting the decision to dive into that cold flipping water. Pretty soon however, the semester was just a week away and I still had not recorded a single video lecture.  In the end, I just had to overcome the stage fright…and I probably did it for one reason: I had already told everybody I was going to flip my class and I needed the content ready to go…by tomorrow.

Now the truth is, I am a perfectionist.  I knew that I could easily spend a month working on each lecture, finding the perfect images, drawing the perfect visuals, linking to the perfect supplementary resources, and then embedding the perfect assessments.  But I as I ran out of time to make this happen, I had to accept the imperfections of the product and just get the job done.

After pulling together flipped lectures for three courses, I’ve definitely gotten better (and more comfortable) talking to myself in my office or my living room.  My skin is a little tougher too…I don’t shrink into the corner and hide when my students tell me that my right eye was twitching in last night’s lecture, or that my hair looked like I’d just gotten out of bed.  In fact, by the end of my first semester of flipping, I was so comfortable (or desperate?) that I actually recorded a flipped lecture in the Seattle airport. Topic?  The male reproductive system.  While this was one of the more popular lectures with my students, I still blush when I think about THAT one.

Buongiorno da Italia!

Salve i miei colleghi!

FLO_1635I am writing this post from Florence as Anatomia Italiana 2013 is near half way completed. HAPS members Ellen Arnestad, Dic Charge, Caryl Tickner, Cris Martin, Shery Medler, Kathy Tyner, Heidi Pearson, Mark Neilsen, and yours truly, have spent the last eight days in Rome and Florence. As many of you know, the ancient history, Renaissance art, and culinary experiences are overwhelming. But, the most unique aspect of our time in Italy has been our visits to venues important to the history of anatomy education.

In Rome we visited the National Museum of the Sanitary Arts in one of Europe’s oldest hospitals, Santo Spirito in Sassia. There we were greeted by Prof. Gaspare Baggieri who lectured about the role of that institution in early medical education and research. He also shared with us medical tools and alchemy instruments that dated back over 500 years. And today in Florence we visited the La Specola anatomical wax museum at the University of Florence, as well as the Basilica of Santo Spirito to see the crucifix Michelangelo carved at 17 in gratitude for access to corpses for dissection.

We look forward to our visits to the University of Bologna and the University of Padua where we will visit important anatomical wax museums as well as historic anatomy theaters. I will be sure to post a photo and a few words about those experiences.

Connecting art and science is integral to this experience, and many of us are discussing (over wine and pasta!) how we are going to enhance our classes by incorporating the concepts developed during Anatomia Italiana.

The exciting idea about all of this is that in 2014 HAPS members can participate in Anatomia Italiana and also enroll in a three-unit HAPS-I course. A month of online readings prior to the travel experience, followed by the submission of a teaching element after a visit to Italy is the essence of the course. If the 2014 HAPS-I Anatomia Italiana course is something you are considering, you can download the syllabus by clicking here. Details are also on the HAPS-I registration page, which can be visited by clicking here. The entire travel program can be reviewed at the Anatomia Italiana webpage. Keep in mind that it is also an option to travel with Anatomia Italiana and not enroll in the HAPS-I course.

FLO_1679My next post will be from Venice in a few days from now.

Buona giornata, e ci vediamo a presto,

Kevin Petti, Ph.D.
San Diego Miramar College

Summer Travels, part 1

0604 (2)
The car is loaded. The excitement is rising. Let’s go!

It’s nice to have the summer to travel. For the past few years, I’ve spent most of the summer break driving around the US, visiting family, friends, and points of interest. I can be a workaholic during the school year, so it’s good to get away and clear my mind for awhile. Recharging the gray matter for the new school year is invaluable.

I’ll load up the car in mid-May and head out for a few months. The first major destination is, of course, the annual HAPS conference. I get to spend a week with about 500 friends and colleagues, sharing ideas and stories. These can really get the creative juices flowing during the coming travels. From there, my travels aim towards family, friends, and some specific destinations. I’ll take my bicycle and golf clubs along, as well as my pub-hunting journal. Searching for brewpubs is a great way to find hidden gems in communities, such as bicycle and hiking trails, golf courses, local museums, and so forth.

HAPS 2013 Annual Conference in Las Vegas!
HAPS 2013 Annual Conference in Las Vegas!

I also try to find HAPSters along the way. It’s neat to spend times with HAPS colleagues away from the conference. Seeing them in their native environment is eye-opening into the minds of my colleagues and friends.

As an example, this summer’s conference was in Las Vegas, Nevada.  I attended a number of interesting seminars and workshops, had innumerable discussions with attendees about so many different topics, and networked with people in order to continue many of these discussions after the conference ended (see what you miss by not attending?). Serving as chief bartender in the President’s Suite for a week allowed me to converse with colleagues about a number of topics, both related to our work and not.  And as the current President-Elect, I am going to need that experience in the President’s Suite!

Chester (3)
Chester with casts just before the Achilles separation.

After the conference, I headed west to California, Oregon, and Washington. I drove through national parks, visited colleges, found a few brewpubs, and got in some good exercise. HAPS members Mark Bolke and John Martin – in Vancouver, Washington – say hi to everyone. In Seattle, I visited family, including Chester who just entered this world in March! Like me and his mother, Chester was born with club feet. It was fascinating to learn how treatment plans have progressed from when I was a little one. Surgeon Vincent Mosca is doing amazing work, including an Achilles’ tendon separation when Chester was only 12 weeks old! I was awe-struck to hear about the procedures and how well Chester is responding. Go, little guy!

At that point, I was only 2 weeks into the summer’s 10-week journey. In my next blog, I’ll share with you my adventures in Montana, Minnesota, and points beyond. May this summer allow your mind to wander.

Shadowing: Week 3

A cardiothoracic surgery to remove masses from the lung amazed me by not only the coordination of the surgeons, but their ability to use imaging and touch.  The patient was ventilated as needed for the doctors to reduce the size of the lung tissue to see around inside the chest.   Seeing the wounds closed with preloaded rows of staples was an “aha” moment for me.

Angiography of an aneurysm in a cerebral artery.  Source: Wikipedia.
Angiography of an aneurysm in a cerebral artery. Source: Wikipedia.

Wednesday morning: oncology.  The patient had previously had their cancerous gallbladder removed by laproscopy, but the margins came back still positive for cancer.  Today the surgeons had to open the patient to take out part of the liver.  A row of staples won’t work in this case.  Cautery, fibrin laced mesh and a tissue gel all helped seal the remaining organ.

Last shift of the week, Friday afternoon to evening.  The neurosurgeons had an aneurism to clip.  By the time I arrived the right temporal and meninges had already been reflected.  The angiogram was displayed on video screens in the operating room.  Doppler was used to “hear” if the clipped vessel was completely closed.   Before they closed the skull I noted to myself that the brain does not appear as impressive as its many functions truly are, and I don’t think I could be a neurosurgeon.  Not due to the physical talents necessary, but for the mental risks involved.

5- Recording Flipped Lectures

"When information and expertise are no longer scarce, teachers must offer a different experiencce in the classroom if students are to engage."

In the last post, I talked about the many different ways to flip a class.  When I decided to flip my classes, I spent a lot of time thinking about my student population and what form of the flip would work best for them.  My classes are filled with primarily non-traditional pre-nursing students who are usually returning to school and trying to balance several jobs, several kids, and several dramatic life events, all at the same time. I decided that they would benefit most if I actually kept the lecture delivery of new content, because it would help them organize and prioritize the massive quantities of information they would be expected to process and remember. This meant I had to find or create relatively interesting video lectures for my students to watch before coming to class.

I spent about three minutes looking for quality videos online that I could ask my students to watch.  I quickly decided that rather than spend any more time searching for the perfect FREE and OPEN resource (they don’t exist…yet…), it would be worth the time to make my own video lectures, which of course, would be perfect…right?

I decided to make the videos as personal as possible so I wouldn’t lose the powerful motivating effect that takes place when students personally engage with their instructor.  I also wanted the video lectures to be as much like my in-person lectures as possible. Finally, I wanted the ability to embed interactive assessments throughout the lectures, to help engage students and give them the chance to check their understanding.  (Note: I’ve been recording video lectures for a year and have yet to embed these assessments in the product.  Still looking for that 36 hour day…)

After a great deal of research followed by a healthy dose of trial and error, I decided to use Adobe Captivate to build the lectures.  I created video recordings that were essentially specially choreographed screen-captures.  I ended up using the following approach:

  1. I set up a webcam to capture ME as I delivered the lecture. I simply placed the webcam image in the top left corner of the screen.
  2. I put together an interactive outline/menu of the lecture and placed it in the bottom left corner. I highlighted where we were in the lecture, so students could keep track of the big picture. Each part of the outline was a separate mini-lecture, so students could skip around if they wanted, or review something particular.
  3. The rest of the screen functioned as my whiteboard/computer screen.  I have a tablet with a pen and I use that to draw pictures in Adobe Illustrator. Sometimes I put images in Illustrator and then I can draw on those too. Other times, I just show images in PowerPoint. I can even go online, as long as I ensure that the part of the website that I want visible is within the capture screen.

When I export the lectures, I end up with video files of each “part” that I put into a playlist on YouTube, a PDF file of the entire lecture that I throw in Dropbox, and a folder of files that I put in my LMS and link to from our course website.

It takes me 3-4 hours to record one lecture.  This includes the actual delivery of lecture material as well as all the detail work required to post the content online.  I could spend 30-40 hours recording one lecture…but I’ve vowed NOT to edit my videos.  In the next post, I’ll talk about some of the unique vulnerabilities you face when choosing to make videos of your lectures (especially if you don’t edit…)