Archive | August, 2013

It’s Been a Busy Week

29 Aug

It’s been a busy week. We are all so busy, I’ll keep this brief. But it is never too busy to learn anatomy. Some do so in interesting ways. Check this out Anatomy Model

10- Professional Development

25 Aug
Brain activity during a day in the life of a student...

Class and watching TV…what do they have in common? Minimal brain activity!

I was very lucky to attend a talk by MIT physics professor Eric Mazur last week at Humboldt State University’s Institute for Student Success.  While Mazur never once uttered the word “flip”, he clearly was advocating an inverted classroom model like we’ve been discussing here on this blog.  He used technical terms to describe the two stages of the flip: transfer (in which information is acquired outside of class) and assimilation (in which information is processed during class time).

Mazur also offered a compelling visual to support the idea that students can be quite inert during “lecture”.  This figure was taken from a paper entitled “A Wearable Sensor for Unobtrusive, Long-term Assessment of Electrodermal Activity” (doi: 10.1109/TBME.2009.2038487).  It provides a very interesting visual regarding brain activity during “class”.

Image from

A week of student electrodermal activity. Compare the brain activity recorded during TV time and lecture…does this disturb anyone else?

I am also including some of the different resources Mazur mentioned throughout the talk.  I’m lobbying for more hours in the day so I can explore them more fully.  I would be interested in hearing your opinions, if you have experiences with them.

  1. Peer Instruction Network
    This site describes itself as a place that “connects innovative educators from across the globe.”  I am intrigued by the possibility of SHARING materials with other interested educators.  As Murray Jensen noted in the comments to last week’s post, it takes time to develop the activities to use during class.  It would be very valuable to have a place where sharing (and vetting) could occur.
  2. Peer Instruction Blog
    It looks like during the school year, these guys publish a post about every two weeks.  The content is pretty straight forward, and I find it interesting to follow.
  3. Just In Time Teaching
    Mazur referred often to this technique, which makes use of assessment data gathered before class to inform WHAT HAPPENS during class time. 
  4. Team-Based Learning
    I’ve always been intrigued by increasing the amount of group work that happens in my class. 

My classes start this week, so of course I’m madly putting materials together to get ready.   I love this time of year…but it is definitely BUSY.  That is why I have absolutely NO IDEA what I’m going to write about next week!

Shadowing Trauma Surgeons

23 Aug

My last week in Sacramento, in addition to trying to pack and get everything back in my car, I was sent follow a resident in the Emergency Department.  This service is especially difficult because its patients range from the mentally agitated to those in car accidents.  While the interns may only have to cut away clothing, someone must be ready to open the patient.  The cases I saw, in quick succession, give a hint of the diversity one resident had to deal with the same evening.DSCN2512

Case number one: an adult male, previously treated for injuries sustained when he fell of his bicycle a week earlier.  Had been sent home with broken ribs.  Difficulty breathing brought him back.  Imaging showed a light region where the lung should be.  He had developed a hemopneumothorax.  Blood and air needed to be removed, if not successfully in the ER then by a surgeon.  Under local anesthetic an incision was made and the whisper or air was followed by gurgling blood.  He was sent home with a chest tube.

Case two: teenage girl on bike hit by car.  Imaging shows no internal injury but a large wound to her left thigh needed debridement and dressing.

Case three: 20 month old boy bitten around the right eye by pit bull.  No one saw the attack.  The mother carried the screaming child in.  Once calmed by medication, images were taken to look for fractures to the skull and facial bones.  The wounds were deep punctures, probably needing eventual cosmetic repair.

Case four: adult male with continuous abdominal pain since previous evening’s meal.  All symptoms point to blocked gallbladder…he was the only one scheduled for surgery.

Every case gave me a little more knowledge about some system in the body which I’ll now be able to weave into my anatomy lectures.  Classes start next Monday so my summer of shadowing is over.  If you ever get a similar opportunity, I encourage you to take it…but not if it involves renting an un-airconditioned room in Sacramento for the summer!  Teri

Where Did the Summer Go?

21 Aug
(photo credit: U.S. Air Force photo by Larry McTighe; from Wikimedia Commons)

(photo credit: U.S. Air Force photo by Larry McTighe; from Wikimedia Commons)

I feel like I’m in one of those sports-car ads: Goes 0 to 60 in blah blah seconds.

I did not teach this summer. For the past three years our district in San Diego has not offered summer science classes due to budget cuts. In the past, I didn’t mind not working over the summer as my daughter was young and it made it easier with her being off from school. But this summer, now with a teenage daughter who has chosen to sleep her summer away, it would have been nice to keep my brain a little more active, as I feel that I am either in the beginning stages of early AD (just kidding, my sense of smell is just fine), or have this un-located lesion between my brain and my mouth (also probably not true, but if it were, I trust that my fellow HAPsters would direct me as to the most likely anatomical/physiological place to locate it), as I try and construct meaningful sentences and feel like, after being home “relaxing” for so long, I sound like those guys from the Jersey Shore. (No offense to my friends from NJ).

I did not do much traveling this summer. Well, I did go to the HAPS annual conference in Las Vegas, and as usual, had a great time with my fellow HAPSters. I learned some  new things from the update speakers, and really learned some great things from the workshops. Came back totally motivated to try some new activities in my classes and incorporate some new information, but then… summer set in. Sometimes I wish the annual conferences were at the end of summer, so I can get motivated and then dive right in to a new semester of teaching and immediately implement all of the great things I learned. Right now, I’m honestly struggling to remember what I was so excited about. Time to break out those notes I took.

Yes, I did get a chance to cross off some little projects on my to-do list, modifying some lab activities, updating some lectures, but not as much as one would think with so much time on my hands.

So, after not teaching this summer and spending a rather quiet and low key two months at home, I find myself now at the precipice of a new fall semester. Three full days of meetings, emailing new students, updating my website, a HAPS Board of Director’s conference call using new video conferencing (thank goodness for teenage daughters), oh, and I have to write a blog as the Western Regional Director…

And we’re off!

I both love and dread the first week of classes. And hopefully that disconnect between my brain and my mouth heals itself… umm… quickly, yeah, that’s the word.

9- Attendance

18 Aug
Rembrandt's "The Anatomy Lecture of Dr. Nicolaes Tulp"

Maybe students would show up if “lectures” were always like this!

Concerns about student attendance is one of the arguments I’ve heard against flipping.  Why would students bother coming to class if they can get all the content on their own time?  Unfortunately, my lecture attendance did drop in my flipped classes.  Of course, I can’t be sure that attendance decreased solely because of the flip.  Maybe “life happened” more often to students in my flipped classes?  But I don’t think this is the case.  I think that when “life happened” to students in the flipped classes, they were more likely to decide they’d already gotten the content when they watched the video lecture, so attending class simply slipped  to a lower priority.  They assumed that as long as they completed the content acquisition portion of the flip, they had all the tools they needed to succeed in the class.  But these students were missing the part of the flip that moves BEYOND a simple online course.  The flip takes advantage of many benefits of online education (self-pacing, differentiated instruction and scheduling flexibility) but then it ADDS a component (active learning during class time with the benefit of instructor feedback) that makes it BETTER (in my opinion) than either modality by itself.

In the process of brainstorming ways to deal with these attendance issues, I began with this: I must actively demonstrate the value of participating in the activities we do during class time.

So this semester, I will assign a relatively small number of points (5% of the course grade) for in-class clicker activities, which I’m hoping will be meaningful and relatively hassle-free.  I will give students two free passes to accommodate when “life happens”, and will probably offer bonus points for students who do not use the freebies.  They will know the menial consequences of missing class and will see that I value their participation enough to reward them with points.  Couple this with some direct coaching and encouragement, and I think I will have a different experience with lecture attendance. I look forward to relaying any changes I see based on these adjustments.

Next week I will report on a talk I am attending at Humboldt State University’s Institute of Student Success.  The talk will be given by Eric Mazur, a physicist from Harvard who authoritatively advocates lecture-avoidance and provided powerful inspiration for my original decision to flip my class.

Out of the Country with A&P on the Mind – Part 2

14 Aug

As a continuation of my blog from Aug. 7, below are some additional observations from my recent trip to France.  The emphasis of the trip was on architecture and landscaping, but of course my mind wandered to A&P in a humorous way.

Touring the Chateau Fontainebleau, I noticed this statue with 5 breasts.  She is obviously well-suited for multiple births, but think of all the prolactin and oxytocin needed to get things going!


Among the modern art seen at the Centre Pompidou was this painting – a large skull with rope tied around it, displayed in a huge tiled box.  I’m trying to understand the symbolism. Perhaps this is the skull of a former bar hopper who “tied one on” too many times?


In the gardens at Versailles, there was a special series of stone exhibits called “Anatomie.”  One of the sculptures is shown here.  What do you think?  Is it a kidney with a ureter coming out?  I guess this is why I majored in science and not in art.


In a bookstore window I saw this paperback.  The title is translated as “Man Explained to Women.”  I’m guessing it is more than just anatomy.


I’ll end by mentioning “chocolat” – French hot chocolate.  In France, you can get chocolat at any bistro, restaurant or bar, any time night or day – which is awesome for chocoholics like myself.  On my return to the USA, I was thrilled to learn of the exciting research from Harvard Medical School ( documenting improved blood flow to the brain as a result of drinking hot chocolate (done with older subjects, but I’m certain it must work for everyone).

I lost count of how many cups of “chocolat” I had in one week (the blood flow in my brain was incredible), but I want to give a shout out to the location where I had the best chocolat in Paris.  That would be the café in the Musee d’Orsay – a former train station that now houses an amazing collection of impressionist art.  My new motto for Musee d’Orsay is “You’ll come for the art, but you’ll stay for the chocolat!”


Main hall of Musée D’Orsay & a cup of thick, rich chocolat

Enjoy the rest of the summer and best wishes heading into the fall semester.  Always keep your students smiling as they learn.

Shadowing Surgical Oncology

13 Aug

Of all of the medical specialties I knew I’d be seeing, I’ve had the most history with cancer.  The first operation I ever learned of was my mother’s mastectomy.  She much later was treated for bone cancer.  My father and I have had skin cancers removed.  So the idea of seeing a patient under the knife was both interesting and hard to dissociate from.

The first major cancer operation I observed was one of the longest.  A soft tissue cancer near the chin had invaded the mandible.  A team of surgeons from both Oncology and ENT worked in shifts.  First they cancer was removed, then the jaw was rebuilt and the neck closed.  The most frightening part was that while the surface tissue looked different, to my untrained eyes, I could not fathom how they knew when to stop cutting.  Leaving stray cancer cells behind after a surgery of this length would be horrifying.  They of course can follow up with chemotherapy or radiation, but the tissues heal more slowly in those cases.

A much more common and shorter surgery is the one my mother had so long ago.  A total mastectomy.  Not as a pre-emptive strike before cancer, but to remove one that has been found.  Working with plastic surgeons the breast can be reconstructed, but not until after the initial wound heals and if necessary extra skin is stretched by an implant.  During the mastectomies I witnessed, it was hard not to think of my mom or my own potential risk.  I’m glad to know that there are both medical doctors and specialized surgeons training to fight this insidious disease.


Mastectomie (Photo credit: Wikipedia)

8- DO Something!

12 Aug

Figuring out how to motivate students to come to class prepared is the first half of a successful flip.  Figuring out how to keep them motivated by providing meaningful activities during class time is the second half of the challenge.

Image of weightlifters and coaches from

Doing something during class besides lecture takes practice. But the more we practice, the better we get! (Image source: Wikimedia Commons)

Perhaps one of the biggest disadvantages of asynchronous content delivery is the fact that students cannot interact with me as I explain things.  This is tough for some students.  In an attempt to address this, I usually start every day by asking students to write their questions on the board as they file into class.  I then survey their questions, organize them into groups (though wouldn’t it be cool if THEY did that task!?), and make a quick plan to ensure we spend some time on each question. I am going to explore the use of an online discussion board this semester to try and facilitate greater participation in this activity, because it was usually the same people who were always brave enough to write their questions on the board.

I found that attending my first HAPS annual conference in Las Vegas in May provided a hearty dose of inspiration toward improving my performance with the in class activities.  Here is a list of some of the things I’m looking forward to DOING during class time in the fall.

  1. Case studies
    I attended three different workshops on the use of case studies while in Las Vegas in May. Cherie McKeever from Great Falls College in Montana made the creation of case studies look a lot easier (and more fun!) than I’d thought it would be.
  2. POGIL
    I am eagerly anticipating the unveiling of the set of POGIL activities for A&P, as these inquiry-based activities will be an amazing way to spend “lecture” time.
  3. Practice quiz questions
    I will be using clickers for the first time this semester and am excited for the game-like (and publicly anonymous) atmosphere they will facilitate.
  4. Performances!
    While this was one of my favorite things to do with the class time (“BE a muscle contraction!”), it wasn’t the most popular thing.  Of course, some of my students loved getting active and creative. Others dreaded the activities, and made sure I knew it.

On most days, I did not have a clear idea of what I was going to do with the lecture hour.  I don’t think this is ideal.  However, I became rather adept at coming up with questions and challenges and tasks on the fly.  I tried to create a variety of experiences so students wouldn’t get bored, though I often worried that they might decide I was wasting their time and stop attending class all together.  In the next post, I will talk about how the flip affected lecture attendance.

Out of the country with A&P on the mind – Part 1

7 Aug

As of July 1, I began my term as the new HAPS secretary.  However, summer is slow for board meetings, so I found alternate ways to practice my skills at observing and recording details.

I just returned from a trip to France organized by the architecture department of my college.  While observing buildings and landscaping as a non-credit student, I couldn’t help but see some things through the lens of an A&P professor. I hope you will enjoy the humor and can perhaps even use some of it in your A&P courses in the coming year.

First, at the Musée du Louvre I was struck by a sign at the entrance to one of the men’s rooms.   The green part of the sign was normally posted by itself, indicating the way to an emergency exit.  However, this one was unusual in being paired with the men’s room logo.   One of the other travelers in our group was an MD, and the two of us joked that the white sign was for men with normal GU tracts, while the green sign was for men with BPH.


BPH …………………. Normal

At the Château de Chambord, I saw a modern “defibrillateur” mounted on the old stone wall. What a contrast in time periods!  Then I noticed the fire extinguisher below the defibrillator.  While the extinguisher itself was not remarkable, the sign next to it was.  Looking at the formula for French water, I could understand why flames are shown coming from the extinguisher itself.  The water in France obviously has a lot more hydrogen in it than our water does!


The controlled electrical output from a defibrillator is one thing, but uncontrolled shock is another.  To avoid this situation in the Paris Metro, there were beaucoup warnings not to touch anything electrical.  The sign below seen in one Metro station was enough to make me toe the line.


Finally, on a serious note and as an indication of the economy and the day-to-day reality in Paris, the following sign was seen by a hospital near Notre Dame Cathedral.  It was in English, obviously to make the point to visitors as well as Parisians.


To be continued …

Shadowing: Vascular Surgery

6 Aug

Just blood vessels?  It struck me as too narrow a field to specialize in.  Not as glorious as Cardiothoracic.  But now that I have seen them in action, the vascular surgeons are some of my most admired.  They deal with some of the sickest patients, for the longest times, and unfortunately for many there is no cure…only help.  Here are the three stages of help I’ve seen these surgeons provide.

First, the rarer problem I watched repaired.  With no symptoms, only caught by luck on images for something else (yet can run in families so people may have forewarning).  An aortic aneurysm that ruptures is lethal, usually even in a hospital setting.  So, if one is found they are watched for changes in size.  The surgery is risky enough not to go in prematurely.  Endovascular surgery allows only puncture wounds in the groin to deploy elaborate stents, but the open surgery is still the standard.

Example of a Stent used in an Endovascular ane...

Example of a Stent used in an Endovascular aneurysm repair (Photo credit: Wikipedia)

Similar stents can be used in the all too common arterial blockages.  Whether anatomical anomaly or the build up of plaque in walls, ballooning the vessel is least invasive, and stenting it a secondary option.  We all have at least fatty streaks in our vessels, said one of the surgeons, but hopefully they are not causing ischemia in out tissues.  The original surgery (I’ve not observed) to remove the atherosclerotic region especially of carotid arteries is an arterectomy.  The area is bypassed, opened, the lining stripped away, and the vessel patched back up.  Because it has not foreign material added, the vessel heals itself relatively well but the surgery is much harder on the patient than femoral access for newer methods.

Finally, the sad result of the tissue ischemia.  Due to the vessel injuries by diabetes, many will develop neuropathy.  The most distal tissues have the longest paths so blood resistance is highest to the feet.  When blockages in the lower limbs occur, muscle and skin of toes often die leading to gangrene.  The saddest day of surgery I observed was when a whole shift was scheduled for amputations.  However, the doctor gave me this  bit of encouragement.  The sooner he removes a small dead area (single toe at best), the faster the patient is able to get back to their lives.

English: Vascular of the toes with the charact...

English: Vascular of the toes with the characteristic . (Photo credit: Wikipedia)