Shadowing: Week 1

The most important thing I had to do before observing surgical shifts at the UC Davis Medical center was to get good shoes.  The recommendation by former interns: Dansko clogs.  The dress code for arriving is business casual, usually followed by a quick change into scrubs.

My first morning I shadowed a resident from the burn service.

English: Stevens-johnson-syndrome
English: Stevens-johnson-syndrome (Photo credit: Wikipedia)

Most of his patients were children seen across the street at Shriner’s hospital.  In clinic he checked on three boys: one with a dog bite, the next had Steven-Johnson syndrome (see pic) where skin is lost due to a drug interaction, a finally a burn.  The worst burn was in an adult from electricity.  The treatments are similar since all affected the integument.

Morning rounds with the vascular team were impressive.  Starting at 5:15am they raced like a pit crew from patient to patient, not only checking for changes overnight but replacing wound dressings.  A large number of their patients are diabetics, feet having the worst circulation.  In the afternoon they began an angiogram/stent of a carotid artery.  The patient was distressed but didn’t seem to understand her movements lengthened the process greatly.  I stayed late and heard the attending checking to see if she had suffered any brain damage…fortunately not.

Shadowing: Getting Started

My internship at UC Davis Med Center began immediately following our HAPS conference in Vegas.  So, while others were touring the Hoover Dam or the Grand Canyon, I had a daylong drive north.  For the three months I rented a room in walking distance, but it’s not a very good neighborhood for walking.

tahoepark-w2e
tahoepark-w2e (Photo credit: sc0ttbeardsley)

My first day was hospital orientation.  Fifty pre-meds needing badges for access to the medical center.  To pass inspection we needed a number of health documents.  I hadn’t seen proof of my own childhood immunizations so blood titers and boosters sufficed.  After paying $5 we were ready for a weekend long crash course in, of all things, human anatomy!

I must say I felt pretty comfortable hearing medical student summarize the systems.  The only new information was on taking patient histories and physical exams (neither of which we are allowed to do).  The fact that they stressed directional terms made me feel good about teaching it to my students.  And happy to say before my first shift in the med center I passed all of the quizzes at the required level of B or better.

I chose three shifts a week to start, the surgical specialties I’ll be shadowing are assigned.  The busiest shift during the week is 6am to 1pm, followed by the 1-7pm.  NIght shifts, 7pm to 2am usually only cover traumas or emergency medicine.  I’m sticking to weekdays for my first month.  Cross your phalanges for me!

HAPS and POGIL

Back on May 1st I wrote about professional development and today I would like to expand upon that post and talk to you little bit about the HAPS POGIL project. As some of you may recall one of the leaders of POGIL, Richard Moog, was an update speaker at the Las Vegas conference. HAPS member and newly elected Central Regional Director Murray Jensen of the University of Minnesota also presented several workshops and is facilitating a National Science Foundation grant to develop POGIL worksheets for anatomy and physiology. Once complete and approved as official POGIL worksheets they will be released to HAPS members for one year and then be archived in the APS archives.
This week me, Jon Jackson, Murray Jensen, and about 40 of Murray’s College in the Schools high school teachers have been working to develop more POGIL worksheets. We have been particularly focused on producing laboratory exercises.
There are a lot of exciting things that you can do with POGIL, including partially or completely flipping the classroom. Stay tuned for the release of the approved POGIL activities and development of more. Also if you would like to get involved you can contact myself at jlapres@hapsconnect.org or Murray Jensen at mjensen@hapsconnect.org.
As a reminder these worksheets will be free to HAPS members only. This is just another perk of membership in Human Anatomy and Physiology Society. Below is POGIL facilitator Laura Trout with her class. Laura was kind enough to come to the University of Minnesota this week to help us with POGIL.

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Anatomy and physiology education at Experimental Biology 2013

I am writing this latest blog while on a plane, returning home to Indiana. Like many other HAPS members, I also am a member in several of our sister societies. This past week, many HAPS members put on their American Association of Anatomists (AAA) or American Physiological Society (APS) ‘hats’ as we participated in Experimental Biology (EB) 2013. Experimental Biology is composed of multiple associations, and their yearly meeting typically is in April each year. Over 12,000 scientists and educators converge on a city and share the latest bench and educational research.

This year, the meeting was in Boston, scheduled to open the Saturday morning after the horrific bombing at the Boston marathon. Many were scheduled to arrive on Friday, the day the city was locked down as the suspects were involved in a shoot out with police. Thankfully, people were able to safely arrive (although most were sequestered in their hotel for the day) and the police were able to capture the suspect.

One of the neat things about EB is that you may attend any of the sessions offered by your or other affiliated societies. Thus, a AAA member may attend an APS session, an APS member may attend a Society of Nutrition symposium, and so on. There simply are too many interesting concurrent sessions to attend!

My focus was on the anatomy education sessions, where I listened to talks about incorporating anatomy in an integrated medical curriculum, the use of team based learning in anatomy, the flipped classroom, and more. I tweeted about the specifics of these sessions throughout the conference. (If you are interested in following me, my twitter handle is @vdoloughlin). In addition, my graduate students and I each presented posters on our anatomical education research. I was able to connect with colleagues, share ideas, and see a truly wonderful city that did not let an act of terror get the best of them.

While EB2013 was energizing and exciting, I am looking forward to going home, seeing my family, and finishing up the semester. And in less than one month’s time, I can’t wait to reconnect with my HAPS family in Las Vegas for our annual meeting! Will you be at this year’s HAPS Annual meeting? Please comment below and let me know!

“Adjust” Your Thinking

There is a debate as old as time in the medical community about the benefits and risks of chiropractic care. Some of the questions are based on the principles of chiropractic care, and some on the practices. Regardless, it is a polarizing topic, despite being the most widely used form of Complementary Alternative Medicine (CAM). 

Image

 I have been in and out of chiropractic care for almost half my life (I’m pushing 30!). What I believe is that the debate lies in the practice, not of chiropractic techniques themselves, but in the delivery of care. I have experienced 2 general types of chiropractors:

   1) Those that see several patients an hour, sometimes callously referred to as the “Rack and Crack” doctors, and

 2) Those that spend significant time (whatever is needed) with a patient one-on-one.

My first chiropractors, a married couple in my hometown, were the latter type, and I continue to travel 2 hours home to see them when I have any issues. Sadly, of all the cities I have lived in and all the chiropractors I have met throughout the years, I only encountered this style 2 more times, once in Arizona and once in my current town of residence. What this signals to me, sadly, is that this is not the most profitable form of care for chiropractors, since any treatments beyond spinal adjustment and traction, such as soft tissue, electric stimulation, ultrasound, and adjustments of other joints take time to perform. My hometown chiropractors place a great deal of emphasis on nutrition, exercise, stress management, and medication-free living. They also stressed returning when it was needed, on a case-by-case basis. It is easy to understand why, at a young age, I developed such a positive view of chiropractic care.

The high-volume chiropractor will see several patients an hour in an open-room setting, which may eliminate a sense of privacy and one-on-one attention from a health care provider. These chiropractors will almost always take X-rays of your spine (which I’ve found are never normal despite the presence or absence of pain) then insist you sign up for a minimum of 25 adjustment appointments, sometimes paid in advance. This is one of the most common criticisms of chiropractors – that patients end up relying on coming regularly to feel well. I am sure countless people have been relieved of their pain and dysfunction with this model, but it is easy to see where the may controversy arise when comparing these 2 styles.

If you are considering chiropractic care for ANY musculoskeletal condition, consider asking a few questions about their style of care. Do they see patients one-on-one in private rooms? Do they see patients as needed, or do they emphasize X amount of visits? If you have a simple to treat condition, this question may be less important, but it is certainly worth asking. Personally, I never see a new medical doctor without reading every review on health grades I can find. Practitioners of complementary medicine should be held to the same standards. 

Best of health to you!

Krista

 

Building homes and partnerships with Medical Sciences and the community

Who let this person have a hammer?
Who let this person have a hammer?

Anatomy and physiology courses offer wonderful opportunities for service learning. Our students may volunteer at local health clinics and hospitals, they may organize health fairs for school children, and/or they may visit individuals in hospices and retirement homes. These service learning ventures often are organized by the professors and it is the students who are the primary volunteers, but this is not always the case. Our medical students at IU frequently initiate and organize their own community engagement ventures. And recently, one such venture solicited both student AND faculty volunteers to work together.

halfway done with the siding!
halfway done with the siding!

This venture was a Habitat for Humanity build. Our first year class representative (Bryce) was active with Habitat for Humanity in the past, and he arranged a Medical Sciences ‘build’ day where both medical students and faculty could participate. Bryce took it upon himself to solicit volunteers, prepare the work schedule, and liaison with the local Habitat for Humanity chapter to set up a good date and site. I’ve always been impressed with Habitat’s work, and I jumped at the chance to participate in a build. In addition, I was looking forward to working with my students and colleagues in a non-classroom setting.

The morning started out chilly and many of us were a little sleepy, but we were excited to begin work.  We began the morning with learning a bit about our tasks (either putting up vinyl siding on two homes or doing the indoor painting) and we met the families who would live in these homes, as they worked beside us.  We learned about the ‘sweat equity’ these families had to earn (by working on other families’ homes first) before they could build a home of their own.  And we met the wonderful coordinators and leaders of the local Habitat chapter.

Many of us had never put up siding before, but we quickly learned, thanks to the guidance provided by Bryce.  Slowly but surely,

from none to done in a day!
from none to done in a day!

the back of one house (which had no siding in the morning) was completely covered with siding by the day’s end.  This was a remarkable feat for us, especially considering we made some mistakes and had to remove some of our work and start over again.  Students and faculty worked as a team towards a common goal.  So the team wasn’t in the hospital room or O.R. – but the team building was incredibly valuable.   And in a single day, we had a tangible product to show for our hard work.

I personally viewed this opportunity as a way that I could help some others in our community.   What I did not expect was how this opportunity helped strengthen the relationships I had with my students and colleagues, and how much *I* learned from this whole venture.

IU School of Medicine Habitat volunteers - a job well done!
IU School of Medicine Habitat volunteers – a job well done!

So I challenge all of you to think ‘outside the box’ when it comes to service learning ventures with your A&P students.  Don’t feel that the community engagement must occur in a health care setting, just because we teach anatomy and physiology.  Perhaps your local animal shelter needs some volunteers to help exercise the animals, or perhaps the local Boys and Girls club would like a group of students and faculty to simply play some board games with their kids.  In the end, we strengthen our relationships with the community and all of us learn to work as a team – and isn’t that what we want our future health care professionals to know?

Hello HAPSters!

Complementary medicineHello HAPS community!

Allow me to introduce myself. My name is Krista Rompolski, and I’m addicted to Anatomy and Physiology (just kidding). I am a first year professor at Drexel University in Philadelphia, PA and am currently starting my third semester of teaching A&P to freshman nursing students. I was introduced to HAPS via a thrilling email from the chair of my department. He asked if I would like to go to Las Vegas for a week in May (he could have stopped there) to attend the Human Anatomy and Physiology society annual conference. Since registering, I’ve grown increasingly excited about the potential of HAPS to reach teachers of A&P, Pathophysiology and other health related courses at all levels of teaching. I am grateful to have a community to bounce ideas off of, share research, and an overall appreciation and fascination for the glorious machine that is the human body.

What has interested me most in my years of studying, teaching and simply living is the potential for disturbance or disease to develop, and how resilient the body is in the presence of chaos. What is even more fascinating is the countless approaches to treating the same conditions, whether chronic pain, infection, injury, or terminal diseases. I have spent a great deal of time exploring and taking personal advantage of alternative medicine at times in my life when I felt conventional/allopathic medicine was leading me nowhere, or at times to even poorer outcomes. There seems to be a great divide in the medical community over the benefits of alternative/complementary medicine versus risks, with some physicians adamantly skeptical or even opposed to alternative treatments, while others may even integrate them into their own practices. Patients are finding it increasingly difficult to know where to go for help and who to trust, since physicians are often under severe time constraints to truly listen to their patients or keep up to date on clinical research findings (which are susceptible to selective reporting).

My goal for this blog series is to share my experiences with complementary medicine, some of which I have been a long-time customer, and others that are new to me. I will share as much detail as I can about the theories behind these treatments so that you can form your own opinions about their potential benefits versus risks in physiology. I will do my best to present non-biased information, with as clear scientific explanations as possible.

I hope you all enjoy the journey, and learn a few things along the way!

Krista

Ultrasound in Human Anatomy and Physiology Education

This past weekend was the first Conference on Ultrasound in Human Anatomy and Physiology Education. As President elect of HAPS, I was invited to participate in a panel session during the conference. Not sure of what exactly to expect, I traveled to Columbia, SC for this inaugural conference.  I was excited to learn of the possibilities of incorporating ultrasound, but my initial ‘gut’ reaction was that I wouldn’t be able to do too much, since I was not a physician trained in the field.  Boy was I wrong!

20130322_170243_resized
John Waters and I (in matching colors) practice visualizing the common carotid artery and internal jugular vein on a very patient USC medical student.

The first day of the two day conference began with some very informative talks about how various medical schools incorporated ultrasound into their medical school curricula.  Among the key points:  a) implement in increments (don’t try to set up an entirely new program all at once), b) make sure you assess the students in ultrasound (and don’t just have it as a ‘neato cool toy’ that you never incorporate in exams or other assessments) and c) it isn’t as difficult to use ultrasound as you would think!  My response to C initially was “Yeah, right”.  I already teach an upper level course entitled Human Anatomy for Medical Imaging, and we do examine ultrasound images in that course.  However, I always relied on a skilled ultrasound tech to do ultrasound demonstrations for me, as I had no idea how to even turn on the machine.

Well, boy was I wrong about the difficulty in doing ultrasound demonstrations myself!  Don’t get me wrong – being a skilled practitioner of ultrasound takes a LOT of work and training.  But I was not aspiring to the level of skilled practitioner.  Rather, I became the ‘enthusiastic novice with gross anatomy knowledge’ who was able to pinpoint where major organs were and pick out basic differences between various tissues.  With the help of many 1st year medical students from University of South Carolina, I and the other conference participants were able to visualize the common carotid artery and internal jugular vein, determine the difference between the thyroid gland and thyroid cartilage, examine cartilaginous and tendinous structures of the knee joint, visualize the kidneys, spleen, liver, and of course, the heart.  Sure, there were times that we were nowhere close to accurately visualizing a particular structure – but with some guidance, we soon learned the basics of the ultrasound machine and some of the tips and tricks to getting a good image.   I jumped in and started using the machine on myself – I learned my gallbladder still appears to be ok, my common carotid doesn’t have any major evidence of atherosclerosis, and my creaky right knee still has some cartilage left. 🙂

Sonogram simulators – the best of ultrasound and a simulated patient, wrapped up in one!

John Waters (fellow HAPS member) and I quickly thought of possibilities of using ultrasound in the undergraduate A&P classes.  It would be very easy to demonstrate key features on the undergraduates and get them excited about visualizing structures in themselves.  Whereas prior to the conference, I would not have considered using ultrasound in my intro level human anatomy class, now I was brimming with excitement about the possibilities.

“But what about the cost?” you may ask.  That can be a sticking point.  Diagnostic-level ultrasound machines can cost 5 or even six digits – well out of range of most undergraduate institutions!  But educators in intro classes do not need the ‘best and the brightest’ of ultrasound machines – they need a basic machine that can provide a decent image and is relatively easy to use. Several ultrasound manufacturers are exploring educational partnerships, and are in the process of developing lower-end machines that wouldn’t cost very much for the educator.  There may be the possibilities of grant monies to fund these ventures. As local hospitals upgrade their ultrasound equipment, there may be the possibility of your institution being able to purchase the hospital’s older machines.  Think outside the box when it comes to funding this venture.

For those of you attending the HAPS conference in Las Vegas this May, you’ll have a chance to see a workshop about incorporating ultrasound in the undergraduate classroom.  I hope you will find this concept as interesting as I did!

Reason # 547 Why I Love to Teach

HAPS members are individuals who are committed to teaching and want to inspire a love of the subject matter in their students.  Teaching is not easy, and there are times when aspects of the job can drag us down.  And then there are the times that reinforce our commitment to the discipline, and remind us why we decided to become A&P teachers in the first place.   Last Thursday was one of those times for me.   It was my last day of teaching medical Gross Anatomy for the semester.  Right as class was to begin, one student stood up and started reciting the following Ode.  Another student stood up and took turns with the recitation.  Turns out that each student wrote a portion of the ode in the form of a haiku, and it related in some aspect to anatomy, or specific class, or our humorous discussions during lab dissections.  The writing is both humorous and touching, and it is a memory I will never forget.  Thank you, Class of 2016!  Below is the  (G-rated/edited) version of the ode:

Odes to Our Gal Val

A Truly Motivating

And inspiring prof

 

Odes inspired by

Our leader on this Journey

Of Anatomy

Embryology

How worthless you are to me

F&#% F#*% F#%*#$ F#%*#$ F#$*% 

 

Our overflowing

lacrimal fluid, floods our

nasal cavity

  

Pick my pimply face

Kenny Loggins’ Danger Zone

Thrombophlebitis

 

 Winwood so bellows

with a guttural roar from

deep in the pharynx

 

 Fore!

 

Henry Gray’s wisdom

You taught me, what to avoid

Pick a zit and die

 

Five

 

Insidious Loops

And, convoluted pathways

Just to work some glands

 

 Like Cincinnatus,

Your willing accomplices

We absently learn

 

While painting pictures

Mind’s eye wanders to Flesh, Bone

One grows, accustomed.

 

 Here’s a scary thought

Without it I’m one ball short (LANCE)

gubernaculum

 

 To be so rigid

surely a covering you are

a very tough mother

 

 Moist muscular walls

Between, like kids in the hall

food slides down the gut

 (get your head outta the gutter)

 File:Circle of Willis en.svg

I hear “katydids”

When you explain flow to brain

Tell Willis he’s bugged

 

 Sir Fickle’s Fast, yeah?

So many layers to know

Another way to die

 

 In and out I slide

Sometimes deviating left

With nerve XII damage

 

 Fingers in my nose

Epistaxis ain’t so bad

I can’t stop, won’t stop

 

Arytenoid muscles

Contract, I whisper to thee

My perineum

  

The periphery

Only canthi, can’t thee see

See me, mon ami

 

 Presbyopia

You’re only twenty-seven

Between you eight eyes

 

 Val loves Family Guy

Oculomotor breaks, Now

she watches the floor

 

Cranial nerve one

Soiled socks smell like lilacs

Schizophrenia

 

Without you I think

Its better to not existFile:Crying-girl.jpg

Lacrimal secrete

 

 We try to find nerves

A tireless search, finding only

Abominations

 

Valerie is nice

Thanks for answering questions

outside of class time

 

 Alien in me

Moves with my every word

No talking for me

 

 Pupil dilation

Melatonin on the rise

Go the f*#$ to sleep