Examples of Physician Assistant/Associate
Rigorous Medical Trainning &
Curriculum
Cadaver
Lab
Curriculum
Sample
Death
and Healing:
First 'patients' teach students
about medicine, compassion in cadaver lab
By Julie Marshall, Camera Staff
Writer
November 17, 2002
The first cut of gross anatomy wasn't easy for
Ivvanee Martinez.
Her cadaver lay on a stainless steel table, its
head and hands wrapped in gauze. Like other medical students in the anatomy
lab, she had to take a striker saw — a vibrating, pie-shaped blade sharp
enough to remove bone — and expose the spinal cord.
"I was grossed-out at first," says Martinez, a
first-year student at the University of Colorado School of Medicine. "I
saw bone shards and I could smell fat." |
photo by:Mark Leffingwell |
Anatomy lab, also known as cadaver lab, has long
been a rite of passage for those committed to a life of healing. In the
early 1800s, medical faculty first began lobbying for legal, as well as
social, recognition of the need for human dissection to further surgical
knowledge. By the 1900s, the cadaver lab became a fixture in the medical
school curriculum.
Today, dissecting cadavers remains an integral
tool for students who must master the names and relations of bones, muscles,
vessels, nerves and organs. Nothing else, not a box of plastic bones or
a textbook will serve the way a formerly living human body will, anatomy
professors say.
For the majority of civilians who never have the
privilege, lab work may seem at best a mystery; at worst someone's sick
idea of academia.
"In any other setting, we would be Jeffrey Dahmer,"
Martinez says.
Students face a naked body, slightly bloated from
preserving fluids and gray in pallor. With gloved fingers, young scientists
disconnect their cadaver's major organs. Flesh is stripped from the bones
to gain entry to intricate muscles and nerves for detailed study.
The complexity of the human body, however, is
no match for a spiraling web of emotions triggered by the subject matter.
Gross anatomy is fraught with fear, wonder, awe and horror, students say,
whether their peers admit it or not.
The inherently antagonistic relationship between
emotionally detached scholarship — having to memorize an ungodly amount
of material in a short time — and the sights, smells and psychological
impact of dissecting a human body, can take a toll. A few students over
the years have quit, says Michael Carry, director of the lab for medical
and dental students.
Traditionally, medical students learned to cope
with human dissection by adopting a cool, emotionally distant attitude,
physicians say. Urban legends abound of students playing practical jokes
with body parts.
But today's generation of medical students are
studying in a different social climate. CU follows a relatively new, national
trend among medical schools to purposefully integrate both scientific and
psychosocial values into the medical curriculum, particularly the anatomy
lab.
In simpler words, professors want to produce not
only doctors with skillful hands, but doctors with a sense of humanity.
And respect for a cadaver on the table helps teach compassion for living
patients in the office, ethics professors say.
At CU, medical students take part in a two-hour
ethics seminar in the second week of gross anatomy, a course co-developed
by psychiatrist Richard Martinez and university chaplain Julie Swaney.
Students are encouraged to talk about their emotions, their spirituality
and even write a letter to their cadaver if they like.
"There are always some students who think it's
silly, like group therapy," says Richard Martinez, who works in CU's Center
for Bioethics and Humanities.
The majority of medical students, however, seem
to appreciate it, based on his post-seminar evaluations.
Even before the course in ethics existed, however,
students were surprising their professors by performing small acts of respect.
They named their cadavers; some prayed. Carry once saw a student shake
his cadaver's hand each time he stood over the table.
Every spring for several years, students at CU
have been inspired to organize a memorial service for surviving families
of their donors.
Ivvanee Martinez looks forward to the service.
"I would like to meet the family," she says. "It
would be interesting to get to know a little bit about this woman."
Cadaver lab
On a Friday afternoon in early October, medical
students dressed in green and blue scrubs briskly walk down a labyrinth
of narrow hallways on the fourth floor of the medical school building in
Denver.
A pungent smell permeates the lab inside locked,
double doors. People assume it's formaldehyde, but that's not the worst
odor in the lab, Carry says. The really awful stench comes from the lipids
or fats breaking down. And then there's other chemicals with potent smells,
such as the antiseptic phenol.
After a full month of working in the lab, the
smell is still an issue for the students, who say it stays in their hair
and in their clothes, which must be washed separately to avoid contaminating
their entire closet.
At 1 p.m., the lab is abuzz with the excited,
chatty talk of students about to dissect the most vital organ known to
inspire lovers and poets — the heart.
They gather in threes around each table, which
is equipped with an overhead light and a bookstand with a copy of "Grant's
Dissector." In four hours, students will detach their cadaver's heart from
its eight great vessels (two arteries, two caval veins, four pulmonary
veins) and learn the inner workings of an organ that can beat for 100 years.
"It's easy to become detached and not stop and
think that the cadaver you are dissecting was a person not too many months
ago," says Carry, who walks around the room in a doctor's white coat, willing
to assist.
Students begin by opening the pericardium, a tough
and fibrous sac that encloses the heart.
Today is a good lesson for James Cromie, who is
thinking about specializing in cardio-thoracic surgery. His cadaver, No.
7227, is a 95-year-old female.
Students know very little of their cadavers, just
a number, age and possible cause of death. But throughout the lab, students
will gain intimate details of their cadaver's life using a scalpel, scissors
and forceps.
No. 7229, for instance, was a smoker. One of the
56-year-old cadaver's dissected lungs, charcoal-gray in color, is stored
in a large plastic bag near his body. Its dry, wrinkled membrane looks
like a deflated balloon — a pocket in which air was trapped led to his
death from emphysema.
A normal, healthy lung from a 39-year-old cadaver
in the same room is pink, taut and heavy, like a wet sponge. Its membrane
is as it should be — a thin, translucent sac that cannot be separated from
the lung.
Many of the older cadavers, like No. 7227, reveal
a orthopedic surgeon's handiwork, such as a hip replacement. One cadaver's
heart bears the sutures of a triple bypass.
Cromie's cadaver has long fingernails with chipped,
rose-colored polish. She likely died of pneumonia and had Alzheimer's.
Facing the body was hard at first, Cromie says,
because he recently lost his 93-year-old grandmother.
"It brought up a lot of emotional things and made
me think a lot about the kind of lives these people led, and about the
people missing them," he says.
Once No. 7227's heart is removed, Cromie watches
as one of his colleagues gently opens the fist-sized organ. Inside are
stark white, spongy, web-like papillary muscles.
"These people wanted us to understand them in
a way no one else has had an opportunity," Cromie says. "It is a really
unique experience, almost a forbidden reality.
"This is truly the last great lesson someone can
give."
First patient
Since 1984, when Carry first began teaching CU's
anatomy lab, he has noticed that some students become overwhelmed with
the emotional impact of the course.
Eight years ago, he opened the door for Richard
Martinez, who works in CU's Department of Psychiatry, and Swaney, a Presbyterian
minister, to develop an adjunct seminar to address issues of medical ethics,
psychology and spirituality that affect students in his lab.
Every year in the second week of anatomy lab,
which begins in late August, an average of 130 medical students spend two
hours in the ethics seminar. Divided into two groups for more intimacy,
students are asked to write creatively about their cadaver or speak openly
about their own emotions.
CU and other schools use the cadaver lab as a
porthole for introducing humanities and ethics into the medical curriculum,
says Martinez, who did his post-doctoral work in medical ethics at Harvard.
Some schools take the concept further and in recent years have added semester-long
courses in lab ethics.
Honoring and respecting the cadaver is a modern
concept in the gruesome history of gross anatomy.
Throughout the 1800s, cadavers were stolen from
graves and church morgues, to be dissected in secret. Executed criminals
and unclaimed bodies of the poor and mentally ill wound up on the dissection
table.
In this century, lab specimens are willing participants
who have a social contract with their students. Reflecting on the gift
of donors makes it easier to commit to learning, Martinez says.
"I like to tell my students, 'The cadaver is not
just the beginning of your professional life,'" Martinez says. "'He's the
first patient who has come to teach you.'"
Facing death
Seth Peacock, a CU-Boulder graduate, thought the
ethics seminar was "silly" at first, he says.
Then he wrote a poem, imagining the voice of his
cadaver:
"ninety five years of tears and joy, fueled movement,
thought and dreams. The remnants of that blaze still smolder within my
skin — gladly I pass these warm seeds on, to nine souls in the wind. In
you the blaze will reignite sending you deep on an explorative flight...."
"I wanted to put myself in the cadaver's shoes,"
he says.
Bridging that gap between science and humanity
is important, students say. First, one has to respect the science.
"The anatomy lab is an amazing tool," Peacock
says. "I can close my eyes and imagine the way the muscles connect or where
to put my finger to stop a bleeding artery in the event of an emergency."
For the student who is emotionally receptive,
there are plenty of reminders that the cadaver was once a living being.
The day the face was unwrapped was a powerful moment for Peacock, who describes
the face as a "direct window to death."
Sometimes the connection to humanity happens when
a student least expects it.
One night, Peacock was working in the lab alone,
studying and moving the arm.
"I realized I was holding the cadaver's hand,"
he says. "I felt the texture of the skin, it was such an intimate thing.
Body and soul
For some students, the anatomy lab is their first
experience staring death in the face. For Jacinta Cooper, it was her first
time confronting her religious beliefs.
Cooper, who belongs to the African Methodist Episcopalian
Church, believes strongly that when a person dies, the soul goes to heaven;
the body is just an empty vessel, she says.
"I had mixed emotions about (working on a cadaver),"
says Cooper, 22, who is enrolled in a dual MD/Ph.D. program. "I thought
... is it OK to do this to a body?"
One of her peers in the lab, she noticed, said
prayers and even brought in holy water.
"I'm religious and I know the soul is in heaven,
but I had to work hard not to feel bad about cutting," Cooper says.
The biggest test came the day she realized that
dissected organs go into a large plastic bucket. This is done to ensure
the body is whole for cremation, Carry says. Ashes are given to family
members.
"The bucket made it all real for me," Cooper says.
So she prayed.
"It's getting better," Cooper says, "but I often
feel tired of the smell. My eyes are sensitive and they burn."
Swaney cannot do anything about the noxious odors,
but she is an expert on spirituality.
Like Martinez, Swaney encourages her students
to explore their cadaver's whole person, beyond the biological and into
the spiritual realm.
"I like tell my students, 'You may know your cadaver's
brain, but not its thoughts and dreams ... you might know its heart, but
not when it loved or the times it was broken."
Spirituality and anatomy are not necessarily dissonant
disciplines or belief systems, says Swaney, who is pastoral care coordinator
for CU Health Sciences Center.
"You can't find the soul in anatomy, and yet,
you can," Swaney says, because the altruistic decision to donate one's
body to medicine is a profoundly spiritual act and one that grants insight
to an individual soul.
Knowing this gift, she says, should lessen emotional
or spiritual tension in the lab.
'Good closure'
Every spring, students from CU's medical programs,
including dental, physician assistant and physical therapy students, participate
in a memorial service called a Service of Thanksgiving and Respect.
Students read poems and share creative writing.
Last May, a student a capella group, called Arrhythmia, performed "Ave
Maria."
It's a way of gaining closure and thanking the
families, says Carrie Cera Hill a second-year medical student, who organized
last year's service.
The memorial service was always student-driven,
says lab director Carry. The idea began in the late '80s, when one student
asked permission to place a flower on his cadaver. That same student came
back to ask for a memorial service. The first year, a handful of students
and families attended. Last year, 50 family members and about the same
number of students attended.
Families are asked to speak at the service. Normally,
students don't know who is related to whom, but sometimes a spouse or sibling
of the donor will reveal a clue — a tattoo, a scar — about their relationship.
The service, held in a courtyard with a fountain
on the medical school campus, is a rare and peaceful moment to reflect
and set aside the rigors of medical school, says Kristi Knute, who helped
organize last year's service.
Most important, the service offers thanks to the
families, she says.
"There is a lot of emotion that goes into anatomy
lab, you have to try to be scientific, but everyday you are reminded that
people die," Knute says. "For me the service was good closure."
Contact Julie Marshall at (303) 473-1305 or MarshallJ@dailycamera.com
http://www.bouldernews.com/bdc/county_news/article/0,1713,BDC_2423_1548430,00.html
SAMPLE
CURRICULUM
Master
of science physician Assistant studies Admission Requirements
1. A bachelor's
degree with a "B" average (3.0) or higher from an accredited institution.
2. Test scores
for the Graduate Record Examination Aptitude Test or the Medical College
Admissions
Test, taken within the past five years.
3. Students
must have completed the following prerequisites:
(1)Biological sciences: five laboratory/lecture courses from a Biology
Department to include at
least anatomy, physiology and microbiology. (Biochemistry is recommended.)
(2) Chemistry: four laboratory/lecture courses from a Chemistry Department,
to include at
least organic chemistry.
(3) Psychology: one course in psychology (Developmental or abnormal psychology
is
recommended.)
(4) Statistics: at least one statistics course.
(5) Humanities: at least five courses in the humanities are required (A
course in ethics or Medical
ethics is highly recommended.)
(6) A minimum of 200 hours of patient care experience or a combination
of health care experience
and research.
First Year (67 credits)
Summer Semester
PA Seminar
Biochemistry
Human Gross and
Microscopic Anatomy/Genetics
Health Care Systems
Microbiology and
Immunology
Mechanisms of
Disease (Physiology/Pathophysiology)
Fall Semester
Clinical Medicine
I (Internal Medicine)
Medical Ethics
and Law
Physical Diagnosis
I (includes clinical practicum)
Pharmacology and
Therapeutics - I
Clinical Diagnostics
Medical Literature
and Research Methodologies
Spring Semester
Fundamentals of
Surgery
Clinical Decision
Making
Physical Diagnosis
II (includes clinical practicum)
Clinical Medicine
II (Maternal/Child Health)
Emergency Medicine
and Clinical Procedures (includes ACLS)
Mental Health
and Illness
Community Health
and Wellness
Pharmacology and
Therapeutics - II
Second Year (48 Credits)
48 Weeks of Required Rotations
Core Rotations:
Emergency Medicine
- 8 weeks
Family Practice
- 8 weeks
Geriatrics/Psychiatry
- 4 weeks
Internal Medicine
- 4 weeks
Obstetrics and
Gynecology - 4 weeks
Pediatrics - 4
weeks
Surgery - 4 weeks
12 Weeks of Elective Clinical Rotations
from the following:
Neurology
Neonatalogy
Forensic Medicine
Orthopedics
Radiology
Rehabilitation
Trauma Surgery
Cardiothoracic
Surgery
Dermatology
Neurosurgery
Other medical and surgical subspecialties
may be arranged.
Master of Science in Physician Assistant
Studies Degree Requirements
(115 credits)
Hospital gives
student experience in her field
TIMOTHY J. GONZALEZ / Statesman Journal
Mindy Glivinski (left), a student at Oregon Health & Science University,
scrubs up with Dr. Harris Waters before a surgical procedure Wednesday
at Silverton Hospital. Glivinski is studying to be a physician assistant.
Silverton Hospital is helping to teach Mindy Glivinski to be a physician
assistant.
SHAWN DAY
Statesman Journal
December 18, 2003
SILVERTON — When she graduates in August from Oregon Health & Science
University, Mindy Glivinski will be ready for work as a physician assistant
in the Mid-Willamette Valley.
As part of her studies, the 26-year-old from Carlton, in Yamhill County,
has spent the past five weeks helping Dr. Harris Waters and Dr. James Nealon
perform surgeries at Silverton Hospital. Her last day at the hospital will
be Friday.
During her five weeks in Silverton, Glivinski has gained practical experience
helping in the operating room during surgeries, including a double mastectomy
and a carotid endarterectomy, a serious surgery done to reduce the risk
of stroke by clearing plaque from the outer carotid artery.
She also has spent time talking with patients, learning to recognize
symptoms and illnesses, and applying techniques she learned through classroom
instruction.
“I’ve gotten to see a lot, and I’ve done a lot of suturing,” Glivinski
said. “This has been a really helpful rotation. I’ve learned a ton.”
Surgical rotations are a mandatory part of the 26-month Master of Physician
Assistant Studies program at OHSU, and they are a critical step in preparing
students for a career as a physician assistant, Glivinski said.
Glivinski graduated from the University of Oregon in 1999 with a bachelor’s
degree in general science, but she always wanted to work in medicine. She
spent a few years working in medical offices before deciding to enroll
at OHSU.
“I thought about the medical school route, but after doing some research,
I determined it wasn’t for me,” said Glivinski, who lives with her husband
in Aurora. “I want to have a family and time to enjoy it. That’s why I
chose the PA profession.”
Besides helping doctors during surgeries and other procedures, physician
assistants also diagnose illnesses and conduct tests on patients.
Pat Kenney-Moore, associate director of OHSU’s physician assistant program,
said that demand for certified physician assistants in Oregon is high,
with the majority working in primary care. She said that one-fourth of
Oregon’s physician assistants specialize in surgery.
Glivinski said that working with Waters and Nealon at Silverton Hospital
has been especially helpful.
“They’re both great teachers,” she said. “You can’t learn everything
from a textbook. They’re very good at explaining the practical side of
things.”
Glivinski’s rotation at Silverton Hospital is her fifth of 11 needed
to complete OHSU’s master’s program. She has worked in offices and clinics
specializing in orthopedic cases, obstetrics gynecology, community medicine
and pediatrics. In January, she will begin working at a dermatology clinic
in Salem to supplement her knowledge of skin-related problems.
Waters said he works with four or five physician-assistant students
rotating through his office every year. He said that providing hands-on
training for students also helps him keep his own skills sharp.
“It keeps your mind going,” Waters said. “As surgeons, we do things
almost routine, but when you have a PA around, it makes you think a little
more about what you’re doing.”
Waters and Glivinski said that Silverton Hospital’s rural location makes
it a strong learning ground for students looking for experience in a variety
of medical cases.
“Part of the mission statement of OHSU’s (program) is to train PAs to
work in rural, underserved areas,” Glivinski said. “Having grown up in
Carlton … I’d prefer to work in a smaller area.”
source: http://news.statesmanjournal.com/article.cfm?i=72462
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