Cadaver Lab Isn’t Just for First Years

sarto

Credit: Rob Swatski

Of all the things people say they remember learning in medical school, the location and function of the sartorius muscle is usually not one of them. For me, I can still see the muscle lying diagonally across the dissected thigh—small but purposeful, leaving me to wonder how this tiny thing so miraculously and perfectly made it from one side of the leg to the other through evolution and use.

This memory is representative of how thought-provoking and educational cadaveric dissection was for me as a novice clinician. The sight of the
cadaver on the gurney, along with the smells, the noises, and the presence of a real human being in front of me, were my first clinical experiences of bedside learning from a patient, and it had a significant effect on me.

Despite living in the digital age where extraordinary feats in medical technology have occurred over such a short period of time, cadavers remain a fundamental part of medical education. Training and educating students with human cadavers is not just a pedagogical exercise. Cadaveric dissection emphasizes understanding of a structure’s spatial orientation and function, but perhaps more importantly, it provides a contextual environment that differs from rote memorization that often accompanies anatomical learning. Additionally, cadaveric education has gained wider importance at the post-graduate level as a training element for surgical and emergent ultrasound-guided procedures.

Dr. Demetrios Demetriades, Chief of Trauma and Surgical Intensive Care at Los Angeles County Medical Center in Los Angeles, understood the value of this type of training, and in 2006 worked with the County of Los Angeles to create a cadaveric procedural training lab for post-graduate trainees. The lab was designed to be used by residents and fellows for procedural education, practice, and anatomical dissection. There is a dedicated, full-time staff that includes a perfusionist, a technical assistant, and an administrative team through the Department of Surgery. The lab is used 2 to 3 times a day by various surgical specialties, anesthesia, and the emergency medicine residency, which includes our ultrasound division. The emergency ultrasound division uses the lab once a month to train residents and ultrasound fellows how to perform various point-of-care ultrasound-guided procedures, such as ultrasound-guided central and peripheral line placement.

Unlike other simulation modalities such as gel phantoms, human tissue phantoms, or simulators, performing ultrasound-guided procedures in the cadaver lab allows the trainee to have the tactile experience, where (s)he is touching skin, performing the procedure, and using real procedural tools on human tissue. The importance of this from a training and educational standpoint is that the trainee is in a controlled setting, has time to reflect upon the learning as it occurs, can discuss procedural technique openly with the attending, and can perform the procedure repeatedly in a safe environment.

For emergency medicine providers, the impact of using the procedural cadaver lab for ultrasound-guided procedures and anatomical learning cannot be underestimated. John James (2013) estimated that more than 400,000 deaths occurred in a 3-year span due to medical errors in the hospital setting, making it the third leading cause of death in the U.S. The conditions by which we practice our specialty are always under the auspices of being emergent. Although it has been well documented that ultrasound makes care safer and more efficient, ultrasound as a modality warrants the same practice and repetition as the procedures it provides assistance to. The cadaver lab provides this exposure to openly learn in an inaugural fashion and by one’s mistakes. It seems fitting, then, to make the cadaver lab a more central part of medical education—a place we can come back to on a regular basis as we learn and improve our skill.  Just think of the memories we’ll make.

What learning experience had the most impact on you? What other experiences should we ensure continue? Have a cadaver lab story to share? Comment below or let us know on Twitter: @AIUM_Ultrasound.

Tarina Lee Kang, MD, is Assistant Professor of Clinical Emergency Medicine and Division Chief of Emergency Medicine Ultrasound at the Keck School of Medicine of USC.

At the Intersection of Science, Engineering and Medicine

Flemming Forsberg PhDDuring the 2015 AIUM Annual Convention, AIUM sat down with Flemming Forsberg, PhD, recipient of the Joseph H. Holmes Basic Science Pioneer Award to talk about the award, his motivation, and the future of medical ultrasound. Here is what he had to say:

Question #1:
What was your reaction to being named the recipient of this award?

Question #2:
What motivates you?

Question #3:
What role does failure play?

Question #4:
How does the United States differ from the rest of the world when it comes to medical ultrasound?

Question #5:
Where do you see the future of medical ultrasound?


What do you see as the future of medical ultrasound? Where are there some additional intersections?
Comment below or let us know on Twitter: @AIUM_Ultrasound.

Flemming Forsberg, PhD, FAIUM, FAIMBE, received the 2015 Joseph H. Holmes Basic Science Pioneer Award from the AIUM. Dr Forsberg is Professor, Department of Radiology at Thomas Jefferson University. He also serves as Deputy Editor of the Journal of Ultrasound in Medicine.

The Nerve of Ultrasound

I’m a fan of ultrasound. In the past, ultrasound has been seen as the less attractive cousin of the other imaging modalities, CT and MRI. Maybe that’s why I champion it so much, because I can’t help but root for the underdog! Either way, I am always eager to find ways to incorporate ultrasound in my practice as a musculoskeletal radiologist. It is fast, convenient Ultrasound and MRI of Nerveand inexpensive, and patients tend to find the experience less daunting than being in a metal tube.

Now, I think it is high time that ultrasound take a place on the front lines of nerve imaging. We’ve made several advances in the imaging of nerves under ultrasound; nerves have a characteristic appearance on ultrasound and it is often used for image guidance in nerve blocks. In my practice, we use ultrasound to diagnose and treat nerve pathology. However, a lot of nerve imaging is still primarily done via MRI. This is probably because much of the research in nerve imaging has been done in MRI. Additionally, many clinicians are not aware of the diagnostic capabilities of high resolution ultrasound in nerve imaging. I’m hoping to change that!

Funded by a generous grant from the AIUM’s Endowment for Education and Research, my colleagues and I are hoping to compare the utility of ultrasound in nerve imaging to MRI. What we hope to confirm is that ultrasound has similar diagnostic capabilities to MRI in the imaging of neuropathy. In addition, we plan to use ultrasound’s capability for dynamic imaging to produce new methods for evaluation of the brachial plexus and peripheral nerves. This grant will fund one of the largest volume studies of ultrasound in nerve imaging, which will in turn help to further expand the role of one of the most valuable imaging modalities we have. So, hopefully soon, this “underdog” will have its day.

In what other areas is ultrasound emerging from its “underdog” label? Where can we use Ultrasound First? Comment below or let us know on Twitter: @AIUM_Ultrasound.

Ogonna Kenechi “Kenny” Nwawka, MD is the assistant attending radiologist in the Hospital for Special Surgery as well as assistant professor of radiology at the Weill Medical College of Cornell University.

Dr. Nwawka’s research project is being funded by a $50,000 grant from the Endowment for Education and Research. To help support these and other projects, consider donating.