Nov. 30, 2005
By Susan Green
The lights are bright. Everyone is talking. The scent of embalming chemicals is overpowering. And although it may look like a typical gross anatomy lab, it's not. It's the new August Immersion for first-year medical students at the College of Osteopathic Medicine, and by the end of program the students themselves will have changed as much as their first patients.
In conventional anatomy labs the intention is to take apart the human body and try to understand its anatomy. But during the August Immersion, there's a subtle difference. While taking things apart and looking at the body's structure, students are also focusing on how muscles and bones work together to make people move. They then use this knowledge to better understand how this relates to common disease states.
"When we look at the forearm, we're not just looking at how this muscle attaches to these bones," says Lawrence Witmer, professor of anatomy. "We're also interested in carpal tunnel syndrome and how that relates to the structure of the forearm."
The goal is to put anatomical science into the context of patient care that students can use throughout the rest of their medical education.
Palpation -- A new language
Also separating this immersion from typical gross anatomy courses is the integration of osteopathic manipulative medicine (OMM), which is a way of evaluating and treating, through palpation, the muscles, bones, joints, and tissues of the human body in relation to the internal organs.
Understanding surface anatomy is an extremely important part of OMM and it's a key tool that can be used to alleviate a patient's problem, whether to decrease pain, increase mobility or as part of the treatment for physical trauma. So one day each week is dedicated to an OMM lab designed to introduce medical students to the relationship between gross anatomy and osteopathic principles, practices and language.
During the OMM lab, students have an opportunity to understand how what they see on the surface of the skin relates to what's underneath it. Physicians, as well as anatomists, advanced medical students and physical therapists work alongside students in both labs, showing them the clinical relevance of the anatomical structure.
"The August Immersion is a very unique opportunity for us in the college," says David Eland, D.O., F.A.A.O., associate professor of family medicine and instructor of the OMM lab. "The benefit to offering OMM and gross anatomy concurrently is that students can see the correlation with what they are learning from the cadavers when palpating certain aspects of human anatomy on a live patient." For example, figuring out how to find the 12th rib on a live patient isn't as easy without the anatomy lab experience.
Most students don't have any experience with how to touch people in a therapeutic fashion and they're initially as hesitant about touching live patients as they are about touching a cadaver. Beginning with the first OMM lab, the idea of professional touch is stressed and reinforced. Once they're comfortable with that, what really hits home for student physicians is the realization that they can do things with their hands -- palpation -- that are going to help their patients both diagnostically and therapeutically.
First-year student Nicole Veitinger says, "It was a great comprehensive look at everything in anatomy. When we talked about vertebrae in the anatomy lab, it was exciting to go into the OMM lab and see the exact muscle we talked about that day and to see how that muscle would contract when palpated."
Cutting and snipping
Human dissection has been a required part of medical school for decades and often considered a rite of passage. But while medical students usually can't wait to decipher the human body's secrets, many are a bit squeamish about the process of cutting, snipping and pulling skin and muscle, and sawing through bone.
In the beginning, Jamie Mack says she was extremely nervous, yet excited at the same time, "I won't forget my first day of medical school. Our group picked me to make the first incision, I was afraid I'd do something wrong, but I did it and ended up doing really well."
Worrying about making a mistake and doing something wrong is a common thought among new medical students and it can be somewhat intimidating.
"There is some concern about making mistakes, and you don't want to be disrespectful," Veitinger says. "But at the same time, you're not going to hurt them."
Witmer says working with human remains has taboos in every culture, but great care is taken in the gross anatomy lab to divorce personal details about the individual from the cadaveric specimen. Once they begin their lab work, it's so fascinating and important, that students usually set aside their uncomfortable feelings and focus on the process.
"It's a humbling experience," Veitinger says. "This is someone who has decided to give you the last gift that they'll ever give anyone, and you'll spend the next year working on this person to learn more about human anatomy and physiology."
Stitching it up
Anatomy will always be part of the curriculum since all physicians need basic knowledge of the human body. It's the quintessential medical school course. Since anatomy isn't strictly clinical or surgical in nature, but related to common diseases, the immersion makes an effective segue to the rest of the medical school's curriculum.
Both Mack and Veitinger thought the immersion was extremely helpful and a significant experience. "I'm constantly thinking back to where the bones and muscles are in the body, what they do and what they are innervated by," Mack says. "I gained a lot of knowledge and it wasn't as stressful as I thought it would be. And what I learned I'll be using for the rest of the year."
Veitinger agrees. "I thought it was a great experience," she says. "It was very stress free, but it really facilitated our learning. There were a lot of clinical correlations and that really got us interested in what the rest of the year will bring for us."
Designed to give students a strong foundation in the clinical application of anatomy, the August Immersion did what it set out to do.
"I think this was a wonderful opportunity for these students to come together around a common learning experience. They bonded well and learned to study together," says Keith Watson, D.O., general surgery, associate dean for graduate medical education and one of the gross anatomy instructors. "This is a life-changing process for them -- working with their first patient. I anticipate this will make them stronger students."
* Late Latin, to dissect.
Susan Green is a writer with University Communications and Marketing.