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School of Medicine discoveries

08
2014

Cadaver Rounds moves what was a purely anatomical experience into the clinical realm

Cadaver Rounds animation

Table 19 used animation to showcase the unique opportunity they had to CT scan our cadavers. “We used the full coronal CT view of our cadaver as a reference to present each of our findings,” explains team member Abrahm Behnam. A screenshot of the webportal through which the students accessed their CT images serves as the starting point of their presentation. Images courtesy of the Class of 2017′s Abrahm Behnam.

A new twist on the traditional gross anatomy course is giving medical students an unprecedented opportunity to expand beyond basic anatomical observations. For the first time, they can send suspicious tissue biopsies to the pathology lab and even obtain a full body CT-scan of the cadaver itself.

Along with observations made during dissection, those results help them assemble a plausible clinical picture of the cadaver – a picture they then present to their classmates in “Cadaver Rounds.” In the culmination of the gross anatomy course, teams of students describe their cadavers’ major clinical problems, the typical prognosis of possible diseases found, suggest clinical or lab tests relevant to the case and, finally, a likely cause of death.

“Cadaver Rounds has moved what was a purely anatomical experience into the clinical realm,” says M. Alex Meredith, Ph.D., course director and professor of anatomy and neurobiology. The course now challenges students to observe structural anomalies in the body and then ask “what that person’s health profile was like and how those problems may have impacted their lives.”

That’s in line with larger curriculum changes the medical school debuted last year. The new course of study is clinically driven, using the preclinical years to encourage students to think of the patients they will encounter in the future.

With access to reports from pathology and radiology, students now have a self-directed opportunity to confirm, enhance or even refute or explain their observations in the gross anatomy lab. And in August, after all the dissections and other observations are completed, the student teams presented their findings to their classmates.

Cadaver Rounds animation

Table 19’s objective findings, integration and case scenario were presented along with animations describing the pathologic and diagnostic findings. Images courtesy of the Class of 2017′s Abrahm Behnam.

For Meredith, it was “perhaps the best day I’ve ever had as a teacher. The presentations were more than we could have imagined they would be both in content and in style.”

Susan R. DiGiovanni, M.D., assistant dean for preclinical medical education, was on hand for the presentations, too.

“I so wish we had something like this when I was a student,” she says. “I liked anatomy, but we didn’t much feel like future doctors as we toiled in the lab for hours trying to identify nerves, tendons, arteries and veins that had little meaning to us because we had no way of knowing how it related to patient care. There has never been anything like Cadaver Rounds.”

She remembers her own classmates discovering an abnormality during dissection and running over to other tables to compare it to what ‘normal’ looked like. “We never put the story together to think about our cadaver as a patient. Cadaver Rounds has the students looking at their cadavers in whole new light. They thought of them as a person. They wondered what their story was. They played sleuth to put the clues together much as pathologist would.

“I was astounded at the professionalism of the students’ evaluations and how carefully they thought about their ‘first patient’ in such detail. I couldn’t believe their creativity and incredible use of technology. They put many faculty to shame!”

The four teams who earn the highest scores on their presentation received the distinction of “Best Cadavers” along with copies of the recently published biography, “Medicine’s Michelangelo: The Life & Art of Frank H. Netter, M.D.”

2014 Cadaver Rounds Award Winners

Baughman Society Winner: Anatomy Dissection Table 10
Christopher John Hagen
Rebecca Anne Maddux
Lindsey Marie McKissick
Shreya Jagdish Patel
Samay Sappal
Metul Ketan Shah
Sherna Sarvajna Sheth

Benacerraf Society Winner: Anatomy Dissection Table 25
Claiborne Downey
Diane Denise Holden
Sarah Louise Hughes
Vanessa Monique Mitchell
Olga Mutter
Andrew Percy
Taylor Magruder Powell

Harris Society Winner: Anatomy Dissection Table 22
Jamaal Christopher Jackson
Michael Christopher Krouse
Andrew David Lyell
Ye Ri Park
Katherine Ann Pumphrey
Advaita Punjala
Megan Elizabeth Shaffer

Warner Society Winner: Anatomy Dissection Table 7
Harnek Singh Bajaj
Mark Raymond Cubberly
Maria George Hadjikyriakou
Samuel Micah Orwin
Vikash Parekh
Sarah Elizabeth Pauli Smith

08
2014

Bequest creates scholarship in mentor’s memory

Thomas Poole

Thomas Poole, M’61, and his wife, Kay. Photo courtesy of Chris Gotshall.

Thomas R. Poole, M’61, grew up in a small West Virginia community. He and his family washed their clothes and their bodies in the town’s namesake, Briar Creek, and pumped drinking water out of the ground. That was more than 80 years ago.

From those humble beginnings, Poole’s path led him to medical school and to a fulfilling career as an obstetrician. Now retired and living in Palm Coast, Florida, with his wife, Kay, Poole recently alerted his alma mater that the couple has made provisions in their estate plan for a $1 million bequest. In doing so, they became members of the MCV Society. The planned gift memorializes Poole’s mentor and friend, Daniel T. Watts, Ph.D., with a scholarship fund that will support generations of students in the Virginia Commonwealth University School of Medicine.

In 1966, Watts, a nationally recognized pharmacologist, became dean of the School of Basic Health Sciences and Graduate Studies at the Medical College of Virginia. But Poole met him before that, when Watts was chair of pharmacology at West Virginia University.

“He interviewed me as I applied for medical school at West Virginia,” Poole said. “He knew I was a poor fellow and wondered how I was going to finance my family while I was in medical school. He offered me a job in his lab that would pay $300 a month for a year. That was hard to refuse. I got to know him very well. He was a man of great integrity. I couldn’t have been luckier to have that opportunity to work with him.”

Poole completed his first two years of medical school at West Virginia University before finishing his studies at MCV.

Watts touched many lives throughout his career. Lou Harris, Ph.D., vice chair of the VCU School of Medicine’s Department of Pharmacology and Toxicology, was attracted to VCU in 1972 because of Watts’ leadership of the unique School of Basic Health Sciences, which is now a part of the VCU School of Medicine.

“A School of Basic Health Sciences was completely unusual in medical schools across the country at the time,” Harris said. “As dean in the late ’60s and early ’70s, Watts put together a group of fantastic faculty and associate deans. He was a brilliant manager and very encouraging of our working in the community particularly in programs to increase minority students’ interest in science.”

Under Watts’ deanship, Harris said, the school created a program that exposed high school students to on-campus lab instruction, and he advocated for the development of the Ph.D. program.

“With Watts’ help and support, we built a very large graduate and postgraduate program that has consistently received high national rankings. He was a good friend,” Harris said.

The Pooles feel fortunate to be in the position to memorialize Watts.

“I’m getting into my twilight years and want to do what I think is best because I’ve been so fortunate,” Poole said. “I thought so much of Dr. Watts who once asked me if the shoes I was wearing were the best I had. I replied, ‘They’re not only the best shoes I have, they’re the only shoes I have.’ The next day he gave me a pair of his own.”

This article by Nan Johnson first appeared in the 2014 summer issue of the Power of Personal Philanthropy.

08
2014

AAMC features the Class of 2017′s Clay Downey in its Aspiring Docs series

Class of 2017's Clay Downey

Clay Downey has been featured on the AAMC website for his interesting, non-traditional path to medical school

The medical school has a reputation for welcoming non-traditional medical students onto the MCV Campus. One of them is the Class of 2017′s Clay Downey, whose inspiring story has been featured by the AAMC in its Aspiring Docs series.

Their website proclaims: “Clay had a business degree, no science prerequisites, and no experience in a health care setting, but he decided to pursue a career in medicine anyway.”

The feature got its start when the AAMC put out a call for non-traditional applicants to tell their stories. Clay saw it and volunteered.

“I thought it would be a great opportunity to share my thoughts about the process,” he said. “I wasn’t sure if my story could apply to others out there, so I went ahead and gave it a shot.”

The AAMC’s web feature takes the form of a Q&A in which Clay talks about what sparked his interest in medicine and how he took it “one step at a time” on the challenging path to prepare to apply and enter medical school.

“I think being a non-traditional pre-med applicant and waiting to take classes later turned out to be a huge advantage,” Clay told the AAMC. “I already had a degree in business administration, so I was able to schedule only the classes that interested me. I tried to put together classes that fed into each other (i.e., physiology and anatomy), and I think it gave me a much stronger foundation coming into medical school than if I needed to work other classes into my schedule.”

Clay’s process interested the AAMC so much that they worked with him on a second story about his experiences as a medical scribe.

“I worked as an emergency department scribe for two years before medical school. This was the perfect job for me because it gave me incredible exposure to the day-to-day life of a physician, and really reaffirmed my decision to go to medical school.”

16
2014

1904 graduate practiced medicine on the western frontier

Charles Johnson Kinsolving1904

C. J. Kinsolving at his 1904 graduation from University College of Medicine. Scroll below for a slide show of more photos provided by Doc Kinsolving’s family.

Shortly after earning his medical degree in 1904, adventure-loving Charles Johnson Kinsolving packed his bags and headed west. His goal was the Alaskan frontier.

Before that, the Abingdon, Va., native had been to South Carolina to work in a cotton mill. And he’d made the 300-mile trip to Richmond to enroll in the University College of Medicine. Founded in 1893, UCM would merge with MCV in 1913.

On his westward trip, Kinsolving would occasionally interrupt his travels with short-term assignments. By the fall of 1906, he’d already worked for a time as a staff physician for mine operations in both West Virginia and South Dakota.

And on a Sunday in October, he was again making the most of his adventure, taking a roundtrip excursion on a steamboat. He departed from Coeur d’Alene, Idaho, where he’d taken a position as a staff physician at the local hospital. He disembarked on the docks of St. Maries for some lunch and to wait for the return trip.

As his grandson Laurence Kinsolving tells the story, “word spread that a doctor was in town.” Soon, he received an urgent request to treat an injured man at a waterfront hotel. He always carried his black bag with him, but he did need to restock his medical supplies. “He set out to visit a local drugstore,” his grandson continues. “When the druggist learned that the visitor was a physician, he asked Dr. Kinsolving to look in on several loggers with serious injuries residing in the rooms upstairs.”

An afternoon spent in treating broken bones and other injuries left Kinsolving so concerned for his patients that he missed the return trip to Coeur d’Alene, and spent the rest of his life in St. Maries. “He never made it to Alaska until after retirement.”

Kinsolving briefly returned to Virginia in 1909 to marry his childhood sweetheart, Julia Elizabeth Eanes. He carried her west to the frontier where, her grandson says, she found it astonishing that a town of 1,100 inhabitants could support 11 saloons.

University College of Medicine

The University College of Medicine was established by Hunter Holmes McGuire, M.D., in 1893 just three blocks away from MCV. It was first known as the College of Physicians and Surgeons. In 1913, MCV and UCM merged through the efforts of MCV Professor of Surgery George Ben Johnston, M.D., and Hunter H. McGuire’s son Stuart McGuire, M.D., who was president of UCM at the time.

Their home doubled as a medical office. Kinsolving – known simply as “Doc” around town – was accustomed to making house calls far outside St. Maries, sometimes accepting nothing more than chickens, venison or eggs as payment. In his career, Doc would face Idaho’s fires of 1910, treating injured fire fighters and going four or five days without unsaddling his horse or getting any rest. In the end, the fires would claim the life of his and Julia’s newborn daughter.

He also battled the deadly flu pandemic of 1918. “He treated over 500 flu victims,” reports his grandson, “many under quarantine, but was proud to say that he did not lose one patient.”

In 1945, Doc Kinsolving closed his black bag for the last time and fully retired to his Goosehaven farm. He was known, though, in those later years after retirement to sometimes keep office hours at the Elks Lodge where he was a charter member and to give fistfuls of silver dollars to his grandchildren, including Laurence Kinsolving, of Marianna, Fla.

Our thanks to Laurence Kinsolving for sharing his grandfather’s story with us.

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01
2014

Alumna Marcella Fierro’s continued service to forensic medicine featured in Richmond Academy of Medicine newsletter

Marcella F. Fierro, M.D.

Fierro retired in 2007 from her post as the state’s Chief Medical Examiner, where she investigated the results of some of the nation’s most notorious crimes.

Retirement hasn’t hindered how alumna Marcella F. Fierro, M.D., is impacting the future of forensic medicine. Following a 34-year career and serving as Virginia’s Chief Medical Examiner, Fierro has remained a steady influence in her field. Recently featured in the summer issue of the Richmond Academy of Medicine’s quarterly newsletter, Fierro describes her current work educating others and advocating on behalf of the profession that she dedicated her life to serving.

Fierro’s recent work includes the 2009 publication of a book she co-wrote with her colleagues on the NAS Committee on Identifying the Needs of the Forensic Community: “Strengthening Forensic Science in the United States: A Path Forward.” Fierro shared her thoughts on the publication of the book for the Richmond Academy of Medicine’s Ramifications, “If you asked me what’s the most important achievement of my career, this had to be one of them.” The book outlines basic infrastructural necessities in the field of forensic medicine and is being used to garner support from Congress to address those needs.

Widely known as the inspiration for Patricia Cornwell’s Kay Scarpetta book series, Fierro also has appeared on TV including a recent PBS special on New York’s first trained medical examiner. Asked how she’s coped with what she’s witnessed as Virginia’s CME, Fierro compared it to trauma surgeons and other physicians who help accident victims. She told Ramifications: “You realize what the patient needs is not your emotions or your outrage. What the patient needs is your care, and no one but you can provide it. The discipline is you know you can do something—you can speak for that patient.”

Fierro has multiple connections to the medical school. She completed her residency and fellowship training with the School of Medicine in 1973 and 1974 respectively. She also served on faculty and as the chairman of the Department of Legal Medicine and Pathology until her retirement in 2008.

Read more about her recent activities and her plans for the future in the Ramifications’ summer issue, page 14.

By Eleana M. Legree

15
2014

Medical School debuts Cadaver Rounds for first-year students

Cadaver Rounds

The Class of 2017’s Kymia Khosrowani, Kaila Redifer and Andy Green discovered an unusual structure in the course of their dissection. They sent a biopsy to the pathology lab to determine if it was an enlarged lymph node or a mis-shaped adrenal gland as they suspected.

In an era when some other medical schools have dropped or limited the gross anatomy lab, it’s more pertinent than ever on the MCV Campus.

Just as in years past, first-year medical students learn from their “first patient.” But now they have an unprecedented opportunity to expand beyond their anatomical observations. For the first time, they can send suspicious tissue biopsies to the pathology lab and even submit the cadaver itself for a full body CT-scan. In return, as first-year sleuths, they’re asked to assemble a plausible clinical picture of the cadaver from their different observations.

It’s called Cadaver Rounds.

“Each cadaver is different and has a different medical life history,” says M. Alex Meredith, Ph.D., course director and professor of anatomy and neurobiology. “Studying the cadaver has been so valuable in helping students develop a visual picture of the body’s 3-D structure and to see the body’s variability. Now, we are pushing those observations further to estimate – from discovered things like scars, shunts, implants, tumors and the like – what that person’s health profile was like and how those problems may have impacted their lives.” ”

Working in teams, the students dissect the cadaver with intensive study of 20 different regions of the body. Along the way, they make daily logs of important anatomical or pathological findings as well as suspected medical problems from scars, implants and tumors.

M. Alex Meredith, Ph.D.

M. Alex Meredith, Ph.D.

Meredith points out “Some clinical syndromes exhibit multiple pathologies.” By spotting and recording clues along the way, students eventually may be able to correlate separate observations to a single disease process. The reports from pathology and radiology provide an opportunity to confirm, enhance or even refute or explain the students’ observations.

The dissection experience culminates in August, when the student teams formally present their findings to their classmates. They’ll be expected to describe any major clinical problems identified, the typical prognosis of diseases found, suggest clinical or lab tests relevant to the case and, finally, a likely cause of death. As a result, the whole class will have the chance to learn from 32 “first patients.”

Through Cadaver Rounds, students have early exposure to new skills. For example, they test out their dexterity with a scalpel as they slice biopsies and prepare them for the pathology lab. Once submitted, the Pathology Department prepared the slides and Davis Massey, M’96, PhD’96, H’01, associate professor of pathology, read each specimen and provided a standard Path report.

Students also learned how to read a CT-scan thanks to the Class of 2006’s Peter Haar, M.D., Ph.D., who is now on faculty in the Department of Radiology, who arranged the CT scans for all 32 cadavers. He also organized tutorials by the radiology staff for the students to examine and interpret the scans.

Meredith says Cadaver Rounds will ultimately prepare students for participating in Grand Rounds. A medical school staple, in Grand Rounds a physician presents a patient’s case or a new medical advance to an audience consisting of doctors, residents and medical students. Less common now, traditionally the patient would also attend the session.

The four teams who earn the highest scores on their presentation will receive the distinction of “Best Cadaver” along with a copy of the recently published biography Medicine’s Michelangelo: The Life & Art of Frank H. Netter, M.D. Netter was described in a NY Times book review as “possibly the best-known medical illustrator in the world.”

Meredith was a medical illustrator himself (Hopkins, 1978) before completing his Ph.D. in anatomy on the MCV Campus in 1981. He says “Cadaver Rounds has moved what was a purely anatomical experience into the clinical realm.”