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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.”

05
2014

Alumna Mary Beth Steinfeld recalls her father’s tenure as Dean of the Medical School

Jesse Steinfeld, former dean of the medical school and former U.S. Surgeon General

Jesse Steinfeld, former dean of the medical school and former U.S. Surgeon General

Jesse Steinfeld, M.D., the 11th Surgeon General of the United States and former dean of the School of Medicine, died Aug. 5 at age 87.

Never reluctant to take a controversial stance when he knew he was right, he stood up for the health of the nation in Washington, D.C., and for the role of the physician in Richmond, said his daughter, Mary Beth Steinfeld, M.D., a graduate of the Class of 1981.

“He spoke to our class on the first day of medical school. He remarked on the general appearance of the class. He said, ‘You all wore suits and were clean-shaven and professional looking when you came for interviews. Here you are now in shorts with long hair and beards. You don’t look like the same people.’ He told us our appearance and behavior will reflect on MCV. If we were going to be physicians we needed to look the part. It embarrassed me at the time, but later I realized how appropriate it was.”

He wasn’t one to mince words for a cause he believed in. Jesse Steinfeld’s passionate and outspoken fight against tobacco use put him on the national radar – and eventually led him to the MCV Campus.

A cancer researcher and top official at the National Cancer Institute, he was named Surgeon General in 1969 by President Richard Nixon. In office, he was outspoken about the dangers of smoking.

Under his leadership, cigarette manufacturers were required to strengthen the label on cigarette packs to the familiar, “Warning: The Surgeon General has determined that cigarette smoking is dangerous to your health.” He advocated for a ban on smoking in restaurants, airplanes and other public places, a visionary concept that took several decades to come to fruition.

By all reports, it was for these radical ideas that he was forced out of office by the Nixon administration.

When recruited onto the MCV Campus to be dean, Steinfeld had reservations about taking a job in the heart of tobacco country, said his daughter. “It was remarkable, given he was the former surgeon general and so prominent in his anti-tobacco stance.

“He questioned the Board’s wisdom. One of the board members told my dad that they wanted to prove that MCV was an academic center with academic freedom and that they had the power to appoint whomever they wanted. “I knew it was a big deal, but I didn’t realize how conscious the people who recruited him were about that freedom,” said Mary Beth Steinfeld, who serves as an associate clinical professor of pediatrics at the UC Davis School of Medicine.

And surprisingly, said his daughter, Steinfeld had no conflicts or confrontations with area tobacco companies during his time in Richmond.

“I’ve been working in academic medicine most of my career and so over time I’ve come to appreciate how remarkable his jobs and achievements were.”

Jesse Steinfeld with his wife Gen and their daughters (left to right) Susie, Mary Beth and Jody

Jesse Steinfeld with his wife Gen and their daughters (left to right) Susie, Mary Beth and Jody

Steinfeld’s tenure on the MCV Campus, which ended in 1983, was marked by significant achievements, including increased research funding, increasing the number of residency positions, equalizing practice plans and stressing preventative medicine.

Though always professional and demanding of excellence in his students and staff, Steinfeld had a lighter side, recalled his daughter. “My class was full entertainers. They made up songs about our med school experiences.

“My mom and dad enjoyed having the med students over to their house at graduation for a barbecue, with chicken, beans and so on. The students seemed to like it, too.”

And so the Class of 1981 composed “Cold Beans at the Dean’s.”

“My father loved that song,” recalled Mary Beth Steinfeld.

Leaving Richmond for the Medical College of Georgia was a bittersweet time for the family, said Mary Beth Steinfeld. “They really liked Richmond.”

One of her fondest memories is sitting with her family at dinner, discussing ideas and people. “We had an ongoing habit of constantly debating ideas, and we were always trying to make our father laugh and be proud of us.”

Jesse Steinfeld was proud of Mary Beth’s medical career. “On my first clinical rotation, I took care of an elderly woman who was hospitalized due to heart failure. She needed to gain weight, so I stayed by her side and fed her a milkshake and talked to her. It took hours.

“I remember feeling sad for her when she told me her family didn’t visit. The next morning I told the intern, with pride, that she’d gained five pounds! The intern panicked, saying, ‘Oh no, her lungs are filling with fluid due to congestive heart failure!’

“Nevertheless, my father always remembered that I took the time to feed her that milkshake and listen to her. I think it made him proud of me.”

Jesse Steinfeld was a tireless advocate for preventative care and the importance of diet and exercise. When he was leaving in 1983, he told The Richmond News Leader, “As a faculty, we have to have both the time and the inclination to teach preventative medicine. Physicians, as a rule, think somebody else is telling patients about prevention….Kids are supposed to learn about health in school. But grade schools do a very poor job in teaching about the body and health.”

In later years Mary Beth Steinfeld learned that her father liked to share the benefits of his role as dean. Harold Maurer, M.D., then-Chairman of Pediatrics, recalled that when Main Hospital was built in 1982, Steinfeld got control of the emptied East Hospital. Mauer wrote to Mary Beth Steinfeld to share a memory: “He called a chairs meeting, at their house, to distribute the space. I took two floors, which allowed me to recruit a new division of cardiology. I recruited students to paint the floors on the weekends. Hal Fallon (Chair of Internal Medicine) took two floors and Lazar Greenfield (Chair of Surgery) took two floors. Cary Suter (Chair of Neurology) didn’t want any. What heady times! There are many great stories about Jesse as Dean at MCV.”

By Lisa Crutchfield

03
2014

M3 Shikha Gupta is featured columnist in the Richmond Times-Dispatch

Shikha Gupta and JFStrauss IMG_6110

Class of 2016’s Shikha Gupta with Dean of Medicine Jerry Strauss, M.D., Ph.D. and the Strauss Cup

The Aug. 3 edition of the Richmond Times-Dispatch featured the Class of 2016’s Shikha Gupta as a guest columnist.

Her first-person account describes how the medical school’s new curriculum and the new McGlothlin Medical Education Center are changing the way medicine is taught. She writes: “the architecturally inventive and academically advanced McGlothlin Medical Education Center – the new (and vastly improved) home of the medical school.”

As a third-year medical student who began her studies in 2012, Shikha has experienced what medical school is like both before and after the opening of the McGlothlin MEC. As a result, she has speaks from personal experience about the transformation that is taking place.

You can read her column, The evolving education of our medical wizards, that was adapted from the spring 2014 edition of Ramifications, a quarterly publication of the Richmond Academy of Medicine.

01
2014

Class of 2016’s Maximilian Jameson-Lee named to G. Watson James III, M.D. Scholarship

The Class of 2016’s Maximilian Jameson-Lee

Class of 2016’s Maximilian Jameson-Lee

On May 1, more than 40 students participated in the annual Medical Student Research Day.

This year’s Research Day saw a dramatic increase in the number of students presenting as a result of a change to poster session format. “In the past we had oral presentations and, because of limited time, only about 10 to 15 of the submitted abstracts were chosen for presentation,” said Gordon Archer, M.D., senior associate dean for research and research training in the School of Medicine. “This year the poster session format – and the poster printer purchased by our office – made it possible for everyone who did any summer research to present their work.”

Some of the presenters were past participants in the school’s Student Summer Research Fellowship Program, a two-month program between the M1 and M2 years in which students perform research under the guidance of a faculty member in the medical school. Other medical student presenters conducted research under the guidance of a medical school faculty mentor outside of the summer program.

Each year, three awards are given for the most outstanding presentations and research projects. The $1,000 first prize is made possible by the G. Watson James III, M.D. Scholarship Endowment that carries the name of a 1943 graduate of the medical school who went on to become Chairman of the Division of Hematology. At his death in 2001, James’ friends and family established the scholarship that goes to the medical student who wins the research competition, a fitting legacy for the outstanding physician-scientist. The second prize of $500 and $250 third prize are funded by the School of Medicine’s Dean’s Office.

Judges assessed the competition through various criteria in order to determine the top three presentations, including a coherent hypothesis, the presenter’s understanding of the background information of their research topic and the level of their participation in the experimental work. Finally, the judges scored the students based on the quality of their poster presentation and their ability to articulate findings and conclusions.

This year’s James Scholarship winner is the Class of 2016’s Maximilian Jameson-Lee. After earning a bachelor’s degree at the University of Florida, he went on to the National Institutes of Health to conduct infectious disease research. He then completed a Ph.D. in Immunology and Cancer from the University of Virginia and post-doctoral studies at Naval Research Labs in Washington D.C.

At Student Research Day, Max presented findings from a bone marrow transplant study that sought to refine the match between bone marrow donors and recipients for improved outcomes. Max explains that, today, bone marrow transplants are matched at 8 genetic locations and for blood type. For approximately the same price, whole exome sequencing looks at over 20,000 loci, which opens the door for a much more individualized approach. Less expensive than whole genome sequencing, exome sequencing analyzes just the coding regions of the genome.

Working in the research lab of Amir Toor, M.D., Max’s team performed whole exome sequencing on nine bone marrow donor/recipient pairs, searching for genetic differences. These differences could potentially cause the new immune system from the donor to recognize the recipient as foreign, thereby triggering an immune response that could produce adverse events such as graft vs. host disease. His research group found large differences on the genomic level but were not able to correlate those differences with transplant outcomes.

By Anish K. Desai

01
2014

Vigneshwar Kasirajan named Chair of Surgery

Chair of surgery

Vigneshwar Kasirajan, M.D.

Vigneshwar Kasirajan, M.D., has been named Chair of the Department of Surgery effective immediately. Kasirajan joined the MCV Campus in 2000. A professor of surgery and chair of the Division of Cardiothoracic Surgery, he has served as interim chair of the department since July 1, 2013.

Kasirajan has transplanted over 150 donor hearts in his career and is also one of the pioneers in the surgical implantation of artificial hearts and other mechanical assist devices. In 2006, he led the first surgical team on the East Coast to implant the SynCardia Total Artificial Heart, the only device of its kind approved by the FDA. His work in this field has helped establish VCU as one of the leaders in the realm of artificial hearts.

“Dr. Kasirajan has helped to create a vibrant environment at VCU,” said Jerome F. Strauss III, M.D., Ph.D., dean of the School of Medicine. “In addition to his work with transplant patients, he is at the forefront of a new frontier in cardiac surgery that includes artificial hearts and mechanical assist devices. As the lead investigator on a number of national clinical trials, he is addressing some of the most urgent issues in cardiac surgery.”

Based upon his experience and success with artificial hearts, Kasirajan was selected to be the lead investigator of a national clinical trial for the Freedom Driver, a small, portable air compressor that keeps artificial hearts pumping and allows patients to leave the hospital.

Kasirajan earned his medical degree at Madras Medical College, Madras, India and completed his internship and residency at Government General Hospital in Madras. His postgraduate medical education and training continued at the Cleveland Clinic Foundation, in Cleveland, Ohio, as chief resident in general surgery, followed by a fellowship in cardiothoracic transplantation and mechanical assist devices and appointment as administrative chief resident in thoracic and cardiovascular surgery.

24
2014

Medical school unveils resource to help teachers inspire students

Kenneth Warren, Ed.D.

The medical school has debuted a new resource, iTeach in Medical Education, to help faculty meet the challenge of satisfying adult students’ need for small groups, case-based problem solving and simulation. The website is an online toolbox of podcasts, videos, presentations and news to help them create their own course content.

Hand in hand with the McGlothlin Medical Education Center’s 2013 opening came a new innovative approach to medical education. The most significant renovation to the VCU School of Medicine’s curriculum in more than 30 years, it’s designed to satisfy adult students’ need for small groups, case-based problem solving and simulation.

Such a complete curriculum redesign, though, calls on faculty members’ ability and willingness to abandon ineffective approaches and embrace new technologies and teaching methods.

To help that along, the medical school’s Office of Faculty Affairs has created a website, iTeach in Medical Education, to give faculty a toolbox of podcasts, videos, presentations and news that’s relevant and useful for creating their own course content.

On the site, they’ll find monthly features on faculty members like Peter Haar, M.D., Ph.D., a 2006 graduate of the medical school who is now on faculty in the Department of Radiology. He expanded the traditional gross anatomy course by providing CT scans for all 32 cadavers. He taught students how to analyze and interpret the scans with the help of a series of screencasts – online videos that combine computer screen displays with audio narration. The students could watch the videos any time, any place and on any device.

The site also currently features Alan Dow, M.D., and the Class of 2017’s Scott Hirsch. From the perspective of faculty and student, the two talk about how the school uses case-based learning to help students apply basic science knowledge to clinical scenarios.

Kenneth Warren, Ed.D.

Kenneth X. Warren, Ed.D.

“The site is designed to enable faculty to innovate their teaching methods, illuminate their best practices and inspire their learners,” says Kenneth X. Warren, Ed.D., assistant professor and instructional technologist for medical education. “It serves as a central location to share inventive strategies, faculty narratives and multimedia resources related to medical education.”

One of his goals is to promote faculty fluency in digital media and technology, and so the iTeach site serves as its own model in that regard. Powered by VCU WordPress, the easy-to-use publishing platform incorporates content like podcasts, YouTube videos and presentations. With Warren’s support, the faculty development group helps faculty manage information overload by curating the flow of information relevant to medical education and re-tweeting what’s most valuable.

In addition to disseminating information, Warren wants to build community among teaching faculty who are spread out over the MCV Campus, the McGuire VA Medical Center and the medical school’s Inova Campus in Fairfax. The site’s online forums will allow them to discuss their experiences with new methods and strategies.

Since its April launch, the site has been accessed nearly 2,000 times. Over the course of six weeks this spring, a quarter of the site’s visits came from outside of Virginia. So far, the resources from the teaching strategies modules are proving most popular with videos that include internal medicine’s Residency Program Director Stephanie Call, M.D., who shares perspectives on the value of team-based learning and Assistant Dean Michael Ryan, M.D., on the importance of writing meaningful learning objectives.