Archive for the ‘Science Education’ category

East meets west: Stanford students can sample Tibetan medicine during clerkships

June 13, 2017

Photo by Unsplash

Stanford medical students must master genetics, biochemistry and immunology, among other disciplines. But school leaders don’t want these future doctors to be stumped when their patients describe their acupuncture sessions, or have questions about herbal supplements or other alternative therapies.

To help familiarize Stanford medical students with these practices, the students spend a day shadowing a practitioner at a participating integrative medicine clinic during their family medicine clerkship.

“We want to introduce students to the idea that the patients they see in clinic are using these other health-care systems,” said Art Johnson, coordinator for the family medicine clerkship. “They need to partner with patients in managing their health in the best way possible, and utilize all available resources.”

The Kunde Institute, a center for Tibetan wellness and healing located in Daly City, is one of these participating clinics. It offers a unique opportunity for students because most integrative medicine clinics in the Bay Area focus on Chinese medicine, Johnson said. About 10 Stanford students per year shadow practitioners at this center, said Tracy Rydel, MD, who directs the family medicine clerkship.

Tibetan Medicine, which originated more than 4,000 years ago, attributes the roots of all disease to an imbalance of the three Nyepas (rlung, tripa and peken) that emanate from the three mental poisons of desire-attachment, hatred-anger and closed-mindedness. Treatments at the Kunde Institute include herbal medicines, hot oil therapy, acupuncture, copper cupping, and individualized counseling on diet, nutrition and lifestyle behaviors.

At the Kunde Institute, the participating students learn from Menpa Yangdron Kalzang, LAc, who has a Tibetan medicine degree from the Tibetan Medical University in Lhasa, Tibet and a master’s in traditional Chinese medicine from Five Branches University in Santa Cruz. They learn about the connection between the physical, emotional and mental health of patients, one student told me.

Stanford medical student Victoria Boggiano first learned about Tibetan medicine when she attended a symposium at Stanford, she said. When she shadowed Kalzang, she told me she became very interested in how Tibetan medicine can complement the biomedicine traditionally taught in medical school. Boggiano described her experience via email:

“I spent an afternoon with Menpa Kalzang shadowing her as she saw patients with a variety of ailments. I remember really distinctly that two separate patients we saw that day had very bad plantar fasciitis, an inflammation of thick tissue in the foot that leads to pain in the heel and bottom of the foot. Before coming to the institute, neither patient had been able to walk without feeling terrible pain that had been resistant to any of the medications or physical therapy that their primary care physicians had provided them. Both patients started seeing Menpa Kalzang to receive acupuncture and herbal remedies, after which they both saw dramatic reductions in their symptoms. It was incredible to see how much Menpa Kalzang had helped them!”

Since 2008, about 100 Stanford students have visited Kunde, Kalzang said. She said she plans to continue with the program.

“I do this to build bridges between the Western and Eastern medical systems,” Kalzang said. “We need to establish integrative medical systems that allow providers from different disciplines to share information and put in referrals for both types of treatments. This is particularly important for patients with complex cases when Western or Eastern medical systems alone can’t answer or solve the problem.”

Boggiano hopes to be part of this vision of integrative care. After medical school, she plans to specialize in family medicine and work in a primary care clinic. She explained:

“I am eager to learn more about alternative medicine, and particularly Tibetan medicine, both by continuing to work with Menpa Kalzang and by gaining additional clinical experience. It would be incredible to work at a clinic where both biomedicine and alternative medicine are practiced side by side. Tibetan medicine encourages us to view patients in a holistic way and reminds us that mental health and physical health are incredibly intertwined. Patients deserve to receive both types of health care.”

This is a reposting of my Scope blog story, courtesy of Stanford School of Medicine.

Engineering better opioids: A podcast featuring Stanford bioengineer Christina Smolke

May 31, 2017

Obtaining compounds from nature, such as opioids from poppies or taxol from yew trees, is hard and time-consuming. So researchers, including Stanford’s Christina Smolke, PhD, are working to synthesize medically useful compounds by reengineering nature.

Smolke, a professor of bioengineering, describes her efforts to engineer yeast to make opioids on a recent episode of the “Future of Everything” radio show.

“These are compounds in nature that the opioid poppy has evolved to make. And to date, our chemists have not been able to develop efficient processes to make these compounds,” Smolke told show host Russ Altman, MD, PhD, a professor of bioengineering, of genetics, of medicine and of biomedical data science. “So we still farm this drug crop of opioid poppy to produce these molecules and the raw materials to make these molecules. And there are many limitations that come about from doing that.” These limitations include environmental and geopolitical risks, she said.

Smolke explained that she tackled this research even though many experts in the field viewed it as impossible — because it involved reengineering a complicated set of reactions and mix of enzymes that work together within the opioid poppy to build the opioid molecules. Over 10 years, her research team developed the very challenging platform technology to “prove that it could be used with any compound found in nature.”

“The final yeast strain that made the initial opioids molecules had 23 different enzymes put into it. So one of the challenges was identifying the enzymes from the opioid poppy and then moving them into yeast,” Smolke said.

But the trickiest part, she explained, was getting them to work in yeast, which is a very different organism than opioid poppies. The researchers had to modify each of the enzymes to create a yeast strain that could churn out opioid molecules.

There is more work to do though, including creating yeast that are more efficient at making the opioid compounds, as well as using the technology to make better opioids with less side effects so they are less addictive. Luckily, Smolke expects her new research projects to go more quickly now that they’ve developed the basic tools.

“We’re probably around 5 years away from molecules coming from yeast-based platforms to actually be in the medications that you’re taking,” Smolke explained. “Some of that lag is due to the engineering that we have to do to make the processes efficient enough so they can be scaled up at a commercial setting. And others are [due to] regulatory approvals.”

This is a reposting of my Scope blog story, courtesy of Stanford School of Medicine.

Build-your-own robot can tackle biology and chemistry experiments

March 29, 2017

Building off-the-shelf Lego robots can teach kids important skills like mechanical engineering, computer programming and teamwork. Now, Stanford bioengineers are adding life sciences and chemistry to the list.

Stanford researchers have developed a liquid-handling Lego robot capable of a range of experiments — integrating robotics, biology, chemistry, programming and hands-on learning into a single, open-source educational tool. Built from a cheap plastic syringe and a Lego Mindstorm EV3 Education kit, the robots are designed to pipette fluids into and out of plastic containers commonly used in laboratories.

The team also designed and tested several fundamental experiments for elementary and middle school students using their DIY robots and common household items like food coloring, salt or sugar, which are described in a recent paper published in PLOS Biology.

One of the favorites is an experiment that teaches kids about density and buoyancy by sequentially layering colored liquids with different salt concentrations into a single test tube — demonstrating that the liquids float on top of each other instead of mixing, and explaining why objects float or sink.

“We would love it if more students, do-it-yourself learners, STEM teachers and researchers would embrace this type of work, get excited and then develop additional open-source instructions and lesson plans for others to use,” said Ingmar Riedel-Krus. PhD, assistant professor of bioengineering, in a recent news release.

This is a reposting of my Scope blog story, courtesy of Stanford School of Medicine.

Bringing innovative education to emergency medicine: A Q&A with a doctor/filmmaker

March 23, 2017

What do immersive simulations, filmmaking and emergency medicine have in common? One answer is Henry Curtis, MD, a Stanford clinical instructor in emergency medicine who’s using innovative tools to educate medical students and residents about emergency medicine.

Curtis’s latest endeavor is a class called EMED 228: Emergency Video Production, which teaches students how to impact emergency care through film by “telling a story that matters.” I recently spoke with him about his use of filmmaking and simulation games.

Why do you use simulations and filmmaking as education tools?

“Both simulation and filmmaking serve different purposes for emergency medicine education. Immersive simulation is an arena. It’s a place where learners can experience a medical emergency in a safe environment. They make medical decisions, perform procedures and communicate with the patient and their team. When it is all over, they reflect on what happened. Aside from real life clinical experience, there is no better educational technique.

Filmmaking imagines and documents life. Video based learning has many advantages, not the least of which is reproducibility —a final cut is independent of individual human factors that could affect quality on any given day. It is fascinating to bind the experiences unfolding in a simulated medical emergency with videos. For instance, engagement videos can function to more powerfully immerse the learner into a given clinical scenario. Information videos can relate valuable educational cues more effectively than a photo, announcement or text flashed on a screen. Video based debriefing allows playback of the important moments in a scenario.”

What inspired you to create the EMED 228 course? What does it entail?

“I’ve been pursuing a master of fine arts in directing for the last few years at the Academy of Art University in San Francisco. I wanted to give back to Stanford and share the filmmaking skills I’ve acquired with students.

EMED 228 is open to undergrads, grads and medical students. We were fortunate to have a nice mix of students of all different educational interests and filmmaking experience enrolled. They were exposed to an overview of filmmaking. We began the first day with theory. The class then quickly progressed to understanding and implementing the practical aspects of creating a final product — using a robust array of equipment, including multiple high-definition DSLR cameras, GoPros, drones, remote focus pulling devices and gimbals.

The entire class culminated in a screening and Q&A session of the documentary that we created titled, Care Flight in the Golden Hour. We aimed to provide insight into the process and people delivering care to critically ill patients in Lake Tahoe requiring air medical evacuation. These caregivers provide a service, which oftentimes will make the difference between life and death of healthy people who are having a tragic day. We chose to film on location in Truckee, California. Hannah Rasmussen, a first-year medical student, acted as a teaching assistant. Her efforts were invaluable in organizing our remote and on-site collaborations.”

As a child, did you want to be a film director when you grew up?

“I did not always know that I would be so drawn to the storytelling art of filmmaking or that I would prefer to be in the role of directing. I did know that I preferred film to photos when creating memories. In fact, I have many more short videos than photos in the memory closet. During the last year of my emergency medicine residency, I chose to concentrate on the use of film in disaster medicine education and this is where my filmmaking life really began.

Stanford University is a rich world of opportunity. It has encouraged me to chase my interests and carve out a niche in the medical humanities. The department of emergency medicine is fully supportive of my journey. With such resources and encouragement offered at so many levels, I encourage everyone to seek out their passion in this environment.”

This is a reposting of my Scope blog story, courtesy of Stanford School of Medicine.

Reimagining Nutrition Education: Doctor-chefs teach Stanford medical students how to cook

January 30, 2017
5

Photograph courtesy of Michelle Hausman

Stanford medical students still learn traditional topics like anatomy, genetics and neuroscience. But now, they can also learn how to cook, thanks to a new hands-on course developed in part by Stanford’s Michelle Hauser, MD.

A former Le Cordon Bleu chef, Hauser is currently an internal medicine-primary care attending for Stanford residents and a postdoctoral research fellow at the Stanford Prevention Research Center. She teamed up with Stanford pediatrics instructor Maya Adam, MD; physician Tracy Rydel, MD; nutrition researcher Christopher Gardner, PhD; physician-chef Julia Nordgren, MD; and Stanford chef, David Iott, to launch the new class, which is featured in a video.

Hauser said the course aims to teach future clinicians how to cook healthy food, so they can more effectively counsel their patients on nutrition and diet. Intrigued, I spoke with her recently.

Why did you introduce this course?

“Diet is the most significant risk factor for disability and premature death in the US. However, less than one-third of medical school and residency programs offer a dedicated nutrition course to their students. When courses are available, many schools use outdated, overly long and complicated online modules rather than in-person nutrition instruction. They often just focus on nutrients, whereas patients think of nutrition in terms of food. And most schools don’t teach how to effectively counsel patients to change their behavior around eating — people know it is healthy to eat more vegetables, but how do they accomplish this? We need to better prepare physicians to treat the underlying causes of disease and to prevent diet and lifestyle-related diseases from occurring in the first place.”

How can your course help?

“Teaching kitchens are the perfect, hands-on medium to help doctors learn about food. By learning to prepare delicious, healthy food for ourselves, we become healthier — and studies show that physicians with healthy habits are more likely to counsel patients on those habits. Additionally, it’s more fun and memorable to learn about food and nutrition while cooking and sharing meals together than it is to sit in a lecture hall.

As a platform to teach about nutrition, our new teaching kitchen elective focuses on how to prepare healthy meals based on plants and whole foods, a diet that is ideal for the majority of the population. We also teach a concept called the “protein flip” — instead of having the center of your plate be a large piece of meat, you use meat as a garnish for a plate full of plant-based foods, such as vegetables, fruits, whole grains, legumes, nuts and seeds. Think veggie chicken stir-fry with brown rice or a main course salad with a small portion of grilled salmon.

Our sessions use a flipped classroom format. Before class, students view engaging preparatory videos online (and many of these are available through Stanford’s Food and Health series). At Stanford’s teaching kitchen, they watch the chefs’ cooking demonstrations and then lace up their aprons and start chopping and cooking. In addition, Tracy Rydel, Maya Adam, Christopher Gardner and faculty from other medical programs are cooking alongside the medical students to represent the lay cook’s perspective, as well as spread the idea of using teaching kitchens to others in the Bay Area and beyond. At the end of each session, we all share and eat together.”

How do you make healthy food appealing?

“Healthy food has gotten a bad rap for far too long. We need to make sure that healthy food is delicious if we expect people — including ourselves — to eat it so that it can nourish our bodies and prevent nutrition-related chronic diseases. Food is a huge part of all of our cultural identities and is intricately linked with many of our fondest memories. I often see medical professionals in training and in practice tell patients to stop eating a whole variety of things — many with personal and cultural significance — without helping them figure out what and how to eat differently. And these conversations often make it sound like the patient needs a ‘special’ diet inappropriate for the whole family. Instead, we need to celebrate the togetherness of sharing healthy food.

 For the final project, the students will make favorite healthy foods that mean something to them. For instance, I would make hummus, tabouli and falafel wraps (falafels rolled up in warm whole-wheat pita bread with chopped tomatoes, scallions, cucumbers and spring mix drizzled with lemon-tahini sauce). As a vegetarian with a dairy allergy, my Irish-immigrant family’s traditional Christmas dinner normally left me with a lonely potato and a few token veggies. However, a few years back I cooked this Middle Eastern meal for my family and it was a hit. And this year, my mom requested that we make the meal as the centerpiece of our Christmas spread!”

This is a reposting of my Scope blog story, courtesy of Stanford School of Medicine.

Dr. B’s brain collection helps local students learn anatomy

November 21, 2016
mg_2144_jsh

Photo courtesy of Donna Bouley

Most of the time, veterinary pathologist Donna Bouley, DVM, PhD, provides pathology support for Stanford researchers and clinicians who work with animals.

But she also has an unusual hobby: Bouley, known to all as Dr. B, collects animal brains. Since 1997, she and others have taken “Dr. B’s Brain Collection” to local schools for a variety of science programs. Fascinated by this idea, I contacted her to learn more.

What inspired you to create your brain collection? What does it include?

“When I first started as faculty at Stanford, there were some preserved brains in the necropsy [animal autopsy] lab. I decided to start collecting more brains from animals that came to necropsy, when we didn’t need their brains to make our diagnosis. The word somehow got out that such a resource existed on campus. Now, I actually have two collections that are almost identical, because multiple labs were interested in borrowing the collection at the same time.

In each collection, I try to have at least one of the following brains: sheep, pig, dog, macaque, squirrel monkey, rabbit, owl, rat, mouse, cyclid (fish), and Xenopus laevis (an African Clawed frog). The brains are preserved and sealed in ‘seal-a-meal’ style bags or jars.

If any new species come through necropsy, I try to get brains from those animals. I also have to replace damaged ones each year, since the enthusiasm of middle schoolers can often result in the rough handling of my bagged brains. My necropsy tech keeps a close watch over the condition of the collections and replaces brains as needed or when available.”

How do you use the collection at Stanford?

“I teach a freshman seminar called Comparative Anatomy and Physiology of Mammals that tends to have several pre-vet and pre-med students each year. I use these brains to demonstrate various features that are similar or different between them, such as overall size, location of the cerebellum or the extent of brain surface folds and ridges. For instance, in lower mammals such as rodents — that survive mainly on instinct rather than cognitive processing — the brain has a very smooth surface. In mammals such as a pig, dog, or macaque that are higher functioning and quite intelligent, the brain surface is highly folded or convoluted. And dolphins and elephants have even more convolutions in their brains than humans!

I also have colleagues that teach Comparative Neuroanatomy at the graduate level and they borrow the brains.

I can only speak about my own college student reactions to exposure to this field and tell you in general they are amazed and in awe. They never look at animals the same after taking my class.”

How do others use the brain collection?

“Graduate students from Stanford psychology or neurobiology labs generally take a brain collection to nearby middle schools, where they work with students during a science class. They most likely also bring some human brains that they compare to the animal brains. Having unique visual teaching tools — real brains, not models or pictures — helps the middle schoolers gain insight into the complexity of the nervous system. Learning about anatomy from a truly comparative aspect is incredibly valuable, because it demonstrates the similarities as well as the unique differences between humans and other mammals.

I’m sure that ‘Dr. B’s Brains’ provide a very lasting impression on students.”

This is a reposting of my Scope blog story, courtesy of Stanford School of Medicine.

Stanford medical student illustrates mnemonics

October 19, 2016
Illustration courtesy of Nick Love

Illustration courtesy of Nick Love

Medical students frequently turn to mnemonics to master human anatomy, but they’re usually just catchy phrases. Now, Nick Love, a second-year Stanford medical student, has created a more entertaining way to memorize anatomy: a set of illustrated mnemonics, which he has published in the form of a book and website. I recently spoke with Love about his project.

What inspired you to illustrate the anatomic mnemonics?

“When I began medical school, I was totally unaware as to the central role mnemonics play in medical education and beyond. They are everywhere! Their sometimes wacky and ridiculous wordings intrigued me — I wondered if they could serve as a unique source of ‘found imagery,’ starting points for visual exploration. I brought up this idea with Audrey Shafer, MD, director of the Biomedical Ethics and Humanities medical school track, and she kindly encouraged me and linked me up with an awesome mentor for the project, pediatric anesthesiologist and painter Samuel Rodriguez, MD.”

Where did you get the mnemonics and how did you choose your illustration style?

“They are all essentially common med school mnemonics. Fourteen of the 16 mnemonics were passed on to us as medical students, mainly by our clinical anatomy teaching assistants via the ‘whiteboards’ in the anatomy lab. I sourced one mnemonic directly from the internet, and I altered another because its original form was too raunchy for publication. At the moment, I am, unfortunately, too behind on too many things to add more.

In terms of illustration, I was motivated to try a digital-analog-digital process. I’m currently intrigued by combining the reproducibility of computer-aided illustration with the inherent chaos of spreading paint or ink. Also, I wanted to maximize color usage, insert a bit of whimsy into the illustrations and experiment with recursive imagery.”

Do you have a favorite mnemonic?

“My favorite mnemonic is ‘canned soup, really good in cans.’ It helps one remember the branches of the descending aorta — canned soup, really good in cans, representing celiac, superior mesenteric, renal, gonadal, inferior mesenteric, and common iliac arteries. The phrase ‘canned soup, really good in cans’ strikes me as rather humorous, like it was made for an ad campaign when soup was first put into cans. Genius, whoever came up with it.”

Do you have any art training? Who are your favorite artists?

“Before coming to medical school, my training was mainly in science. However, last year I took two art classes at Stanford, ‘Digital Photography’ and ‘Video Compositing,’ both of which were awesome. As a kid, I mostly played sports, video games and outside. The desire to make things came later.

My favorite artists include Alphonse Mucha, David Hockney, Kiyoshi Yamashita and Andy Warhol. Currently, my favorite museums are the Cantor Arts Center and the Anderson Collection — right here at Stanford and only about 1 km from the medical school! I also try to go to the Tate Modern when I’m in London.”

Do you hope to include art somehow in your future medical practice?

“I’m very much interested in learning more about what is referred to as the ‘art of medicine,’ and I hope to have the time to keep creating. At the moment, I’m most drawn to visually-based medical specialties, such as dermatology, pathology, radiology and nuclear medicine.”

This is a reposting of my Scope blog story, courtesy of Stanford School of Medicine.


%d bloggers like this: