Each spring semester, the University of New England College of Osteopathic Medicine (UNE COM) hosts a student-designed and delivered continuing education program called Clinical Anatomy for the Advanced Provider (CAAP).
In this program, medical students are given the unique opportunity to teach health care providers outside the structured didactics and case presentations of preclinical medical education. The UNE COM Emergency Medicine (EM) Club recognized the need for such opportunities for students during the preclinical years and had the resources on campus to provide the community with this educational opportunity.
CAAP is a 1-day, 8-hour educational program that provides community health care providers with four hours of clinically relevant anatomy lectures, typically encompassing airway, cardiac, gastrointestinal, genitourinary, and neurology systems, taught by second-year UNE COM medical students. The afternoon consists of four hours of hands-on, small group teaching sessions during which participants rotate through stations focused on similar systems in the UNE COM human body donor/gross anatomy lab. First-year students conduct most of the lab instruction, with the exception of neuroanatomy which is taught by second-year students. Lifeflight of Maine nurses and paramedics conduct an advanced airway skills session that runs concurrent with the afternoon anatomy lab sessions. For many participants, the program is their first opportunity to visit a human body donor/gross anatomy lab to see and handle human specimens. It provides a rare setting where clinical providers from multiple areas of medicine, from nursing to paramedicine to physical therapy, literally explore the human body together.
Prior to 2017, the EM Club at UNE COM offered similar anatomy programs but focused on a tactical EMS audience. With those programs as a framework, in 2017, medical student members of the UNE COM EM Club assessed their incredible resources – the human body donor/gross anatomy lab, extensive anatomy knowledge, and the strong support of the UNE COM Anatomy Department. The CAAP program was conceived with an objective of giving back to the medical community by offering an anatomy program with clinical focus for advanced providers, such as paramedics and nurses. The program also offers continuing education credits as a part of the event. By charging participants a modest fee, the program serves as an essential fundraiser for the EM Club while remaining a cost-effective form of continuing education for community providers. Most importantly, efforts are made to ensure the sustainability of the program, involving both first- and second-year medical students in the planning and execution of CAAP. Templates for lectures and teaching points continue to be handed down for the program’s continuation in 2020 and beyond. Planning in this fashion has allowed continuity and continued success in subsequent years, along with opportunities for ongoing development and innovation. A partnership was also established with Lifeflight of Maine, whose providers brought their vast clinical and educational experience to the event to teach the participants a variety of airway techniques, tips, and tricks in what is a highlight of the program. After a successful inaugural program in 2017 with 40 participants, CAAP has continued to grow with 65 participants in 2018 and 75 in 2019. In 2019, the program raised over $3,600 for the EM Club.
A Unique Educational Experience for Medical Students
Teaching students how to teach is not routinely a core component of preclinical and clinical medical education despite the fact that it is generally a requirement in residency and often becomes a cornerstone of a physician's career. Effective teaching begins with thorough understanding. CAAP challenges student’s knowledge base beyond brute memorization so they are prepared to answer questions that arise. Sharing knowledge with those from the medical community, but outside of a direct peer group, provides a unique opportunity to begin to hone the skills necessary to communicate clearly and develop engaging presentations. There is also the hope that student involvement in CAAP will inspire students to be educators and seek out further opportunities that will assist in the development of these skills later in medical school, residency, and beyond. Through CAAP, students are afforded an early chance to present to a large group or teach in the dynamic setting of the human body donor/gross anatomy lab—an example of how medical education instruction can be uniquely taught (through practice) in medical school. Further, as the students develop the ability to apply fundamental anatomy in a more integrated approach to problem solving, it is hoped this will translate to improved clinical care.
The medical students participate in a program debrief immediately following the conclusion of the event. This open forum facilitates discussions of successes, opportunities, and—perhaps most importantly—pearls of knowledge. The results of this debrief feedback session are used to improve CAAP for the following year. There is ongoing work, evaluation, and introspection to improve the program for the participants and the learning experience for the students each year.
The Success of CAAP
One fundamental component of educational instruction is evaluation—was it effective? Accordingly, CAAP is followed by a participant survey to gather quantitative data on the perceived effectiveness of the program and qualitative feedback on what works well and what could be improved. The survey includes a 10-point Likert scale that asks about the usefulness of both the lecture and lab components (1 = not at all useful, 10 = very useful) and similar questions to determine whether a participant would attend the program again and whether they would recommend the program to friends or co-workers (1 = would not recommend, 10 = would definitely recommend). Regarding utility, the lecture portion of the program received average ratings of 8.8, 9.3, and 9.3 in 2017, 2018, and 2019, respectively. Over the same years, the lab portion received average ratings of 9.5, 9.8, and 9.8. After CAAP in 2019, 84.4% of participants indicated that they would “definitely” return and 87.5% would “definitely” recommend the program to their friends or co-workers. These numbers suggest that CAAP is perceived as useful.
Overall, the qualitative feedback each year consists of several common themes. Respondents express gratitude for the event with the student contributions and the hands-on lab portion singled out as the most useful parts of the day, representing the profound and unique experience of being in a human body donor/gross anatomy lab. Many participants describe the continually evolving curriculum and new information gleaned at CAAP as reasons for attending year after year. The participant survey indicates that having a mix of physicians, Lifeflight providers, and medical students creates an “amazing environment to learn.” Health care students and providers regularly speak to how the program “brings a lot of the pieces together” related to anatomy and their everyday practice. CAAP participants report feeling like they can draw better connections between clinical practice and anatomy, strengthening bedside care through a different perspective on anatomy.
Importantly, critiques spanning from lectures to the catered lunch choices present the opportunity to respond to constructive criticism with action and improve the program the following year. For example, the program has evolved to provide outlines and notes to the participants, increase the time spent in the human body donor/gross anatomy lab, tailor the airway skills session to the providers in the room, and streamline the registration process.
CAAP is a unique educational experience for medical students, as it provides an early opportunity to practice educating, which is not often a core component of medical education, yet a duty as a resident and physician. Medical students have the opportunity to teach in large group settings, interact with the local health care community, and share the UNE COM resources. It is hoped that student-run educational courses engage medical students in the methodology of teaching and inspire them to become successful medical educators. This comes with an added benefit of solidification of the preclinical anatomy, which is paramount in many aspects of the practice of emergency medicine—from ultrasound to basic procedures.
Special thanks to everyone involved in the planning and success of Clinical Anatomy for the Advanced Provider over the years, including Frank Daly, PhD, Frank Willard, PhD, Hank Wheat, Peter Tilney, DO, Michael Bohanske, MD, Duane Siberski, DO, Brad Boehringer, RN, Michael McDonough, RN, Frank Marowitz, DO, Victoria Huckestein, DO, Sean Bilodeau, DO, Jack Lewis, DO, Riley Liptak, MS4, Kaitlyn DeStefano, MS3, Brett Armstrong, MS3, AJ Halstein, MS3, and all the other amazing UNE COM student volunteers. More special thanks to Lauren Westafer, DO for her edits and support while we were writing. All photos by Kristen Insardi, MS3 with permission from UNE Anatomy Faculty. To learn more about the UNE COM Emergency Medicine Club, follow on Instagram at @unecom_em.