Coursera, the global online learning leader, announced the launch of its health vertical – a broad portfolio of health content from the world’s top universities curated specifically to help address the acute shortage of skilled workers in the health industry and meet the demands of a digital health economy.
The CU Anschutz Medical Campus is among the top-ranked institutions in health partnering with Coursera to release 100 new courses, 30 new specializations and two public health-focused master’s degrees to provide learners with the skills they need to enter high demand jobs, mainly related to Health Informatics, Healthcare Management and Public Health. Notably, CU Anschutz played a vital role in the launch, providing over one-fourth of the courses and more specializations than any other Coursera partner.
CU Anschutz plays vital role in offering new courses
“The University of Colorado Anschutz Medical Campus is pleased to be a national innovator in digital education. This past year, with our partners at Coursera, we have launched the first course specializations in health care on the Coursera platform, sharing some of our faculty’s educational expertise with 36 million learners throughout the world,” said Roderick Nairn, PhD, provost and executive vice chancellor for academic and student affairs at the University of Colorado Denver and Anschutz Medical Campus. “The breadth of our course offerings reflects the diversity of our campus; Palliative Care, Emergency Medical Services, Caring for Healthy Newborns, School Health, and Clinical Data Sciences are among Coursera’s inaugural healthcare course specializations and are a testament to the global reputation of CU Anschutz in both defining contemporary standards of medical innovation as well as training the next generation of healthcare leaders.”
New specializations to train future healthcare leaders
CU Anschutz offers many specializations, including:
Become an EMT: EMT medical and trauma emergency care. Gain the skills needed to provide first responder emergency medical care.
Clinical Data Science: Launch your career in clinical data science. A six-course introduction to using clinical data to improve the care of tomorrow’s patients.
Newborn Baby Care: Newborn baby care skills. Gain skills in newborn baby care, safety and health including breastfeeding, safe sleep and screenings.
“I am deeply passionate about driving innovation in healthcare,” said Daphne Koller, co-founder of Coursera. “The sector, which is under enormous strain to support the needs of a growing and aging population, presents a huge opportunity for meaningful technological transformation that stands to not only improve health outcomes for people around the world but also reduce the increasingly unaffordable costs of healthcare, both to individuals and to society. I’m excited to see Coursera and its partners coming together to help realize that potential by providing access to flexible and affordable education options that can help usher in the next generation of healthcare workers in high-demand fields like health informatics, healthcare management, and public health.”
CU Anschutz joins Johns Hopkins University, University of Pennsylvania, Rice University, the University of Michigan and the Imperial College of London in launching health care specializations. The new specializations will roll-out through 2019 and will be available for a subscription range of $39 to $79 per month.
In Chase Lewis’ first semester at the CU School of Dental Medicine, he dug deep into human anatomy on his school-provided iPad. He used a state-of-the-art dental trainer that simulates drilling on an actual tooth. He even explored new worlds, including a land of dinosaurs and the surface of Mars, in the new Immersive Learning Suite.
In the suite, which has 10 virtual reality headsets and backpacks available for checkout, Lewis and his classmates explored digital environments that are on the leading edge of education for future dentists. While enjoying content that’s tailored to their individual learning styles, the students are moving faster, and in a more engaged manner, into all facets of their training.
“With all the opportunities we’ve been given, students can go in any direction,” said Lewis, who already holds a master’s degree in modern human anatomy. “As a first-year dental student, to get access to those three pieces of technology, was awesome. All of the investment here is future ready. It’s great for everything we need” to become dentists.
Indeed, the CU School of Dental Medicine is pioneering a multi-modal, digital approach to learning. It is one of only a handful of dental schools nationwide with Simodont dental trainers, which provide high-fidelity simulation and training. Previously, dental students first picked up hand pieces during pre-clinical lab, typically a second-semester class. Now, with the Simodont, they are assigned first-semester psycho-motor exercises with hand pieces on the VR trainer.
“It puts them farther ahead quicker than in the past,” said Michael Henry, DDS, PhD, the school’s associate dean for academic affairs. “Dentistry is a visual art; it’s based on three-dimensional relationships. So, utilization of VR technology really allows us to take advantage of that.”
Goal: Pioneers in education
At a retreat two years ago, school faculty and leadership discussed how students are best served by experiencing content through multiple modalities. The brainstorm sparked plans to further invest in both innovation and personnel to support all aspects of pre-clinical, didactic and clinical dental education.
“We have this incredible generation of people who have grown up with technology as a greater focus in their lives. So, how do we maximize that?” said Dean Denise Kassebaum, DDS, MS. “How do we make opportunities to take this very special student and develop a productive educational experience that is different from the regular dental education? Everything we do is an intentional investment. It’s designed to engage the learner and make sure we position our graduates to be future ready.”
In the Immersive Learning Suite — which, with an emphasis on basic sciences, is among the first in the nation’s dental schools — students use an app that allows them to explore in stunning detail all the systems of human anatomy. In the VR environment, they view a 3D representation of a body, then construct (or deconstruct) it with the muscular, cardiovascular, nervous, digestive and other systems of anatomy.
Between the VR anatomy and the resiliency options, the latter offering relaxing earthly or otherworldly excursions, “we have a hard time getting them out of there to go to class,” said Tom Greany, DDS, assistant professor and director of academic technology initiatives.
Better, faster training
The dental school will track and measure the effectiveness of the new tools. So far, results are encouraging. Professors are able to monitor how long, and how effectively, students are using the Haptics Advanced Technology Suite. “In the Introduction to Dentistry course we were able to track their scores when they repeated exercises multiple times,” Greany said. “Did they get better, faster, and did their efficiency improve? We were able to show some early evidence that that appears to be the case.”
Performing procedures with a hand mirror — called indirect vision — is typically a difficult skill for dental students to learn. “I’m looking in the mirror and I think my hand is going one way and it’s going the opposite way,” Lewis said. “So (the indirect vision training on the Simodont) is a great opportunity to learn that early on. I’m excited for it.”
Because a digital scan of a patient’s teeth can be uploaded into the Simodont, students can practice on a virtual simulation of an actual person they will treat in, for instance, a board exam.
Developing best practices
Beyond training for a high-stakes scenario like a board exam, the various technologies are paying off in many personalized-learning situations as well.
Ben Wilkoff, the school’s program manager for digital education and academic technology, was struck by the “beautiful” way a student took notes on arterial flow in the brain. The student, using his iPad, represented the arterial system as a subway map. “It’s letting them be the agents of their learning,” Wilkoff said. “They are the ones who get to determine, ‘This is what I need to enable and empower my learning.’”
The dental school is measuring outcomes with the new modalities and will explore how to best apply the new technologies, including possibly forging collaborations with other disciplines on campus.
“We want to get good at it — really, really good at it — and write some of those best practices so others can feel good about moving forward,” Wilkoff said. “We’ve had students using the VR technology and we ask, ‘What would make this better? What would make this more supportive?’ I think those are the best questions we’ve been asking.
“We are literally the only ones doing this and establishing what it looks like for other folks,” he said.
The VR immersions in resiliency, meanwhile, encourage health care providers to recharge and refresh in breathtaking virtual spaces. “There is a comprehensive set of things we all ought to consider about being a health care provider, and that starts with being healthy yourself and being able to be present and mindful for the patients you have the privilege to treat,” Kassebaum said.
Scratching the surface
The dean noted that VR environments also offer opportunities for empathy training for health care providers. For example, there are VR applications that show a user what it’s like to be colorblind.
“How can we truly teach empathy for some of the limitations that people may have? That’s part of being a health care provider and providing person-centered care,” Kassebaum said. “We’re now positioned to expand into even broader areas with these new technologies. We feel like we’re right at the edge, scratching the surface on something that has so much potential.”
Lewis, meanwhile, looks forward to the rest of his dental school experience at CU Anschutz. He loves that the commitment to the cutting-edge technology is so great that students can use it any time; there’s no waiting for access.
“It’s all right here, so go try it,” he said. “You can be as excited as you want about it. Let’s see what happens.”
Persistent because she refused to take no for an answer when she volunteered to donate her body to his Visible Human Project. Persistent because, after he accepted her request, she kept pushing when Spitzer initially refused to show her the large freezer where he stores cadavers, and the equipment he used to grind them into slices nearly the width of a human hair.
‘We need to bring her back to life, to develop a living cadaver.’ – Victor Spitzer
Now, almost four years after she died from heart disease, Potter persists in a most profound way. She’s been frozen, sectioned and sliced — all in support of medical education. And now she exists in 27,000 photos taken of her entire anatomy, which is gradually being assembled in high-resolution digital form.
Deep within the Fitzsimons Building, Spitzer sits in his laboratory which is festooned with roses on walls outside the freezer; the paintings were done by two students in the master’s program in Modern Human Anatomy. Potter, who was known as the flower lady at the Ninth Avenue and Colorado Boulevard location of the CU Health Sciences Center, requested that flowers be kept near Spitzer’s freezer, a place she always felt needed some brightening.
“I would think Susan is smiling because she ended up where she wanted,” Spitzer said. “She wanted to end up in the students’ minds.”
That’s the abridged version of an unusual story.
National Geographic: 14 years on a single story
This is what Potter read in a newspaper about the National Library of Medicine-supported Visible Human project some 25 years ago: A CU team led by Spitzer and David G. Whitlock, MD, PhD, had sectioned off, from head to toe, both a male and female cadaver, using a calibrated machine to grind off layers to as small as one-third of a millimeter. Each layer of the body was then photographed. Spitzer’s team took thousands of photos and then organized the data to allow users to interactively tour a virtual human body.
Now, another array of photos will document Potter’s story to a worldwide audience. National Geographic assigned a photographer and writer to chronicle Potter’s unusual journey. Back in the early 2000s, the magazine thought it would be a one-year assignment. Potter had been in a serious car accident, was in a lot of pain and was mostly confined to a wheelchair. She expected to die within a year. “National Geographic came on board to document her life for the next year and, in fact, continued on for the next 14 years,” Spitzer said.
When Potter lodged her request, Spitzer didn’t plan to become her friend. “I didn’t want to become her friend; I wasn’t particularly happy about imaging and sectioning my friend,” he said. “I knew her back when she sold flowers in front of the chancellor’s office on the Ninth Avenue campus every Christmas. She did a lot of things to support the medical school. This was her last wish to support it as best she could, in donating her body.”
A living cadaver
And, because technology improved since the original Visible Human project in 1993, much more detail will be seen in Potter’s virtual anatomy. The original Visible Human was ground into sections of 1,000 microns for the male (300 microns for the female); Potter’s body was ground off 63 microns at a time, resulting in thousands more photographs being taken. By comparison, a human hair is about the same diameter.
Spitzer’s lab isn’t stopping at photos. Through his company, Touch of Life Technologies, located in the Fitzsimons Innovation Community, he is developing ways to fabricate the feeling of living tissue. “There’s no reason for us to keep a virtual cadaver,” he said. “We need to bring her back to life, to develop a living cadaver, one that you can see move or move in response to what you ask her to do. Being able to feel and touch and see is something very doable today.”
Behavior and personality join anatomy
Assembling the images is a small part of the overall project. Identifying everything in Potter’s body is an enormous task. When she is fully rendered, along with the material collected by National Geographic, medical students will be able to sift through her anatomical data, while getting a picture of her psychological background.
Potter’s background is somewhat murky. She didn’t talk much about her childhood, only that she grew up in Germany under difficult circumstances. As an adult she was plagued by health issues, confined to a wheelchair but always looking for some way to give back to the CU School of Medicine. “We care about everything,” Spitzer said. “We want to correlate the anatomical with her feelings and her behavior, which is more the social sciences.”
Support from the School of Medicine, the Department of Cell and Developmental Biology and his company allowed Spitzer to create a living cadaver of Potter. Still, many more donations are needed. “We need to look at the anatomy of the virtual world as close as we do in the real world,” he said. “Someday, we need a bookshelf of bodies, or virtual human anatomy, from the very young throughout the aging process,” including people of all ethnicities.
She continues to talk to students
Early in their medical school career, CU medical students are introduced to the cadaver process and hear from people who want to donate their bodies. Potter spoke to the class, and several students ended up following her life as they moved into their professional careers.
“Susan has passed, but the last two years she has continued to talk to our students through video recordings saying why she’s donating, how she’s trying to help them and the whole health care profession,” Spitzer said. “So, she’s already in front of our medical students, just not her anatomy. Next year, they’ll see some of her anatomy, and every year they’ll see more of her anatomy.”
In the video recordings of her life, they’ll also see how passionate she was about furthering the understanding of the human body. “She told people she would be in a freezer,” Spitzer said. “She agreed — but not at first — to being on the internet for the entire world to learn from her. She mainly wanted to be a donation to help the students at CU.”
When it came time to section Potter’s 87-year-old body, the professor was able to distance himself emotionally from what he was doing to his friend, the flower lady. “She was my friend, and I was happy to do what she wanted me to do,” he said.
He then paused and added, quite matter-of-factly (as you might expect of a scientist): “From dust thou art, to dust thou shall return.”
Although the 90-minute phone marathon can offer a crash course in stress control and mental cleansing, it provides CU, volunteers and Channel 9 viewers so much more, participants say.
“It gave me a sense of the needs of the community members, and it helped me learn how to think on the spot,” Larson said. “As a pharmacist, it’s really important to be able to communicate effectively and respond accurately in a way that the patients understand. It was great practice.”
Fulfilling a growing need
Because of the popularity of the service (no volunteer’s phone ever sits quiet) coupled with serious medical matters taxing the community, Channel 9 recently boosted the airings, making Pharmacist Line9 a monthly event, said Lynne Valencia, Channel 9 vice president of community relations.
Many of the questions I answered I felt really made a difference in their lives, whether it was preventing drugs from falling into the wrong hands or averting a serious health event. — Briana Williams
From an opioid-addiction crisis gripping the state to a severe flu season lingering on, critical issues have heightened the need for the partnership, said Valencia, an alumna of CU Denver. “CU students and faculty members supply the expertise that people are looking for, and we provide the platform. They offer our viewers sound advice and a great service.”
“It really can help supplement what you are learning in class,” said third-year graduate student Briana Williams, an active volunteer, including with Line9, and an intern at University of Colorado Hospital. “You definitely get questions right off the bat that you are like: I have no idea how to answer this. But you have to think on your feet and use the resources that you are taught in pharmacy school.”
Facing tough questions
Armed with Centers for Disease Control guidelines and other medical and prescription directives, Williams and Larson quickly fell into the groove of the call-ins, which generally include two students and two faculty members. Apprehensive her first time, when she was a second-year student, Larson said she remembered a lesson from school: It’s OK to say I don’t know.
Calls can run the gamut from the simple — Where can I get a flu shot? — to the moderate — How do I dispose of addictive medications? — to the complicated — What will I do if I can’t refill my pain-pill prescription?
With new regulations threatening opioid access, many calls relate to the crisis, including from fearful patients who rely on the drugs, Larson said. “I found those questions kind of challenging. A lot of these people have been living with chronic pain for years, and it’s the only thing that can get them out of bed in the morning.”
The anonymity factor can embolden callers to ask more complicated and sensitive questions, Williams said. “Without having to actually go to a physician or pharmacist and see them face to face, they can ask these questions without thinking in the back of their minds that somebody is judging them,” she said.
Volunteers can confer with their colleagues on the Line9 desk, or, when a question falls outside of their expertise, refer the callers to their physicians, Williams said. “You have to know your boundaries and your scope of practice.”
Educating the pubic
Regardless of whether they can answer the question, the volunteers educate patients and urge them to use their physicians and pharmacists as resources. “I don’t know a pharmacist who wouldn’t provide any patient a phone consultation, but a lot of people don’t know that,” Larson said.
I think it really gets out to the public that pharmacists are not just pill-pushers; that we really have a lot of education that we go through to provide more services. And we are typically one of the more accessible health care professionals. — Briana Williams
Williams, who said she chose the CU Anschutz Medical Campus for graduate school partly because of the state’s progressiveness in the pharmaceutical field and the school’s emphasis on multidisciplinary teamwork, said taking part in events like Line9 also helps educate people about her profession.
“I think it really gets out to the public that pharmacists are not just pill-pushers; that we really have a lot of education that we go through to provide more services. And we are typically one of the more accessible health care professionals.”
‘A greater purpose’
A lot of people don’t know where to go for help, Williams said. “Many of the questions I answered I felt really made a difference in their lives, whether it was preventing drugs from falling into the wrong hands or averting a serious health event.”
In today’s competitive world, volunteering can also boost student’s chances at jobs and residency programs, said Williams and Larson, who both work in pharmacies and have their eyes on residencies post-graduation. Larson recently learned that she matched to a PGY1 residency with UCHealth Memorial in Colorado Springs.
Residencies are not required, but they can help set pharmacy students up for careers in hospitals and clinical settings after graduation. This year’s residency numbers for CU Pharmacy are on par with previous years, with 64 percent of those who applied matching, tying the national average.
“I just can’t stress it enough how important work and volunteering is,” Larson said. It also helps students stay focused on what comes at the end of their heavy college load. “I remember going to work after an exam and being grateful to see there’s a lot to look forward to,” she said. “It’s all for a greater purpose.”
Boyrer, MS, MA, BSN, RN, recently became the inaugural master’s degree graduate of a first-of-its-kind CU Anschutz program centered on the military and veteran population.
Launched in 2015 by CON Professor Mona Pearl Treyball, PhD, RN, FAAN, the Veteran and Military Health Care (VMHC) program covers a breadth of unique needs in the veteran community, whether it’s dealing with the traumas of war, enduring deployment of family members, or quieting suicidal thoughts.
“I have family and friends who are military members and first-responders,” said Boyrer, CON coordinator of strategic partnerships. “Seeing the physical and psychological issues that they were experiencing made me realize I needed to understand it better.
Offering a firsthand look
That understanding came easier with Pearl Treyball at the helm, Boyrer said. The retired U.S. Air Force colonel worked from the ground up during a 22-year-military career, living the dynamics of military life that she now teaches.
While in the Armed Forces, Pearl Treyball did everything from caring for wounded warriors as a flight nurse, to serving as a unit commander, to working with top military officials at the Pentagon. Also in the military, her now ex-husband served often on the frontline in Special Forces.
“He had a lot of PTSD (post-traumatic stress disorder), and it eventually broke up the family,” said Pearl Treyball. “I know firsthand the impact on family and the traumas of war. So I made it my next mission to try to create leaders for a better system.”
Students learn the culture, dynamics and consequences of military and veteran life, with classes on everything from mental health first aid to women in the military. “There are so many issues that women have to deal with that you would never think about,” Boyrer said, using breastfeeding or finding a restroom during combat in the male-centric military environment as examples.
The curriculum also focuses largely on veteran and military health care delivery and ways of improving the systems, another area Pearl Treyball brings experience to both as provider and patient. A three-time cancer survivor, she has been a patient in military and VA settings.
A program with impact
Boyrer, a wife and mother of two, said Pearl Treyball’s design of the online program also made it more doable and impactful. By using both synchronous and asynchronous models, students can work at their own pace, but also have face-to-face time with online discussions, Boyrer said.
“You get to meet your cohort of fellow students, and you kind of go through the program with them, even though we’re from all over the country,” she said, adding that she could not have taken the program with her full schedule if it were not online.
VMHC also emphasizes personalized assignments, making it more useful for students, Boyrer said. “My topics were relevant to my area of interest and practice, which is community engagement and homeless veterans, whereas somebody else might focus more on traumatic brain injury,” she said.
“And the assignments are something you can actually take with you when you’re done to make a difference in veteran care,” said Boyrer, who was recently accepted into the Leadership for Educational Equity Program (EdD) at CU Denver.
CU in the community
For instance, during her clinical training, Boyrer worked with the nonprofit Soldiers Angels in creating a project aimed at feeding, educating and joining together the veteran community. Once a month, Boyrer organized a dinner at Valor Point, a VAMC-Denver domiciliary.
“She did an outstanding job enlisting different resources from the community,” Pearl Treyball said, adding that Boyrer would also recruit volunteer educators, such as nutritionists, for the dinner event. “It’s something that is going to be longstanding in the community. And she made it educational and fun for veterans.”
Meals were provided by veteran-friendly or veteran-owned restaurants or from famous area chefs and were often therapeutic. “If you can get the military members together, and they can talk about similar experiences, then a lot of them open up more,” Boyrer said.
So for another assignment, Boyrer created a resource guide highlighting everything from fundraising events for veterans to alternative care for military and ex-military, such as canine, equine and yoga therapies.
Now the team of a newly organized Veteran and Military Health Area of Excellence on the CU Anschutz campus, which includes CON’s Lori Trego, PhD, CNM, retired Army colonel, plans to expand Boyrer’s guide and use it as a springboard in becoming a premier resource, Pearl Treyball said.
Boyrer will also transfer some of her new military knowledge to her job, which is largely focused on increasing nursing presence on the CU South Campus. “We’ve created the first CU mini-nursing program, set to launch in March, with one course focusing solely on military health care.”
‘It can help anyone gain more of an appreciation of our servicemen and women so that we can all join together in improving their well-being. And the experience Mona brings to the textbook is just priceless.’ -Allison Boyrer
Advocating for CU and veterans
Boyrer, a Florida transplant who quickly grew to love Colorado and CU, spends free time skiing and hiking with family (which includes two dogs), volunteering in her kids’ classrooms, and (at least one time) playing “Wheel of Fortune.”
“I auditioned when I first moved here for my job,” said Boyrer, who ultimately found herself standing next to Pat Sajak at the prize wheel. “I gave a big shout out to CU and the College of Nursing,” said Boyrer, a self-described dedicated CU advocate, who now has more fodder for her promotional pitches as the VMHC’s first master’s graduate. “It’s neat. I kind of helped pave the way.”
The curriculum is up-to-date, powerful and informative, Boyrer said.”It can help anyone gain more of an appreciation of our servicemen and women so that we can all join together in improving their well-being. And the experience Mona brings to the textbook is just priceless.”
In the end, his patient died. But as Ajay Major, MD, MBA, then an intern, flipped through the old veteran’s medical record, he found comfort in the memories the notes inspired.
Now Major, a second-year internal-medicine resident on the University of Colorado Anschutz Medical Campus, calls up those memories of the witty old man with terminal cancer who always asked for bourbon (and his devoted wife who always rolled her eyes in response) as a continual reminder of the importance of compassion in health care.
“Medicine is hard,” Major said. “We see a lot of patients with a lot of difficult medical issues, and I think burnout stems not just from feeling overworked, but also from feeling that we’re not truly caring for our patients on a human level.”
Major, co-president of the CU Anschutz School of Medicine (SOM) Resident Chapter of the Gold Humanism Honor Society, spread his message during the society’s annual Solidarity Week Feb. 12-16 by encouraging his colleagues to take part in the week’s centerpiece program, Tell Me More (TMM).
Changing the conversation
Armed with a TMM questionnaire and a smile, second-year internal-medicine resident Megan Griff, MD, entered her patient’s room, finding Betty Redwine, 77, wrapped in a light blanket and relaxing in a chair. “Is it OK to talk and find out about your life?” Griff asked, after explaining the program and introducing Major and attending physician, Jeannette Guerrasio, MD.
“OK,” Betty Redwine said, returning her doctor’s smile. “But it’s nothing exciting,” she said, grinning up from beneath a black-suede, shower-like cap she informed her guests was taming her unruly hair.
Prompted by four TMM questions, Redwine soon was sharing pieces of her past. Topics of capillaries and high blood pressure gave way to children’s feats and life’s treasures, sounding more like tea-time chatter than hospital-room discussion. When Redwine let a little secret slip, the room exploded in utterances of disbelief.
“What?” Guerrasio said, after Redwine revealed she worked as a registered nurse for 35 years. “Why didn’t you tell us?” asked Griff. “My mom is a nurse, too,” Griff said, when the commotion subsided. “You guys are hard-workers,” she said, patting Redwine’s hand.
Staying centered on the cause
While it might seem miniscule, a small dose of compassion can result in an array of benefits, Major said. “It allows the patient to feel that the care team really cares about them, but it also brings some catharsis for providers. Just finding out a little bit more about our patients’ lives outside of the hospital can help re-center us in the work that we are doing as physicians and, I believe, help prevent burnout.”
On the patient side, studies show compassionate healthcare results in higher patient satisfaction, a higher pain threshold, reduced anxiety and better outcomes, according to the Gold Foundation, which cites supporting studies on its website.
“People develop diseases for lots of reasons, and everyone’s lives really affect the way they respond to health problems,” said SOM Chair of Medicine David Schwartz, MD. It makes sense that trusted patient-provider relationships result in better care, he said. “We need to know how their lives might be contributing to the development of disease, and how their lives might contribute to our ability to effectively treat their disease,” he said.
Remembering: ‘I’m a person’
Looking up from her bed as the TMM trio walked into her room, Frances Cory, 79, had them laughing before even agreeing to chat. “You want to talk beyond my medical condition? You mean you don’t care about my medical condition anymore?” said the mother and grandmother, who later responded to a question about her biggest strength: “My sense of humor.”
Cory, who shared with her visitors that she had served more than 5,000 volunteer hospital hours during her lifetime, said she thought the program was important. “It’s nice to know that you take the time to talk to your patients. I’m a person.”
The TMM program offers a valuable reminder for medical students that their patients are people, and not just medical mysteries to solve, Guerrasio said. “I actually, as a doctor, find these conversations really helpful. And it’s what makes me come to work every day.”
Notes about the patient-doctor chat are jotted down on the TMM questionnaire, which is then displayed on the wall so that everyone involved in that patient’s stay, from therapists and nurses to doctors and janitors, can use it as conversation fodder, Major said.
‘The more passionate individuals are about their profession, and the more they enjoy what they are doing, the more engaged they become. These things feed on each other in very positive ways.’ ̶ David Schwartz, SOM Chair of Medicine
Seeing nothing as too small
By getting to know his end-stage cancer patient and his wife as an intern, Major learned not just about his patient’s bourbon routine, but that he was a strong war veteran who had “always been a fighter.” That helped Major, when the man opted for a late chemo-treatment that was questionable at his stage and age. While the patient fared well through therapy, he developed an infection afterward that ended his fight.
When his patient was transferred to hospice, Major told his palliative caregivers about the bourbon. As he looked through his patient’s medical record after learning of his death, Major was jolted by one caretaker directive: Bourbon, one ounce at bed time as needed.
“It seems like such a small detail,” said Major, who published an article in JAMA Oncology about the patient experience. “But when his fighting wasn’t working anymore, he started thinking about things he really enjoyed in life. And having his little bit of bourbon was kind of important to him. So we made sure he could have that to the end.”
In under an hour, Margaret, 57, a grandmother who suffered a stroke and is partially paralyzed, lost her foods stamps, faced eviction from her home and was robbed of her jewelry and valuables. These events left her and her son, Miles, 36, his wife, Melinda, 36, and their daughter, Mandy, 15, confused, frustrated and worried.
This was no ordinary family. First-year CU School of Dental Medicine students took on these roles during the first-ever Poverty Simulation, a three-hour session in which they experienced the same struggles as real low-income families. Having the time and money for dental and health care was often last on the list as these families worked to pay rent, buy food and take care of their children.
“My family is out working or looking for work and it’s kind of frustrating because I’m paralyzed and I have to stay here and can’t help more,” says dental student Rebecca Ryan, 24, who played Margaret, the family matriarch. “But that’s the reality of life – it can change in a second and that’s what happened to Margaret.”
The Poverty Simulation is part of Community Engagement I, a fall class that introduced 81 first-year dental students to public dental health, says William D. Bailey, DDS, MPH, CU School of Dental Medicine Chair, Department of Community Dentistry and Population Health.
“We want our students to be aware of the barriers and inequities in accessing dental and health care,” says Bailey, adding that the hands-on Poverty Simulation experience is more powerful than any lecture.
The goals of the simulation were to raise students’ awareness of the realities of poverty, while helping them understand stereotypes and misconceptions about low-income families, says Deidre Callanan, RDH, DC, MPH, a CU School of Dental Medicine Clinical Instructor, Community Engagement.
“The hope is that students now understand some of the barriers and frustrations to accessing services, including health and dental care for those with limited resources,” Callanan says. “We want our students to graduate with a deeper understanding, respect and compassion for their patients while they are out in the community, in the school clinics and when they become practicing dentists.”
How the simulation works
At the start of the Poverty Simulation, students received packets and worked in groups as makeshift families. The packets provided them descriptions of family members, their ages, employment situation, health status, income and monthly bills. Some families owned vehicles; others could only use bus passes to get where they needed to go.
Their tasks? They had to provide food, shelter and basic necessities for a month. They also received information on resources that would help them survive. About 20 community volunteers represented various agencies that could provide services for these families – from food and rent assistance to childcare. Each 15 minutes of the simulation represented a week in their lives.
There also was a bank, an employer, a juvenile detention center, utility and mortgage companies, a pawnshop, and a health care clinic, among other businesses and agencies.
The students represented four different types of families during the simulation. They included a family of four or five; some had two parents and others were single parents with children. Some students posed as elderly single people with health issues and little family support.
Dental student Ryan Koster, 22, was surprised to find out he was a pregnant 16-year-old girl.
“I’m due in two months, we just got evicted and I’m not doing too hot,” says Koster, adding that he’s had no access to health care. “It’s crazy, it’s eye-opening. It’s a lot more interactive than I thought. This experience has helped me understand different people and situations. This will make me a better dentist.”
A family in crisis
For the family of Margaret, Miles, Melinda and Mandy, the struggles resonated with the dental students who played their parts.
“It definitely gives you a different perspective of how people live,” says Hassanain Zaheer, 23, who was15-year-old Mandy. “This simulation helps us understand the hoops people have to go through. This is the first time I’ve done anything like this – it’s a unique experience.”
Stanford Smith, 29, who represented Miles, the father, said he gained new insight as the only wage earner in a large family.
“I didn’t know what we were going to do – it was hard to get things done and you had to learn to work the system,” he says. “It was so frustrating because you’re trying to do everything, but the lines were long and you couldn’t get stuff done.”
He says the experience helped him understand the complexities low-income families face every day.
“This is a great program – it really made me see what it’s like to live on minimum wage,” he says. “It makes me want to do more and help the people I see as patients.”
While her “family” faced challenging life situations and tough decisions, Messay Ibrahim, 25, said she didn’t realize life could be so difficult.
“As Melinda, I’m unemployed and I tried to get a job, but I couldn’t,” she said. “It was just so hard trying to pay our bills and we still got evicted. We just had so many things thrown at us.”
She says the experience will make her a better dentist.
“It helps us to know where our patients are coming from and all the emotions and stress that comes with living in poverty,” she says. “The one thing I did like was that our family did try to work together to overcome all our challenges – and I’m thankful for that.”
The line of physicians in the Kenagy-Vance family stretches across states, continents and generations. For centuries, these medical men have guided the health of communities from Switzerland to Pennsylvania to Idaho and beyond.
And most of their skills were acquired in the same place – the University of Colorado School of Medicine (SOM). Four generations of the family received their MDs here. Dr. John Brough (JB) Kenagy started it all when he graduated from the SOM – located in Boulder then – in 1906.
The family’s next two physicians – Drs. Fayre H. Kenagy (class of 1920) and J. Corwin (Corky) Vance (class of 1971) – attended the medical school in Boulder and then the CU Health Sciences Center in Denver. Corky’s father, Edward Pershing Vance, who married Barbara Eloise Kenagy, took a different path: He enjoyed a successful career in natural resource stewardship in the Pacific Northwest. Dr. Karl Kenagy Vance, son of Corky and Karen Vance, extended the family’s black-and-gold legacy into the 21st century by attending medical school at the CU Anschutz Medical Campus from 2005 to 2009.
Karl applied to about 10 medical schools, but chose CU. “The combination of the high-quality education at the medical school and the lifestyle of being in Colorado factored in,” says the avid cyclist and skier. “Also, it was something I thought would be cool – that I would be the fourth generation of my family to go to the CU School of Medicine.”
The family history of physicians goes back to Bern, Switzerland, where Corky’s sixth great grandfather, Hans Gnage, practiced medicine before fleeing the country over religious persecution of Mennonites. “Family legend has him seeing a patient when the police came to arrest him for draft evasion,” Corky says. “His wife had the policeman sit down to wait for him and offered food and drink, but then sent their son to tell his father to leave the country instead of coming home. His family joined him later.”
Hans arrived in Pennsylvania in 1742 and joined the Amish community, where he resumed work as a physician. It would be several generations later when JB Kenagy, born and raised in a Mennonite community in Ohio, would leave his career as an educator and move from Gunnison to Boulder. After graduating from CU medical school in 1906 he moved to Rupert, Idaho, to practice internal medicine.
His son, Fayre Kenagy, aspired to become a doctor just like his father. He was drafted into World War I but received a deferment to finish his medical degree.
Keeping the CU tradition going
It was Fayre who delivered J. Corwin Vance in August 1945, starting a lifelong bond with the boy who went by the nickname Corky. “I was in awe of my grandfather and wanted to follow in his footsteps. I therefore also attended the CU medical school,” Corky says. “When Karl was born, we named him Karl Kenagy Vance, after his grandfather. He later decided to attend the CU medical school as well, having heard how great it was.”
The elder Dr. Vance is now retired, but Karl worked with his father during the final year of his practice in Minneapolis. Karl now works with several of Corky’s longtime staff members, though in a different dermatology practice. The Twin Cities are a fitting home for the Vances as twin interests abound in father and son, including a shared love of fine food and wine. When they aren’t pursuing culinary interests, you can find Corky and Karl on their bicycles or in planes traveling the world. Sometimes they’re globetrotting and cycling – as they did on a recent family trip to Italy.
Incidentally, they both met their wives while attending the CU medical school. Corky met Karen while she was a lab technician, and Karl hit it off with Pamela while out on the town with classmates.
Just as Corky was inspired to pursue medicine by his grandfather, Karl looked up to his father, who became the first dermatologist in the Twin Cities to perform Mohs surgery – a micrographic procedure that removes skin cancers. “He found it rewarding. Growing up around medicine, you get an understanding of the process, the responsibilities and the ups and downs of it,” Karl says. “Mostly, it’s a fulfilling career because it’s a daily opportunity to help people.”
Camaraderie with CU classmates
Excellence in clinical care
“If you want to get clinically grounded, the CU School of Medicine is as good as any,” says Dr. Corky Vance, who attended the SOM from 1967 to 1971. “I got to see acute and emergency care at Denver General, and at University Hospital I got to see the rare cases you heard about from your professors. We also went out to the Fitzsimons Army Hospital (as it was known then) and saw cases and procedures that you were going to see in your own practice. There was a real advantage to having that much exposure to clinical practice.”
The retired physician says the SOM is even better since moving to the CU Anschutz Medical Campus. “Having everything together – with the hospitals on campus, as well as the VA – it really makes it even easier to get clinical exposure.”
Unlike the camaraderie he enjoyed at CU Anschutz, Karl struggled to connect with his pre-med classmates as an undergraduate at Stanford University. But he excelled in chemical engineering, and it wasn’t long before he connected that discipline to his burgeoning interest in wine. After graduating from Stanford, he became an assistant wine maker in Northern California and Australia. A few years later, however, he realized that winemaking couldn’t quite match the fulfillment of medicine.
At CU Anschutz, Karl loved his classmates – “It was hard to find people who weren’t into skiing and biking,” he says. And he was influenced by Dr. J. Ramsey Mellette, the faculty member who trained him on Mohs surgery. Back in the 1970s when Corky first performed Mohs, it was a new and innovative procedure. “Now, this procedure is pretty widespread,” Karl says. “I like it because of the precision in which we take the cancer out, and I enjoy the creativity involved in the reconstruction (of the tissue).”
Mohs is usually performed on a patient’s face, so the reconstruction of the skin requires utmost precision to minimize scarring.
Finding a mentor in the SOM
Corky was inspired to pursue dermatology by Dr. Robert Goltz, who in the late 1960s served as head of the Dermatology Department in the medical school. Corky so enjoyed Goltz’s teaching that he took the professor’s early-morning class on public health. “Dr. Goltz noticed that I was a hard worker, that I liked dermatology and was good at it,” Corky says. “I was good at visual learning, and that’s why dermatology appealed to me. You have to be able to memorize what rashes and other conditions on the skin look like.”
Goltz proved to be the catalyst for Corky’s career in Minnesota. Goltz, who had just accepted a job as chair of dermatology at the University of Minnesota, suggested Corky pursue his residency in the Land of Lakes.
Now, as Corky and Karen settle into retirement, they watch their progeny carry on the Kenagy-Vance caregiver tradition. Karl has established his own thriving practice in Minneapolis, while his sister Chardonnay, who attended medical school at Wake Forest University, is a family practice doctor. The life in medicine has made for a full, satisfying ride for the elder Vances – and a lasting family legacy that’s anchored in CU’s SOM.
“The most important thing is your job,” Corky says. “If you have a miserable job, you’ll be miserable wherever you are. If you have a rewarding job – as we are lucky enough to have – you’ll be happy.”
On a recent Friday, Gabriela Andrade, a second-year dental student from the CU AnschutzSchool of Dental Medicine (SDM), was putting the finishing touches on a group project. She stacked sandwiches on a platter, and her group lined up to explain to their instructors and classmates about an extra ingredient they added to the hummus: chipotle peppers.
Because of a program funded by Delta Dental of Colorado to support interdisciplinary education among health professionals, called the Frontier Center, the classmates, 17 CU dental and medical students, join culinary nutrition chefs side-by-side each week in a Culinary Medicine/Dental Medicine elective course. The class is a venture of the School of Medicine (SOM), the SDM and the College of Culinary Arts at Johnson & Wales University (JWU). Every Friday the students gather in JWU’s production kitchen to talk about and taste food—for academic credit.
As Andrade’s group described how the peppers contributed a pleasing heat and flavor, as well as added nutritional benefits, their instructor chimed in with suggestions for ingredient substitutions. Then the class heard the words they had been waiting for all afternoon: “let’s eat.”
An interdisciplinary education in nutrition
The class, which will meet for eight Fridays, consists of a two-hour discussion and quiz on nutrition, followed by hands-on training in cooking techniques, including knife skills, working with fresh produce, and making healthful substitutions in recipes. Students work in small groups to produce different parts of a complete meal: appetizers, salads and a main course. Clinical nutrition students from JWU are on hand to provide guidance and experience.
The interdisciplinary focus of the course is one of its primary benefits, according to Tamanna Tiwari, MPH, MS, BDS, a clinical instructor at the SDM. “As the first School of Dental Medicine to offer an elective for Culinary Dentistry, we are adding to our innovative, interdisciplinary curriculum,” she said. “Our dental students work as a team with medical students. They take ownership of projects together.”
The course aims to fill a gap in medical education by providing students with the latest research on clinical nutrition and instruction on how to communicate lessons about nutrition to their future patients. “Diet has a huge effect on the whole person,” said Mark Deutchman, PhD, SOM professor. “This class fills in a knowledge gap. It will make our students better practitioners and help them to address all aspects of a patient’s health.”
Adding tools to their toolkits
For medical student Nick Stephanus, the class is an opportunity to add more tools to his toolkit. “In primary care, many illnesses are chronic, and can be managed by careful monitoring of one’s diet,” he said. “This class teaches us how to give good advice to future patients, so that physicians can say more than just ‘manage your calorie intake.’”
Andrade, too, plans to use the skills she gains in the class to help her future dental patients. “I plan to work with Hispanic populations and with patients with a lower socio-economic status,” she said. “They may not have had a lot of education about nutrition, and this class will help me to better communicate tips for a healthier lifestyle and oral health.”
Although the Culinary Medicine/Dental Medicine course focuses on skills that students can use to help their future patients, the class agrees that they are already benefiting by taking their work home. The skills they are learning have allowed them to cook meals that are more nutritious for themselves. They’ve also cultivated camaraderie with the nutrition students from JWU, who will go on to work in the medical field as dietitians and clinical researchers.
“The JWU students enjoy the interchange of information with CU,” said Marleen Swanson, RD, the department chair of the JWU Culinary Nutrition program. “They glean a better understanding of the medical world through case studies that they review with CU students.”
Following their taste buds
With a growing awareness of the important role nutrition plays in preventive care, and the lack of nutrition education in medical and dental schools across the country, the Culinary Medicine/Dental Medicine course will make a significant contribution to medical education. The interdisciplinary approach at CU Anschutz, along with the partnership with JWU, are producing medical and dental professionals who are knowledgeable and enthusiastic about healthy eating.
For good reason. The smells wafting from the kitchen classroom every Friday are mouthwatering, and the energy in the room is contagious. Both Andrade and Stephanus look forward to the class each week. “Cooking is an experiment,” Andrade said. “I’m learning as I go, but I’m also following my taste buds.”
It was nothing like his native Cuba, where Quintana Hijano was an oral and maxillofacial surgeon before emigrating to the U.S. in 2011. Or East Timor, where he spent two years operating on patients injured during the county’s struggle for independence. He was the nation’s only oral and maxillofacial surgeon and was on call 24/7.
On Friday, Quintana Hijano, a student in the School of Dental Medicine’s Advanced Standing International Student Program, will graduate near the top of his class. He’ll earn his Doctor of Dental Surgery degree, which is necessary for Quintana Hijano to practice in the U.S.
It also sets up his next step—getting into a four-year residency program for oral and maxillofacial surgeons. That would allow Quintana Hijano, 39, to restart a career that he has loved as long as he can remember.
“I remember I was playing on the street one day and there was a car accident. I saw this guy bleeding all over the place,” Quintana Hijano said. He wondered what doctors would do to save and heal the man, and it was the start of a career. “Since I was a kid, I wanted to be a facial surgeon. I told my mom when I was 5, ‘when I grow up, I want to do that.’”
Now, after putting on hold a career that has spanned oceans and continents so he could start a new life in America, Quintana Hijano is a big step closer to performing surgeries and helping patients. Again.
“Nothing comes without effort”
The Advanced Standing International Student Program offers dentists who have earned their degrees in foreign countries the opportunity to earn a Doctor of Dental Surgery degree at the University of Colorado School of Dental Medicine. Graduates of the two-year accelerated program are able to take any state or regional board exam, and thus are eligible for licensure to practice in the U.S. This program accepts 40 students each year.
“It was really tough decision,” Quintana Hijano said. “I’m really attached to my folks. I didn’t know when I was going to see them again, because I would be banished for leaving Cuba.”
Quintana Hijano said Cuba produces well-trained dentists, doctors and surgeons—just not many of them, especially in the past few decades, because spots in Cuba’s top universities and medical schools are limited. Students have to compete for top scores each step of the way to have a shot at getting the few specialist jobs available each year. The path included multiple “make-or-break” national exams, where elite students are ranked and get to pick their profession.
“I said, ‘I have to excel to do this,’” Quintana Hijano said.
Quintana Hijano was ultimately accepted into the oral surgery and maxillofacial program at the Cienfuegos General Hospital, affiliated to the Higher Institute of Medical Sciences of Villa Clara, Cienfuegos’ Campus. He trained and practiced in Cuba, before its government sent him on a humanitarian mission to East Timor, a nation on an island between Indonesia and Australia. East Timor had just won independence from Indonesia after a long-running guerrilla war that ended a brutal occupation.
Quintana Hijano was the only oral and maxillofacial surgeon in East Timor. He performed reconstructive surgeries on people injured in the war or in accidents. He also trained medical students and translated the Ministry of Health’s national guidelines into Spanish to be used by the Cuban medical personnel and to help educate 1,000 new East Timorese doctors.
Additionally, he attended weekly meetings with the Minister of Health and other staff to discuss the nation’s health care strategies.
Coming to America, finding Colorado
Quintana Hijano would return to Cuba and practice for a few years before going to Venezuela in 2010 on another humanitarian mission. Over time, a feeling began growing that his future would not be in Cuba. The strain of not being able to say what you think and other stresses were taking a toll.
“It was really tough decision,” Quintana Hijano said. “I’m really attached to my folks. I didn’t know when I was going to see them again, because I would be banished for leaving Cuba.”
The decision also could have ended his career.
“I had to put aside what I loved, doing surgeries. I didn’t know if I’d be able to do it again,” Quintana Hijano said. “But I was ready to come here, roll up my sleeves and do whatever [it took].”
In October 2011, Quintana Hijano made the stressful 40-hour trip, which took him through several countries before he arrived in the U.S. Quintana Hijano declined to give details, because Cubans still make that voyage and the authorities watch. He also declined to discuss the relationship between his new home and his old one and what the future might hold.
But Quintana Hijano is clear about his love for the people of Cuba and the beauty of the country.
“It’s a really nice society and a beautiful country. The people are friendly, people are really willing to help you at any time, and anywhere,” Quintana Hijano said.
Beginning anew at Anschutz
Quintana Hijano ended up in the Phoenix area. Although unable to practice as a doctor or dentist, he was able to help patients, working as a dental assistant and in a dialysis clinic. But he still wanted to be a surgeon and decided to restart his education. That would mean going through dental and medical school all over again. That also meant more high-stakes tests competing against other experienced professionals for admission.
But Quintana Hijano kept it in perspective. “I always look way ahead into the future. It doesn’t happen in one day, it takes forever.”
The only program for international students Quintana Hijano applied to was at the CU School of Dental Medicine. He says finding the program was a lucky break. While other dental schools have similar programs, by the time Quintana Hijano was ready to apply in 2013, CU Anschutz was the only school still taking applications. The wait since 2011 had been long enough, so he sent in his application.
“[I] was shocked and very flattered,” he said about getting admitted. “I thought there were people more prepared than me.”
“It was something random,” Quintana Hijano said. “But when I got here, I realized it was God’s will. This is a really, really good school.”
Going back to school didn’t seem to be a problem for Ivan, said Professor Elizabeth Towne, DDS. She directs the Advanced Standing International Student Program and worked closely with Quintana Hijano.
“Though he was an oral surgeon with an admirable career, he became a student again and eagerly embraced the basic level tasks of working on plastic teeth, and treating all the minor maladies we encounter in general dentistry,” Towne said. “He is supremely humble. He has been open to critique and criticism, and eagerly sought it out.”
Quintana Hijano said his classes have been a great way to learn the American system. Faculty members have been approachable and ready to offer professional and personal guidance. He also likes that American dentists are able to see patients from the start, develop a treatment plan and relationship, and see their progress.
That’s not a surprise.
“He has a big heart, and feels great empathy for all his patients,” Towne said. “He is a very kind, gracious and compassionate person.”
Colorado provided one shock, though. A life in hot climates and then Phoenix didn’t prepare him for Colorado winters. The day he came to Aurora to interview and visit was cold and snowy, which was the only downside, at least at the time.
But now, as Ivan awaits “match day” on Jan. 30 to find out where he’ll go for a residency program, he relaxes by skiing. He’s getting better, and he said he has even survived a few runs down the black diamond trails he went down “by mistake.”