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Pushing the limits of medicine in deep space

CPR on Mars

NEAR HANKSVILLE, UTAH – Ben Easter, MD, steps onto a rocky ledge overlooking a dry riverbed. He cranes his neck and points into the canyon.

Injured crewmate exercise
Students tend to an injured crewmate (instructor Allie Anderson) during a simulation exercise at the “Medicine in Space” class in southern Utah.

“Right here,” the emergency medicine doctor says with a gleeful glint, belying his boyish looks, “we’re going to foment some chaos and see what happens.”

The simulation is designed to test whether students, thrust into a search-and-rescue scenario where they must navigate rugged topography and rapid-fire events, are able to organize into teams and solve cascading problems, all the while racing the clock to save injured and ill crewmates.

“We want them to walk up onto this ridge and not know where exactly the patient is, and have a kind of ‘oh crap’ moment,” says Easter, on the teaching staff of a new class that blends wilderness medicine and aerospace engineering.

In a remote part of southern Utah – at the Mars Desert Research Station to be precise – 21 University of Colorado Boulder aerospace engineering students, a mix of graduate students and undergrads, became Martians. They experienced seven days of gut-knotting, brain-twisting moments along with after-burner bursts of inspiration – nudging more than a few students into changed-life territory.

New horizons

It all comes courtesy of a cross-discipline teaching team and its novel idea to create a boundary-pushing Maymester course.

“Medicine in Space and Surface Environments” blends the expertise of CU Anschutz emergency medicine physicians with the engineering minds of CU Boulder students and Assistant Professor of Aerospace Engineering Allie Anderson, PhD. Anderson and Easter co-led the three-week class, which started with the engineers obtaining Wilderness First Aid certification in Boulder.

The course cements the unique positioning of CU Anschutz and CU Boulder experts, along with aerospace firms on the Front Range, to solve the complex problems arising from humankind’s most ambitious quest – to travel the roughly 250 million miles to Mars, and ultimately colonize the desolate planet.

MEDICINE ON MARS – 3-part series

Part one, June 19: Students experience a Maymester class of gut-knotting, brain-twisting moments along with after-burner bursts of inspiration.

Part two, June 26: Podcast about the week of medical emergency simulations at the Mars station.

Part three, July: Video of the innovative CU Anschutz-CU Boulder collaboration.

Mit Senavinin, a senior in aerospace engineering, said the week in the desert propelled him to consider new career paths in aerospace medicine.

“You don’t really have that firsthand experience or get that frame of reference without these trainings,” he said, still sweating from doing 40 minutes of CPR on “fallen” crewmates who had been electrocuted.

So now Senavinin is rethinking his plan to become a jet pilot. “This class has really made me want to go into medicine,” he said. “This experience opened that door. It’s really the bridge between engineers and physicians.”

Impulse to explore

Conversely, Marissa Palamara said the medical scenarios gave her the “heebie jeebies,” but as a sophomore in aerospace engineering she relished all the engineering problems thrown at students.

Fire in the Mars Habitat
In one of the many emergency exercises, students battled a simulated fire that broke out inside the Habitat on Mars.

How do you perform CPR through a spacesuit (answer: not easily)? How can one piece of spacecraft equipment be designed for multiple functions? Can a spacesuit be retooled to minimize astronaut exertion? Because muscle atrophy is common for astronauts, what kinds of exercise equipment could keep crew members fit on a lengthy voyage?

‘This experience opened that door (to studying medicine). It’s really the bridge between engineers and physicians.’ – Mit Senavinin, a senior in aerospace engineering

As the trainings unfolded, each growing in complexity, the students navigated the unpredictable nature of the human factor – “the soft fleshy thing inside the spacesuit,” as one instructor put it – in all its messy and complicated glory.

“We get to see how different people lead, how people play different roles within the team, and just how to work more effectively as a team,” Palamara said. “That’s all very important as engineers.”

The simulation exercises, which are the norm in medical training, aren’t as typical for engineering students, according to Anderson. The class offered a pulse-pounding sense of what biomedical engineering is really like, she said.

“This course,” added Easter, “is all about bringing those two disciplines together to improve what we can accomplish in human space flight.”

Giving a lecture on Mars
Allie Anderson, PhD, center (gray T-shirt), leads a session on a rare sunny day during the Maymester week at the Mars Desert Research Station.

It’s also about a basic human impulse.

“Humans have an innate sense of exploration and desire to cross an ocean or climb the next hill to see the view,” Easter said. “And now that frontier has become space – the moon and eventually on to Mars. I think something about working together to accomplish those goals just satisfies something within us as explorers.”

‘Can anyone hear me?’

Search-and-rescue save
Crewmates come to the aid of Amin, center, during a search-and-rescue exercise in a rugged canyon.

For seven days the students were Martians. They donned orange spacesuits in addition to – during the many simulations (aka extra-vehicular activities, or EVAs) – helmets, gloves, air packs and radio units.

The brisk desert wind buffeted the group as excursions unfolded on foot and in motorized rovers across a very Martian-like backdrop. The research station campus stands in stark white contrast to the Playdough-esque jumble of Utah’s otherworldly landscape of red spires, hoodoos and powdery sand.

In the search-and-rescue EVA, the crisis was daunting: an aborted spacecraft launch left three astronauts strewn across a ravine, including a hypoxic one perched on a distant outcropping. The crash triggered a multifaceted operation that only intensified when a search-party member suffered a “broken” ankle and was mistakenly left behind.

He patched through a message: “This is Amin. Can anyone hear me? (Silence on the radio). Please come in. I’m hurt and lost and unable to walk. (More silence). I don’t want to die here.”

Ten minutes later, a crewmate scrambled to Amin’s canyon location with an urgent message about dwindling air. The rescuer, swinging Amin’s arm over his shoulder, was direct: “Our consumables are getting very low, so we need you to keep up the pace, OK?”

Cardiac arrest, asthma attack, hypoxia, disorientation, electrocution, broken bones and smoke inhalation were among the maladies the students confronted on Mars. Triage units sprang up in the Hab, splints were applied in the field, and stretchers were created from found fabrics.

“It’s like ‘The Martian’ movie – some true, some Hollywood – but it keeps your head spinning,” said Gregory Vorontsov, a graduate student in bioastronautics, who aspires to become an astronaut. “The instructors throw out these problems, and it becomes: What do you do? How do you keep your head cool in crazy environments when chaos breaks out?”

Thinking from a different angle

Compared to the resources available on Mars, the medical systems on the International Space Station (ISS) are luxurious. For instance, if an ultrasound image is needed in orbit, an Earth-based doctor can provide real-time, step-by-step guidance from Mission Control. Or, if a major medical emergency occurs, an ISS astronaut could be at a terrestrial hospital within one to two days.

Prepping a rocket for launch
Gregory Vorontsov, left, a graduate student in bioastronautics, helps Sean Serell, MD, an anesthesiologist at UCHealth, prepare a rocket at the Mars Desert Research Station.

But many Earth-based interventions don’t work on Mars.

“You’ve got to start thinking medically from a completely different angle,” Vorontsov said. “You can’t even get right to the patient’s skin. Plus, the factors of (spacesuit) decompression, and what do you do if something breaks?”

There is also the very serious issue of surviving the actual trip to Mars. It’s a six- to nine-month voyage with no instant messaging to Earth; one-way communication delays, between a spacecraft and command center, range from four to 20 minutes each way.

“Whatever resources we take with us when we leave Earth are what we’re going to have with us for the entire time period of the mission,” Easter said. “Evacuating an injured crewmember to a hospital will be impossible, and resupply will be minimal to non-existent. So the design and scope of an exploration medical system really needs to be much more comprehensive than our current paradigm with the International Space Station.”

Pushing the limits

James Kurrle, MD, who is training to be an aerospace doctor in his native Australia, met Easter at an aerospace medicine course offered through the University of Texas Medical Branch. The UTMB class is where several of the wilderness medicine instructors met and started putting together the space medicine curriculum.

On day six in the desert, when the sky finally cleared, Kurrle glanced between the heavens and the terrestrial actions of another EVA. He watched the students prepare to launch a small rocket 12,000 feet above the research station. The plan was to precisely propel medical supplies hundreds of miles, from one Martian Hab to another.

While this rocket exercise amounted to a “micro” training, the blunt-talking Aussie sums up the challenges of “macro” space travel – and aerospace medicine – thusly: “You need to engineer the hell out of it to make it safe.”

Hab at night
The Mars Desert Research Station, located near Hanksville, Utah, glows under the desert night sky.

And that’s just considering the relatively short, into-orbit-and-back trips being launched by private companies such as SpaceX, Blue Origin and Virgin Galactic. Issues multiply astronomically when spaceflight extends millions of miles into a highly radiated environment, a place of no do-overs.

“Especially when it comes to medicine,” Kurrle said, “there’s the known unknown, and then there’s the unknown unknown – you don’t even know that you don’t know something. With classes like this, that’s where we’re trying to push the limits.”

Rocketing toward ‘risk analysis’

Rocket launch on Mars
Students in the aerospace medicine course launch a rocket 12,000 feet above the research station. In the simulation exercise, they propelled medical supplies hundreds of miles, from one Martian Habitat to another.

In addition to being a physician and an assistant professor in the CU School of Medicine, the Harvard-educated Easter is the Deputy Element Scientist in NASA’s Exploration Medical Capability, part of the space agency’s Human Research Program.

Easter said the “Medicine in Space” class intentionally draws from “probabilistic risk analysis,” a key element of engineering. It’s all about learning how engineers think and talk about buying down risk.

“We’re translating our medical expertise into the language that the rest of NASA is using,” he said. “Certainly, CU Boulder is one of the leaders in the world in this field of doing the actual research that’s helping NASA to buy down those risks.”

In a different iteration of the course, “Martian Medicine Analogue and Research Simulation,” Easter’s team teaches physicians, who come from all over the world, about medical emergencies arising in space. The healthcare professionals experience similar trials of communicating on a single radio frequency, trekking over foreign terrain, and prioritizing multiple issues to achieve the best outcome.

Discovering exceptionalism

For the students, many unforeseen challenges were best weathered with a laugh.

Like when tents somersaulted in the desert wind. Or when the tarp protecting their makeshift “mess hall” collapsed. Or when overnight temperatures plunged into the 30s.

Arika Armstrong, an aerospace graduate student as well as an engineer for Lockheed Martin Corp., said the adversity only enhanced matters. “You’re talking about isolated, extreme environments (of space), so what better than to throw a group of college students out in the rain and wind and cold and have them figure out how to deal with things?”

She recounted how all 21 students got on the same radio channel in the first EVA – “a disaster; everyone was talking to each other” – and by week’s end were nearly flawless in their communications. “We had to figure out how to make it work, and we absolutely did,” Armstrong said.

Anderson, the aerospace engineering professor, likewise saw students change; they grew in confidence and even discovered their exceptionalism.

Glowing helmet
A space helmet, worn by a CU Boulder aerospace engineering student, glows in the dark desert night. Communicating by radio with over 20 people proved to be quite challenging, the students learned.

“You see some students who were almost fearful of a leadership position over the course of the week say, ‘Yeah, I want to do that. I want to take charge, because I know that I’m needed right now,’” she said. “I think that’s another reason why the experiential learning is so important.”

Out-of-this-world goosebumps

Britney Force, a sophomore in aerospace engineering, kissed her comfort zone goodbye almost immediately.

First, her tent was tossed by the wind, and she slept the rest of the week in her SUV. Then, after a communications snafu on the search-and-rescue drill, she was thrust into a point position for triaging patients. Force, who aspires to work for Elon Musk’s SpaceX, said, “It was fun to be in charge … even for me, with no medical experience.”

Reflecting on the week – the moody weather, the tedious camp food and the rigorous curriculum – Force realized she was smitten.

“We first got in the spacesuits and stepped in the airlock and did the light exercise just like astronauts do. And then walking out,” she said, her eyes scanning the horizon. “It gave me goosebumps just to imagine what that would actually be like. It was really cool.”

Group photo on Mars
Students and instructors participating in “Medicine in Space and Surface Environments” enjoy a light moment near the end of the three-week Maymester class.

Instructors in the CU Anschutz-CU Boulder collaborative Maymester course, “Medicine in Space and Surface Environments,” were:

  • Benjamin Easter, MD, assistant professor of emergency medicine at the CU School of Medicine
  • Allison Anderson, PhD, assistant professor of aerospace engineering sciences at CU Boulder
  • Dana Levin, MD, Columbia University Department of Emergency Medicine
  • James Kurrle, MD, aerospace medicine resident in Australia
  • Arian Anderson, MD, emergency medicine resident at Denver Health
  • Joel Vaughan, MD, an EMT for UCHealth
  • Katie Joy, teaching assistant for the Department of Emergency Medicine, Wilderness Medicine Section, CU School of Medicine
  • Sean Serell, MD, anesthesiologist at UCHealth
  • Rick Cole, MD, flight surgeon at NASA and emergency medicine physician

Photos by Matt Kaskavitch, director of digital engagement in the Office of Communications, CU Anschutz.

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How do you run a pandemic simulation?

This spring, fourth-year School of Medicine students were once again on the front lines of a pandemic.

Whoa, nothing to worry about! You don’t need to check Twitter, these are fictional pandemics. It’s an annual tabletop exercise designed to teach students preparedness and effective communication in emergency situations. Originally developed by internal medicine doctors Linda Overholser, MD, and Nichole Zehnder, MD, Associate Professor of Emergency Medicine Charles Little, DO, has run the exercise since 2012.

CU Anschutz Today sat down with Little to ask him about his perspective in organizing and running the event the past eight years.

Charles Little, DO, associate professor of emergency medicine

What is the purpose of this exercise?

Medical students don’t really get any exposure to disaster or emergency management throughout their medical school curriculum, unless they show a special interest in doing an elective in some of that type of work. But almost all physicians at some point in their career will be involved in some emergency incident, and we want them to have at least some basic understanding of what the process is.

The exercise does several things:

First, it outlines what happens in pandemic influenza, which historically occurs every 10 to 20 years.

Second, it gives them an overview of what the health emergency response system looks like. It’s not just hospitals; it’s the entire community including clinics:

  • Public health has a very big role in infectious disease outbreaks.
  • Emergency management has an important role in any big event like that.
  • And then, EMS (emergency medical services) and transportation also play key roles.

We want them to have an understanding about all the players, other than just physicians, hospitals and clinics.

The third thing is to give them an opportunity to work in small groups on a “novel event” they really haven’t thought about before, and then do decision-making and generate a plan with limited background and limited understanding of what’s actually going on. They have to work a little bit through the fog of events.

How are students grouped together for this exercise?

We generate the number of spots we’re going to have, which this year was based on the number of community experts we had who were available to come help.  

The one group that we let self-select is the ethics group, because we want people who actually have an interest in that who will participate in those discussions. Right before the exercise starts, we’ve got all the other groups assigned, and then we ask for a show of hands and pick approximately 10 people out of the audience to do ethics.

You break students into six different groups (public health agencies, cities, hospitals, clinics, ethics and the media). Do the students do better at specific “roles”?

I think it’s probably a little easier for them to grasp the clinics and the hospitals. They actually do very well in any of the groups, just because they’re overall pretty high performers, and they’ve worked in groups before. Things like the Office of Emergency Management are pretty far from their kind of previous training and understanding, so I think that and public health are a little harder. I think they all have some limited exposure to EMS, so I think they probably understand that a little better. But overall, they do well in all the groups.

Similarly, are there any roles students are challenged by more than others?

For all the groups, they actually really jump into it pretty well.

Even in things that [don’t] have anything to do with medicine, like the media group, they actually take to it pretty well. They’ll take out cell phones and they’ll start shooting videos of themselves as reporters. They figure out fairly early on in the process what the challenges are, and the goal of the media group is to get them to understand how the media can help you or hinder you, and you have to be forthcoming with reliable information, but not overshare things you’re speculating about.

What trends have you noticed year over year with this exercise? How has the simulation changed?

In terms of the exercise design, I refine it each year, and early on, what I did was I started to refine it to be more in the structure of the tabletop exercises that we do in the emergency management and disaster realm. And that helped to streamline it and make it somewhat easier to administer.

‘It’s a pretty huge undertaking … It’s pretty intense. I think the students understand a little bit about what it feels like to actually manage a real disaster.’ – Charles Little, DO, pandemic simulation organizer

This is actually, as these exercises go, a pretty huge undertaking. We’ve got 180 students, and we’ve usually got about 40 to 50 subject matter experts, and they all have to be coordinated. We’ve gotten better at that over the years.

From the student’s standpoint, it’s very interesting that different classes seem to have slightly different personalities, and some classes are a little more engaged, other classes are a little more reserved. But I think every year, they all get something out of it.

How would you describe the energy in the room during the simulation?

The students are actually very engaged in trying to work through problems, and it’s a pretty high-energy event. Usually they’re pretty tired by the end of two to three hours of doing this, because it’s a lot of decision-making, a lot of concentration, and a lot of active thinking, and responding to information they’re getting both by email from us, but also the requests they’re getting from other groups for support and information-sharing and things like that.

It’s pretty intense in that fashion. I think they understand a little bit about what it feels like to actually manage a real disaster.

What kind of feedback do you get from students afterward?

The vast majority of students find it very interesting and engaging. There are a couple people who clearly don’t like making decisions with no information that are high consequence, and that seems a little distressing to them. Overall, it’s generally a very engaging exercise with something they don’t do frequently. And they recognize that once they leave school, they may be involved in these type of events.

What do you hope the students take away from the simulation?

We want them to understand what any type of public health disaster kind of looks and feels like, and how you would go about managing it. And who your partners would be.

What is your favorite aspect of running the simulation?

It’s really fascinating to watch the students work through this with the subject matter experts. And that, I think, is the greatest thing.

And one other thing I’ll point out is we have about 45 subject matter experts who come year after year and help support this, and that goes from city emergency managers to county and state public health leadership, to people who do emergency management in clinics and hospitals. And I think they do it for a couple reasons.

One is they realize it’s important for the doctors who are generally leaders to have an appreciation of this, but they also have quite a bit of fun doing it. They’re willing to carve out an entire half-day once a year, year after year. That’s been tremendously helpful.

What have you learned personally by doing the simulation?

That’s a good question. I think I’m really impressed with how engaged the students will get with something when there’s a goal set in front of them that’s something they didn’t really consider was probably part of the responsibilities they would ever have, or something they would ever engage in.

I’m pretty impressed with how quickly they adapt, and move forward with that.

I’m also really impressed by the way the community has stepped forward to help support this exercise. I have to do some work to recruit people every year, but it’s been really rewarding to see how people come back and support this because they feel it’s a valuable event for the students.

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Virtual human, a living cadaver, pushes boundaries of anatomical science

When Victor Spitzer, PhD, director of the Center for Human Simulation at the University of Colorado School of Medicine, talks about his friend Susan Potter, he often describes her as “persistent.”

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.

Susan Potter's upper body
Victor Spitzer, PhD, said Susan Potter’s body was ground off 63 microns at a time, providing high-resolution detail of her anatomical features.

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.”

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Answering the call: Line9 partnership puts pharmacy school to action

As soon as Bayli Larson hung up the phone, it rang again. She closed her eyes. It rang again. On the third ring, Larson took a deep breath, exhaled slowly and picked up the receiver.

Larson, a fourth-year graduate student in the University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, wasn’t facing a harassing caller. A firm believer in the benefits of volunteering, Larson was staffing the phones for Pharmacist Line9.

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.”

Volunteering ranks high on the priority list of CU’s pharmacy school, recently named the recipient of the 2017 Lawrence C. Weaver Transformative Community Service Award from the American Association of College of Pharmacy (AACP). While fulfilling unmet needs in the community, volunteer events move CU students’ education beyond the textbook.

“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.”

Briana Williams on 9Line desk
Briana Williams, left, takes a rare break to smile for the camera. Her colleagues, from left to right: Liza Wilson Claus, Emily Zadvorny and Peter Rice.

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.”

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Military nursing program graduates first master’s degree student

Some people just like finishing first. For Allison Boyrer, a University of Colorado Anschutz Medical Campus faculty member in the College of Nursing (CON), that means everything from a Master of Science program to a stint on the “Wheel of Fortune.”

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.

Boyrer with her dogs
Allison Boyrer shows off her canine “family members.”

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.

Boyrer at Broncos
Allison Boyrer, posing with her daughter, quickly adopted Colorado life after clinching her job with CU Anschutz.

“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.

Bringing it all together

Veteran-focused programs are rife in the Denver area and on the CU Anschutz and CU Denver campuses, recently named top university campuses for veterans, Boyrer said. “But I don’t think people know all of what’s available out there,” said Boyrer, whose sister is director of Canines Providing Assistance to Wounded Warriors (C-P.A.W.W.), a CON Health Research Initiative for Veterans.

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  

 

Boyrer on Wheel of Fortune
Allison Boyrer crushed her competition during a holiday “Wheel of Fortune” episode in 2015, during which she gave a “shout out” to her then-new employer, the University of Colorado Anschutz Medical Campus.

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.”

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Honor Society: A small dose of compassion goes a long way

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

Dr. Griff with Cory
Megan Griff, MD, chats with University of Colorado Hospital patient Frances Cory as part of a program aimed at teaching the value of compassion in medicine.

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.

TMM team meets with nurse
Ajay Major, MD, MBA, left, and Jeannette Guerrasio, MD, right, talk with Anne Marie Fleming, RN, about the Tell Me More program.

“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.”

 

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Poverty simulation helps dental students gain compassion

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.

Poverty simulation at CU School of Dental Medicine
Dr. Deidre Callanan hands out fake money, bus passes and other materials to dental students participating in the poverty simulation.

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.

CU dental school student Rebecca Ryan
Dental student Rebecca Ryan played the role of “Margaret,” the family matriarch, in the poverty simulation.

“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.”

 

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Four generations of one family receive MDs at CU

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.

Fayre Kenagy at Denver General Hospital
Fayre H. Kenagy, center, is pictured at the old Denver General Hospital circa 1917. Fayre was the second member of the Kenagy family to receive his MD from the CU medical school.

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.”

Swiss start

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.”

Drs. Vance sip cappuccinos in Italy
Drs. Corky and Karl Vance take a break from cycling to enjoy cappuccinos during a family vacation in Italy last fall.

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.

Karl and Corky Vance in the CU School of Medicine
On Karl’s graduation day in 2009, Drs. Karl and Corky Vance stand in front of the photos of CU School of Medicine classes of 1919 and 1920 in the SOM. Corky was inspired to pursue medicine by his grandfather, Fayre H. Kenagy, who is pictured in the class of 1920.

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.

Drs. Vance at CU medical school graduation
Drs. Karl and Corky Vance at Karl’s graduation from the CU School of Medicine in 2009.

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.”

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Our students don chefs’ hats to further their education

Students from the Culinary Medicine/Culinary Dentistry present a meal they prepared
Students from the Culinary Medicine/Dental Medicine present a meal they prepared

On a recent Friday, Gabriela Andrade, a second-year dental student from the CU Anschutz School 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.”

Gabriela Andrade, a School of Dental Medicine student, practices her knife skills
Gabriela Andrade, a School of Dental Medicine student, practices her knife skills

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.

Tamanna Tiwari, a clinical instructor at the School of Dental Medicine
Tamanna Tiwari, a clinical instructor at the School of Dental Medicine

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.’”

Mark Deutchman, professor at the School of Medicine
Mark Deutchman, professor at the School of Medicine

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.”

School of Medicine students like Nick Stephanus learn cooking skills and how to communicate nutrition tips to their patients
School of Medicine students like Nick Stephanus learn cooking skills and how to communicate nutrition tips to their patients

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.”

 

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A grad’s journey from Cuba and conflict zones to CU Anschutz

One cold afternoon, Ivan Quintana Hijano walked through the University of Colorado School of Dental Medicine. The chilly temperature brought back memories of the first time he visited Colorado.

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.

Ivan Quintana Hijano
Ivan Quintana Hijano in the CU Anschutz School of Dental Medicine. Quintana Hijano is a Cuban immigrant and graduated with honors from the Advanced Standing International Student Program.

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.”

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