Anatomy Class Introduction to the First Patient

Anatomy Class Introduction to the First Patient

Learning Objectives

The student will be able to:

1.  Apply clinical observation skills of general appearance including age, gender, body habitus, and identifying features to the cadaver.

2.  Associate identified clinical findings with anticipated impact on daily life including ADLs (bathing, dressing, grooming, mobility noting any aides, continence, feeding), IADLs (phone use, med use, shopping, cooking, cleaning, finances, transportation) AADLS (recreation, church, school, work), relationships, and self-concept.

Suggested agenda (note this is only a 15-20 minute encounter):

First 10 minutes (Learning objective 1):

Have students uncover the face.

·  Ask students to estimate the age of the patient and note gender.

·  Explore with students what features they are using to estimate age (color of hair, wrinkles, etc) and gender (ear piercings, hair length, hair color, etc.)

Then uncover the entire body and reconsider age and gender observations.

·  Discuss what additional features contribute to age estimate (color of axillary hair, wasting of muscles, etc.).

Next introduce the concept of body habitus with a discussion of two components: development and body size. Help students to classify the cadaver.

·  Note the distinction if available for amputation (developed part removed) vs. developmental abnormality (part was never complete)

·  If the cadaver is “wasted” note if it appears generalized (ex. systemic process such as cancer) or localized (ex. limb atrophy post stroke)

Then look over the full anterior and posterior of the body for any interesting findings and identifying features.

·  Perform a detailed skin exam for moles, birthmarks, scars, tattoos, piercings, and wounds.

·  Look over the body for medical technology: pacemakers, tubing, etc.

·  Help students describe the features of the findings with some specificity such as color, condition (flat or raised, straight or jagged), size, and location. Rulers are available in the lab (note measurements use metric system).

·  Help students begin to consider anatomic location (examples: scar is located in the right lower quadrant of the abdomen; 4x4cm pressure ulcer is overlying the sacrum). Encourage discovery of explanations for medical devices.

Take a moment to identify the patients age and occupation (use the anatomic number and refer to the chart posted in the lab). With this information and the students’ estimate of age, comment on the concept of age comparison (does the cadaver actually look older or younger than stated age OR are the students in need of developing this skill)

Second 10 minutes (Learning objective 2):

Have students associate identified clinical findings with anticipated impact on daily life. Provide an introduction to functional ability: ADLs, IADLs, AADLs with possible means of compensation.

For example if an older patient has had an above the knee amputation of right leg what could be the impact:

ADLs: Difficulty standing to bath (compensation possibly use of shower chair)

Difficulty ambulating (compensation possibly use of prosthesis, crutches, wheelchair…does the stump looked calloused, are the arms bulky from use of crutches, are there pressure ulcers on the sacrum from sitting in a wheelchair)

Difficulty with continence due to delayed access (compensation possibly more frequent use of bathroom, presence of a urinal or bedside commode)

IADLs: Difficulty driving (compensation possibly use of left foot or hand controls, public transportation)

Difficulty shopping (compensation possibly use of shopping cart with scooter, home delivery of groceries)

AADLs: Consider impact on known occupation, possible influence on recreation/church

Relationships and self-concept: Consider the amount of care this person may have needed; how difficult would it have been for a spouse of similar age to meet these needs; would the person likely have been cared for at home or in a facility; how advanced was the disease process(es); does it appear that the person was relatively well until the end of life or experienced a process of prolonged duration. Encourage reflection on how these issues may affect relationships.

Bring closure to the session.

·  Encourage students to recognize that we have provided an introduction to skilled observation and clinical reasoning.

·  They should continue to practice and build these skills both in the CLC and as they proceed with dissection of the cadaver.

Information for faculty reference:

Doctoring 1 materials: TIPS FOR ORAL REPORT (a skill used in every CLC encounter, items d,e,f not used with cadaver):

Telegraph the message with the information you elicited.

a.  Age comparison=looks older than, younger than, or appears stated age

b.  Gender=what you think they are J

c.  Body habitus=two components 1. parts present=well developed (or has birth defects, dwarfism, etc) 2. body size=well nourished (or wasted, cachexic, overweight, morbidly obese)

d.  Consciousness level=alert or see Mosby page 92, table 4-2

e.  Demeanor=pleasant, cooperative or hostile, angry, uncooperative, etc.

f.  Health status=appearance such as “in no acute distress” or moribund, toxic, acutely ill; avoid “healthy”, some people dying of cancer look to be in no acute distress but I would not consider them healthy

g.  Identifying features=tattoos, prominent scars, etc.

Ex. “Today I interviewed Mrs. Poole, she is a 71 year old woman who appears younger than her stated age; she is well developed, well nourished; alert; pleasant and cooperative; in no acute distress”

Avoid “I saw Mrs. Poole, she states she is 71 years old but I think she looks younger, her body habitus was well developed and I think well nourished, I assessed her consciousness level as alert, etc.

Anatomy materials: Anatomy “First Patient” Reports (students will provide presentations during Doctoring and Medical Histology classes; today’s activity will assist the students with items 1-4)

Directions for completing and presenting the cadaver report:

1.  You and your team are responsible for documenting your observations of your assigned cadaver. This should include any observations of scars, moles or tubes protruding from skin, to anatomical variations, surgeries or pathologies of internal structures.

2.  You will be able to have digital photographs taken of significant findings for use in your final report.

3.  You will need to work with your group to determine and make note of the effect a pathology, variation or surgery may have had on the cadaver when he/she was alive. Consider effects on a biological (symptoms), psychosocial (influence on occupation, relationships) and functional level (ADLs, IADLs).

4.  When you identify a pathology, anatomical variation, or surgery, you should consult with the anatomy faculty, teaching assistants and pathology faculty to better characterize the finding.

5.  At the beginning of each unit, starting with unit #2, a representative of the group will present the cadaver report for the region dissected the prior unit to the anatomy faculty member or teaching assistant and a member of the new dissection team.

6.  The completed written report will be turned in at the end of the course. The report should be turned in as a digital format. You will need to learn how to add notations, arrows, labels, etc to the images in the report.

7.  You and your group members will give patient presentations of cadavers in both the Doctoring and Medical Histology courses in the fall. These reports will be presented to your fellow classmates along with clinical and basic science faculty. Therefore you will need to put together Power Point presentations for these sessions based on subsets of the information below:

i.  Age and gender of cadaver

ii. Last occupation

Along with any significant findings in the:

iii.  Surface anatomy

iv.  Thorax

v. Back and spinal cord

vi.  Upper extremity

vii.  Abdomen

viii.  Head

ix.  Neck

x. Pelvis

xi.  Lower Extremity

And, finally your group should indicate:

1.  Based on all of your findings, the suspected cause of death

2.  Based on findings, the anticipated functional ability prior to death

Copyright 2007, Florida State University College of Medicine/ Lisa Granville, MD. This work was supported by a grant from the Donald W. Reynolds Foundation. All rights reserved. For information about using this form, contact Lisa Granville, MD at