Teaching med students with movies, objects and rare books

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April 30, 2017 00:16

There are creative ways to educate future doctors to think and not memorize, according to a recent Jerusalem symposium




doctors oversee patient

Doctors oversee patient. (photo credit:DANI MACHLIS/BGU)

The place where doctors perform surgery is called an operating theater because operations were originally carried out in tiered theaters or amphitheaters while male medical students and other spectators wearing black suits observed. The procedures were very unsterile and anesthesia was not used. Today’s operating rooms are spanking clean, brilliantly lit, modern, full of hi-tech gadgets – and they boast many women doctors, nurses and technicians.

One can learn many things in medicine from observing doctors and patients in surgical theaters, from watching movies and visiting medical museums and medical libraries. Medical libraries around the world use new digitized and printed volumes as well as also rare old anatomy and other books. Some also have medical museums with collections.

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Medical students tend to eye the future to be abreast of the most advanced technologies and techniques, but they also need to look backward to appreciate the time when general anesthesia and antibiotics, for example, were discovered. These basic yet revolutionary advances should not be taken for granted.

“In school, most pupils hate history because they had to memorize dates,” noted Prof. Yoel Donchin, a 73-year-old retired Hadassah University Medical Center anesthesiologist who now teaches the history of medicine at the Hebrew University Medical Faculty in the same Ein Kerem campus.

“Today, we can use visuals to explain medical history and practices.”

He was speaking last week at a small symposium titled “Do Anatomical Collections Still Matter?” held in honor of the visit to the medical school by colleagues from Riga’s Stradins University in Latvia, regarded as the world’s third-leading medical museum (after those in London and Washington).

The campus’s Berman Medical Library, directed by Sharon Lenga, with 60,000 book titles and 5,000 newspapers, has been modernized and refurbished and offers plenty of room for students to sit on lounge chairs and even on the carpeted floor. The museum, open to the public, is on the third floor of the library.

“We try to create an emotional experience for our visitors. We redesigned museum after thinking of ways to reengage visitors,” said Lenga. It is open five days a week (8:30 a.m. to 19:45 p.m. Sunday through Thursday) to students, faculty and the general public. The permanent exhibit complements the existing medical library, which serves the staff and 3,000 students of medicine, dentistry, pharmacy, nursing, public health and occupational therapy, in addition to clinical academic staff at the Hadassah University Medical Center. It is increasingly being digitized.

In the library, said Lenga, students take a breather and watch episodes of House M.D., the US TV medical drama that ran for eight seasons on the Fox network until 2012 and starred Hugh Laurie as Dr. Gregory House. Although the hero seemed to hate humanity and his diagnoses were unconventional, medical students have found discussing the fictional cases useful to their studies, Lenga said.

“For some time, we noticed that medical students didn’t stop by the library and museum,” said Lenga. “Now they do, and they want to know more. Like public libraries, we have changed our spaces to make them comfortable and welcoming for relaxation.”

TO GIVE some perspective to medical students in their 20s who take for granted that antibiotics “always existed,” Donchin gives a five-week course on presenting medical issues through movies.

“We collected more than 6,000 movies on medical themes,” Donchin explained. “They can view them not only on their laptops but also on their smartphones. We find that one can use movies for historical understanding and research – not just books and documents.” Films are more natural and attractive to today’s students than just reading text, he added.

While Donchin collects medical objects, his most intense interest is in using films, historical movies and contemporary ones reenacting events from the recent or distant past. These give his students an understanding of what has been done – right and wrong – to patients over the centuries.

The course is part of the humanistic “Man and Medicine” curriculum, which includes the history of medicine. Watching the films at home and later discussing the implications gives students a chance to understand the revolution that has occurred in medicine, Donchin said.

He showed the seminar audience a rather ghoulish 1903 film of a diseased leg actually being amputated. The surgeons don’t even wash their hands with soap and water and they don’t wear gloves. The leg is sawed off in two and a half minutes, after which the surgeon, Ernest von Berman, makes a small bow toward the camera.

A fictional Boris Karloff movie, The Body Snatcher, is used by Donchin to teach anatomy. With plenty of blood, a surgeon operates on a woman lying above a sawdust floor as she was belted to the table.

A more recent movie describes how 18th-century English physician Edward Jenner developed a vaccine from a boy’s cowpox sore to protect the world from smallpox and saved a significant number of people around the world.

Yet another film presents a 19th-century French biologist, who was not even a physician, saving the life of a little boy who was bitten by a rabid dog. The boy, named Joseph Meister, survived and appears later as a functional adult.

Another film presents an early attempt by Walter Reed Hospital doctors at artificial respiration, but it was doomed to fail, as the patient, who lies on his stomach and his back – rather than chest – is pressed while he is given oxygen. This approach was in practice as late as 1965. The unfortunate patient was put under general anesthesia to simulate artificial respiration.

“Today,” noted Donchin, “you couldn’t do this on animals without permission from the authorities.” The effort failed. Medical students then are shown the effective technique of mouth-to-mouth respiration.

A specially meaningful movie was the 1940 biographical production, Dr. Ehrlich's Magic Bullet, starring Edward G. Robinson, about the famous German scientist and physician Paul Ehrlich. Despite much ridicule from colleagues, he developed the technique for selectively staining cells with colored liquids and was able to isolate tuberculosis bacteria. He also developed “magic bullet” chemicals injected into patients to fight infectious diseases. Medical students, said Donchin, discuss the ethical problems of whether to give the injections or not.

Donchin shows a movie set in Massachusetts General Hospital on the discovery of ether to prevent pain. Dr. John Collins Warren, the first dean of Harvard Medical School, painlessly removes part of a tumor from a patient’s neck. When the man wakes up, Warren asks the patient how he feels and is told: “Feels as if my neck’s been scratched.” Warren then turns to his medical audience and said: “Gentlemen, this is no humbug.” Even veteran doctors remember this moment with emotion, Donchin recalled.

The HU professor noted that a medical student who studied the film Amadeus on Mozart did his thesis on a DVD rather than writing it.

“Although the use of movies to teach medical students has not been proven effective via evidence-based medicine techniques, I think it’s really worth trying,” Donchin concluded.

ASIDE FROM the movies, medical students in Ein Kerem are encouraged to visit the modern medical library. It contains collections of medals, Hebrew amulets, medical stamps, ancient instruments and more. Leading up the stairs to the library are bookplates in black and white and drawings to whet the appetite. The first electrical pacemaker is one of the objects on display. The collections focus on teaching medical students about the history of medicine and the interface between past and present, but the professionally designed and curated collection “deserves the attention of the wider public,” said Prof. Kenneth Collins, formerly of Glasgow, who researches the subject at the medical school and was present at the seminar, which was presided over by medical faculty dean Prof. David Lichtstein.

Collins was co-editor of the fascinating book Moses Maimonides and His Practice of Medicine with HU emeritus Prof. Samuel Kottek (also present at the event) and Prof. Fred Rosner of New York’s Mount Sinai School of Medicine and the Albert Einstein College of Medicine. Kottek, Collins and Donchin are academic consultants to the attached medical museum and lovers of old medical memorabilia.

Kottek said at the seminar that “doctors and students need a medical library to teach modesty. Each generation thinks they know everything. They need to be exposed to ideas over the ages and realize how much they don’t know.”

PROF. JURIS Salaks, professor of the history of medicine at Riga University, told the audience that there are some 55,000 museums in 202 countries around the world, only a small minority of which are devoted to the history of medicine. “We have not only such a museum but also one devoted to the subject of pharmacy.”

The majestic Riga facility’s 100-year-old anatomy collection includes bones and organs – and even whole fetuses – preserved in formaldehyde (first discovered in the middle of the 19th century). Medical museums usually begin when retired doctors and others donate their collections to an institution. Prof. Pauls Stradins, 1896 - 1958, was a “doctor, scientist, organizer, pedagogue and passionate collector.

“His wife,” said Salaks, “was not pleased with his hobby. He wanted to teach medical students the history of medicine from objects and not from books. He created our collection by donating them to the state.” He added that a survey of visitors to the Riga collection showed that 42% were school pupils, 32% individual adults, 9% families, 4% seniors, 4% children and only 9% students.

“People do not come to a museum to learn something but to develop a skill of learning,” he said. “Too many museum collections are not used, not displayed, not investigated and not published. Sometimes they are not even of interest to the museum where they are actually kept. Museums generally want to collect everything, but they have to be professional and keep only those things of value.”

Leva Libiete, curator of the historical medical collections at the Latvian museum, discussed whether anatomical collections still matter.

“A century ago, they were very important for medical students. Today, anatomy has been digitalized. You can learn it without human remains. We had shrunken tissue stored in jars. Medical lecturers used to keep them at home even and invite students over.” She noted that there was a decline in her museum’s collections in the Soviet 1950s, and some things got lost or lost their purpose. We had a collection of skulls from the 12th to 18th centuries. Some medical students used to ‘keep’ the skulls assigned to them. Some were lost.”

The Riga University Medical School, of which the museum is a part, still conducts dissections from cadavers, but it has become much rarer, said Libiete.

“Many people objected to these parts being displayed and demanded that they be buried. The Karolinska Museum in Sweden is now returning skulls of bodies to the Maori people. I think anatomical collections still have medical and social relevance, as specimens show how scientists retrieved DNA from cholera strains, and one can learn how epidemics spread over the centuries. We have in our collection the remains of a two-headed baby; today they are aborted. Students can see medical conditions that don’t exist today, such as rickets.”

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