Saturday, March 03, 2007

Teaching Eye Anatomy to Medical Students

The resident on the eye pathology service teaches the medical students each Monday morning anatomy of the eye and pathology to start their required rotation in Ophthalmology (part of surgery). We employ a systematic method for teaching the students and the ophthalmology residents are to follow this system. Do not deviate from this method!!! It has been developed by the attending over the past 21 years and is highly effective. Historically the anatomy teaching session has been one of the most popular sessions of the week for the medical students (by their evaluations). Just as important it is a learning session for the resident in teaching anatomy and pathology from a human eye rather than some picture. This is not an opportunity for the resident to develop their own style of teaching. We want you to learn the power of the Socratic method. No notes, pictures or props are permitted. You are to teach from your knowledge and the human eye as your only resource. Likewise the students will not be permitted notes, books, or writing implements. They have been instructed to study the material on line prior to this session and now have the opportunity to demonstrate their knowledge. Here are the steps you will follow.
Set up the lab for teaching:
1. Put the 4-5 chairs, preferably the ones without wheels and others that are not particularly useful to use at the gross table on the side opposite the double headed microscope. You will be seated at the microscope. Clean off the table.
2. Pick out a gross specimen from the cabinet on the left. These will usually be marked "for teaching." The specimen will be 2 calottes of a horizontally sectioned human autopsy eye.
3. Clean a class petri dish carefully with soap and water. Then fill it to the top (at least at the top of the label on the dish) with 50% alcohol (in the brown container). There is a small metal mesh disc that works nicely for holding the eye. Put it in the Petri dish.
4. Clean off your forceps so they are free of any green ink.
5. Place the eye in the dish and put it in the center of the table where it will be visible to all students.
6. Also find your teaching glass slides in a wooden box in the cabinet above your desk. Put them next to the multiheaded microscope for now.
7. Obtain the examinations from the attending pathologist.
For the session:
1. Begin by administering the examination on anatomy. The attending will provide you with the test and answer sheets. The students have been told to study this material in advance and expect to be tested.
2. At the end of the test period (when the student are done ~ 20 minutes, you will grade the exams with the attending pathologist.
3. Those students who pass will now go on to view a dissected human eye and attend your session on pathology.
4. Those students whose knowledge base is unacceptable will be relegated to the library for further study of the basic material and will take another examination later in the week.

5. For those student who have passed and remain in the room with you will now sit at the chairs around the lab table.
6. You will follow the teaching of Socrates. You will not lecture to students. You will simply ask them questions and let them find the answers. The session begins by you learning each of the student's first names and ask what specialty they are interested in.
7. You will use your forceps as a pointer (do not touch the internal ocular structures or you will ruin the teaching specimen). You will point to an anatomic structure that you want them to recognize and ask them its name. If they don't know the name ask them to describe the location in detail and to create a name. This will be a test of your understanding of how anatomic structures are named (for example the derivation of conjunctiva from conjoining the eye and eyelids). If one student does not know the name move to the next student and so on until you reach a student that knows the name. Once the name of the structure has been identified ask all the students who were clueless to recite and spell the name. This will help to reinforce their knowledge. In fact this will go very quickly because they have already demonstrated their knowledge on the exam but will give them confidence.
8 . Move to the compound microscope multiheader. Using the glass slide of a normal eye point with a pencil successively to following structures and ask the students to name them. Here is convenient to just go around in a circle. If you have done your job properly the students will race through this section and you will be amazed at what you have taught them. Now place the slide under the the multiheaded compound microscope. Turn the pointer light on medium, not high or you will burn the bulb out and then have to teach without a bulb. This is an experience you would like to avoid. Ask the student to each take a seat at one of the head of the microscope and use the pointer to ask them to name the various ocular structures. Cover all the same structures that you did in the gross spending more time on the layers of the retina, ciliary body, iris, choroid, sclera, optic nerve. In each case the students are naming the structures. You simply point to them.
Ocular Pathology: Now move to the pathology slides. Generally this is best done by letting the each students look at one slide grossly. Ask them to take a moment to study it without a micrscope and try to make a diagnosis. The following diseases should be covered: melanoma, retinoblastoma, glaucoma, diabetic retinopathy. In most cases they will be able to do this by studying the size of the eye (retinoblastoma, glaucoma), identify the blue tumor (retinoblastoma, melanoma) or see a cupped optic nerve head (glaucoma) or tractional retinal detachment (diabetic retinopathy). Then you can show them the finer points under the microscope; all the time asking them to describe what feature you are pointing to and how it came to be. We are expanding the teaching collection to give the residents a broader depth of teaching.
9. Good luck and have fun.

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