the nesthesiologist assistant - Case Western Reserve University ...

THE
INSIDE THIS ISSUE
Fall 2012, Issue 21
Feature Article Preview...…...…..1
Office News………………....…..1-4
Comings and Goings…………...2-4
Admissions Corner……………….4
Dates for Your Calendar…..…....4
TSA Annual Meeting……….....…5
Student Chief Messages……….5-7
Alumni News……………......….7-8
Fruits & Veggies…….……..……..8
Comfort Food Recipes………......9
Feature Article, Dr. Voltz….10-14
11100 Euclid Avenue, Lakeside 2533
Cleveland, Ohio 44106-5007
www.anesthesiaprogram.com
216.844.8077
Joseph Rifici
Executive Editor
Allison Morgan
Jennifer Puin
Senior Editors
Katherine Flach
Graphics Editor
Contributers:
William Agbor-Baiyee, PhD
William Deitmen
Kathy Duong
Amanda Hardy
Courtney Ruffalo Miller
Michael Pippin
Donald Voltz, MD
OFFICE NEWS
Fall 2012
NESTHESIOLOGIST ASSISTANT
Case Western Reserve University
Master of Science in Anesthesia (MSA) Program
Medical Education, Technology,
Change and Vision for the Future
In this issue, Donald M. Voltz, MD, addresses the use of technology in medical
education, and specifically his use of technology in the course he teaches for the
MSA Program, “The Physiology of Anesthesiology Practice.” Dr. Voltz is a dynamic
educator who has been using technology in education for the past 12 years. When
the MSA Program expanded to off-site locations, Dr. Voltz incorporated online
learning for the program’s entire student body. His courses have been extremely
well received by his students. In this article, Dr. Voltz addresses his teaching
philosophy, the future of medical education, and the goals for the use of
technology in education. (See Page 10 for Dr. Voltz’s full article)
“Technology has and will continue to change the traditional
pattern of how we learn and interact with one another.”
“Students are very comfortable watching an online video at a time that is best
for their learning style, whether that is when they are running on a treadmill,
walking through a park, sitting in a coffee shop, or during a drive.”
“Technology is the clay I use for my creative outlet. This being said,
I become as frustrated with the use of technology as anyone.”
“The goal then for all of us is not to shy away from the use of technology in
medical education, but to engage students and meet their needs by providing
clear expectations and mentoring them to ensure they stay on course and
feel comfortable interacting with the professor even if it is not face-to-face.”
Profile of MSA Program in D.C.
William Agbor-Baiyee, PhD, Education Manager – Washington, D.C. Location
The Master of Science in Anesthesia Program located in Washington, D.C. was launched in May
2012 with an inaugural class of 16 students drawn from six states. The new program follows the
establishment of the anesthesiologist assistant programs in Cleveland and Houston in 1970 and
2010, respectively. These programs were established to contribute to Case Western Reserve
University’s mission to employ preeminent approaches to “improve people’s lives,” and vision to be
“recognized internationally as an institution that imagines and influences the future.”
Attractions of D.C. Program
Although programmatic elements such as mission, objectives, policies, curriculum, degree, and
admission requirements along with tuition and fees are common across the three program sites, the
location of the D.C. program in the nation’s capital is a unique asset. (Continued on next page)

OFFICE NEWS
Washington, D.C. is the dynamic and vibrant capital of
the United States. The three branches of the federal
government—legislative, executive and judicial—are
situated here. National museums and monuments are
located on or close to the National Mall. The city is
home to many foreign embassies and headquarters of
several international and professional organizations,
trade unions, non-profits and lobbying groups. Of
particular note is D.C.’s rich healthcare resources
including several nationally ranked hospitals.
Clinical Partners
Our D.C. program offers students opportunities to
learn in the classroom, simulation lab and clinical
environments. Clinical partners for the program include
Washington Hospital Center, Providence Hospital and
Children’s National Medical Center. Additional clinical
partners are being developed. Students encounter and
consider applications and demonstrations of anesthesia
during their study in the program. Within and across
the academic contexts of the program, students learn
the basic sciences and anesthesia as they relate to
professional practice, theory, research and policy.
There is the expectation that graduates of the D.C.
program, like their peers in the Cleveland and Houston
locations, will continue the CWRU tradition of
excellence in their practice across the nation and
contribute to the AA profession and society.
Shane Angus, D.C. Program Director
Leading the process from conception to reality has
been Shane Angus, AA-C, Program Director of the
Washington, D.C. location. He guided founding
functions such as hiring personnel, facilitating the
process to acquire approvals and accreditations, as well
as facilitating efforts to design and construct the
program’s space that includes a simulation lab,
classroom, conference room, copy room, and reception
and student areas.
Shane has derived satisfaction from his leadership role
and believes the new program will produce
exceptionally competent anesthesiologist assistants who
will serve their patients, profession and society.
According to Shane, guiding the processes to implement
the new program demanded patience, creativity and
support of other critical players.
Supporters
The realization of the D.C. program would not have
been possible without engaged support from CWRU
and other strategic stakeholders. First, invaluable
support for the MSA Program came from the following
at CWRU: Matthew Norcia, MD, Executive Medical
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Director and Joseph Rifici, Executive Program Director;
MSA Program staff including Jennifer Puin, Michael
Nichols, Laura Bishop and William Agbor-Baiyee;
Howard Nearman, Chairman, Department of
Anesthesiology; Pam Davis, Dean, School of Medicine
and Chris Masotti, Vice Dean for Finance and
Administration for the School of Medicine; University
Faculty Senate; Charles Rozek, Dean, School of
Graduate Studies and Barbara Snyder, University
President. In addition we would like to thank all the
individuals from finance, facilities, and CWRU
administration whose help and support we
depended on.
Second, various D.C. based stakeholders also
supported efforts to implement the D.C. program,
including Steve Parker, Chairman, WHC Department of
Anesthesiology; Eileen Begin, Director of Medical
Education, Department of Anesthesiology; Janis
Olawski, Chief Medical Director at MedStar
Washington Hospital Center; Cezar Koev, Chairman,
Department of Anesthesiology at Providence Hospital;
and Richard Kaplan, Chief, Department of
Anesthesiology at Children’s National Medical Center.
Third, professional organizations such as the D.C.
Academy of Anesthesiologist Assistants and D.C.
Society of Anesthesiologists supported the efforts to
develop the MSA Program in D.C. Thank you to
everyone who had a hand in the events that aligned to
bring about our new program. The MSA Program at
Case Western Reserve University continues to be
shaped by moments of inspiration, perseverance,
courage, and leadership—moments that make up our
legacy of excellence in education.
COMINGS AND GOINGS
We would like to
give a big welcome to
the new staff and
faculty of the Case
Western Reserve
University MSA
Program!
MSA Cleveland
Joseph Dodson –
Education
Coordinator, start
date September 4.
After getting married in August, my wife and I relocated
from Indiana to join the Cleveland community. My bachelor's
degree is in religious studies from Indiana University.
(Continued on next page)

COMINGS AND GOINGS
For the past two years, I've been working at IU as a project
associate with the Equity Project, an education policy
research center. From 2009-2010, I served as a Fulbright
scholar in Swaziland, where I worked with several
orphanages to improve their psycho-social care programs. I
am excited about my new role as education coordinator with
the MSA Program.
MSA Houston
Ken Maloney, AA-C – Director of Didactic Instruction,
start date August 1. Ken majored in biology at Emory
University and graduated from Emory’s AA program in
1994.
I am married with four children: Nathan 15, McKenna 13,
Logan 10, and Sariah 8. Tami is my wife of 18 years. We
are heavily involved in our church activities and with Boy
Scouting. I am coming back to the academic side of
anesthesia after a seven-year hiatus from teaching. Prior to
that I taught in the Emory AA program for approximately
eight years. I accepted a job in Northern Alabama to work
less hours with no call or weekends so I could help Tami
raise our kids. It was a great choice since I was very involved
with the kids’ activities, home schooling classes, and helping
with the daily routine. In Alabama I worked in an
ambulatory surgery center but had little academic
stimulation. I am ready to get back to educating our future
anesthetists.
MSA D.C.
David Dunipace, AA-C (’08) – Director of Didactic
Instruction, start date June 1.
After graduating from CWRU, David accepted a
position as an AA with MedStar Washington Hospital
Center.
Page 3
David just completed a term as President of the District
of Columbia Academy of Anesthesiologist Assistants,
and recently participated in medical mission trips to
Manila, Philippines. He holds a BS in Biological Sciences
from Ohio University and a MS in Anesthesia from
Case Western Reserve University.
A friend introduced David to the AA profession during
his undergraduate years at Ohio University. David
applied for admission in the MSA Program to fulfill his
desire for a fast-paced and challenging career while also
making a difference in peoples’ lives. For future AAs,
David would advise them to work hard in school and to
get as much clinical experience as possible. When David
is not working at the hospital or teaching students, you
may find him running, biking, and swimming. He recently
completed his first triathlon and hopes to do a
marathon in the spring.
Sabena Kachwalla, AA-C (’07) – Director of Clinical
Instruction, start date June 1.
Sabena is an AA at MedStar Washington Hospital
Center and Providence Hospital in Washington, D.C.,
and she is Treasurer of the District of Columbia
Academy of Anesthesiologist Assistants. She received a
BS in Biology, graduating with honors and cum laude,
and a BA in English from the University of Alabama. She
earned her MS in Anesthesia at Case Western Reserve
University.
Sabena has always wanted to go into medicine since she
was a young child. The privilege to care for people is
satisfying for Sabena. She often encounters different
challenges in her practice and continues to grow with
each passing day. Sabena advises aspiring AAs to always
see themselves as life-long learners. Sabena has
participated in medical mission trips to Manila,
Philippines and enjoys traveling, reading, running, and
watching movies.
(Continued on next page)

COMINGS AND GOINGS
MSA D.C.
Ashish Patel, AA-C – Director of Simulation
Instruction, start date June 1.
Ashish is currently an AA at MedStar Washington
Hospital Center. Before joining the hospital, Ashish was
a full time anesthetist in Atlanta at Grady Memorial
Hospital, and a PRN anesthetist at Anesthesia Practice
Management and Atlanta Anesthesia Practice. He
received his BA in Molecular Biology and Biochemistry
at Rutgers University, and a MS in Medical Science in
Anesthesiology and Patient Monitoring Systems at
Emory University School of Medicine.
A friend introduced Ashish to the AA profession. The
mental and engaging aspect of anesthesia helped him
decide to become an AA. After taking care of patients,
what Ashish appreciates most are their smiles, jokes,
and thank yous during recovery. He believes that trying
clinical situations, which require a reliance on his
training as well as clinical experience to make quick life
saving decisions, are challenges to his duties as an
anesthetist. Ashish would advise prospective AA
students to go into the operating room and shadow
AAs, and to contact current students and AAs to
determine if the profession is the right fit for them.
Ashish enjoys spending time with his family, running,
and biking.
ADMISSIONS CORNER
Jennifer Puin, PhD, Manager of Administrative Operations
We would like to thank our applicants for their interest
in the MSA Program. We are happy that you recognize
the quality of our program and the exciting
opportunities available at Case Western Reserve
University. Our admissions committee is privileged to
read your applications and learn about your
achievements, talents, and goals.
For our applicants who have applied through the new
Page 4
online application system, Hobsons, please login to the
system to see which of your application materials have
been received. We go into the system on a daily basis
and record the materials that have been received.
For those who still need to submit MCAT scores,
please e-mail your Verification Code and AAMC ID
Number so that we may go online to print and verify
your scores. Our e-mail is
info@anesthesiaprogram.com.
As a reminder, prerequisite coursework may be
completed in Spring semester 2013. All undergraduate
and prerequisite coursework, however, must be
completed with acceptable grades before our program
starts at the end of May 2013.
We are currently reviewing applications and will be in
touch with you shortly to provide an update on the
status of your application. If you are applying to more
than one program location and are invited for an
interview, you will interview in your location of
preference as indicated on the top of your Statement of
Objectives. All the best!
DATES FOR YOUR CALENDAR
Oct 13-17: ASA Conference in Washington, D.C.
Nov 22-25: Thanksgiving Holiday
Dec 3: Clinical Comprehensive and Basic Science Exams
Dec 14: Last day of Fall semester classes for
1 st year students
Dec 15-Jan 1, 2013: Winter break for 1 st year students
Dec 21: Final grades due to registrar by 11:00 am
Dec 22-Jan 1, 2013: Winter break for 2 nd year students
Feb 9, 2013: NCCAA Certifying Examination

STUDENT NEWS
Texas Society of Anesthesiologists Annual
Meeting
Michael Pippin, Houston Student Chief
Faculty members Dr. Sam Gumbert, Gary Jones, and
Deb Lawson, as well as students Brian Yeager, Paul
Menzel, and Michael Pippin all attended the 2012 Texas
Society of Anesthesiologists annual meeting in San
Antonio at the Hyatt Hill Country Resort from
September 6-9. The students attended many standout
lectures, some of which were delivered by the
anesthesiologists they work with on a daily basis at
Memorial Hermann Hospital, Texas Children’s, and the
Heart and Vascular Institute-Texas Medical Center. Not
Another New Anticoagulant or Antiplatelet Agent!, Dangers
of Perioperative Opioids, and Perioperative Management of
a Patient with a Foreign Body in the Airway were a few of
lectures. The students participated in workshops on
Regional Anesthesia and TEE.
The University of Texas at Houston provided a
luncheon and lecture by Dr. Girish Joshi of University
of Texas Southwestern Medical School on fluid
management in adult patients that challenged a lot of
the long standing views and management strategies
anesthesia providers utilize.
The student and faculty representation from
Case-Houston attended a legislative meeting with TSA
physicians and Texas Academy of Anesthesiologist
Assistants (TAAA) representatives to discuss goals and
issues affecting healthcare, our profession, physician
practice, and anesthesia as a whole.
The annual conference attracted many different vendors
from Anesthesia Machine Manufacturers,
pharmaceutical companies, and medical technology
companies. As the sole academic institution
represented at the conference with an exhibit booth, a
lot of buzz was generated in regards to our profession,
program, and scope of practice. As AAs continue to
grow within the state of Texas, the work of the Case
faculty and students at the conference helped facilitate a
relationship with new physicians, private practice
groups, and anesthesia networks in the state of Texas.
The growing support we as a program have received
from physicians in the state is reassuring and points to a
bright future for our profession as a whole in the Lone
Star State. We would like to thank the Texas Society of
Anesthesiologists, The University of Texas at Houston
Department of Anesthesiology, and all the
anesthesiologists who kindly welcomed Case-Houston
to their annual meeting.
Page 5
Paul Menzel, Brian Yeager, and Michael Pippen at TSA
Deb Lawson and Gary Jones with student leaders at TSA
MESSAGES FROM STUDENT CHIEFS
Houston Student Chiefs
Kathy Duong and Michael Pippin
Fall semester continues to bring an abundance of
experiences to the Houston Program. Numerous
second year students have already traveled to Missouri,
Ohio, Georgia, and Washington, D.C. The new OB
rotation at Washington Hospital Center in D.C. began
this past August. Students have shared much positive
feedback specific to the ample opportunities given to
manage a vast array of cases and place spinals and
epidurals.
Earlier this year, a new leadership position was created
(Continued on next page)

STUDENT NEWS
for the American Society of Anesthesiologist Political
Action Committee (ASAPAC). Deborah Agustin was
selected for this position. Since multiple issues affecting
anesthesiologists directly impact AAs, Deborah is
constantly involved with the political component of the
ASA. She learns about issues facing the anesthesia field
and encourages student involvement. Monetary
donations to the ASAPAC are a simple yet significant
way for students to become involved. Donations fund
advertisements and support politicians who convey the
ideas of anesthesiologists. The ASAPAC, for the first
time, will award the Alabama Cup to AA programs that
achieve 100% participation. We hope that both
Houston classes will again have 100% participation just
as they did last year.
In addition, second year students on their Neurology,
Trauma, and Pediatric rotations at Memorial Hermann
Hospital have begun participating in the resident and
faculty journal clubs. This opportunity has been a great
experience for students to learn in a multi-disciplinary
fashion on topics such as malignant hyperthermia,
transfusion, and apnea in preterm infants. Also, a few
second year students represented the program at the
annual Texas Society of Anesthesiologists Conference
in San Antonio, Texas. The students attended lectures,
political meetings on the legislation specific to AAs,
workshops, and medical device demonstrations.
We wish success to the first years as they continue to
gain knowledge and confidence, and to the second years
as they continue rotations and begin preparation for the
board exam in February!
Cleveland Student Chiefs
William Deitmen and Amanda Hardy
Page 6
Hello everyone! We hope that you had a great summer
and are off to a good start with the fall semester. We
are excited to say that the first years are finally full
force into their fall semester. They are in the operating
room two days a week, followed by class the remainder
of the week. They recently completed their Basic Life
Support (BLS) and Advanced Cardiac Life Support
(ACLS) certifications through the American Heart
Association.
Our second year students are in the operating room
five days a week. They attend Basic Science lectures
with first year students and anesthesia residents at
University Hospitals on Tuesdays. In addition, both first
and second years attend Wednesday Case
Presentations which are given weekly by second year
students. We encourage AAs and Attendings to join us
at these conferences on Wednesdays from 4-5:30 pm in
SOM E501. CME credit is available for conference
attendees.
Second year students recently started more extensive
preparations for their board exam, which will be held
on February 9, 2013. In preparation for this exam, the
second year students have begun to hold board review
sessions each month. These sessions are led by an
anesthesiologist who gives a short lecture and covers
practice board exam questions on a specific anesthetic
topic. We would like to give special thanks to Dr.
Sheryl Modlin and Dr. Evan Goodman who have
covered the topics of pediatric and obstetric anesthesia,
respectively.
Another important event that several of our second
year students will be participating in is the American
Society of Anesthesiology (ASA) conference which will
be held in Washington, D.C. from October 13-17. Both
of our AAAA student reps, Brian White and Juliette
Burnham, will be attending, along with several students
from both the Houston and D.C. programs, the two of
us, and any other students that are available to attend.
During this conference, these students will attend
numerous educational seminars and aim to network
with the many anesthesiologists there in regards to
expanding both the AA practice as a whole and our
student rotations for the CWRU AA programs.
In addition to the board review sessions, second year
(Continued on next page)

STUDENT NEWS
students are responsible for selecting a topic and
articles for a journal club meeting at some point
throughout their second year. Our first year students
take turns attending these meetings as well. We’d like
to thank Jennifer Winters from Hospira for sponsoring
our first journal club meeting, along with Dr. Adam
Haas, who was instrumental in helping lead the meeting.
We still have many opportunities for attendings to get
involved in both our board review and journal club
sessions, and we’d greatly appreciate any help! If you
are interested in helping lead either of these events,
please contact Bill Deitmen
(william.deitmen@uhhospitals.org) or Amanda Hardy
(amanda.hardy@uhhospitals.org).
Lastly, we would like to give a warm welcome to our
new MSA office personnel and a big thank you to our
current office staff, as this group has recently made
some changes in their roles and responsibilities. Laura
Bishop is now the Network Marketing and Recruitment
Coordinator for all three CWRU MSA locations, but will
still be residing with us in Cleveland. Jen Puin is now
Manager of Administrative Operations. In addition, we’d
like to welcome aboard two new faces, Allison Morgan
and Joe Dodson, who have recently joined our staff.
Allison will serve as Education Manager, Joe Dodson as
Education Coordinator. Thank you to all these people for
continually working hard to improve our program and
educational experiences.
Thanks again to all of the individuals at our numerous
clinical rotation sites who continually donate their time
and effort towards bettering our education. We wish
everyone a great fall semester, and the best of luck to
our fellow students as you proceed through the MSA
Program.
ALUMNI NEWS
MSA Cleveland Student Leaders
Standing, left to right:
Brian White, AAAA Student Rep
William Deitmen, Student Chief
Sitting, left to right:
Juliette Burnham, AAAA Student Rep
Amanda Hardy, Student Chief
Shawn Duvall, AA-C, (’04) Completes
Cleveland Triathlon and Wins Age Division
Page 7
1) How did you find out about your triathlon,
and what made you decide to train for it?
I found out about the triathlon from Mike
McDermott (’09) - my goal for training was to
get in better shape. I really don’t enjoy running,
so the swimming and cycling added nice variety.
2) How long did you give yourself to train, and
how did you start?
I trained for four weeks before the event, and
(Continued on next page)

ALUMNI NEWS
I started by using the Beginner Triathlete Guide
from Triathlete magazine.
3) Where did the Cleveland triathlon take place - i.e.,
where did you swim/run/bike?
The Cleveland triathlon was located at the Rock and
Roll Hall of Fame; the swim was in the harbor, the
cycling took place on Lakeshore Blvd, and the run went
around Browns Stadium.
4) What did you like best about the experience?
I liked competing and being there with my dad the best,
although winning my age division was nice too.
5) What advice would you give to someone who is
considering training for a similar event?
My advice would be to start slow and buy only
high-quality equipment, or you will be buying a second,
replacement piece of whatever it is very soon. The cost
can climb quickly so save your money.
HEALTH AND WELLNESS
Fruits & Veggies: Eat More!
Courtney Ruffalo Miller, Master’s Candidate in Art History
and Museum Studies
September is Fruits & Veggies More Matters month.
The More Matters campaign is a national public health
initiative from the Produce for Better Health
Foundation and Centers for Disease Control and
Prevention to increase American’s consumption of
fruits and vegetables.
Nutritionists recommend that you eat a variety of
colorful fruits and vegetables to maximize your intake
of important nutrients and reap the most health
benefits. Here are some helpful tips for how to
incorporate more fruits and vegetables into your meals.
Page 8
Dried Cranberries: Add to salads, sautéed spinach or
green beans.
Red Peppers: Roast and add to sandwiches. Slice thinly
and dip in hummus.
Carrots: Shred and stir into marinara sauce. Roast with
a little honey and seasoning.
Sweet Potatoes: Slice into strips, drizzle with olive oil
and bake for 30 minutes.
Rutabaga: Boil and mash with a little butter or olive oil.
Bananas: Blend in a smoothie for extra sweetness or
mash into a hot cereal.
Avocado: Mix into tuna salad as a substitute for
mayonnaise.
Spinach: Puree and use in your favorite brownie recipe.
Zucchini: Shred and add to any muffin or quick bread
recipe.
Peas: Add frozen peas to canned soups or pasta dishes.
Eggplant: Cut into strips, bread lightly and bake for an
easy side dish.
Grapes: Rinse and freeze in a plastic bag for an easy and
light treat.
Blueberries: Add to a bowl of cereal or mix into yogurt.
Other Ways to Eat More Fruits and Vegetables:
*Aim to fill half your plate with fruits and vegetables.
*Prep and cut fruit and vegetables ahead of time so that
they are ready to use in a weeknight meal or eat as an
impromptu snack.
*Plan to use fresh produce during the beginning of the
week because it tends to spoil quickly; finish the week
with canned and frozen fruits and vegetables.
*Replace half the meat in a recipe with beans and/or
vegetables—
consider meat a
flavoring rather than
the main component
of a meal.
*Have fruit for
dessert—try grilling
pineapple or
peaches and baking
apples or pears.
For more information, go to
www.fruitsandveggiesmorematters.org

HEALTH AND WELLNESS
Healthified Fall Comfort Food
Allison Morgan, MA, Education Manager
Crustless Mini Pumpkin Pies
Ingredients:
2/3 cup white whole wheat flour
¼ tsp baking powder
¼ tsp baking soda
¼ tsp salt
2 tsp pumpkin pie spice
1 (15 oz) can of pumpkin puree
½ cup sugar
¼ cup brown sugar
2 large eggs
1 tsp vanilla extract
¾ cup fat free half and half
12 servings fat free Reddiwhip (or other canned
whipped cream)
Directions:
Preheat the oven to 350. Line 12 muffin cups with
cupcake liners and lightly mist the inside of the
liners with cooking spray.
In a medium bowl, combine the flour, baking powder,
baking soda, salt and pumpkin pie spice and whisk
or stir together to combine.
In a large bowl, combine the pumpkin, sugar, brown
sugar, eggs, vanilla and half and half, and stir or
whisk together until thoroughly combined. Add the
dry ingredients and continue to whisk together
until smooth and combined.
Fill the muffin liners evenly with the batter and bake for
20 minutes. Let cool in the pan and then transfer to
Page 9
the refrigerator to chill. The pies will deflate a bit
as they cool. Serve chilled with a spray of whipped
cream on each mini pie.
Nutrition Information:
per serving from myfitnesspal.com: 114 calories, 22 g
carbs, 1 g fat, 3 g protein, 2 g fiber
Source: Emily Bites, http://www.emilybites.com
Crock Pot Applesauce
Ingredients:
8 medium apples (use a combination of Golden
Delicious, Honey Crisp, Fuji, Gala, etc.)
1 strip of lemon peel - use a vegetable peeler
1 tsp fresh lemon juice
3 inch cinnamon stick
5 tsp light brown sugar (unpacked) - or agave
Directions:
Peel, core, and slice the apples.
Place them in the slow cooker. Add the cinnamon stick,
lemon peel and brown sugar.
Set crock pot to low and cook for 6 hours. Stir apples
occasionally, apples will slowly become a delicious
applesauce. Remove cinnamon stick and use an
immersion blender to blend until smooth. If you
prefer a chunky sauce, leave sauce intact.
Servings: 12 • Size: 1/4 cup
Calories: 65.9 • Fat: 0.2 g • Protein: 0.2 g •
Carb: 17.5 g • Fiber: 2.8 g • Sugar: 12
Sodium: 0.6 mg
Source: Skinnytaste.com

FEATURE ARTICLE
Medical Education, Technology,
Change and Vision for the Future
Donald M. Voltz, MD
Technology Changing Education
A historic point in medical education occurred in 1910
when Abraham Flexner wrote a report titled, "Medical
Education in the United States and Canada." This led to
the closure of many medical schools that did not have
well-defined curriculums for their students, and was
also the beginning of modern medical education. One
hundred years later, Dr. Donald Berwick, past
administrator for the Centers for Medicare and
Medicaid Services, stated "The status quo is not fit for
the future. We have to cut that Gordian knot between
content in the curriculum, time, and societal needs."
The practice of medicine is constantly under barrage by
new research, techniques, and economic, social, and
humanitarian pressures. As with most large
organizations, change is often resisted and solutions are
often posed as a new panacea. Since the introduction of
the Flexner report, medical education has become a
more noble profession with a desire to meet the varied
needs of society, students, and patients.
On the eve of many as of yet ill-defined changes that
will impact the field of medicine and potentially the
number of patients entering into the healthcare system,
further pressures will be placed on the educational
system responsible for training the future medical
personal. We are currently seeing additional pressure
placed on practitioners coupled with increasing costs of
training students and limits on resources, the most
obvious resource being time. Notwithstanding, the
amount of information flowing into the medical
establishment continues to grow at an exponential rate.
Page 10
"In whatever way the education of the physician is viewed, it
is remarkable how little change has taken place in the
fundamental organization of medical education over the
past half century."
Robert Ebert
The aforementioned quote is as true today as it was in
1977 when it was first stated by the former dean of the
Harvard Medical School. I disagree with some aspects
of this quote, especially in the area of anesthesiology
education. The introduction and expansion of critical
event simulation, airway management tools, techniques,
and concepts, and the expansion of the anesthesiology
profession to include anesthesiologist assistants are
significant changes to our specialty. With the
concomitant changes in computer technology, we are
seeing significant changes and expectations for a new
paradigm in education. In a relatively short period of
time, we have seen numerous computer technologies
that have impacted the flexibility and interchangeability
of information. PowerPoint has replace the original
‘slide show’ using 35 mm slides, while webinars allow
one to not only view remote lectures anywhere one
can access the Internet but also to interact with the
presenter using a variety of software platforms or social
medial tools. Technology has and will continue to
change the traditional pattern of how we learn and
interact with one another.
The notion that online education would revolutionize
the educational landscape has been touted for many
years, being embraced by major academic institutions:
MIT, Stanford, and CWRU have been developing and
releasing open courseware for at least a decade. John
Hennessy, the president of Stanford University, predicts
the demise of lecture hall university education and
foresees it being replaced with an online framework.
Dr. Hennessy is putting this to the test by not only
moving undergraduate and graduate level courses to an
online framework, but also opening up this new
academic delivery method to anyone who wants to
enroll in the classes. A devout believer in online
education, Dr. Hennessy feels that it will transform the
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academic arena in the upcoming years, stating "It's going
to change the world, and it's going to change the way
we think about education" (IEEE Spectrum; May 2012).
He believes this mode of delivering education will not
stop at the undergraduate and graduate level but will
integrate into high school and quite possibly lower
levels as well. Numerous educators believe that the
current educational system, specifically lectures given in
large halls that repeat year after year, is not engaging or
rewarding for the students or the professors.
This is not the way students want to learn; they want a
more engaging experience, on their time, and
conducted in a more efficient manner.
Transition to Online Teaching
One of the greatest criticisms to online education is a
lack of physical presence, for both the students and the
professors. My transition from traditional lectures in
front of students to an online format was difficult for
me for this very reason. Over my years of teaching, I
have worked to be a dynamic educator playing off the
expressions and feedback I received from the students.
I have been able to read the non-verbal cues when
students were not following my train of thought. This is
no longer present in my online lecturing. To
compensate for this during the development of my
lectures, I have added additional evidence, redundancy
in explaining complex topics and integrating the
questions received from the students into the lectures
to prevent the same confusions from arising in the next
class. The concerns from my side of the teaching
dialogue are also compounded by those of the students.
Many students have expressed concerns about not
being able to interact with the instructor when
something is not clear, not being able to address these
concerns to a live person at the moment the confusion
arose in large classes, or not being able to maintain the
self-motivation required when there is no scheduled
lecture to attend at a given time and place. Students
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have raised concerns about keeping up with the
material, feeling that the lack of a structured, scheduled
lecture will foster procrastination resulting in poor
uptake and retention of the material covered.
Students Spearheading Change
Instructors are not the major driving force behind
online education; it is the students who are
spearheading many of these changes. Students enrolled
in undergraduate and graduate programs are children of
the technology era. They have been raised on e-mail,
cell phones, Twitter, and any of the other social media
platforms that have come and gone. A transition from a
traditional classroom lecture by a professor in front of
any number of students is not improved by simply
moving the content online. A poorly thought-out,
in-person lecture and watching the floating head of a
speaker with a group of PowerPoint slides are not
much different (Hennessy, John IEEE Spectrum; May
2012). Students are very comfortable watching an
online video at a time that is best for their learning
style, whether that is when they are running on a
treadmill, walking through a park, sitting in a coffee
shop, or during a drive. They also are able to pause,
replay, and increase
the playback speed
if they process
information better
at a faster pace.
Individual shifting
of time, geography,
or how the student
interacts with the
lecture opens up a
whole new level of
freedom. Another
area that is greatly
expanded through
the use of
technology is the
use of interactive
learning.
Technology Assisting Remote Education
Technology is also assisting in the adoption of remote
education. Introduction of the iPad and the slew of
tablet PCs that followed have begun to influence how
educational material is distributed. A change in the
business model for textbook companies is upon us and
the use of multimedia embedded into books has
brought about new ways to interact with students.
Interactive textbooks allow for a shorter time to
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integrate new
information into books,
building of collaborative
learning networks
between students and
teachers, and collection
of information such as
through the use of
interactive surveys or
dynamic presentations to
reinforce traditional
textbooks. The cost of
generating these
resources and the
technological experience
required to develop and
distribute learning
materials is falling.
I have been using
technology in education
for the past 12 years.
All of my lectures have
been recorded and
posted for students to access after the lecture. When
we expanded the Case Western Reserve University
MSA Program to off-site locations, the leadership
agreed to try online learning for all students. Over the
past three years, I have been iterating on the material I
present, the method of delivering this material, and
most recently have been looking to redesign the
experience in physiology to include much smaller
lectures coupled with interactive modules. ANES 456-
458 might be the course name in the CWRU catalog,
but I have called this class “The Physiology of
Anesthesiology Practice” to better encompass my
teaching philosophy as well as the thrust of the course.
It is my goal to use the principles of human physiology
to help students understand how clinical decisions are
made in a rational and systematic way. This philosophy
requires more than just the presentation of facts that
are then reiterated by the students on the exams;
instead, it encourages the students to think about how
to combine the basic science concepts with
critical-thinking in the operating room. Throughout my
lectures, I attempt to relate common patient scenarios
that the students have been involved with during clinical
care so they can practice the thinking discussed during
the lectures. I am working to incorporate more
interactive modules into these lectures in an effort to
string together related material as well as to develop
decision-making skills in the students without the
pressure of the clinical environment.
Creative Outlet
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I enjoy working with technology to see how I can make
my life better by using my time in a more efficient
manner. Technology is the clay I use for my creative
outlet. This being said, I become as frustrated with the
use of technology as anyone. I consider myself a
guarded optimist when it comes to the use of
technology. It is a tool, and like any tool it can be used
with a good result for certain problems while producing
damage if misused. Still, the struggle for those of us in
the educational community is not how can we use
technology to engage our students, but instead how we
can craft compelling, relevant educational material that
facilitates understanding, retention, and fosters
application of the material learned. Lectures without a
clear understanding of what is trying to be
communicated, the story, will not be enhanced by
technology. The goal then for all of us is not to shy
away from the use of technology in medical education,
but to engage students and meet their needs by
providing clear expectations and mentoring them to
ensure they stay on course and feel comfortable
interacting with the professor even if it is not
face-to-face. Development of an open and clear
communication channel is very important for online
education.
Developing Open and Clear Communication Channel
For “The Physiology of Anesthesiology Practice,” this
communication takes many forms. The class has a
website that serves as the centralized collection of
lecture materials and class handouts, and also allows for
students to add comments or questions for any of the
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lectures. A weekly newsletter, sent via e-mail to each
student every Monday morning, serves to communicate
the expectations for the upcoming week. Finally, a
real-time, online web conference is set up weekly to
allow for interaction with myself and the students. This
forum serves as a platform to ask questions that often
lead to mini lectures expounding on the information
covered during that week’s recorded lectures. I feel
strongly that students need to feel comfortable bringing
any questions or concerns to me using either e-mail,
small group or individual web-conferences, or phone
communication.
“Fireside chats” are a new addition to the class this
year. These are small lectures on topics that the
students bring to my attention and may not be covered
during the course, or not covered in the detail that
students want. To foster the fireside chats, I have
encouraged students to bring questions, curiosities, or
interesting cases they have been involved with to serve
as the basis for these discussions. All of the interactions
I have with the students are recorded and made
available to the entire class. Students who might not be
comfortable interacting in a group setting, even online,
are encouraged to contact me to set up an individual
web conference in an effort to answer their questions
without others being involved. The class has become a
small social network, which allows everyone to learn
from the questions and experience of others. Many of
the concerns raised by students early in the course
pertaining to the online distribution of lectures have
been alleviated by the end of the first semester. Many
students enjoy the freedom they gain from the online
class, reducing their stress and allowing them to focus
more energy on other classes when the demands are
high while not missing anything from this class.
The Future
Where do I see medical education going in the future
and where do I hope to help foster education for the
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Master of Science in Anesthesia Program? Clinical
demands have impacted medical education and are
likely to remain a challenge for the future education of
healthcare providers. Online distribution of learning
materials will likely expand within the medical education
arena and many of the current limitations will be
addressed as the technology and needs are modified.
Over the past ten years, there have been significant
improvements in the ability to produce high quality
materials and easily distribute these to students. The
Stanford experience with online education has been
amazing, with more than 100,000 students (including
myself) enrolling and completing the assignments. As a
student with Stanford, I was able to see things
differently and use the experience to add to my own
lectures, and to appreciate the frustrations that can
develop from a student viewpoint. I found this
experience to be a very rewarding one and something
that I would have otherwise not been able to
participate in due to geographic and time constraints.
The ability to design and build online learning systems
for this large number of students is a technologic feat
worthy of praise. It does not, however, provide
validation or suggest that all learning should be
automated and distributed online.
There are limitations that arise such as ensuring
appropriate mastery of the information, prevention of
cheating, ensuring that students are completing the
work, and adequately assessing the students as they
progress through the course. On the operational side,
the challenge of grading assignments, designing proper
assessment tools, and meeting the needs of the
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students must be addressed and the courses modified
to meet evolving student and societal needs. Ultimately,
all students must pass standardized tests for any online
course, as they would for any “conventional”
educational course. This must include a verification of
student identity and an assurance that the student
demonstrated his or her mastery of the material
without outside assistance. One of the powerful
benefits that almost spontaneously arises when a large
body of students are joined together in an online
learning experience using principles of social
networking is the convergence on correct answers and
solving of issues that arise.
Building a Learning Community
I am working to encourage more public, social
communication between students in an effort to build a
learning community that supports peer-to-peer
interactions and group input on questions and
problems, often very quickly. The ability for students to
provide input and share experience with other students
becomes a powerful learning tool. There is far more
power in groups than individuals. The professor’s role is
to moderate the student discussions and provide
guidance into how to think about the problem, as
opposed to just giving the correct answer.
It is my hope to expand this learning network within
the MSA Program to anyone interested in medical
education. Building a network of clinical instructors,
physicians, and interested students allows for
collaboration and iteration of learning materials to
ensure we meet the needs of students and work to
translate basic science concepts into sound clinical
decision making in the operating room.
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Clinical productivity pressure in the field of
anesthesiology and throughout medicine will continue
to challenge medical educators and put stress on
students. I have no doubts that as we all progress in our
careers, we will be engaging in more and more remote
learning to maintain professional certifications. Some of
these remote learning experiences will be done well,
while others will be less so. The use of technology is
not the solution to the problem of bad instruction on
the lecturer’s part, or bad learning on the student’s
part; instead, technology can serve as a tool for the
delivery of information.
We ultimately need to clearly define the objectives for
each learning session, creatively explore different ways
to engage students in the learning experience, and
constantly change in an effort to stay relevant with the
information presented, the needs of society, and the
needs of our profession.