the university of iowa carver college of medicine … · jacqueline kleppe williams. ... writing...

For More information about educational and enrichment experiences for children, check out University of Iowa Health Care STEM Education website: uihealthcare.org/STEM

Or contact: Jacqueline Kleppe WilliamsManager, Community and STEM Education University of Iowa Health Care Marketing and CommunicationsDivision of External Relations4148 WL, Iowa City, IA 52242Phone 877-MED-IOWA or (319) 384-3025 or via e-mail at [email protected]

3rd Edition, 2012 (revised)Managing Editor: Chad Ruback, Assistant Vice President for External Relations, UI Health CareEditor: Jacqueline Kleppe WilliamsWriting Assistance: Susan Green, Elizabeth BairdDesign: Nancy ZearPhotography and Images: Susan McClellen, Dr. Ignacio Ponseti, Cochlear Limited, UI Department of Ophthalmology, National Eye Institute

University of Iowa Health Care is a fully integrated academic medical center, uniting the UI Roy J. and Lucille A. Carver College of Medicine, University of Iowa Hospitals and Clinics, and UI Physicians, the largest multi-specialty group practice in Iowa. As the state’s premier academic medical center, UI Health Care provides high quality, patient-centered care, conducts groundbreaking biomedical research, and educates the scientists and health care providers of the future.

Web Resources For more information and resources related to science, health, diseases and medicine go to the Hardin Library for Health Sciences: lib.uiowa.edu/hardin

Students can learn more about the road to becoming a physician at: medicine.uiowa.edu/osac/admissions/road.html

More information about going to medical school can also be found at: aspiringdocs.org

This website from the National Institute on Deafness and Other Communication Disorders has student and teacher activities: nidcd.nih.gov/health/education/

Information about the “gross side” of science, designed just for kids, can be found at the Grossology website: grossology.org

EXT 13-024 8/12

NAME:__________________________

UI GROSSANATOMY

The University of Iowa Carver College of Medicine presents

Seriously gross

Disgusting

That’s sickYuck

Teacher’s Guidebook

CHAPTER 4 Cochlear Implant SurgeryLearning Points

Talking points before watching the video:• There are good candidates and bad candidates for cochlear implants. Good candidates are people who were born deaf or have developed profound deafness in their life. Someone who has some hearing loss but can still hear is not a good candidate. • A cochlear implant is very different from a hearing aid. Hearing aids amplify sounds. Cochlear implants bypass the damaged portions of the ear and directly stimulate the auditory nerve. Signals generated by the implant are sent by way of the auditory nerve to the brain, which recognizes the signals as sounds.• Most children who receive cochlear implants are between the ages of two and six. This implant, along with lots of therapy, can help young children learn speech, language and social skills.• More than 59,000 adults and children all over the world have cochlear implants.• A cochlear implant is a small, complex electronic device that can help provide a sense of sound to a person who is profoundly deaf or severely hard-of-hearing.• A cochlear implant consists of an external portion that sits behind the ear and a second portion that is surgically placed under the skin.• An incision is made behind the ear and the skin and tissue flap is lifted so that the surgeon can drill into the mastoid bone. A receiver is placed into the drilled-out area and an electrode array is inserted into the cochlea. If everyone reaches behind their ear and finds the pointy bone sticking up, this is called the mastoid bone. This is the bone where surgeons create a hole to make a place for the implant to sit.• An implant has the following parts: A microphone, which picks up sound from the environment; a speech processor, to select and arrange sounds picked up by the microphone; a transmitter and receiver/stimulator to receive signals from the speech processor and convert them into electric impulses; and an electrode array, which is a group of electrodes that collects the impulses from the stimulator and sends them to different regions of the auditory nerve. An implant also has a battery that is C-shaped and worn on the outside of the ear. People with cochlear implants take their battery pack off at night and put it on a charger. While the battery is off, they won’t be able to hear. This is similar to someone who takes their glasses off at night—in the morning the person just slips the battery pack back on.

Talking points after watching the video:• An implant does not restore normal hearing —there is no cure for hearing loss! Instead it can give a deaf person a useful representation of sounds in the environment and help him or her to understand speech.• Hearing through a cochlear implant is different from normal hearing and takes time to learn or relearn.• Some famous people have had this surgery, include a Miss America (1995 winner Heather Whitestone McCallum) and a national radio talk show host (Rush Limbaugh).• The implant, the surgery, and the necessary adjustments and training that happen after the surgery cost an estimated $60,000. • Today’s cochlear implant surgery is a relatively minor operation of just a few hours. Children who have had the surgery have been known to go home immediately afterwards, playing normally with minimal post-surgical effects.

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People decide to become doctors for many different reasons. Some like the excitement of testing their own theories to find new treatments and cures for human disease, while others like the satisfaction of using those treatments to help people. Some people are interested in working with technology to improve health, while others are more interested in exploring the complex systems that make up the human body.

At the University of Iowa, different people with different interests work together every day to make people healthier. Researchers, physicians, nurses, teachers and students work with imaging specialists, physical and occupational therapists, health care administrators, technology experts and countless others to provide some of the best care in the nation.

No matter where your interests lie, there’s a place for you in science and medicine. The University of Iowa Health Care STEM (science, technology, engineering, and math) programs including UI Gross Anatomy will show you a few of the possibilities. We invite you to take a look inside the University of Iowa and see what we’re doing. Use this workbook to explore science, health and disease. Discover the world of medicine at the University of Iowa.

But be warned: Just like medicine itself, it may get gross — but never boring!

1

Science

Health

TechnologyDisease

Medicine

CHAPTER 3 Treating Clubfoot with the Ponseti Method Learning Points

Talking points before watching the video:• Clubfoot is a congenital deformity of the foot that occurs in about 150,000-200,000 babies each year worldwide. • Clubfoot results from the abnormal development of the muscles, tendons, and bones in the foot while the fetus is forming during pregnancy. While researchers have been unable to pinpoint the exact cause of clubfoot, both genetic and environmental factors are thought to play a role. • Clubfoot is about twice as common in boys as it is in girls, and occurs in both feet about 50 percent of the time. This is called bilateral clubfoot.• Clubfoot is one of the most common congenital deformities. Many cases are associated with neuromuscular diseases, chromosomal abnormalities, Mendelian and non-Mendelian syndromes and in rare cases with extrinsic causes.• In Caucasians the disorder occurs in about one per thousand. In Japanese it occurs half as frequently. In South African blacks it occurs three times as frequently, and in Polynesians it occurs six times as frequently.• Dr. Ignacio Ponseti at the University of Iowa developed an innovative, non-surgical treatment for clubfoot involving the gentle, manual manipulation of the child’s foot and the application of toe-to-groin plaster casts. This is called the Ponseti Method.• Treatments started in 1948 at the University of Iowa.• Treated clubfeet are less supple than normal feet, but patients have no significant differences in the functional performance compared to a population of similar age born with normal feet.• Treatment is economical and easy on the baby and the parents. It is the best treatment for clubfoot.• Clubfoot in an otherwise normal child can be corrected using the Ponseti Method of manipulation and plaster cast applications, with minimal or no surgery. Treatment should begin in the first week or two of life in order to take advantage of the elasticity of the tissues that form the ligaments and tendons in the foot. Has anyone here had a broken bone and needed a cast? So, as you know, the purpose of a cast is to keep the joint and ligaments around it still to encourage proper healing. The same principal is behind the casts in the Ponseti Method. The doctor manipulates the joint, a tiny bit at a time, and puts a cast on to hold it in position. • Each week, the doctor removes the previous cast, does another manipulation, and then re-casts the leg.• Dr. Ponseti passed away at age 95 in October 2009. Dr. Ponseti continued to practice medicine until he died, treating clubfoot patients and training doctors in the Ponseti Method.

Talking points after watching the video:• The majority of clubfeet can be corrected in infancy in about six to eight weeks with the proper gentle manipulations and plaster casts.• After the proper alignment is made and the last cast is removed, a splint must be worn for two to three months and at night for the next three to four years to prevent a pro-lapse.• The Ponseti Method is so important because it is a superior method to surgery; it’s inexpensive and can be done with a minimal amount of supplies and training. This means countries with limited medical resources and a higher incidence of clubfoot can still treat their children, whereas before the Ponseti Method the majority of these children would have the problem their entire lives.• There are several famous athletes who were born with clubfoot including soccer star Mia Hamm, figure skater Kristi Yamaguchi, and football star Troy Aikman.

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Cool facts about University of Iowa Health Care

DID YOU KNOW? To become a doctor, you need four years of college, four years of medical school, and at least three or four more years of practice as a resident. But did you also know that once you become a resident, they

pay you to learn?

In 1870, the University of Iowa established the first coeducational medical school in the United States with 31 men and seven women in the

first graduating class.

Over the past decade, the UI Carver College of Medicine brought in more than $1.1 billion in research funding to help find and improve treatments for cancer, diabetes, digestive disorders, heart and vascular disorders, and blinding eye diseases.

Researchers at the University of Iowa were the first in the world to record human EEG activity, the electrical activity in your brain. Today, EEG technology helps evaluate the health of the brain and diagnose nervous system disorders.

University of Iowa graduates include:

- A pathologist who unlocked the mystery of what caused the Spanish Flu pandemic in 1918;

- An innovative investigator who discovered the value of fluoride in strengthening bones, a discovery that led to the creation of Crest® toothpaste;

- A leader in understanding and treating sports injuries who contributed to the creation of the first NIKE® shoe;

- A key researcher in the development of the automobile seat belt in the 1960s;

- And 25,000 other alumni who have tended to the health care needs of Iowans and populations worldwide, and have made significant contributions to biomedical research and medical education.

More than 7,400 health professionals care for more than 50,000 inpatients annually at the University of Iowa Hospitals and Clinics, including 29,000 acutely ill children and adults.

University of Iowa Hospitals and Clinics is one of the nation’s most prestigious teaching hospitals and a leading center for “around-the-clock” multidisciplinary, patient-centered care. The hospital’s commitment to care, compassion and discovery earns high rankings for quality and expertise.

Exploration2

3

CHAPTER 2 da Vinci® Robotic Surgery Learning Points

Talking points before watching the video:• The da Vinci® robot enables surgeons, working from a computer console several feet from the patient, to work at a scale smaller than conventional surgery while at the same time getting a closer look at the surgical site than normal human vision allows.• With the da Vinci® robot, a surgeon operates without physically touching the patient. The da Vinci® system is made of two major parts: a computer console and the actual robot.• The surgeon uses joystick-like controls to manipulate long, narrow, specially-hinged surgical instruments that are inserted through small incisions in the patient’s abdomen. The remote-controlled instruments can access hard-to-reach areas and turn in ways that would be impossible with normal wrist dexterity. You can compare these surgical instruments to really long, tiny arms. If everyone holds their arms out in front of them, those are like the stems of the instruments. Now if everyone opens and closes their hands like lobster claws, this is like the pinchers or grabbers on the ends of the instruments. Now, if you rotate your wrists in and out, this is just like the motion that the instrument can replicate. The pinchers or grabbers are connected to the stem of the instrument by “endowrists,” which function like our own wrists do, to help the pinchers rotate.• In da Vinci® surgeries, there are two surgeons involved. One surgeon sits at the computer console working the joystick controls, while the other stands by the robot to help guide the instruments into the patient.• For patients, this surgery results in less tissue damage, reduced pain and quicker healing. Has anyone here had laproscopic surgery, or had a friend who has…maybe because they tore their ACL playing soccer? The incisions that the da Vinci® system makes in a patient are similar to the scars that laproscopic surgeries leave. There are usually three scars, all about the length of a thumbnail.• To date, da Vinci® has been used in everything from minimally-invasive heart surgery to minimally-invasive cancer surgery, to treat conditions as diverse as prostate cancer, endometrial cancer, morbid obesity and mitral valve regurgitation.• We’re going to watch a portion of a mitral valve repair. The heart has four chambers in it. Two chambers pump oxygenated blood to the body, and two chambers pump the blood (that has been through the lungs) back in from the body. These chambers are separated by little trap doors called valves. Valves control the movement of blood between the chambers. They act like little trap doors to make seals. The “lub-dup” sounds that a physician hears through a stethoscope occur when the heart valves close. When valves don’t close properly, blood can leak through, which can cause problems.• In the video, the surgeon is going to insert a piece of material that looks like a red string (called a prosthetic) that is going to be sewn around the hole, to make the hole smaller and solve the leaky valve problem.

Talking points after watching the video:• Using the da Vinci® Surgical System there is less risk of infection, less blood loss and need for blood transfusions, shorter hospital stay, significantly less pain and scarring, faster recovery, quicker return to normal activities and a potentially better clinical outcome. • The da Vinci® Surgical System combines robotics and surgical technology as never before, enabling a surgeon to provide the most effective and least invasive treatment option available for a wide range of complex conditions. Some robotic surgeons practice their skills by playing video games!• The da Vinci® Surgical System costs roughly $15 million.• At the University of Iowa, several specialties have gained the experience necessary to provide patients with this state-of-the-art minimally- invasive surgery option, including cardiothoracic surgery, obstetrics and gynecology, pediatric surgery and urology.• The University of Iowa became the first in the world to use the da Vinici® Surgical System to remove an adrenal carcinoma (an aggressive, deadly tumor) from a 22-month-old girl. It was also the first time da Vinci® had been used to remove an adrenal mass of any sort from a child. • The University of Iowa became the first to use the system to perform Ladd’s procedure, which corrects a condition in which the intestines do not rotate properly and are at risk for cutting off their own blood supply by twisting.

Hands–On Activity: HeartbeatWith a stethoscope, have student listen to their heartbeat. Have them try to identify the lub-dup sound that occurs when their heart valves close.

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CHAPTER 1 Teacher’s Learning Points – pg. 11

Cataract Removal Eye Surgery

Cataract is a common eye condition that affects millions of people, particularly as they get older. A cataract is a clouding of the eye’s naturally clear lens. The lens focuses light rays on the retina—the layer of light-sensing cells lining the back of the eye—to produce a sharp image of what we see. When the lens becomes cloudy, light rays cannot pass through it easily, and vision is blurred.

Warning: The contents of this video are graphic.

Sclera

Cornea

Pupil

Iris

Ciliary Body

Choroid

RetinaConjunctiva

Fovea (center of the macula)

Area of the Optic Disk

Optic Nerve

Central RetinalArtery and Vein

A scene as it might be viewed by a

person with a cataract.

An acute sudden onset cortical cataract in a person with Type 1 (juvenile) diabetes.

Images courtesy of National Eye Institute

Lens

Seriously gross

Student Questions:

CHAPTER 1 Cataract Removal Eye SurgeryLearning Points

Talking points before watching the video:• A cataract is a clouding of the eye’s naturally clear lens. The lens focuses light rays on the retina—the layer of light-sensing cells lining the back of the eye—to produce a sharp image of what we see. When the lens becomes cloudy, light rays cannot pass through it easily, and vision is blurred.• Your eye becomes like a window that is frosted or yellowed. You can compare vision with a cataract to looking through a frosted car windshield.You can still see, but not very clearly, and when another car’s headlights shine in, you can’t see anything but light.• Cataract is a common eye condition that affects millions of people, particularly as they get older.• Cataracts occur normally with age. Does anyone have a grandparent who has had cataracts, or even an older pet? Dogs and cats can get cataracts too!• Cataracts also develop from eye injuries, certain diseases, medications, or long-term exposure to sunlight. Your genes may also play a role in cataract development.• Over time, cataracts can affect your vision, causing symptoms like blurriness, poor night vision or glare, which gradually worsen if the cataracts are not removed.• An eye surgeon will remove the cataracts and in most cases, restore good vision.• Surgery for cataract removal is all done under a microscope.• Before surgery, the patient is given eye drops and perhaps a mild sedative to help make them comfortable. A local anesthetic will numb the eye. The skin around the eye will be thoroughly cleansed, and sterile coverings will be placed around the patient’s head. The patient may see light and movement, but will not be able to see the surgery while it is happening. This is similar to when you’re in the dentist’s office getting a cavity filled. You’re awake, and they help hold your mouth open, but they numb the tooth so you don’t feel the filling.• Usually with cataract surgery, a small incision is made in the eye.• The front portion of the thin outer covering of the lens is opened to allow removal of the cataract inside.• Fluid is injected inside, to keep the space between the lens and the rest of the capsule, and to loosen the lens.• The cataract is gently broken up by the vibrations of a small needle, and then is vacuumed out by the needle.• A folded lens implant is inserted through the small incision and into the capsule where it unfolds and permanently takes the place of the clouded natural lens.

Talking points after watching the video:• Surgery is usually done on an outpatient basis, either in a hospital or an ambulatory surgery center.• Lasers cannot be used to remove cataracts.• After surgery is completed, the doctor may place a shield over the eye to help protect it for about a week.

That way the patient won’t accidentally rub it in his or her sleep, and it will help keep dirt and dust out of the eye.• During the first week after the surgery, the patient may feel a little tenderness or feel like there is something in the eye—but it’s not painful. The doctor gives some eye drops for the first week to prevent infection. • After the surgery, the patient sees the doctor in the first week to make sure there is no infection and things are healing properly, and then schedules the next appointment.• After a month, most people are healed enough to begin wearing their contacts again.

Hands–On Activity: Eyeball DissectionCow’s Eye Dissection (Watch online, learn more about eyes, do your own dissection)http://www.exploratorium.edu/learning_studio/cow_eye/index.html

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11

Where in the eye does a cataract form?

A cataract forms in your eye’s lens.

Name two ways people can get cataracts.

Millions of people get cataracts as a normal part of aging. Other people get them from

eye injuries, certain diseases, medications or long-term sun exposure.

How do you lower your risk of getting cataracts?

Lower your risk of cataracts by wearing sunglasses and a hat, and eating a healthy diet with

a lot of green leafy vegetables and fruit. Do not smoke or drink.

Are patients awake during cataract surgery?

Yes, but they receive a numbing drop or an injection of anesthetic

into the eye. They may also get medication to relax them during

the surgery.

• The University of Iowa is an international leader in vision research and care with particular strength in inherited eye diseases. People from all over the world come to the University of Iowa because of this reputation.

• Scientists at the University of Iowa are using stem cell biology and tissue engineering to regenerate cells in the eye with the potential to restore vision.

• Your eyeball doesn’t fall out when you lean over or walk because it is held in by six hard-working muscles. The muscles pull your eyeball back and forth, so you can read and look around. Each day these muscles move about 100,000 times. For your legs to get the same workout, you’d have to walk about 50 miles!

DID YOU KNOW?

4

The skills you develop by playing video

games may help you with the skills needed to become a robotic surgeon.

5

A UI s

urge

on si

ts at

the c

ontro

llers

of th

e

da V

inci® Su

rgica

l Syst

em.

A young woman wearing a cochlear implant.

Name two ways someone might become deaf and qualify for a

cochlear implant.Genetics, sickness (meningitis, rubella), medicines or head trauma.When placing a cochlear implant, the surgeon drills a hole in

what bone? Where is it located? (Requires watching the video to answer.)

The mastoid bone, located just behind the ear.How does a cochlear implant differ from a hearing aid?Hearing aids make sounds louder so the damaged ear can hear

them. Cochlear implants go around the damaged parts of the ear

altogether and directly stimulate the auditory nerve, which sends

sounds to the brain.

How will you prevent future hearing loss for yourself?Turn down loud noises (music); wear protection over ears

when around loud machinery.

Student Questions:

How does a Cochlear Implant Work? 1. A microphone located externally behind the ear picks up sounds and turns them into electrical signals.

2. The electrical signals are sent to a speech processor, worn either on the body or on the ear, where they are “coded,” or turned into a special pattern of electrical pulses.

3. Electrical pulses are sent to a coil located behind the ear on the outside, which transmits them across the skin by radio waves to an array of electrodes implanted deep within the cochlea.

4. The implant sends a pattern of electrical pulses to a tiny radio receiver located just under the skin behind the ear.

5. The receiver sends the pulses along an electrical wire wrapped within the cochlea.

6. The wire delivers the energy to an array of electrodes, sometimes as many as 22.

7. The auditory nerve picks up the tiny electrical pulses and sends them to the brain, where they are recognized as sound.

3.

2.

4.1. 5.

Imag

e co

urte

sy o

f Coc

hlea

r Lim

ited.

Image courtesy of Cochlear Limited.

10

The da Vinci® Surgical System is a robotic “surgeon” that helps humans perform “minimally invasive” surgery — meaning it is done through a very small opening rather than a large incision. With the da Vinci® robot, one surgeon stands by the robot to help guide the instruments into the patient, while another surgeon sits at computer controls several feet away and directs the robot’s arms, much like playing a video game. The da Vinci® robot magnifies the area being operated on so surgeons can get a better look, and moves in ways that a surgeon’s hands cannot.

In 2002, the University of Iowa helped pioneer robotic surgery and has continued to lead the field. Today, many other hospitals in Iowa and elsewhere also use the da Vinci® system.


Seriously gross

CHAPTER 2Teacher’s Learning Points – pg. 12

da Vinci® Robotic Surgery

There are a variety of reasons why someone might become deaf and qualify for a cochlear implant. This can include genetics (born this way), sickness (meningitis, rubella), medicines (some antibiotics or chemotherapy), or even head trauma. In order to understand how the cochlear implant replaces missing sound, it is important to understand how we hear. When you hear a doorbell, car alarm or crying baby, your outer ear, made of cartilage, collects the sound and sends it into the middle ear. The sound waves bounce off your eardrum, then the three tiniest bones in your body — called the hammer, anvil and stirrup (together, smaller than an orange seed) — make the sounds louder before sending them to the inner ear and then through the cochlea, where tiny hair cells turn them into electrical energy. Your brain receives the energy and recognizes it as the “sound” of a doorbell, car alarm, or a crying baby.

For a person who is profoundly deaf or severely hard of hearing, this process doesn’t work properly. For them, a cochlear implant may provide them with a sense of sound. Although it sounds very different from normal hearing, eventually the brain gets used to it and learns to recognize sounds, so that many people with cochlear implants can hear alarms, environmental sounds and conversations.

A cochlear implant is very different from a hearing aid. Hearing aids simply make the sounds louder, so that damaged ears can hear them. Hearing aids can be very useful for the majority of the hearing impaired population, but for a small segment not enough benefit is gained from hearing aids. Those patients are then cochlear implant candidates. Cochlear implants go around the damaged parts of the ear altogether and directly stimulate the auditory nerve, which sends sounds to the brain.

The cochlear implant, a small, complex electronic device, consists of an external portion that sits behind the ear to pick up sound; a second part that is surgically placed under the skin; and an array of electrodes that are placed about an inch into the cochlea.


DID YOU KNOW?• People with cochlear implants have difficulty understanding the intricate combination of sounds we recognize as music. The University of Iowa is one of the lead institutions working to improve technology so that people with cochlear implants can enjoy listening to music again — or maybe for the first time.

• The University of Iowa is a leader in helping children with hearing loss. The University of Iowa was the first in the world to place an advanced cochlear implant in a child who was born deaf.

• You naturally raise the volume of your voice when you’re in a noisy environment. Turn up some music, have your partner start talking then suddenly turn off

the music — just hear how loud their voice seems!

Student Questions:

• The da Vinci® robot is used for lots of procedures at the University of Iowa including surgeries in the stomach, intestines, colon, heart, kidneys and reproductive organs.

• The University of Iowa was the first in the world to use robotic surgery to remove a diseased colon from a child.

• Robotic surgery is especially helpful during very long operations, when, due to fatigue, a surgeon’s hands may start to tremble.

DID YOU KNOW?

How many surgeons does it take to perform surgery using the da Vinci® robot?

Two. One surgeon sits at the computer console and one stands by the robot to help

guide the instruments into the patient. But there is an entire team of health care

professionals in the operating room to make sure things run smoothly.

Name three surgeries that the da Vinci® robot is used for in patients today.

Stomach, intestines, colon, heart, kidneys and reproductive organs

What are the advantages of the da Vinci® robotic surgical method

compared to other types of surgeries? Using the da Vinci® surgical

system results in less risk of infection; less blood loss and need for blood

transfusions; shorter hospital stay; significantly less pain and

scarring; faster recovery and a quicker return to normal activities

with a potentially better clinical outcome.


Cochlear Implant Surgery

9 6


Treating Clubfoot with the Ponseti Method

7 8

Dr. Ponseti, born in 1914 on the Spanish island of Menorca, learned as a teenager how to do intricate, precise work by helping in his father’s watch repair shop. When he was 16, he attended the University of Barcelona where he earned degrees in biology and medicine. After his graduation, in 1936, he served as a medic during the Spanish Civil War, treating hundreds of bone and joint wounds. He left the country as a political refugee, and after spending some time in Mexico, came in 1941 to the University of Iowa to finish his medical residency.

In 1944, he joined the University of Iowa’s orthopaedic surgery faculty. (Doctors who specialize in orthopaedic surgery work with the muscles, bones and joints of the body.)

Dr. Arthur Steindler, head of the department at the time, asked Dr. Ponseti to review the results of clubfoot surgeries being performed at the University of Iowa. What Dr. Ponseti saw was not encouraging. He found that children treated with the surgery often had foot stiffness, pain, arthritis and limited movement as adults, and often required additional surgery.

Dr. Ponseti came up with his method by studying the anatomy and functions of a baby’s foot. “If you know how to untwist the foot, that’s all you need to know,” he said, although coming up with the technique took several years and convincing others to use it took even longer. Today, however, due in large part to Dr. Ponseti’s dedication to helping children with clubfoot, the Ponseti Method is used all over the world and is recognized as the best treatment for the condition. Hundreds of doctors came to University of Iowa Health Care from all over the world to be trained by Dr. Ponseti and his colleagues. Dr. Ponseti treated patients until his death in October 2009 at the age of 95. With a parent or adult, check out www.ponseti.info to learn more about Dr. Ponseti and to view more videos about clubfoot.

Student Questions:

DID YOU KNOW?• Many famous athletes, including figure skater Kristi Yamaguchi, soccer great Mia Hamm, and football star Troy Aikman, were born with clubfoot.

• At birth you have 350 bones in your body. You now have 206 bones. What happened to the rest? They fused to other bones to make larger bones.

What is clubfoot?

When muscles, tendons and bones in the foot develop abnormally

while the baby is still a fetus inside its mother.

Why did Dr. Ponseti develop the Ponseti Method of clubfoot correction?

Because surgical patients ended up with pain, stiffness, arthritis

and limited movement.

How long does the Ponseti Method take from start to finish?

About four years.

Clubfoot is a birth defect that happens when the muscles, tendons and bones in the foot develop abnormally while the baby is still a fetus inside its mother. Each year, 150,000 to 200,000 babies all over the world are born with clubfoot.

While researchers have been unable to pinpoint the exact cause of clubfoot, both genes and the environment are thought to play a role. Fortunately, Dr. Ignacio Ponseti, a doctor at the University of Iowa, developed an innovative, non-surgical treatment for the condition that is safe, easy, cost-effective and most importantly, successful in almost 100 percent of cases. The Ponseti Method, which Dr. Ponseti

came up with more than 50 years ago, involves gently stretching the child’s foot back into place and keeping it there with a series of toe-to-groin plaster casts. After several weeks in the casts, the child then wears a brace, first all the time and then only at night, until he or she is about four years old. After that, no more treatment is usually needed.

2 Weeks

3 Weeks

4 Weeks

5 Weeks

Seriously gross

There are a variety of reasons why someone might become deaf and qualify for a cochlear implant. This can include genetics (born this way), sickness (meningitis, rubella), medicines (some antibiotics or chemotherapy), or even head trauma. In order to understand how the cochlear implant replaces missing sound, it is important to understand how we hear. When you hear a doorbell, car alarm or crying baby, your outer ear, made of cartilage, collects the sound and sends it into the middle ear. The sound waves bounce off your eardrum, then the three tiniest bones in your body — called the hammer, anvil and stirrup (together, smaller than an orange seed) — make the sounds louder before sending them to the inner ear and then through the cochlea, where tiny hair cells turn them into electrical energy. Your brain receives the energy and recognizes it as the “sound” of a doorbell, car alarm, or a crying baby.

For a person who is profoundly deaf or severely hard of hearing, this process doesn’t work properly. For them, a cochlear implant may provide them with a sense of sound. Although it sounds very different from normal hearing, eventually the brain gets used to it and learns to recognize sounds, so that many people with cochlear implants can hear alarms, environmental sounds and conversations.

A cochlear implant is very different from a hearing aid. Hearing aids simply make the sounds louder, so that damaged ears can hear them. Hearing aids can be very useful for the majority of the hearing impaired population, but for a small segment not enough benefit is gained from hearing aids. Those patients are then cochlear implant candidates. Cochlear implants go around the damaged parts of the ear altogether and directly stimulate the auditory nerve, which sends sounds to the brain.

The cochlear implant, a small, complex electronic device, consists of an external portion that sits behind the ear to pick up sound; a second part that is surgically placed under the skin; and an array of electrodes that are placed about an inch into the cochlea.


DID YOU KNOW?• People with cochlear implants have difficulty understanding the intricate combination of sounds we recognize as music. The University of Iowa is one of the lead institutions working to improve technology so that people with cochlear implants can enjoy listening to music again — or maybe for the first time.

• The University of Iowa is a leader in helping children with hearing loss. The University of Iowa was the first in the world to place an advanced cochlear implant in a child who was born deaf.

• You naturally raise the volume of your voice when you’re in a noisy environment. Turn up some music, have your partner start talking then suddenly turn off

the music — just hear how loud their voice seems!

Student Questions:

• The da Vinci® robot is used for lots of procedures at the University of Iowa including surgeries in the stomach, intestines, colon, heart, kidneys and reproductive organs.

• The University of Iowa was the first in the world to use robotic surgery to remove a diseased colon from a child.

• Robotic surgery is especially helpful during very long operations, when, due to fatigue, a surgeon’s hands may start to tremble.

DID YOU KNOW?

How many surgeons does it take to perform surgery using the da Vinci® robot?

Two. One surgeon sits at the computer console and one stands by the robot to help

guide the instruments into the patient. But there is an entire team of health care

professionals in the operating room to make sure things run smoothly.

Name three surgeries that the da Vinci® robot is used for in patients today.

Stomach, intestines, colon, heart, kidneys and reproductive organs

What are the advantages of the da Vinci® robotic surgical method

compared to other types of surgeries? Using the da Vinci® surgical

system results in less risk of infection; less blood loss and need for blood

transfusions; shorter hospital stay; significantly less pain and

scarring; faster recovery and a quicker return to normal activities

with a potentially better clinical outcome.


Cochlear Implant Surgery

9 6

The skills you develop by playing video

games may help you with the skills needed to become a robotic surgeon.

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e

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A young woman wearing a cochlear implant.

Name two ways someone might become deaf and qualify for a

cochlear implant.Genetics, sickness (meningitis, rubella), medicines or head trauma.When placing a cochlear implant, the surgeon drills a hole in

what bone? Where is it located? (Requires watching the video to answer.)

The mastoid bone, located just behind the ear.How does a cochlear implant differ from a hearing aid?Hearing aids make sounds louder so the damaged ear can hear

them. Cochlear implants go around the damaged parts of the ear

altogether and directly stimulate the auditory nerve, which sends

sounds to the brain.

How will you prevent future hearing loss for yourself?Turn down loud noises (music); wear protection over ears

when around loud machinery.

Student Questions:

How does a Cochlear Implant Work? 1. A microphone located externally behind the ear picks up sounds and turns them into electrical signals.

2. The electrical signals are sent to a speech processor, worn either on the body or on the ear, where they are “coded,” or turned into a special pattern of electrical pulses.

3. Electrical pulses are sent to a coil located behind the ear on the outside, which transmits them across the skin by radio waves to an array of electrodes implanted deep within the cochlea.

4. The implant sends a pattern of electrical pulses to a tiny radio receiver located just under the skin behind the ear.

5. The receiver sends the pulses along an electrical wire wrapped within the cochlea.

6. The wire delivers the energy to an array of electrodes, sometimes as many as 22.

7. The auditory nerve picks up the tiny electrical pulses and sends them to the brain, where they are recognized as sound.

3.

2.

4.1. 5.

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Image courtesy of Cochlear Limited.

10

The da Vinci® Surgical System is a robotic “surgeon” that helps humans perform “minimally invasive” surgery — meaning it is done through a very small opening rather than a large incision. With the da Vinci® robot, one surgeon stands by the robot to help guide the instruments into the patient, while another surgeon sits at computer controls several feet away and directs the robot’s arms, much like playing a video game. The da Vinci® robot magnifies the area being operated on so surgeons can get a better look, and moves in ways that a surgeon’s hands cannot.

In 2002, the University of Iowa helped pioneer robotic surgery and has continued to lead the field. Today, many other hospitals in Iowa and elsewhere also use the da Vinci® system.


Seriously gross

CHAPTER 2Teacher’s Learning Points – pg. 12

da Vinci® Robotic Surgery

Student Questions:

CHAPTER 1 Cataract Removal Eye SurgeryLearning Points

Talking points before watching the video:• A cataract is a clouding of the eye’s naturally clear lens. The lens focuses light rays on the retina—the layer of light-sensing cells lining the back of the eye—to produce a sharp image of what we see. When the lens becomes cloudy, light rays cannot pass through it easily, and vision is blurred.• Your eye becomes like a window that is frosted or yellowed. You can compare vision with a cataract to looking through a frosted car windshield.You can still see, but not very clearly, and when another car’s headlights shine in, you can’t see anything but light.• Cataract is a common eye condition that affects millions of people, particularly as they get older.• Cataracts occur normally with age. Does anyone have a grandparent who has had cataracts, or even an older pet? Dogs and cats can get cataracts too!• Cataracts also develop from eye injuries, certain diseases, medications, or long-term exposure to sunlight. Your genes may also play a role in cataract development.• Over time, cataracts can affect your vision, causing symptoms like blurriness, poor night vision or glare, which gradually worsen if the cataracts are not removed.• An eye surgeon will remove the cataracts and in most cases, restore good vision.• Surgery for cataract removal is all done under a microscope.• Before surgery, the patient is given eye drops and perhaps a mild sedative to help make them comfortable. A local anesthetic will numb the eye. The skin around the eye will be thoroughly cleansed, and sterile coverings will be placed around the patient’s head. The patient may see light and movement, but will not be able to see the surgery while it is happening. This is similar to when you’re in the dentist’s office getting a cavity filled. You’re awake, and they help hold your mouth open, but they numb the tooth so you don’t feel the filling.• Usually with cataract surgery, a small incision is made in the eye.• The front portion of the thin outer covering of the lens is opened to allow removal of the cataract inside.• Fluid is injected inside, to keep the space between the lens and the rest of the capsule, and to loosen the lens.• The cataract is gently broken up by the vibrations of a small needle, and then is vacuumed out by the needle.• A folded lens implant is inserted through the small incision and into the capsule where it unfolds and permanently takes the place of the clouded natural lens.

Talking points after watching the video:• Surgery is usually done on an outpatient basis, either in a hospital or an ambulatory surgery center.• Lasers cannot be used to remove cataracts.• After surgery is completed, the doctor may place a shield over the eye to help protect it for about a week.

That way the patient won’t accidentally rub it in his or her sleep, and it will help keep dirt and dust out of the eye.• During the first week after the surgery, the patient may feel a little tenderness or feel like there is something in the eye—but it’s not painful. The doctor gives some eye drops for the first week to prevent infection. • After the surgery, the patient sees the doctor in the first week to make sure there is no infection and things are healing properly, and then schedules the next appointment.• After a month, most people are healed enough to begin wearing their contacts again.

Hands–On Activity: Eyeball DissectionCow’s Eye Dissection (Watch online, learn more about eyes, do your own dissection)http://www.exploratorium.edu/learning_studio/cow_eye/index.html

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Where in the eye does a cataract form?

A cataract forms in your eye’s lens.

Name two ways people can get cataracts.

Millions of people get cataracts as a normal part of aging. Other people get them from

eye injuries, certain diseases, medications or long-term sun exposure.

How do you lower your risk of getting cataracts?

Lower your risk of cataracts by wearing sunglasses and a hat, and eating a healthy diet with

a lot of green leafy vegetables and fruit. Do not smoke or drink.

Are patients awake during cataract surgery?

Yes, but they receive a numbing drop or an injection of anesthetic

into the eye. They may also get medication to relax them during

the surgery.

• The University of Iowa is an international leader in vision research and care with particular strength in inherited eye diseases. People from all over the world come to the University of Iowa because of this reputation.

• Scientists at the University of Iowa are using stem cell biology and tissue engineering to regenerate cells in the eye with the potential to restore vision.

• Your eyeball doesn’t fall out when you lean over or walk because it is held in by six hard-working muscles. The muscles pull your eyeball back and forth, so you can read and look around. Each day these muscles move about 100,000 times. For your legs to get the same workout, you’d have to walk about 50 miles!

DID YOU KNOW?

4

3

CHAPTER 2 da Vinci® Robotic Surgery Learning Points

Talking points before watching the video:• The da Vinci® robot enables surgeons, working from a computer console several feet from the patient, to work at a scale smaller than conventional surgery while at the same time getting a closer look at the surgical site than normal human vision allows.• With the da Vinci® robot, a surgeon operates without physically touching the patient. The da Vinci® system is made of two major parts: a computer console and the actual robot.• The surgeon uses joystick-like controls to manipulate long, narrow, specially-hinged surgical instruments that are inserted through small incisions in the patient’s abdomen. The remote-controlled instruments can access hard-to-reach areas and turn in ways that would be impossible with normal wrist dexterity. You can compare these surgical instruments to really long, tiny arms. If everyone holds their arms out in front of them, those are like the stems of the instruments. Now if everyone opens and closes their hands like lobster claws, this is like the pinchers or grabbers on the ends of the instruments. Now, if you rotate your wrists in and out, this is just like the motion that the instrument can replicate. The pinchers or grabbers are connected to the stem of the instrument by “endowrists,” which function like our own wrists do, to help the pinchers rotate.• In da Vinci® surgeries, there are two surgeons involved. One surgeon sits at the computer console working the joystick controls, while the other stands by the robot to help guide the instruments into the patient.• For patients, this surgery results in less tissue damage, reduced pain and quicker healing. Has anyone here had laproscopic surgery, or had a friend who has…maybe because they tore their ACL playing soccer? The incisions that the da Vinci® system makes in a patient are similar to the scars that laproscopic surgeries leave. There are usually three scars, all about the length of a thumbnail.• To date, da Vinci® has been used in everything from minimally-invasive heart surgery to minimally-invasive cancer surgery, to treat conditions as diverse as prostate cancer, endometrial cancer, morbid obesity and mitral valve regurgitation.• We’re going to watch a portion of a mitral valve repair. The heart has four chambers in it. Two chambers pump oxygenated blood to the body, and two chambers pump the blood (that has been through the lungs) back in from the body. These chambers are separated by little trap doors called valves. Valves control the movement of blood between the chambers. They act like little trap doors to make seals. The “lub-dup” sounds that a physician hears through a stethoscope occur when the heart valves close. When valves don’t close properly, blood can leak through, which can cause problems.• In the video, the surgeon is going to insert a piece of material that looks like a red string (called a prosthetic) that is going to be sewn around the hole, to make the hole smaller and solve the leaky valve problem.

Talking points after watching the video:• Using the da Vinci® Surgical System there is less risk of infection, less blood loss and need for blood transfusions, shorter hospital stay, significantly less pain and scarring, faster recovery, quicker return to normal activities and a potentially better clinical outcome. • The da Vinci® Surgical System combines robotics and surgical technology as never before, enabling a surgeon to provide the most effective and least invasive treatment option available for a wide range of complex conditions. Some robotic surgeons practice their skills by playing video games!• The da Vinci® Surgical System costs roughly $15 million.• At the University of Iowa, several specialties have gained the experience necessary to provide patients with this state-of-the-art minimally- invasive surgery option, including cardiothoracic surgery, obstetrics and gynecology, pediatric surgery and urology.• The University of Iowa became the first in the world to use the da Vinici® Surgical System to remove an adrenal carcinoma (an aggressive, deadly tumor) from a 22-month-old girl. It was also the first time da Vinci® had been used to remove an adrenal mass of any sort from a child. • The University of Iowa became the first to use the system to perform Ladd’s procedure, which corrects a condition in which the intestines do not rotate properly and are at risk for cutting off their own blood supply by twisting.

Hands–On Activity: HeartbeatWith a stethoscope, have student listen to their heartbeat. Have them try to identify the lub-dup sound that occurs when their heart valves close.

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12


Cataract Removal Eye Surgery

Cataract is a common eye condition that affects millions of people, particularly as they get older. A cataract is a clouding of the eye’s naturally clear lens. The lens focuses light rays on the retina—the layer of light-sensing cells lining the back of the eye—to produce a sharp image of what we see. When the lens becomes cloudy, light rays cannot pass through it easily, and vision is blurred.


Sclera

Cornea

Pupil

Iris

Ciliary Body

Choroid

RetinaConjunctiva

Fovea (center of the macula)

Area of the Optic Disk

Optic Nerve

Central RetinalArtery and Vein

A scene as it might be viewed by a

person with a cataract.

An acute sudden onset cortical cataract in a person with Type 1 (juvenile) diabetes.

Images courtesy of National Eye Institute

Lens

Seriously gross

CHAPTER 3 Treating Clubfoot with the Ponseti Method Learning Points

Talking points before watching the video:• Clubfoot is a congenital deformity of the foot that occurs in about 150,000-200,000 babies each year worldwide. • Clubfoot results from the abnormal development of the muscles, tendons, and bones in the foot while the fetus is forming during pregnancy. While researchers have been unable to pinpoint the exact cause of clubfoot, both genetic and environmental factors are thought to play a role. • Clubfoot is about twice as common in boys as it is in girls, and occurs in both feet about 50 percent of the time. This is called bilateral clubfoot.• Clubfoot is one of the most common congenital deformities. Many cases are associated with neuromuscular diseases, chromosomal abnormalities, Mendelian and non-Mendelian syndromes and in rare cases with extrinsic causes.• In Caucasians the disorder occurs in about one per thousand. In Japanese it occurs half as frequently. In South African blacks it occurs three times as frequently, and in Polynesians it occurs six times as frequently.• Dr. Ignacio Ponseti at the University of Iowa developed an innovative, non-surgical treatment for clubfoot involving the gentle, manual manipulation of the child’s foot and the application of toe-to-groin plaster casts. This is called the Ponseti Method.• Treatments started in 1948 at the University of Iowa.• Treated clubfeet are less supple than normal feet, but patients have no significant differences in the functional performance compared to a population of similar age born with normal feet.• Treatment is economical and easy on the baby and the parents. It is the best treatment for clubfoot.• Clubfoot in an otherwise normal child can be corrected using the Ponseti Method of manipulation and plaster cast applications, with minimal or no surgery. Treatment should begin in the first week or two of life in order to take advantage of the elasticity of the tissues that form the ligaments and tendons in the foot. Has anyone here had a broken bone and needed a cast? So, as you know, the purpose of a cast is to keep the joint and ligaments around it still to encourage proper healing. The same principal is behind the casts in the Ponseti Method. The doctor manipulates the joint, a tiny bit at a time, and puts a cast on to hold it in position. • Each week, the doctor removes the previous cast, does another manipulation, and then re-casts the leg.• Dr. Ponseti passed away at age 95 in October 2009. Dr. Ponseti continued to practice medicine until he died, treating clubfoot patients and training doctors in the Ponseti Method.

Talking points after watching the video:• The majority of clubfeet can be corrected in infancy in about six to eight weeks with the proper gentle manipulations and plaster casts.• After the proper alignment is made and the last cast is removed, a splint must be worn for two to three months and at night for the next three to four years to prevent a pro-lapse.• The Ponseti Method is so important because it is a superior method to surgery; it’s inexpensive and can be done with a minimal amount of supplies and training. This means countries with limited medical resources and a higher incidence of clubfoot can still treat their children, whereas before the Ponseti Method the majority of these children would have the problem their entire lives.• There are several famous athletes who were born with clubfoot including soccer star Mia Hamm, figure skater Kristi Yamaguchi, and football star Troy Aikman.

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13

Cool facts about University of Iowa Health Care

DID YOU KNOW? To become a doctor, you need four years of college, four years of medical school, and at least three or four more years of practice as a resident. But did you also know that once you become a resident, they

pay you to learn?

In 1870, the University of Iowa established the first coeducational medical school in the United States with 31 men and seven women in the

first graduating class.

Over the past decade, the UI Carver College of Medicine brought in more than $1.1 billion in research funding to help find and improve treatments for cancer, diabetes, digestive disorders, heart and vascular disorders, and blinding eye diseases.

Researchers at the University of Iowa were the first in the world to record human EEG activity, the electrical activity in your brain. Today, EEG technology helps evaluate the health of the brain and diagnose nervous system disorders.

University of Iowa graduates include:

- A pathologist who unlocked the mystery of what caused the Spanish Flu pandemic in 1918;

- An innovative investigator who discovered the value of fluoride in strengthening bones, a discovery that led to the creation of Crest® toothpaste;

- A leader in understanding and treating sports injuries who contributed to the creation of the first NIKE® shoe;

- A key researcher in the development of the automobile seat belt in the 1960s;

- And 25,000 other alumni who have tended to the health care needs of Iowans and populations worldwide, and have made significant contributions to biomedical research and medical education.

More than 7,400 health professionals care for more than 50,000 inpatients annually at the University of Iowa Hospitals and Clinics, including 29,000 acutely ill children and adults.

University of Iowa Hospitals and Clinics is one of the nation’s most prestigious teaching hospitals and a leading center for “around-the-clock” multidisciplinary, patient-centered care. The hospital’s commitment to care, compassion and discovery earns high rankings for quality and expertise.

Exploration2

CHAPTER 4 Cochlear Implant SurgeryLearning Points

Talking points before watching the video:• There are good candidates and bad candidates for cochlear implants. Good candidates are people who were born deaf or have developed profound deafness in their life. Someone who has some hearing loss but can still hear is not a good candidate. • A cochlear implant is very different from a hearing aid. Hearing aids amplify sounds. Cochlear implants bypass the damaged portions of the ear and directly stimulate the auditory nerve. Signals generated by the implant are sent by way of the auditory nerve to the brain, which recognizes the signals as sounds.• Most children who receive cochlear implants are between the ages of two and six. This implant, along with lots of therapy, can help young children learn speech, language and social skills.• More than 59,000 adults and children all over the world have cochlear implants.• A cochlear implant is a small, complex electronic device that can help provide a sense of sound to a person who is profoundly deaf or severely hard-of-hearing.• A cochlear implant consists of an external portion that sits behind the ear and a second portion that is surgically placed under the skin.• An incision is made behind the ear and the skin and tissue flap is lifted so that the surgeon can drill into the mastoid bone. A receiver is placed into the drilled-out area and an electrode array is inserted into the cochlea. If everyone reaches behind their ear and finds the pointy bone sticking up, this is called the mastoid bone. This is the bone where surgeons create a hole to make a place for the implant to sit.• An implant has the following parts: A microphone, which picks up sound from the environment; a speech processor, to select and arrange sounds picked up by the microphone; a transmitter and receiver/stimulator to receive signals from the speech processor and convert them into electric impulses; and an electrode array, which is a group of electrodes that collects the impulses from the stimulator and sends them to different regions of the auditory nerve. An implant also has a battery that is C-shaped and worn on the outside of the ear. People with cochlear implants take their battery pack off at night and put it on a charger. While the battery is off, they won’t be able to hear. This is similar to someone who takes their glasses off at night—in the morning the person just slips the battery pack back on.

Talking points after watching the video:• An implant does not restore normal hearing —there is no cure for hearing loss! Instead it can give a deaf person a useful representation of sounds in the environment and help him or her to understand speech.• Hearing through a cochlear implant is different from normal hearing and takes time to learn or relearn.• Some famous people have had this surgery, include a Miss America (1995 winner Heather Whitestone McCallum) and a national radio talk show host (Rush Limbaugh).• The implant, the surgery, and the necessary adjustments and training that happen after the surgery cost an estimated $60,000. • Today’s cochlear implant surgery is a relatively minor operation of just a few hours. Children who have had the surgery have been known to go home immediately afterwards, playing normally with minimal post-surgical effects.

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14

People decide to become doctors for many different reasons. Some like the excitement of testing their own theories to find new treatments and cures for human disease, while others like the satisfaction of using those treatments to help people. Some people are interested in working with technology to improve health, while others are more interested in exploring the complex systems that make up the human body.

At the University of Iowa, different people with different interests work together every day to make people healthier. Researchers, physicians, nurses, teachers and students work with imaging specialists, physical and occupational therapists, health care administrators, technology experts and countless others to provide some of the best care in the nation.

No matter where your interests lie, there’s a place for you in science and medicine. The University of Iowa Health Care STEM (science, technology, engineering, and math) programs including UI Gross Anatomy will show you a few of the possibilities. We invite you to take a look inside the University of Iowa and see what we’re doing. Use this workbook to explore science, health and disease. Discover the world of medicine at the University of Iowa.

But be warned: Just like medicine itself, it may get gross — but never boring!

1

Science

Health

TechnologyDisease

Medicine

For More information about educational and enrichment experiences for children, check out University of Iowa Health Care STEM Education website: uihealthcare.org/STEM

Or contact: Jacqueline Kleppe WilliamsManager, Community and STEM Education University of Iowa Health Care Marketing and CommunicationsDivision of External Relations4148 WL, Iowa City, IA 52242Phone 877-MED-IOWA or (319) 384-3025 or via e-mail at [email protected]

3rd Edition, 2012 (revised)Managing Editor: Chad Ruback, Assistant Vice President for External Relations, UI Health CareEditor: Jacqueline Kleppe WilliamsWriting Assistance: Susan Green, Elizabeth BairdDesign: Nancy ZearPhotography and Images: Susan McClellen, Dr. Ignacio Ponseti, Cochlear Limited, UI Department of Ophthalmology, National Eye Institute

University of Iowa Health Care is a fully integrated academic medical center, uniting the UI Roy J. and Lucille A. Carver College of Medicine, University of Iowa Hospitals and Clinics, and UI Physicians, the largest multi-specialty group practice in Iowa. As the state’s premier academic medical center, UI Health Care provides high quality, patient-centered care, conducts groundbreaking biomedical research, and educates the scientists and health care providers of the future.

Web Resources For more information and resources related to science, health, diseases and medicine go to the Hardin Library for Health Sciences: lib.uiowa.edu/hardin

Students can learn more about the road to becoming a physician at: medicine.uiowa.edu/osac/admissions/road.html

More information about going to medical school can also be found at: aspiringdocs.org

This website from the National Institute on Deafness and Other Communication Disorders has student and teacher activities: nidcd.nih.gov/health/education/

Information about the “gross side” of science, designed just for kids, can be found at the Grossology website: grossology.org

EXT 13-024 8/12

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UI GROSSANATOMY

The University of Iowa Carver College of Medicine presents

Seriously gross

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Teacher’s Guidebook

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