Canadian Medicine

The print edition of July's National Review of Medicine will be with you in the next day or two. Here's a handful of highlights to look out for:

In our front page Interview, AIDS activist and longtime NDP politician and diplomat Stephen Lewis (left) talks about his surprising respect for Brian Mulroney, his not-so-surprising disdain for Stephen Harper and what's not in his RCMP file. (.)

The death of life support patient Samuel Golubchuk hasn't solved the court case or the ethical battle being waged by physicians, policymakers and his family over who has the final say when it comes to pulling the plug on a terminal patient. . Who do you think should have the final say? Take our poll on this blog (right) or (to be eligible to win a deluxe picnic backpack).

Important (and lengthy) new guidelines on how to tackle blood clots are covered on page 8 and can be read on our website . The recommendations offer new options for treating high risk pregnant patients, as well as bridging for surgery.

How we shall miss them. Ontario and Quebec health ministers "Furious" George Smitherman (left) and Philippe "Dr Phil" Couillard (right) move on. In this issue . Both ministers were featured in front page interviews in NRM: Mr Smitherman and Mr Couillard .

: the discovery of a gut microbe that prevents colitis offers new hope for IBD sufferers.

Don't forget to fill out our on the Practice Management and Personal Finance issues affecting today's physician - you could win a Gourmet Grill from Napoleon.

Photos: NRM/Liam Maloney/Mark Coatsworth/Francis Vachon
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This morning the nine CEOs of Alberta's nine recently dismantled health regions showed up to work to be told to clear their desks and make themselves scarce by noon, . Their keys, company cars and credit cards were also seized and they were reportedly escorted from their respective buildings.

"These people have worked hard for their regions for years, now they're being treated like criminals," an anonymous observer told the Herald.

Ken Hughes, chair of the Alberta Health Services Board that replaces the nine health regions, took place: "They were treated with a great deal of respect and there was no such activity." At any rate, their rumoured massive severance packages (upwards of $1 million each by some estimates) should make up for any rough treatment the execs may or may not have received. Three of the CEOs - Pam Whitnack (Chinook), Andrew Will (Aspen) and Jim Saunders (East Central) - have been offered jobs with the new board.

We on the province's plans to shrink its nine health regions into one in our June issue. Health Minister Ron Liepert, who took the helm in March after the provincial election, told NRM's Sam Solomon that "the system was designed around the region, not the patient."

But critics say the move is a quick and poorly thought-out way to save the ministry money in the short term that won't solve any of the big picture problems like physicians shortages and wait times any time soon. "The notion is that by making the system bigger and more monolithic, they'll increase efficiencies. We saw the opposite happening during previous restructuring," Liberal health critic Dave Taylor .

That's right, we've been down this road before - or should I say, up it. Before the nine health regions there were 17; before that healthcare was run centrally by the Ministry of Health. Hmmm, anything sound familiar?

Health observers will continue to watch the goings on in the country's richest province with interest. After all, if they can't get it right with all that oil dosh, does anyone stand a chance?

Image: Cowboy boot, Edmonton, Alberta from

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Med students learn and retain better when their lessons are accompanied by visual aids like medical illustrations.

But to help the doctors of tomorrow, medical drawings need to be accurate and clear. Creating them is a science. Just ask medical illustrator .

"As an illustrator you have to research, sketch and figure out the spatial relationships to say, illustrate a nerve pathway," says Ms Kryski, a Master's candidate at U of T's biomedical communications program -- the only program of its kind in Canada. "Then you have to arrange that knowledge visually so the viewer can easily understand."

She spoke to NRM about what it takes to create an illustration (like the one of emphysema tissue destruction she did above) and the future of 3D modelling applications in medical education.

You first studied fine arts, but what's involved in becoming a medical illustrator?
At first I was very interested in becoming a doctor, but with illustration I found I could join two of the things that excite me.

In our program at U of T we join med students in the first 10 weeks of their training for four hours of cadaver dissection and four hours of lecture every day; covering anatomy, pathology, and neuroanatomy.

As an artist I knew I'd be referring back to the dissections throughout my life, so I took a lot of mental images since I remember things through spatial relations and visualization.

How do you prepare a drawing?
It's a lot of reading and sketching. You need to learn the details and which ones to emphasize over others to make the message clear. There are a lot of things that would be too messy if you just took a picture of them.

To illustrate, say, a nerve pathway, especially in the skull, it's very important to grasp the theory of where things are. Then you arrange that knowledge visually in a way that the viewer will understand, and run it by experts.

A lot of the most complex topics are best captured in pen and ink. Many people learn better from simpler diagrams.

Right now you're working on a experimental U of T web application, --a 3D anatomy tutorial. What's that about?
I've created the pterygopalatine fossa module (to be released) and I'm working on a study evaluating the educational effectiveness of the 3D model on recall compared to learning from static images.

Are 3D programs effective?
I haven't evaluated the data yet, but it looks positive. 75 students participated in the study. They wrote a pre-test on their knowledge of the skull section, half used the 3D module and half used static images as a refresher. Then we conducted a post-test to see the difference in their recall.

Are there other interesting web applications out there along similar lines?
The is neat. It's an online database of CT scans. They started with one cadaver and are trying to build up a library of people. It's important to have a large library of specimens: men, women, children, the elderly... because there are lots of quirks in the anatomy of different groups.

Is there a piece you're particularly proud of?
My was a challenge. I've never seen one like the one I did. There are lots of outer ear and auditory canal illustrations. But to capture the relationship between the inner ear and the brain stem I had to gather lots of spatial information about the two.

Some have the misconception that medical illustrations are just artists playing around with computers. Good illustration is about getting the accuracy of the object. It's a science.

Illustration:
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