She calls herself "the pig princess." She reads pig magazines, wears pig pins, displays a Miss Piggy doll in her office, and has a pig-shaped doorstop. "I feel very attached to these animals," says Arlene Davie, executive vice president, Travel Planners Inc., San Antonio, TX.
Davie's attachment is the result of planning a hands-on continuing medical education (CME) course in laparoscopy, involving 150 pig cadavers. She has a strong stomach and a sense of humor, which proved helpful when her staff played a prank on her during another meeting (ophthalmology) she organized that involved pig specimens.
"Someone asked me for a Diet Coke from the ice chest," she recalls. "I opened it up and found 400 pig eyes staring at me. It looked like a peep show!"
The occasional touch of gallows humor can be essential, because for most medical meeting planners, hands-on courses involving cadavers or animal specimens can be exercises in anxiety.
"I don't relax at these courses. There is always something to worry about," says Nancy Bashook, director of professional development for the American Association of Neurological Surgeons (AANS), Park Ridge, IL. "I worry about the instruments not being there, the cadavers not being in good shape, thenot being attentive to the participants."
Despite the potential for problems and the expensive, labor-intensive nature of these meetings, they continue to grow, driven by advances in surgical procedures and the surgeon's need to practice them.
FOLLOW YOUR NOSE "Preplanning and coordination are the most important," stresses Richard Whitworth, MD, director of postgraduate education for the Department of Anatomy at Louisiana State University's Medical Center. "There are 400,000 things that can go wrong, from being short-staffed to having a poorly trained anatomist, to not having enough instrumentation, or the wrong instrumentation," says Judy Sherr, manager of surgical skills education, American Academy of Orthopedic Surgeons (AAOS), Rosemont, IL. And that's just the beginning:
Pig specimens shipped from Philadelphia to Atlantic City got separated from their packing slip.
"It was a hot June, and by the end of three days, we found them by smell," recalls Jim Breeling, director of education for the American College of Chest Physicians (ACCP), Northbrook, IL. If you are not familiar with the company shipping the specimens, Breeling suggests asking for references from those who have used the company before. "With material like that, assign somebody to keep on top of it all the time. It is not like shipping boxes of paper."
Rebecca Creek, manager of the scientific assembly department, American Academy of Family Physicians (AAFP), Kansas City, MO, was planning a meeting that involved fresh pigs' feet. Through numerous letters and phone calls, she alerted the meat packing house of the importance that the specimens be delivered fresh, not frozen. The day of the meeting arrived . . . the meeting started . . . and still the pigs' feet had not been delivered. Finally, they arrived-frozen in a block of ice. "We were thawing out the pig's feet in the bathroom sink, in the microwave," recalled Creek. "Never again!" She now holds a preconvention meeting the night before, so she can check the specimen in case it is not prepared properly.
ORDERING, SHIPPING, AND STORING Animal specimens can often be ordered through a hotel's catering department, or a local butcher. Meeting planners should specify whether the specimen need to be fresh, frozen, or embalmed-and don't expect a catering department to do embalming! Cadavers are difficult to acquire, but can be secured through medical schools that have a body donor program. Planners need to plan for lead times of up to a year, with availability varying by region.
Along with reserving specimens in advance, precautions must be taken once they are secured. Fresh cadavers must be tested for infectious diseases. "We always caution our participants that even though the specimens have been tested, they should consider them potentially infectious," says Whitworth. At AAOS meetings where specimens are used, participants are required to sign liability waivers, says Sherr.
Even labeling is important. "You don't want to label specimens in a way that becomes a point of curiosity for the hotel staff," says Pamela McDonald, meeting planner for the American Society for Reproductive Medicine (ASRM), in Birmingham, AL. "We just write 'Laboratory specimens. Do not dispose. Not for human consumption.'"
How the specimen is stored once it arrives should be specified in writing to the hotel or convention site. Poor refrigeration or handling can cause the cell structure to deteriorate, rendering the material useless. "Make the extra effort to see where the storage is," says AAFP's Pam Williams, manager of CME production and accreditation. "The butcher could have delivered specimens unfrozen, yet the hotel put them in the freezer."
COMMUNICATE WITH THE TEAM The success of these courses depends on all the players involved working as a team. In addition to the specimen supplier and shipper, these include the chairman or course director, the equipment supplier, and all relevant hotel personnel.
THE COURSE DIRECTOR: "Course directors must identify exactly what is needed in the laboratory," says the AANS's Bashook. "They are not used to thinking through every single instrument they may need for the procedures done in the course, because these things are usually taken care of for them in their practice." She also alerts the course director during the sessions when faculty members lose focus on participants.
"When surgeons come to a course like this one, they pay a lot-and expect to get attention from the experts," she says. "I see that faculty aren't wandering around. If I see a station unattended, I notify the chairman."
She arranges to have the course director unattached to any one group, so he or she is free to wander the session answering questions. She also numbers each station and gives participants specific station assignments, "rather than having them all walk into the laboratory and not know where to go."
Video coverage of the procedure, to prevent a crowd around the instructor, can also be useful.
AAOS's Sherr encourages faculty to submit step-by-step procedures, like a cookbook, giving participants a clear how-to guide. Instructors are often asked to describe procedures as they do them, with a moderator present to ask and take questions from the audience. "If attendees are straining to see or hear, it dilutes the experience," she says.
THE EQUIPMENT SUPPLIER: Most medical associations accept equipment on loan from a minimum of two companies, sometimes up to five, so they are not perceived to be endorsing a particular product or system. Equipment suppliers, for their part, are selective about to whom they'll lend. Before opting to lend equipment to a meeting, a supplier should investigate the reputation of the meeting, where it is being held, and how far ahead it has been advertised.
There are other issues, as well. "It is very important for the person coordinating the equipment to understand how many people will be there, how many people will be at each station, and how many stations are needed," says Mikki Crawley, a representative for Sofamor Danek, in Memphis, TN, a company that provides hooks, rods, and screws to approximately 70 spine-related meetings a year. Accurate counts are important. Suppliers want to send just enough equipment, because shipping costs can be high.
Equipment suppliers are also the source of information regarding the electrical needs of the equipment to be used during the course. "Different equipment requires different amperage and wattage," says Jody Gold, manager of CME program services for the AAFP.
THE HOTEL: Because of the potential for strong, offensive odors, you should select a large room with a high ceiling and a ventilation system capable of six complete air changes per hour, according to the ACCP's Breeling. The best, he says, are ventilation systems where the air comes in at the bottom and goes out at the top.
Surgical equipment can be large and heavy, so check freight elevator size and capacity before bringing it into the hotel. Some hotels are prepared to be creative about accommodating meetings using specimens. The Walt Disney World Swan in Orlando, FL, puts a popcorn machine outside the meeting room to override the smell of formaldehyde, says Jackie MacKay, the hotel's public relations representative. MacKay says meetings using cadavers must reserve the room for one additional 24-hour period after the session. "The odor must dissipate before the next group is put in the room," says MacKay.
Other standard procedures at the Dolphin: Meeting rooms are not posted, doors are re-keyed, and room temperature is kept at a chilly 62 degrees Fahrenheit.
"We advise meeting planners to remind the doctors not to run outside the meeting room in their medical garb-doctors don't think about that," says MacKay.
Everyone involved must remember that hotels, unlike hospital operating suites, are public places. "The meeting space needs to be accessible from the loading docks, so you are not involving the public in any way," says Davie.
Sam Garcia, director of convention services at the Marriott Desert Springs Resort and Spa, in Palm Desert, CA, meets with staff to discuss what will happen at this type of meeting. Like most hotels, his staff is not responsible for cleaning any biohazardous waste.
"It is very easy for someone to ask the staff in passing to do something. We give them specific instructions to take direction only from us," says Garcia.
Meeting planners must arrange for clean-up. "You must treat this as a clinical environment," says Sherr. "We put in writing that hotel staff is not to handle biohazardous waste. Basically, they set up the room, and their responsibility ends there." A medical waste company should be contacted to provide waste containers and to pick up the medical waste. "Act as if everything is contaminated," says Sherr.
And don't forget security: Many surgical devices are too large for repeated set-up and must stay in the room overnight-and they can also be breathtakingly expensive. If the hotel can't guarantee overnight security, hireguards.
ETHICAL ISSUES Along with logistical concerns, meeting planners often find the use of animals or cadavers bring up unexpected emotions. "One year, we used cow uteri to teach a course. That was very difficult for the staff. It seemed different from chicken gizzards or beef liver. It seemed more personal or cruel or something," says the AAFP's Creek.
Ethical issues such as this are leading planners to seek alternatives. "People stay away from [the use of] live animals because it is very difficult to use an animal in the context of a meeting and meet all of the concerns regarding animal safety and comfort," says Breeling. "It is easier and safer to teach with plastic. It keeps you out of any possible trouble."
An alternative solution to the specimens problem has been proposed by Victor Spitzer, associate professor of cellular and structural biology and radiology at the University of Colorado Medical School.
Spitzer has developed a computerized surgical simulator of a man and woman, called The Visible Human. It simulates real cadavers via 1,878 cross-section photographs (5,189 sections for the Visible Woman). Using the program, surgeons can replicate procedures on a computer screen rather than on a wet-lab table.