Weight Stigma! The Difficult Cadaver | Journal Club
TAPP Radio Episode 93
Episode | Quick Take
Weight stigma among health professionals is a form of discrimination that can have serious consequences in the lives of people who are overweight or obese. These folks are therefore often pre-judged as being difficult patients, for example. Krista Rompolski joins us for a Journal Club episode, where we discuss a paper on how attitudes about large body donors may contribute to weight stigma among health professionals. What’s going on? Is there anything we educators do to influence student attitudes? An important topic for our times, for sure!
- 00:00 | Introduction
- 01:10 | Journal Club with Krista Rompolski
- 03:05 | Sponsored by AAA
- 04:01 | The “difficult” cadaver: weight bias in the gross anatomy lab
- 11:43 | Sponsored by HAPI
- 12:31 | The Conversation Begins
- 29:31 | Sponsored by HAPS
- 30:26 | The Conversation Continues
- 59:46 | Staying Connected
Episode | Listen Now
Episode | Show Notes
Research indicates that weight stigma can cause physical and psychological harm, and that affected individuals are less likely to receive adequate care. For these reasons, weight stigma damages health, undermines human and social rights, and is unacceptable in modern societies. (Joint international consensus statement for ending stigma of obesity)
Journal Club with Krista Rompolski
Krista Rompolski joins host Kevin Patton for another TAPP Journal Club episode!
Sponsored by AAA
A searchable transcript for this episode, as well as the captioned audiogram of this episode, are sponsored by the American Association for Anatomy (AAA) at anatomy.org.
Don’t forget—HAPS members get a deep discount on AAA membership!
The “Difficult” Cadaver
Krista Rompolski summarizes the essential content of this episode’s journal article.
- The “difficult” cadaver: weight bias in the gross anatomy lab (article from the journal Medical Education) my-ap.us/3yfanp1
Sponsored by HAPI Online Graduate Program
The Master of Science in Human Anatomy & Physiology Instruction—the MS-HAPI—is a graduate program for A&P teachers, especially for those who already have a graduate/professional degree. A combination of science courses (enough to qualify you to teach at the college level) and courses in contemporary instructional practice, this program helps you be your best in both on-campus and remote teaching. Kevin Patton is a faculty member in this program. Check it out!
The Conversation Begins
Krista and Kevin discuss what they learned from the article and how that relates to their own experience as teachers and learners. Here are some background resources, if you want to know more about the topics discussed:
- The Bizarre and Racist History of the BMI | Body Mass Index has been used in recent decades as a referendum on individual health. But it was never meant to be. (essay) my-ap.us/3fnmuaX
- What We Talk About When We Talk About Fat Acceptance (public radio interview/conversation) my-ap.us/3btntoO
Sponsored by HAPS
The Human Anatomy & Physiology Society (HAPS) is a sponsor of this podcast. You can help appreciate their support by clicking the link below and checking out the many resources and benefits found there. Watch for virtual town hall meetings and upcoming regional meetings!
The Conversation Continues
There is so much to say about weight bias and its origins among health professionals. Even more than we can fit into this lengthy discussion!
- Implicit and Explicit Weight Bias in a National Sample of 4,732 Medical Students: The Medical Student CHANGES Study (the Phelan paper mentioned by Krista) my-ap.us/3wdG4wX
- The Silent Teacher – A Conversation with Aaron Fried | Episode 29 (where Kevin discusses his wanting to be desirable body donor)
Need help accessing resources locked behind a paywall?
Check out this advice from Episode 32 to get what you need!
Episode | Captioned Audiogram
Episode | Transcript
The A&P Professor podcast (TAPP radio) episodes are made for listening, not reading. This transcript is provided for your convenience, but hey, it’s just not possible to capture the emphasis and dramatic delivery of the audio version. Or the cool theme music. Or laughs and snorts. And because it’s generated by a combo of machine and human transcription, it may not be exactly right. So I strongly recommend listening by clicking the audio player provided.
This searchable transcript is supported by the
American Association for Anatomy.
I'm a member—maybe you should be one, too!
Kevin Patton (00:00:00):
In the abstract of the joint international consensus statement for ending stigma of obesity, published in the journal, Nature, we find this statement. “Research indicates that weight stigma can cause physical and psychological harm and that affected individuals are less likely to receive adequate care. For these reasons, weight stigma damages health, undermines human and social rights, and is unacceptable in modern societies.”
Welcome to The A&P Professor. A few minutes to focus on teaching human anatomy and physiology with a veteran educator and teaching mentor. Your host, Kevin Patton.
Kevin Patton (00:00:52):
In this Journal Club episode, Krista Rompolski and I discuss a paper on how attitudes about large body donors may contribute to weight stigma among health professionals.
Journal Club with Krista Rompolski
Kevin Patton (00:01:10):
Okay, well, we’re here once again with another Journal Club episode with Krista Rompolski. Welcome, Krista.
Krista Rompolski (00:01:18):
Hi, Kevin. Nice to be back. It’s been a while.
Kevin Patton (00:01:20):
Yeah, it has and there’s a reason for that, isn’t there? You just had a new addition to your family. Tell us about that.
Krista Rompolski (00:01:28):
Yes, my son, Noah, was born 11 weeks ago, four weeks early, though. So, that was a bit of a surprise and threw my winter and spring into a bit of chaos. But it’s good for you, right, to build that kind of tolerance in life for the unexpected especially for an obsessive planner like me. So, I’ve joined the throngs of working mothers in academia and just trying to figure out how to make it all work as we all do. So, it’s been great…
Kevin Patton (00:02:00):
All right, well, congratulations.
Krista Rompolski (00:02:02):
Kevin Patton (00:02:03):
That’s great. Even if it did cause us to do some of our … practice our resiliency a little bit.
Krista Rompolski (00:02:10):
Kevin Patton (00:02:10):
And get going. We had already scheduled this conversation before that all happened. And I went back and re-read our article which I’m glad I have more time to let it settle in and that there is so much, like most of the articles you bring us in the Journal Club. There is so much here. So much to unpack that maybe we better start unpacking.
Krista Rompolski (00:02:41):
Kevin Patton (00:02:42):
So, as usual, Krista has provided us a summary of the article so that we’re all talking about the same thing and know what the essential elements of it are. And then, after that, we’ll come back and dive right into it.
Krista Rompolski (00:02:58):
Kevin Patton (00:02:59):
You’ll hear Krista’s summary right after this quick break.
Sponsored by AAA
Kevin Patton (00:03:05):
A searchable transcript and a captioned audiogram of this episode are funded by AAA, the American Association for Anatomy at anatomy.org.
Kevin Patton (00:03:16):
Did you realize that if you’re already a member of HAPS, the Human Anatomy and Physiology Society, that you qualify for a deeply discounted membership in AAA? I’m a member in both organizations and I’m sure glad I added a AAA membership to my HAPS membership. They complement one another in a lot of different ways that give me a richer basket of resources for teaching A&P, and well, a much wider network of peers.
Kevin Patton (00:03:49):
Just go to anatomy.org and click on the membership tab in the navigation ribbon to find out about that discount.
The Difficult Cadaver: Weight Bias in the Gross Anatomy Lab
Krista Rompolski (00:04:01):
The Difficult Cadaver: Weight Bias in the Gross Anatomy Lab. Introduction. Weight bias, defined as negative attitudes towards people based on perceptions about their weight and obesity, adversely affect the quality of patient care and can have serious implications on the doctor-patient relationship. It is well established that physicians and the general population often hold very negative attitudes and self-blaming beliefs about those perceived to have excess body weight.
Krista Rompolski (00:04:33):
A 2014 study with a large sample of medical students found that 75% of students showed some level of implicit weight bias. While some medical schools and health professions programs are beginning to include lessons on or discuss weight bias as part of a more humanistic approach to medical training, the problem is pervasive in healthcare. Research has shown that individuals who feel stigmatized for their weight are more likely to avoid healthcare situations and more likely to experience poor health outcomes than those even of the same body weight who do not experience stigma speaking to the psychosocial factors that influence the relationship between body weight and health.
Krista Rompolski (00:05:17):
Since gross anatomy is often the foundational course for a future health care provider, with a cadaver often being referred to as the first patient, the course may be important in shaping students’ early attitudes towards individuals in larger bodies and fatness in general. No previous study has examined how medical students perceive overweight and obesity within the context of the dissection experience. Therefore, the researchers in this study sought through both a survey and interviews to determine the effect of the gross anatomy course upon their attitudes towards larger cadavers and living patients with overweight and obesity.
Krista Rompolski (00:05:58):
This study was conducted at the Perelman School of Medicine at the University of Pennsylvania. Gross anatomy is taught during the first semester lasting, approximately, three months with two thirds of 100 hours devoted to laboratory time. The study was formed after a survey was sent to all first year students to explore their emotional and early professional experiences during dissection. This initial survey had nothing measuring or examining weight bias, but 10 students offered unexpected, unprompted comments about weight, body image and obesity, leading the researchers to add questions in subsequent interviews.
Krista Rompolski (00:06:38):
The researchers developed a survey to explore these themes that consisted of 12 multiple choice questions related to the anatomy lab experience and added two free text questions addressing body image and attitudes towards individuals with overweight and obesity. These two questions included, “Has the anatomy lab experience changed how you feel about people with overweight obesity”? And, “Has the anatomy lab experience changed how you feel about your own weight?” Other questions not directly related to weight but rather to their feelings about cadavers as individuals and previous cadaver exposure were also included.
Krista Rompolski (00:07:16):
Qualitative analysis was conducted from interviews on the free text responses with these students. 319 first year students responded to the survey between the years 2015 and 2018. Analysis of the 63 free text responses to the question, “The anatomy lab has changed how I feel about people with overweight or obesity,” who marked yes, revealed that for 70% of the students, the course generated negative feelings or attitudes towards body fat or people with overweight or obesity. It generated sympathy for people or anger towards those who made negative comments about larger bodies in only 11% of students.
Krista Rompolski (00:07:59):
For the second weight related question, “Has the anatomy lab experience changed how you feel about your own weight?” 84% indicated that the anatomy course had made a negative impact on their body image. There were no significant relationships between the two questions relative to body weight and age or gender in this study.
Krista Rompolski (00:08:19):
Three major themes emerged from the interview and free text responses. These were difficult bodies, unhealthy bodies and disgust. And these themes played out across student descriptions of cadavers, living patients and their own bodies. The author suggests that these themes support the development of an explanatory model in which students saw the value of a body as related to the ease with which information could be extracted from it and where students framed negative attitudes towards larger bodies as concern for the health consequences as overweight and obesity.
Krista Rompolski (00:08:56):
Students repeatedly describe dissection of larger cadavers as more challenging, time consuming, unproductive and frustrating and that they were learning less than their classmates with smaller bodies. Despite only knowing the final cause of death and age from a tag, students came to the conclusion that obesity does “so much damage to the body” and “physically affects all the organs”. They described adipose tissue as “gross”, “disgusting” and “disturbing” and that “it was everywhere”.
Krista Rompolski (00:09:28):
They connected the difficulty of dissecting larger cadavers to imagine challenges and frustrations faced by healthcare providers caring for patients, such as in surgery, saying, “Surgeons don’t like operating on obese people.” They felt more motivated to encourage future patients to lead healthier lifestyles and that it would be motivating for obese patients to see what they look like on the inside to incentivize weight loss.
Krista Rompolski (00:09:55):
Students largely framed obesity as a controllable state that could be managed with diet and exercise, while none cited socio-economic or biologic factors. For their own bodies, 40 students commented that the course made them worry about their own body weight and if they had too much fat. About half of the students made comments that they wanted to lose weight. Analysis suggests that students perceive gross anatomy as influencing their feelings and attitudes about fat through a complex process wherein academic pressure and classroom commentary cast adipose tissue as disgusting and dissecting larger bodies as difficult, amplify their pre-existing weight bias and body image issues.
Krista Rompolski (00:10:38):
The observation that students say difficult bodies are less educationally valuable is concerning and echoes the narrative of the difficult patient. Given that weight bias poses an obstacle to the ethical care of patients, gross anatomy may be an early site of professionalism and re-education on the topic. The authors conclude that the anatomy laboratory, where medical students act upon their so-called first patients, is an important and previously unexplored potential space in the development of weight bias. And confronting the bias nurtured here may be an important component in the approach to addressing physicians’ attitudes towards individuals with overweight and obesity.
Krista Rompolski (00:11:18):
This study was conducted by Adeline Goss of the Department of Neurology, UCSF, San Francisco, California and by Leah Rethy, Rebecca Pearl and Horace DeLisser of the Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
Kevin Patton (00:11:35):
Krista and I are going to dive into this discussion right after this short break.
Sponsored by HAPI
Kevin Patton (00:11:43):
The free distribution of this podcast is sponsored by the Master of Science in Human Anatomy and Physiology Instruction, the HAPI degree. If you’re looking for some deep discussions led by experienced mentors about factors that deeply affect the learning of our A&P students, including development of professional attitudes and practices, you need to learn more about the HAPI degree. Check out this online graduate program at nycc.edu/hapi, that’s H-A-P-I, or click the link in the show notes or episode page.
Kevin Patton (00:12:22):
There’s a new cohort forming right now. So, now’s a great time to look into it.
The Conversation Begins
Kevin Patton (00:12:32):
Okay, so that article about the difficult cadaver and weight bias and weight stigma. That just opens up a lot of stuff, does it?
Krista Rompolski (00:12:43):
It does, yeah. And what really grabbed me about this article was, honestly, I had a moment when I saw it, that I was like, “No, they beat me to it”. Because weight stigma and weight bias have been a research interest of mine for a couple of years now and it really started because of my experience taking my first dissection course.
Krista Rompolski (00:13:05):
And I had done some dissection before that and have certainly done a lot after, but it was being … Auditing a doctor of physical therapy gross anatomy dissection course with the students just to have that full experience at my previous institution and witnessing the conversations and hearing the frustrations and things like that from my fellow lab members and team members with having to work with a larger body and the time it would take that really got me thinking. I wonder if this gross anatomy experience creates or worsens weight stigma.
Krista Rompolski (00:13:44):
And, this article is about medical students, but in a profession like physical therapy where people have their hands on patients … Professionals have their hands on patients bodies, arguably, more, more frequently and for more time than any other health profession. So, there is already an issue with weight bias in that profession like there are with all the other healthcare professions. But how much worse does the gross anatomy experience make that bias if not addressed in the classroom, which, obviously, it isn’t in the vast majority of curricula. Certainly not in a PT curriculum that I’m familiar with.
Krista Rompolski (00:14:27):
So, that’s what got me thinking. And I went down a literature search and this was two years ago. This had not been ever studied whatsoever. The relationship with gross anatomy study or dissection and weight bias. There were certainly articles examining rates of it and interventions to try to mitigate it in medical professions, in PT and other professions, but nothing regarding the cadaver experience. So, when this came out, I was like, “Oh, somebody beat me to it”. But, certainly …
Kevin Patton (00:14:58):
Right. Hate when that happens.
Krista Rompolski (00:15:00):
Yeah. And, I think, what’s also very interesting about this paper is that it sort of came up accidentally in that they weren’t attempting … The researchers had initially just had a survey about their feelings and experiences doing dissection. And there were just impromptu free text responses related to weight stigma. So, Rebecca Pearl, who’s one of the authors, is a leading weight stigma researcher. And I’m sure she had some part to play with kind of doing a follow up diving into that a little bit more. So, I’m so glad that they publish this and it’s one study, it’s preliminary, but I would love to start serving more students on their experience with this.
Krista Rompolski (00:15:48):
And, I think, it’s both so important to talk about because they are future healthcare providers. So, how does this impact the way that they’ll see and treat patients. But as I said in the summary, this had a serious impact on this group of students’ own body image and feelings about themselves and that’s not something that I’ve seen talked about in previous papers. So, like you said, there is so much to unpack in this article.
Kevin Patton (00:16:13):
Right. And I’m glad you brought up that part of the paper where they talked about how they got into this, because, I think, that that makes it especially relevant that the students brought this up without them asking them about it. In other words, they just were looking at overall feelings and attitudes and did not ask any weight stigma related questions at first, until the students start bringing it up. And then they said, “Oh, look at that. Let’s see what that’s about,” and then they expanded it.
Kevin Patton (00:16:47):
Because, I think, a lot of times, whether it’s conscious or subconscious, when we read research on some of these issues where there … Take a particular, maybe, controversial issue, especially involving attitude, and then they ask about it. It’s like those surveys that are designed to change your mind that they don’t care what the results are. They’re asking you loaded questions because they want you to vote differently in the election or whatever it is.
Kevin Patton (00:17:18):
And so, this laid out the fact that, “Hey, this is the opposite of that. We didn’t go into it looking at weight stigma. We went into it not looking at weight stigma and it popped itself right up.” So, I think, that underscores for anybody who doesn’t feel like this is a thing that, yeah, it is, and this article examined it.
Kevin Patton (00:17:45):
And I also appreciate you bringing up the idea that we’re in a position of training future health professionals. And you talked about your experience in a physical therapy program. Any of the health professions deal with this issue. So, my experience has mostly been with students going into nursing, a lot of them went into other areas as well over the years. The community college, for example, most of our students are thinking of going into nursing. And it’s going to exist in all these health professions. And no matter what their scope of practice is, they’re dealing with patients or various clients in a healthcare setting and this is going to impact them.
Kevin Patton (00:18:32):
So, no matter who our A&P students are, or A students or P students, this impacts us and it kind of gets to that. You talked about in the PT curriculum that you’re familiar with, this isn’t something that’s addressed.
Krista Rompolski (00:18:50):
Kevin Patton (00:18:50):
It’s not addressed in the A&P curriculum that I’m familiar with.
Krista Rompolski (00:18:53):
Kevin Patton (00:18:53):
It’s not addressed, probably, in most curricula, and maybe it will be. But that’s where our role comes in, I think, as individual instructors that we need to make sure that we’re filling our course in with the things that aren’t the expected standardized outcomes, that we have these other outcomes. And, maybe, we should state it in our syllabus, maybe not. But, at least, have them in our mind and do some things that will help that. And I think as this conversation unfolds, we’re going to get to what some of those things might be.
Krista Rompolski (00:19:32):
It’s great that you bring that up and we’ve got a long way to go. But one of the major focuses of the HAPS Diversity, Equity and Inclusion Committee right now is working on those hidden curriculum types of learning outcomes. And I’m on a small subcommittee for looking at weight bias and weight stigma in the A&P curriculum and where we can develop both a better understanding of the physiologic regulation of body weight to destigmatize individuals in larger bodies. But also, where can we talk about the more humanistic side of things and fuse in, “Hey, you are all here because most of you want to be a future health care professional.”
Krista Rompolski (00:20:14):
And like I said in the intro, there’s substantial research that shows that shaming and stigma causes health care avoidance, right? Not, “Oh, yeah. I’m overweight. I need to lose weight. No one told me that before.” As if it’s the first time they’ve heard it. And that somehow, shaming people for any issue is going to lead to better outcomes for them. If shame, and I say this all the time, if shame were enough, there would be no addiction, there would be no habits. It doesn’t work. It doesn’t work.
Krista Rompolski (00:20:53):
And then obviously, we’re not here today to go down the rabbit hole of, well, what really is the cause of obesity and are there problems like can you be healthy in a larger body? That could be a whole other conversation, of course.
Krista Rompolski (00:21:08):
But the main focus here is that stigmatizing people, right, for this issue does not lead to them having better health outcomes. In fact, it leads to worse health outcomes. Whether due to avoidance of health care or the stress associated with the feeling, the pressure to lose weight, or potentially the physiologic damage of perpetually weight cycling, gaining and losing, and the stress that that has on the body, and changes to hormones and things like that.
Krista Rompolski (00:21:38):
So, like I said, there’s obviously a million directions to go with this. And we really need to focus on the psychosocial side of things with these future doctors in this article.
Kevin Patton (00:21:51):
Right. Yeah. And I think, sort of, in addition to the factors that you mentioned in terms of healthcare is, I mean, the weight associated with some certain health outcomes, the undesirable health outcomes, and so on is you mentioned a few factors that might play into that that are psychosocial factors, not direct medical factors.
Kevin Patton (00:22:21):
But another one that I think is very important is this idea that many health professionals get the idea that because they feel there’s this strong association between undesirable health outcomes and a lot of fat in their body, that therefore, they don’t have to treat what the patient is presenting with. It’s like, whatever it is you came in with, “Look at this weight. Oh my gosh, your BMI is off the charts. So, let’s do glucose test. Let’s check your blood pressure. Let’s do all these things,” and kind of ignore the thing that the person is actually coming to get help with.
Kevin Patton (00:23:05):
And then, the explanation is, “Well, yes, of course, you have this issue because you’re overweight. You have that issue because you’re overweight. If you lose weight, you’ll see this will probably get better. And then we’ll look at it and see if it needs treatment or something.” And that seems pretty backwards.
Krista Rompolski (00:23:23):
That’s a very common sequence of events when people present for like knee pain or something like that. It’s just automatically assumed. Because the research studies have shown that a 5 to 10-pound weight loss can reduce load on the knee. Sure, but I know countless numbers of people that have knee pain that are very thin, and you would never treat them that same way. You dive deep on diagnostic and biomechanical testing and things like that to try to find out what’s causing their pain, because there’s no assumption there that the weight is the issue.
Krista Rompolski (00:24:01):
Patients that are classified as by BMI as overweight or obese, it’s like the first, that whole, when you hear hoof beats think horses, but that’s just not fair.
Kevin Patton (00:24:11):
Right. Yeah. The other sort of mistake that we make, I think, besides if you hear hoof beats, there must be horses, the other one is, correlation versus causation. And I think we’ve fallen into that trap of that.
Krista Rompolski (00:24:31):
Kevin Patton (00:24:31):
In a recent episode, I talked about some research that was done with plaque in the brain relative to Alzheimer disease. And how, for a long time, we assumed that that plaque was the problem. If we get rid of the plaque, then we’ll reduce the effects of Alzheimer disease or maybe slow its progression or something. And we’re finding out, no, that’s not doing it. That the plaque is a result of whatever pathology is going on. It’s not the cause of it.
Kevin Patton (00:24:59):
And I think maybe we’re going to find that out about a lot of these correlations between health and having a lot of body fat. But we’re starting to go down that rabbit hole. We’re trying to figure it out. We are not in a position to figure it out any way.
Krista Rompolski (00:25:17):
I know. I almost started to talk about inflammation. So, there you go.
Kevin Patton (00:25:22):
There we go. And then, that can lead us in a lot of directions too.
Krista Rompolski (00:25:24):
Kevin Patton (00:25:29):
And I think we ought to acknowledge here, and I brought it up, I’m guilty of this. I brought up the BMI thing because they were using BMI labels in the paper of overweight. Actually, I was a little surprised that they said that they were talking about body donors with overweight and with obesity. In other words, sort of labeling them according to that BMI chart, which we know, is very problematic in so many ways. Even just looking at the history of how BMI developed and has changed over the years and sort of really entrenching that weight stigma. And really leaving, I think, a lot of health professionals down that road of correlation, as opposed to causation.
Kevin Patton (00:26:16):
But it’s there. I mean, BMI is there and we have to deal with it. And those are the labels that often we have as opposed to some alternative system, which is yet to be developed. So, that’s a conversation I always have with my students is, “Yeah, here’s what BMI is. You need to know what BMI is. You need to know it’s being used, but you need to know it’s got all kinds of problems. And that this is still in flux. There is a lot more science to do before we figure this out.”
Krista Rompolski (00:26:48):
Well, it’s great that you do that, because I would imagine most don’t. Because we’re not taught differently. And you go to a doctor and you get your discharge summary, and it’ll say what your BMI is at the top of the paper. For some people, it might say morbidly obese at the top. It’s like, “Oh, that’s a fun take home,” right?
Kevin Patton (00:27:08):
Yeah. I love that label. Yeah.
Krista Rompolski (00:27:09):
Yeah. Yeah. But with no nuance, and again, not to go down the rabbit hole, but another danger then is assuming that people that are normal BMI aren’t having health care issues, right? There’s so much that you could go, that anyone that’s interested could read about with this. But there’s just basically a strong association between internalized weight stigma and poor health.
Krista Rompolski (00:27:34):
And what that means is internalized weight stigma is essentially feeling that you are less valuable if you are in a larger body. And you could be in a very thin body and have a high level of internalized weight stigma and potentially consume quite a bit of healthcare dollars, because of maybe the poor behaviors you’re engaging with to suppress your weight.
Krista Rompolski (00:27:58):
So, another assumption that I bring that up, because another assumption that’s often made about people in larger bodies is that they’re burdening the healthcare system. And that’s just not there. It’s not true in the literature.
Krista Rompolski (00:28:12):
That one of the biggest healthcare burdens is diabetic care and wound care for diabetes when things have gone on a very, very long time. So, that’s also something that I think is really important for people to hear and realize. And it’s definitely relevant to this paper, because these are, again, future doctors.
Krista Rompolski (00:28:33):
And in many places throughout in the themes that emerged from this that they discovered is that they connected the difficulty of dissecting larger cadavers to frustrations faced by healthcare providers, and didn’t cite any socioeconomic or biologic factors for the larger bodies of the cadavers. They felt strongly that obesity was a controllable state that could be managed.
Krista Rompolski (00:29:01):
I mean, if that most people regain any weight they lost and pretty quickly, so are we all that weak willed? Or is there so much work going on that we’re just not willing to engage with?
Kevin Patton (00:29:15):
I choose B. I think there’s more going on than we know about and that we’re, like you say, willing to engage with. We’ll be right back with more of this conversation.
Sponsored by HAPS
Kevin Patton (00:29:31):
Marketing support for this podcast is provided by HAPS, The Human Anatomy and Physiology Society. Promoting excellence in the teaching of human anatomy and physiology for, yup, over 30 years.
Kevin Patton (00:29:46):
Hey, are you going to the HAPS annual conference? If you are, you really need to check out the schedule of workshops. It’s awesome. Yeah. Okay. I’m giving one of the workshops. But I also want to mention that Krista Rompolski is presenting an important workshop on weight stigma that you don’t want to miss. Go visit HAPS theAPprofessor.org/haps. That’s H-A-P-S, to find out more.
The Conversation Continues
Krista Rompolski (00:30:26):
Kevin, I’m curious to hear about your experiences. Because obviously, your first cadaver course would have been a long time ago and I’m sure you’ve taught in cadaver labs. What were your personal feelings about this article as you read it based on your history?
Kevin Patton (00:30:46):
Yeah. To be honest, a lot of the cadavers that were around when I was studying anatomy, there weren’t that many that were overweight compared to what you see in …
Krista Rompolski (00:31:00):
Things are changing.
Kevin Patton (00:31:00):
… cadaver lab these days. And I wonder how much of that, though, had to do with the availability of body donors and donated bodies. Because I think that there were more than we could use. And so, choices were made about which ones would be used for education. So that sort of gets into this idea of the perfect body donor and the desirable body donor, as opposed to the difficult or undesirable body donor.
Kevin Patton (00:31:40):
And so, we didn’t really have that many. But yeah, I mean, when we did have body donors with a high fat ratio, I mean, there were issues with that. And it was a useful thing to learn about that. I don’t remember some of the comments that were made in this paper or recorded in this paper, I should say, from faculty that were very dismissive of those fatty bodies. And how difficult or time consuming it was to dissect them, how difficult it was to find certain structures and isolate them, and so on. I don’t recall that.
Kevin Patton (00:32:27):
But you know what? I don’t know that these students in this group would have recalled that. I mean some of them did, some of them remember that, but I bet you sure a lot of them just one ear and out the other but not in the sense that they didn’t pay attention. I think, at least subconsciously, they did. And that informed their growing weight bias, their bias against the high fat content.
Kevin Patton (00:32:53):
And so, I suspect that some of that happened to me, without realizing that’s what was going on. Because, I mean, you’re affected by your environment in terms of your social environment.
Krista Rompolski (00:33:06):
Well, I think, and this is a whole other road to go down. But I think the social events of the past year in our country have shown us that it is not enough to just be neutral or silent about an issue. Bias and stigma will continue to exist and grow if you say nothing and do nothing.
Krista Rompolski (00:33:28):
So, I think that just realizing that students are in our very fat phobic culture. Students are going to come in, set up for this experience. And if we don’t talk about it and address it, and try to counteract it as a faculty. If for no other reason than to continue to reinforce the respect and appreciation we say we have for these donors and to be able to study anatomy, then it’s not surprising that these results are what they are.
Krista Rompolski (00:34:01):
So, we need to find, I believe that, and I certainly will be doing this. When I teach my gross anatomy course to PT students, I will be talking about fat quite a bit. And realizing that, yes, look at our textbook images, they’re almost always a very muscular white guy, right? Like there’s no hiding that, right?
Krista Rompolski (00:34:25):
And even in labs, where they’ll be like palpating each other and looking for bony structures and things like that. Most PT students, not to make a generalization, but a lot of PT students are fit or thinner many times because they’re also very into exercise but also feel pressure to look a certain way for patients to listen to them and doctors do as well.
Krista Rompolski (00:34:51):
So, they are not going to be in school palpating larger bodies. We need to talk about those things upfront and not be silent about it, and realize that they can either very overtly or subconsciously turn away patients in larger bodies just by kind of the subtle messaging or attitudes that they have towards them.
Krista Rompolski (00:35:20):
One line from the discussion was that the students say difficult or saw difficult bodies as less educationally valuable, and how concerning that is, because that really echoes that narrative that we see of the difficult patient. So, what impact might that have on their care?
Krista Rompolski (00:35:38):
So, when I gave a guest lecture on weight stigma to a group of physical therapy students, many students were sharing stories of patients feeling just totally beaten down by the healthcare system, that everything is due to their weight. And saying something the wrong way or the smallest interaction can mean you never see that patient again. And then there’s certainly no way to help them at that point.
Krista Rompolski (00:36:06):
So, like I said, so many roads to go down. Because I think this article or any article talking about weight stigma and weight bias today is going to raise, I should say, I don’t know who could be listening that doesn’t have an emotional response to this, whether that responses, “Oh well, it’s ridiculous. Being overweight or obese is the cause of all these diseases and people should feel stigmatized.” Or “You know, this has been my experience in my life. I was in a larger body at a team dissecting. And while they’re complaining about working with fat, I’m standing there thinking, what would they think about me?”
Krista Rompolski (00:36:46):
And that is so echoed in these students comments about generating negative attitudes towards their own weight, their own body image, feeling disgusted by their body fat. It’s just, yeah, it’s heavy. It’s very heavy. In a way, it’s such a very personal, very personal issue. So, I don’t know who could have lived long enough to be listening to a podcast that hasn’t been unaffected by this topic in some way.
Kevin Patton (00:37:14):
Right. Exactly. I don’t know, it’s kind of an area that I think a lot of us need to grow. I mean, all of us have biases of various sorts. And it’s what we do with them and what we do to counteract the biases that are harmful biases.
Kevin Patton (00:37:32):
And just as a big fan of transparency, something that really struck me as I was reading this paper about desirable versus difficult or undesirable body donors to work on. I remember way back in an earlier episode, I think, I wrote it down in my notes here, it is Episode 29. Yeah. It was titled, The Silent Teacher. And it was a conversation with Aaron Fried, who works with body donors with his students at Mohawk Valley Community College.
Kevin Patton (00:38:07):
And we were talking about that, and I said that, “When I got to middle age, I signed up for a program where I was doing resistance training every week, and then I got to twice a week doing resistance training with the idea of making my skeleton and muscles stronger is kind of a health thing to improve my body framework as I age. Because that’s an issue with bone loss and muscle wasting and things like that.” I said in that episode, that something that I often have in mind as I do it is, especially to kind of motivate myself when it’s hard and almost painful to keep going, I say to myself, “Yeah, when I’m a body donor and I am registered as a body donor with a local medical school, when those students get my body, they’re going to love it. They’re going to fight over who gets to dissect me. That’s my goal.”
Kevin Patton (00:39:08):
And then I realized that I never thought of myself as having an issue about my body image. But I do, I mean, we all have our own body image. And I think there are certain things about our body image that we either like or don’t like or want to be better, even if it’s good. And that’s for me that brought up that, “Oh my gosh. If I talk about it that way with my students, am I sort of increasing the likelihood that they’re going to see those with more well-defined muscles as good, and those with less well-defined muscles as bad?”
Kevin Patton (00:39:49):
And of course, there are different reasons for that. Some body donors are very elderly and I’ve experienced some of that muscle wasting.
Krista Rompolski (00:39:57):
Kevin Patton (00:39:57):
So, it has nothing to do with their fitness exactly. I mean, it’s more about their age than their general fitness approach in that.
Krista Rompolski (00:40:08):
Kevin Patton (00:40:09):
And it never has anything to do with a person’s character. And that’s what we’ve made it.
Krista Rompolski (00:40:14):
Kevin Patton (00:40:15):
And I noticed the few times this has come up in live classes with students in the past, where we talk about fatness, people are much more willing to denigrate fatness or fat people, when they’re two feet away from someone that is fat. And I mean, if we have biases about race or ethnicity or ableness or other things, we’re a lot more circumspect about what we say and how we say it. But with weight stigma, we’re not shy about that.
Krista Rompolski (00:40:57):
I mentioned in the intro that there was a 2014 study by Phelan, P-H-E-L-A-N, and everyone can look that up. It was the biggest, the first and largest sample of medical students. And they found that the levels of weight bias were higher than racial bias, bias against poor individuals, and bias against LGBTQ.
Krista Rompolski (00:41:21):
And that might be shocking at first, but then you think, well, the assumption is weight is controllable. You can’t control your race, or your sexual orientation, and things like that. So, it makes sense when you frame it that way, right? That it’s that controllable issue, where I always give the analogy. We put humans on this BMI scale.
Krista Rompolski (00:41:49):
But there’s many breeds of dog, right? And you could feed a bulldog and a greyhound. So, you imagine very different looking dogs, the same diet, make them exercise the same amount, and they’re still going to look like a bulldog and a greyhound.
Kevin Patton (00:42:04):
Krista Rompolski (00:42:04):
We do not apply that to people. So, it’s not possible that someone’s natural body size is larger, whether based on frame, or muscle, or just the genetic factors there, because we all know individuals, we’re going down that wormhole, but I’m going with it.
Krista Rompolski (00:42:21):
We all know individuals that basically don’t have dietary restrictions that have always been thin and vice versa. But like for some reason, this makes us so uncomfortable. And I just think that it’s the weight loss industry, its long, long, long, long history, and then how muddled it got with health.
Krista Rompolski (00:42:41):
Because, absolutely, I’m not here to deny that there’s correlation between high body weight and health and disease, right? Nobody can possibly deny that. But it’s almost like we’re unwilling to tease that apart because we want a simpler answer.
Kevin Patton (00:42:58):
Right. Yeah. And that controllable thing really stuck out to me in this paper, is that, there came a point in the paper where they talked about how the student attitudes were that, “Wow, this was a good learning experience to have these body donors with all this fat and I learned about,” well, okay, there’s two different things going on here. One is, they learned about how much damage it does to the body, which puzzled me because you can see that in a dissection, what?
Krista Rompolski (00:43:32):
Kevin Patton (00:43:33):
What you see is, yeah, you see organs that are infiltrated with fat as compared to the prosection where they picked the so-called perfect body donor. And there isn’t all that fat infiltrated in and making it difficult to find this nerve or that nerve or this blood vessel or that part of the organ or whatever.
Kevin Patton (00:43:57):
And so, they’re making this assumption that because it was difficult to find, or it didn’t look like it does in the textbook, or in the prosected specimen, that therefore, that organ is damaged, that body is damaged. Look at all the havoc this has wreaked. No, there’s just more packing material in there.
Krista Rompolski (00:44:16):
Kevin Patton (00:44:16):
And it’s harder to find it in that extra packing material. I mean, that’s really all you can say at that point. Now, I’m not saying that there hasn’t been any damage. Maybe, there has, I don’t know. But they can’t say that.
Krista Rompolski (00:44:28):
Kevin Patton (00:44:28):
So, they’re assuming that.
Krista Rompolski (00:44:30):
Kevin Patton (00:44:30):
And then, they apply it and say, “Boy, if my patients could see. Boy, then, they would control their weight.”
Krista Rompolski (00:44:37):
Kevin Patton (00:44:38):
Then, that gets back to this old … I need a sound effect for control. The word controllable, whenever it comes up because like alarm bells or something. Because it’s not controllable by … I don’t think. I mean, it’s my opinion based on what I’ve seen. I don’t think it is controllable for many people, their body weight because like as you say, there are other factors like genetics, and other things, too. It’s not just that, not just genetics, but that’s a probably a big component.
Krista Rompolski (00:45:08):
It makes me wonder if it would be valuable for students to take some sort of pathology course, before dissecting because then they would know what disease looks like in a cadaver.
Kevin Patton (00:45:19):
Krista Rompolski (00:45:20):
Whether it’s plaques or clear signs of like a lifetime of long smoking, enlarged, to see what cancer looks like that spread throughout the body. They have no idea. And you mentioned the plaque, the discussion about plaque and dementia. I just know from doing some textbook work that they’re seeing those strong like the APOE4 gene that it’s really about like that chronic inflammation genes. And that’s going to be completely independent of body weight.
Krista Rompolski (00:45:49):
So, just from a personal story, I have so many, but my father, his father, his older brother, and he, all have heart attacks at age 56. All tall, thin men, my dad was a mailman. So, he was walking seven miles a day. And if he wasn’t walking his route, he was walking the golf course, didn’t smoke, didn’t drink, eat a low-fat diet, had a heart attack at 56 and a double bypass at 69.
Krista Rompolski (00:46:16):
But it’s like, well, we want to look at that as the exception, right? And that person just got unlucky somehow, rather than, oh, there’s more going on here …
Kevin Patton (00:46:27):
Krista Rompolski (00:46:27):
… that we don’t really understand. So, yeah, that assumption, like you said that just because there’s fat infiltrating things, that automatically means the bodies are ruined or that the bodies are unhealthy.
Kevin Patton (00:46:40):
Krista Rompolski (00:46:40):
Rather than, it just got to go somewhere, right?
Kevin Patton (00:46:45):
Krista Rompolski (00:46:45):
Rather being. And just on a personal side note when dissecting, I’ve often found some of the best specimens or best organs, or really had large thick musculature in larger bodies. Provided that they weren’t potentially very inactive because then you will get that muscle atrophy as well.
Krista Rompolski (00:47:03):
But I’ll never forget the first cadaver I dissected is a larger man, but young, he was 56 and worked … You could tell like, he was definitely a heavy laborer and his muscles were incredible, but we had to get to them for certain. But it was very worthwhile, in that sense. We had the best samples of every muscle, just because, obviously, having a higher level of body fat requires, if you’re active, requires more muscle, muscle expenditure, so yeah. So, just some thoughts there.
Krista Rompolski (00:47:39):
I want to mention, when you’re talking about your personal kind of history with thinking about, that the lab and BMI and things, it made me think of when I was … So, I had to get, but you mentioned, I just had my son, he came four weeks early. I went into labor and for hours because I have such a high pain tolerance was just like, some bad stomachache.
Krista Rompolski (00:48:05):
But at any rate, my son was breech and did not turn the whole time. He’s just stubborn as me. Like, the whole pregnancy, head was under my right side of my diaphragm, and his butt was in my pelvis.
Kevin Patton (00:48:15):
Krista Rompolski (00:48:16):
So, I thought I was going to get a scheduled C-section, but it ended up being emergent. And, I mean, both two times in the like whirlwind of, they get you on the table, and they’re throwing you around, just basically, so, I think, so you don’t have time to get scared. I mean, as soon as they undraped me, and I bent over for the lumbar puncture, the anesthesiologist’s first words, were like, “Oh, look at those spinous process. Oh, you’re making this so easy on us.” Right?
Krista Rompolski (00:48:50):
And then, they did a lumbosacral plexus nerve block of the ileohypogastric and ilioinguinal nerves, because that really helps with pain post C-section, because of all that. They’re separating your abdominal wall. And so, they’re trying to numb those, and those nerve blocks last about three days. And it was on the dot, when that nerve block. But he was just like, “Oh, god, like I could see your ribs.” He said, “We love our thin patients, they make everything so much easier on us.” And I’m lying there in the middle of a C-section and like, my son’s about to be born and all I could think is.
Kevin Patton (00:49:25):
Yeah. Right. Right. Exactly.
Krista Rompolski (00:49:29):
I’m getting mad and I almost want to say something. I’m like, “No, he’s got a massive needle in my side. I’m not playing here.” But like, god, it’s like, oh, so like, if they’re overly praising someone in a smaller body, I’m sure they’re not outright saying, “Man, you’re making this hard on us,” To someone in a larger body. But what are they saying, or not saying, or what is the dialogue that might make that person feel badly. So, that just reminded me of that from that experience. And it is living proof of what these students are saying in this paper.
Kevin Patton (00:50:08):
Exactly. And the other thing that could have been happening though is, in your situation, okay, they’re praising the thinness of your body in terms of the procedures they have to do.
Krista Rompolski (00:50:25):
Kevin Patton (00:50:26):
But who else is in the room?
Krista Rompolski (00:50:27):
Kevin Patton (00:50:28):
I mean, is there a nurse or another … Any of the health professional team there that might not be thin and might be taking that to heart and what is that doing to them. And I think that kind of comes back to this idea of … And something else that you mentioned earlier along with it, and that is the idea that maybe, they should take pathophysiology or pathology or something first, before they do this.
Kevin Patton (00:50:59):
And that kind of emphasizes that dissections. And we’re talking here about a body donor dissections. But I think this is true, at any beginning level, anatomy and or physiology course. But of course, especially the anatomy part of it, whether you’re doing human body donor dissections or not, you’re still looking at specimens, maybe photographs, or digital models, and different things like that. And I want to circle back to that in a second as well.
Kevin Patton (00:51:32):
But this is at the beginning of their process of learning to be a health professional. And I think there’s a responsibility, therefore, on those of us that teach these beginning courses to really consider establishing those attitudes, or not establishing but mentoring our students in attitudes and showing them maybe a mirror up to what their existing attitudes are and modeling attitudes that are more helpful for health professionals and not saying things like that, like in your experience.
Krista Rompolski (00:52:14):
Easier to start than stop something.
Kevin Patton (00:52:16):
Krista Rompolski (00:52:17):
I mean, like the foundations. I mean, think about, I’m going really broad here. Our early childhood years are absolutely most formative and who we are, how we see the world. Our long-term anxiety, and issues, and things like that. And so, if this is taught and infused at the beginning of a curriculum, there’s far less chance for it to stick in later years.
Krista Rompolski (00:52:38):
But if it’s never addressed, I mean, if you have assumptions for years and years and years, it’s extremely hard to undo those in any aspect because it’s not only, you’ve been told one thing forever. But it’s also, I think, very personal and jarring to be confronted with your own bias, again, in any aspect. And a natural reaction is, to get reflexively defensive because no one wants to be labeled someone that is bias or stigmatizes someone. So, that’s even …
Kevin Patton (00:53:06):
Well, yeah. I think that’s the first thing we need to get over as instructors, as people.
Krista Rompolski (00:53:11):
Kevin Patton (00:53:12):
Is that, yeah. I have biases. I have concerns about my body image. I have ways of communicating. They are not only not helpful but are destructive sometimes. And so, my goal is to continually improve when I see those. But man, it hurts when I see that, when I’m faced with something like that. I think as you said, we all get defensive when that happens.
Kevin Patton (00:53:40):
But, I think, reading this paper and thinking about these things, and maybe exploring it a little bit more, beyond that and I’m glad that HAPS is working on this among other issues of inclusion and diversity and so on. And those are all helpful things that are going to help us be good models for our students. And maybe, think about statements that we make that maybe can avoid it and just kind of weaving in. I said I’d circle back to, so I guess I better.
Krista Rompolski (00:54:12):
Kevin Patton (00:54:12):
And that is, that’s something that, as a textbook author, I’m trying to incorporate more diversity in the representations of the human body that are presented in our books. And I think all of the A&P authors, because I’ve had conversations with a lot of them, are doing the same sort of thing. And that’s great.
Kevin Patton (00:54:39):
I think we also need to look at some of these other things that represent the perfect body and that would be even plastic models that we use in the lab. It would be digital. I mentioned this a few minutes ago, digital cadavers or body donors that we used in these digital products are often you the best example. It’s like with histology slides. We always show them the best example. And then, when they go looking for it …
Krista Rompolski (00:55:07):
Yeah. Sorry, none of them look like this.
Kevin Patton (00:55:09):
Yeah. None of them look like this. Well, no, that’s because we showed you the ideal one, the easy one. And so, are we doing that to our students? I guess, we’re setting up this false ideal just in the learning tools that we use and in the learning environment that we set up for our students.
Krista Rompolski (00:55:28):
Kevin Patton (00:55:28):
So, I think, it is incumbent upon us doing the anatomy to actually do that part of it. And I’ve heard this comment, not often, but when this has come up, I’ve heard the comment of, well, that’s why students take humanities courses. That’s where they learn it. And well, yeah, some of it, humanities courses are very valuable and I think that is part of it. But we have to bring that into the anatomy. I mean, it does no good sitting over there in a humanities course without pulling it into our anatomy course.
Krista Rompolski (00:56:08):
Yeah. I mean, what’s more of a humanistic course than anatomy, like, it’s just …
Kevin Patton (00:56:13):
Krista Rompolski (00:56:14):
That’s a lot of weight to put on that humanities professor.
Kevin Patton (00:56:17):
Krista Rompolski (00:56:18):
And that’s assuming that they could possibly cover every nuance of humanities or ethical response. I mean, ethical treatment of patients or responsibility is. I decided to, like I said, I’m teaching PT students for the first time in a couple of weeks, and I’m doing under gross anatomy instructor.
Krista Rompolski (00:56:36):
And their first assignment in the first week is to choose between three different articles that talk about either the kind of like the history of body donation, and the inherent inequality in that, or kind of all the issues with representation in textbooks. Or there was an article about that, that lack of representation, and how that could lead to both the perpetuation of some beliefs about diseases being associated with certain races, or not understanding differences across ethnicities, and races, and bodies, because we only have, I mean, like white male, very, very often.
Krista Rompolski (00:57:13):
So, their first assignment is to basically do a reflection on that before we teach them a single nerve, or a muscle or things like that. And I’m sure we’ll talk about weight bias and other things that come up throughout. But it’s such a personal course, because nobody can take an anatomy course or physiology, but I think anatomy just hits a little closer, and not think about their own body. It’s impossible, like you said with the fact that you think about like, what kind of cadaver will I be when you’re training?
Kevin Patton (00:57:42):
Krista Rompolski (00:57:42):
And maybe, I just haven’t gotten old enough yet to be thinking about that. But what’s funny about that, Kevin, is isn’t that still speaks to control because you could fall ill with a disease and all that muscle waste away in two months, you know what I mean?
Kevin Patton (00:57:54):
Krista Rompolski (00:57:54):
Now, I’m not saying don’t do it, obviously. But that just speaks to us believing our need to control.
Kevin Patton (00:58:04):
Right, right, exactly. Well, Krista, this has been a great conversation …
Krista Rompolski (00:58:14):
Yeah, I agree.
Kevin Patton (00:58:14):
… and we haven’t even covered half of what we’re talking about.
Krista Rompolski (00:58:14):
I know, read the paper.
Kevin Patton (00:58:15):
Yeah, read. Yeah, please, do read the paper. It is very worthwhile and share this episode with friends of yours that teach anatomy or anatomy and physiology, or even general bio, and so on, and get that conversation started. Talk to them about it. And I think that’s the only way we’re going to start to see broader change.
Krista Rompolski (00:58:36):
Kevin Patton (00:58:36):
And Krista, you talked about doing some things in your course, but we need to all start to go down that road.
Krista Rompolski (00:58:42):
I agree. Just as a little plug, if anyone’s attending the virtual HAPS conference at the end of the month, I’m doing a workshop on the value of talking about and addressing weight stigma in the classroom as a workshop on Wednesday. So, you’ll find that on the schedule, if anyone wants to hear more about it, talk about it, tell me I’m wrong, whatever.
Kevin Patton (00:59:04):
Krista Rompolski (00:59:06):
Real time. Yeah, I can take it. That’s for sure, lots of concerns, so.
Kevin Patton (00:59:10):
All right. Well, this has been great. And I’m sure that in future episodes, we’ll be revisiting this topic. It’s an important one. And please do call in, send emails or whatever with ideas that you have about this.
Krista Rompolski (00:59:28):
Kevin Patton (00:59:29):
And maybe we’ll come back with a different journal article where we can look at a different aspect of this in some future episode. But, Krista, thank you for once again, bringing us a great article and some great insights.
Krista Rompolski (00:59:45):
No problem, happy to do it.
Kevin Patton (00:59:49):
There is just so much we need to explore and talk about related to weight stigma. An easy way to say start that conversation with folks in your network is to share this episode with them and ask them for their thoughts. The easiest way to do that is to go to theAPprofessor.org/refer to get a personalized share link, that will not only get your friends all set up, it’ll also get you on your way to earning a cash reward.
Kevin Patton (01:00:26):
And if you don’t see live links in your podcast player, go to the show notes of the episode page at theAPprofessor.org/93, where you can explore the paper we discussed in this episode. And while you’re there, you can claim your digital credential for engaging with this episode.
Kevin Patton (01:00:49):
You’re always encouraged to call in with your questions and comments and ideas at the podcast hotline. That’s 1-833-LION-DEN or 1-833-546-6336, or send a recording or a written message to podcast@theAPprofessor.org. You’re invited to join my private A&P teaching community way off the social platforms at theAPprofessor.org/community. Hey, I’ll see you down the road.
The A&P Professor is hosted by Dr. Kevin Patton, an award-winning professor and textbook author in human anatomy and physiology.
Kevin Patton (01:01:45):
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