Hello, it's Anthony Chadwick for the webinar vets, welcoming you to another episode of Vet Chat, the UK's number one veterinary podcast. Very fortunate today to have Maria Munz who's agreed to come and chat to me, and we're gonna be talking about anatomy and surgery and diagnostic imaging and all sorts of exciting things. I'm gonna let Maria introduce herself properly, but Maria's a a vet who.

Actually qualified in Portugal first then practised in Portugal, but it has been all over the world, not only practising as a vet, but also working in the universities and bringing a wide clinical element to anatomy that perhaps, you know, I certainly didn't have when I, when I qualified 30 odd years ago, so. Maria, perhaps give us a little intro so that the listeners know where you, where you're coming from, so to speak, and then we can dive right into, I'm sure some really interesting chats. Thank you, Anthony.

It's it's a pleasure. Thank you for inviting me for this chat. So I was, I was studying in Portugal, just like you, I didn't have any, clinical anatomy or applied anatomy as a subject.

My anatomy was just the usual systematic anatomies and, rather boring subject. I never had a passion for an anatomy. As many, many of the students, I'm, I'm afraid.

So I then, practised in, started practising in Porto. Meanwhile, I started, I got a job in, at the university in Porto, right after it, the, the degree began there in Porto. So it's, I, it's a biomedical Sciences, university.

Our faculty. Then in 2011, so about, 1011 years later, I moved to Sydney. I was teaching there for about 2 years and a half, finished my PhD, in Sydney, and I was teaching there 2.5 years with a group, the anatomy group in, at UCID.

Meanwhile, we moved to the US, close to Philadelphia, so I was able to teach at UPenn with Polarine for some time and I'm now living in Germany. I'm not teaching here. I'm glad I have your company to work with.

I'm very happy to continue my anatomy teaching, now on an online version. But yes, it's, it's always a pleasure to, to keep, providing and helping people with anatomical knowledge and, supporting all the vets out there. I don't think that's where, you know, one of the points you made is really important when we go to that school, obviously every course is different, but I would imagine most courses do start with anatomy, close to the beginning, so for the first year, 2 years, I learnt anatomy and.

Sometimes it wasn't really connected to those live cases, so you were learning it, of course, and you were learning where all the veins were and where all the muscles went to and where all the nerves connected to. But we weren't always able to apply that to a medical condition. I mean we were very fortunate back in the day that we would have small classes.

We obviously did some cadaver work, so we would be leaning over, you know, perhaps with a couple of friends looking at what was going on in there, so we got the three dimensional element. But nevertheless, it was still a subject that you understood there was irrelevance, but the relevance wasn't coming at that part of the course. So I, I presume that's similar experience for you when you were when you were learning, and I think this is where it's so important that we do move on and I know we have a lot of Wikivet listeners who are students listening, so it'd be really interesting to hear.

How the model developed in Porto and then was exported to Sydney and and obviously to UPenn as well. So, this idea with the applied anatomy as as a subject itself, we call it clinical anatomy, but it's, it's applied anatomy, stems from the, human, human, medicine degree. So, this, degree was already running in the institute where I was, lecturing, starting in the year 2000.

And they already had this clinical anatomy. So they did what they did is they had, for human medicine, they had the, the normal anatomies, let's call them like that, it's a systematic anatomy. And after those two subjects, they would start with with a third subject, which was clinical anatomy.

And they always thought, and most of it was taught by specialists, but mainly by a surgeon. And they always thought that this was made a big difference between the vet schools in, in Portugal because the difference between Porto and Lisbon and other human medicine, courses were, was quite significant with, with the preparation of the students for, for later on for their future career. And so they brought this over to the vet degree, when the vet degree started in '92 in the same institute.

They brought this idea over to, to teach the systematic anatomies, and then bring this clinical anatomy. So, it does not exist and it still does not exist in other vet schools in Portugal, and now I'm talking about vet medicine. And honestly, I don't know other, other, universities out there in Europe or other countries that they really call it a, a clinical anatomy.

What some of them do is that, like, like Sydney, for instance, did was after they do the systematic anatomies, they had a, a full dissection of a horse, for instance, and they go by sections. So they go by regions, they start with their head and they go full, full, Full away from, from surface and they go layer by layer. It's called topographical anatomy and they talk about the relationship between the, the the structures all the way to the deepest structures, but still not so much looking into the applied, applied benefit of getting the anatomy but more looking into the relationships between them.

Yeah, so I tried to, I, I tried to bring that into UIF. This applied, part of, of anatomy and, at UPenn, the system was just too eclectic and it's just that so much information that they get in such a short time. It's, it's, it's crazy, isn't it, you know, we're not only learning anatomy of dogs but also cats, horses, cattle, sheep, pigs, and actually.

Trying to remember all of that is terribly difficult, whereas actually when you're operating on for a hysterectomy or whether you're operating to do a cystoomy or whatever, there, there are certain things that we need to know that actually allow us to do those operations. So the two things, you know, we learn anatomy partly to do surgery, don't we? That's, that's the reason we learn it or or many of us do.

I know not everybody does a lot of surgery, but. We are veterinary surgeons, you know, that's what we're classed as in the UK, so how do you see Sort of an academic, if you like, anatomist who perhaps isn't doing surgery. Can those two groups come together and work collaboratively well together?

Is it important to have both of them, you know, within a group at a university? That is, that is the thing exactly, so the point is that. I believe the main problem at universities, and that anatomy becomes a monster is because, in fact, these, these academics, so the people who are teaching these, these subjects, so they, they don't have a background of being practitioners themselves.

So they focus on their, on their knowledge and giving this information over to the students without really giving them a purpose. Just for them to understand why this in fact will be important for the future. And this is what I find, is lacking on most universities that, that some of these people realise that there has to be some, some interconnection between anatomy and surgery, anatomy and diagnostic imaging and or imageology as a, as a subject.

And actually I did have that in, in Sydney. I had a very, engaged, surgeon, Christen was his name and, and at the University of Sydney, and he was coming over to my classes to relearn anatomy from me. And so that he would get better with his own knowledge and his surgeries.

So there should be, and there could be some sort of interconnection between anatomy and surgery or anatomy and imageology. But as you've said, you know, across the world, we're not necessarily getting that, that anatomy is still being taught very academically rather than, you know, as a mixture between, obviously. Academically, but also in an applied or a clinical sense.

Mhm. Yeah, unfortunately it's still, it's still very academic, it's . It's, it becomes a rather boring subject if you, if you just go on, on all the little details, because you do not need all the details.

I mean, anatomy can be a monster, but you can make it as light and as interesting as you want. I mean, we tried, back in, in those days in Porto already. Even with the systematic anatomies after teaching bones, we would, we would right away show them some X-rays so they would understand how it looks, how the normal bone looks like, how it articulates with, with the other bones, how this image, rather than a three dimensional what you see in the cadaver or where the, the bone itself, how it looks in the, in the X-ray with a two dimension, imaging.

And then recognising right away, I don't, we would show them some pathologies, we would say them fractures, we would show them arthritis, we would show them some simple examples of abnormal situations, so they, they would have this. Hm. This power to to to have the, the, the ability to recognise the abnormal right away.

So they, they would, they would be happy to be able to, to do that by themselves. Understanding normal radiographs is really important, isn't it, because if we know absolutely what the normal is when we see something that doesn't quite look right, you know, we'll know that oh that shadow there, you know, isn't just a normal shadow, it is something that we should be concerned about and I, I think. We certainly got this at Liverpool University, but it was then in year 4 and year 5, which is then.

You know, 2 years after you've finished your anatomy, and of course you've begun to forget some of that anatomy, so bringing them all together, you know, would be better. Obviously I don't know exactly how they teach the subjects at my old university, it's a long time since I've went, but obviously if, if some of the students are listening to this from, you know, any of the universities cos with our Wiki vet website, we get a lot of students. Coming to Wikiett and then obviously to Webinar vet, it would be great to get an insight and maybe there's a survey, maybe we, Maria, we should set up a little survey at the end of this podcast which people can look at underneath and can answer if they are students and let us know what the situation is like in their, in their universities and whether some of these ideas are catching on because we also have some newer universities like Oklan just up the road in Preston now.

Kee Harper Adams has opened just the last couple of years. I think there's one opening in Aberystwyth, so we are opening up new vet schools now at quite a rate, and I think when I was at university there were about 5 or 6. There's now probably closer to 10.

So the, the numbers have grown rapidly over the last 10 years, so it will be interesting to see if the newer schools are teaching in a different way or if indeed, The older schools are applying different models or that they've stayed very strictly to the sort of model that I experienced when I was at, from my experience I would say that the older universities have stayed with with the. With their old methods and their old ways and our university in Porto was a newer one, so it was in '92, as I said, that they started with a degree and I believe this is the reason why it was also something, something. More innovative that somebody somebody brought up with this clinical anatomy and there was more interaction between the practitioners because there was in the hospital and the and the institute itself and we were always in touch with each other.

Yeah, I must say. I was really disappointed. We had our 30th year reunion two years late, in September and it clashed with the dermatology congress, which was happening in Porto last September.

So I missed Porto. I did go in the 80s and one of my passions, one of my things that I enjoy doing is drinking the Porto wine. So I had a very enjoyable few days in Porto and, and I love the city with the, the boats and the the names of the different porthouses on the, the boat's sails.

It is a fantastic city. The other, I think I really love about Porto is we always beat you in the football. I'm a Liverpool supporter, so .

They're my memories of Porto, but I would love to go back at some point, so I'm, I'm hoping that will happen sooner rather than later. Porto has changed so much since the 80s. It's, it's a completely different city nowadays.

It's, but of course, much more tourism and many more immigrants. It's, it's a completely different place. I went, I went at a good time when the, the port houses still allowed us to go in and and taste their words for free, I think.

Yes, I, I'm afraid I'm not a, a port wine fan, so I cannot, I cannot say if, if things have changed in, in the, in the wine cellars. I do know that there's, there's meanwhile beautiful museums there, which did not exist at the time in the 80s for sure. yeah.

It's a very similar set up to Liverpool in that we have a river flowing through the city, so the River Duro and the River Mersey. On the left bank is Liverpool on the left bank, I think is Porto, on the right bank is Villanova de Gaya or Birkenhead. So there's lots of similarities between the two cities.

And grey days as well. Yeah, grey weather. I but good football teams.

I guess, yes. Did you know the webinar vet has a public community Facebook group? We want to ensure veterinary professionals have a place to stay in the loop with everything that's happening here at the Webinar vets.

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It's interesting going back to surgery and again, you know, the old fashioned way when I left vet school and I was trying to teach myself surgery for something like a perineal hernia, I would use a book and then it was very difficult to get the, the way that the nerves and the muscles and the veins were sort of coming together, what was behind, what was in front, because of course, In a two dimensional book, you can't get that sort of 3D perspective. Exactly. And actually this is where we did something very interesting a few years ago where we developed a partnership with Microsoft with the mixed reality headset called the HoloLens and developed a lovely dog called a German Shepherd dog called Sheba.

And, and started to try and develop that in, in conjunction with a couple of the universities, unfortunately we never got the funding to take it further, but whenever I'm stopped at at conferences, people often say, what's happening with the 3D, model that you created because it was really exciting and I think, Is that perhaps another way with given the difficulties of the bigger vet schools now, bigger sizes, you know, being able to get hold of cadavers and so on, do you see 3D models helping in whatever forms they take? Yes, definitely, this was 11 difficulty we'd had with, with teaching is, when we would teach organs, for instance, we would have a hard time describing, explaining things because you you need so many images to To explain how, how they're, how they're flat, how they, the dorsal part of it connects to the, to the liver, the ventral part of it connects to the, the junum, and, and all of these relationships. They're so difficult to, to, to transmit when, and then when the students themselves have, difficulties with three-dimensionality themselves.

Then it becomes, it becomes the horror. So definitely this, this technology has helped in sense of helping them understand relationships between organs and, and how Each of these layers are somehow built into each other, . That's important for surgery and definitely perineal hernias are a nightmare for most surgeons.

I was called for several of those because people are uncomfortable about, about going, going in. They were afraid of the nerves. They were afraid of the but then the vessels.

Sendal nerve, they were, they were afraid of, of the muscles themselves. What is the operator internal or any, any muscle in there? And how would you flap it in and how would you move it?

It's, it's just crazy. So I, I still keep doing those here, because people are uncomfortable about, about, about going in and, and making sure that they do not damage something by mistake. And it's just, of course, with the perennial earlier things are out of place and so you don't see the normal anatomy, you see something out of the ordinary.

So if not, if you're not used to seeing the normal, then all of a sudden you go in, you see something abnormal, and you're like, where am I? I'm lost. The book is not helping because it's showing me something normal and I, I cannot, I cannot continue.

So. Definitely, 3D helps and but cadavers are in the end, the best tool. You have to, you have to go and see it and see it live to see, to see how, how it really works.

And this is what most surgeons do, when they, when they, they have the cadavers that they. That they have in stock or whatever, they, they just open up and they, they learn by themselves, by, by either with 3Ds or with books side by side, and they just go in and, and learn by dissecting the, the cadaver. Possibly dissecting is still the best tool.

Possibly the newer students being more digitally orientated and you know, used to maybe gaming and things, you know, on their computers that 3D, is, is even easier still isn't it, because whether it was a book or a blackboard. To learn that and to see the different layers was, it was really difficult, whereas I think if we can learn in 3D that is going to quicken up our processes of of picking up things because if we can, obviously everybody learns in a different way, but you know, the, the, the visual memory is a very important part of memory, isn't it? The most important one.

It's the most important one. The thing is, in even in, in, in our, students what they would have they would have cadavers to, to work on throughout the the whole semester and their practicals. And by the end of the semester, as they would prepare for the, the exams, we would again offer them more cadavers to work on by themselves.

So what they would organise themselves in groups, they would come and work in late afternoon and evenings and they would, or weekends even, and they would do it themselves on the, on the cadavers to, to once again go, go through the, the whole thing. So this is. This is again what what we think is the the best tool, or else if you rely on books the whole time and, and then all of a sudden you're, you're in front of a surgery with a live animal and you're, you're, you're lost.

You don't, you don't know where you go. Erythro erythrostomies were also something that I was called for, for cats. This is again microsurgery and again very difficult.

It's minimal layers and also difficult to perform, and several, several colleagues of mine were uncomfortable about doing that, and I would, I would be called to to perform. I remember one of my bosses in my early days, Ian Barkley. And I would sit in and watch him doing spinal surgery, and he would say, I don't know why, why anybody sends me these, they, they are so easy to do.

And of course it's after you've done a few of them, they do become easier, but it is often that initial, you know, taking that leap of faith and. We certainly see in the UK and I don't know if it's a German problem, people being nervous even doing. I won't say basic surgery because I think doing something like a bit ray.

Actually, if you can do a bitch bait, it's a really tough piece of surgery because it challenges you in many ways, but actually it is a standard piece of surgery. So somehow we're also having situations, certainly in the UK where people are leaving that school and they're not confident doing what is a basic or a routine piece of surgery. So how do you think that we can.

Apply some of these models to, to help, or how do we build up confidence in, in surgery, is that, do you think partly also personality wise, because we've got, you know, these highly intelligent students that come in who succeed at everything, once they find something that is too difficult for them, they actually lose a lot of confidence and therefore won't do it again. What, what's your thoughts on, How can we improve, you know, that basic surgery which, you know, is our routine day by day stuff. So, I, I, I'm again coming back to my applied anatomy, practicals in, in, in Porto.

So one of the, one of the main practicals was abdominal surgery. So they would we would just do the like the normal incision in the midline and then expose the organs, and then we would say, let's do a gastrotomy or let's explore the left kidney, or let's do a cystoomy or how would you do that? And this would be part of the exam, of the practical exam at the end of the, it was an oral exam.

And they would just, take out the paper. It could be abdominal surgery, you could be looking into X-rays. It could be, surgical access to the, to the elbow.

It could be different topics. They had like 20 different ones, but one of them was abdominal surgery. So, either you were lucky or unlucky, but it could come out.

I mean, it could be that you're, you have to perform, something in the abdomen, a surgery in the abdomen. And, and you would have to go through it. Independently, if you're a good student, if you're a bad student, if you don't like a small animal clinic, if you prefer horses, you would still have to, to go through this, or you would fail the whole, the whole, degree, the whole, subject, I'm sorry.

So it's, it's something we would push every single student to do. And this, this was the reason why we would, would facilitate those cadavers that each student was able to do it. On his own.

I think there's no way out. Yeah, this, this is right, cause I think. There's not a lot of surgery done.

I, I know when I was training to be a vet, I certainly had done some bit space and cat space before I went out into practise, but not a great deal, and actually it, it's, and they were done while I was part of EMS. I think I did maybe one or two in university, which is not enough to really get you to the level. The more of this you do, the better you can and of course it's finding the right.

Practises for EMS that will let you really get involved, but you also putting yourself into a. A difficult position because it's easy to stand in the corner of the room, but actually you want to be next to the surgeon saying, can I have a go at this? Absolutely.

I mean, you could as a university, you could always and that I I try to bring back. This clinical anatomy, not only offering it to the students themselves during the degree, but later on as a continuing education for vets, for the, for the, the vets which were just starting and I tried to bring this idea and to, to create some sort of . So, a, a course for, for people to come in and just relearn these, these things and practise on cadavers.

So, but it, it never took off and meanwhile, I took off to Sydney. But, yeah, that was one of my. Ideas was to, to offer it to the public or to the, to the vets already practising that they would relearn anatomy and, and look it through again.

Because, of course, you, you look at it when you're in 2nd degree, you're about 1920 years old, and then, and then 5 years later or 6 years later, you then, faced to your first surgery and, and trying to, to perform it on your own, and then you're scared. Because you've forgotten things and yeah, and then this was my idea, just bring it back, bring those those guys back into into the university, offer it to the, to the practitioners and, and that they relearn again. You forget so much all the time.

Of course, even when you're, even when you're in your twenties. Yes, we forget everything. And after the, the degree, you always think, oh my God, what have I done here?

I haven't learned much in this, in this university. You feel like you have nothing. You actually have much of the knowledge in there.

I still, meanwhile, I mean, I'm still working and nowadays, I'm still like, oh, I remember this from, from university. And you think you've lost all of this information. There's still some things which which stuck there that you, you do not acknowledge at the time, but they, but there's still some knowledge up there.

I think most things get stuck. It's actually the retrieval, which is the difficult process, isn't it? Most stuff is actually somewhere in the brain.

It is a case of how easy is it to retrieve it again. It's just when you need it, then, then there's some ideas coming. Oh, I did hear about this sometime in in 3rd year or so, but yeah, it's some, some pieces of information out there, but if you're scared to do it, yeah, why not just practise on cadavers and then feel comfortable to, to do it on a live animal where you have a lot of responsibility.

Maria, . Origado, Dankerer. It's been a great, it's been a great, podcast.

I just to, to look at how we can do these things differently, so it'd be really interesting for those of you listening perhaps who are. Just out of university or still in university, do let us know what your experiences are and how you've been getting taught anatomy as well. But it's been a really interesting time with you, Maria, learning how you do things and I think it's a great way of, improving surgeons if they know exactly where they're going and what those what those bones and everything are all about.

If you, if you're comfortable in anatomy, you will feel comfortable about surgery and, and diagnosing, images, and, it's just. It's just that the way you look at things is, oh, this looks odd and you immediately recognise something is wrong. So anatomy is really your friend.

Thanks again Maria, take care and thanks everyone for listening. This has been Anthony Chadwick from the Webinar vet with another episode of Vet Chat. Take care, bye bye.