Gross anatomy in the surgical curriculum in Switzerland: improved cadaver preservation, anatomical models, and course development.

The invention of new techniques for surgery and interventional radiology demand improved training for ongoing specialists. The Anatomical Institutes in Switzerland support these requirements by establishing hands-on practical training courses by using new procedures for cadaver embalming and model construction. Improvements allow courses to provide students with more realistic simulations of both established and experimental surgical methods. Through these changes, the value of in-depth gross anatomy is enhanced as a topic of fundamental importance for the postgraduate medical and surgical curriculum. The web site http://www.unifr.ch/sgahe/snga.html contains information on courses using the Thiel embalming solution. Details about training courses in Switzerland using anatomical models are available at http://www.heartlab.org, http://www.vascular-international.org, and http://www.elastrat.com.     

A clinical anatomy curriculum for the medical student of the 21st century: Gross anatomy

Human anatomy forms the foundation for clinical medicine: thus its place in the medical school curriculum deserves careful attention. In an attempt to provide guidance to decision-makers involved in clinical anatomy curriculum development at the medical school level, the Educational Affairs Committee of the American Association of Clinical Anatomists (AACA) developed this document, which defines the contours of a gross anatomy curriculum leading to the M.D. or D.O. degree. The main body of the document sets forth the anatomical concepts as well as the subject matter a student should master prior to graduation from medical school. The AACA seeks to ensure that all medical students receive thorough training in clinical anatomy and that each student, regardless of the institution attended, will be exposed to a curriculum that will provide a fundamental level of competence required for the practice of medicine. © 1996 Wiley-Liss, Inc.     

The importance of teaching clinical anatomy in surgical skills education: Spare the patient,use a sim!

Anatomical knowledge is a key tenet in graduate medical and surgical education. Classically, these principles are taught in the operating room during live surgical experience. This puts both the learner and the patient at a disadvantage due to environment, time, and safety constraints. Educational adjuncts such as cadaveric courses and surgical skills didactics have been shown to improve resident confidence and proficiency in both anatomical knowledge and surgical techniques. However, the cost-effectiveness of these courses is a limiting factor and in many cases prevents implementation within institutional training programs. Anatomical simulation in the form of “desktop” three-dimensional (3D) printing provides a cost-effective adjunct while maintaining educational value. This article describes the anatomical and patient-centered approach that led to the establishment of our institution's 3D printing laboratory for anatomical and procedural education. Clin. Anat. 32:124–127, 2019. © 2019 Wiley Periodicals, Inc.     

解剖学手术操作示教在解剖教学第二课堂中的探索

 作为北京协和医学院教学改革的一部分,开设了解剖学手术操作示教的选修课。精心选择临床病例,实行小组教学。课程内容包括师生共同参与集体备课、临床讲座、手术示教或录播、学生实践以及课后总结等。该课程不仅巩固了解剖学内容,还强调了所学知识在临床中的应用及其重要性,同时也培养了学生的学习兴趣和团队合作意识。     

Human preservation techniques in anatomy: A 21st century medical education perspective

Anatomy is the cornerstone of education for healthcare professionals with the use of human material providing an excellent teaching tool in the modern curricula. The ability and quality of preservation of human remains has enabled such use. The introduction of formaldehyde as a preservative in 1893 was an important step in the history of preservation. With the European Union directive on the use of formaldehyde and its expected banning, anatomists are trying to find a more convenient and safe substitute. In this review, we compare the different techniques used based on the need for embalming, fixative used, period of preservation and the features of the embalmed specimen. The fact that embalming is used in different disciplines, multiple purposes and described in different languages has led to the development of ambiguous interchangeable terminology. Overall, there is a lack of information specifically classifying, listing and comparing different embalming techniques, and this may be due to the fact that no internationally recognized experimental standards are adhered to in this field. Anatomists strive to find an embalming technique that allows the preserved specimen to accurately resemble the living tissue, preserve the body for a long period of time and reduces health risk concerns related to working with cadavers. There is a need for embalming to shift to an independent modern day science with well‐founded research at the heart of it. While this may take time and agreement across nations, we feel that this review adds to the literature to provide a variety of different methods that can be employed for human tissue preservation depending on the desired outcome. Clin. Anat. 28:725–734, 2015. © 2015 Wiley Periodicals, Inc.     

Clinical anatomy as the basis for clinical examination: development and evaluation of an Introduction to Clinical Examination in a problem-oriented medical curriculum

Clinical anatomy is usually defined as anatomy applied to patient care. The question is asked whether students of a new horizontally and vertically integrated medical curriculum recognize the subject as the basis for clinical examination. A clinical anatomy practicum was developed in the special activity, "Introduction to Clinical Medicine," held in the second year of the Pretoria medical curriculum. The practicum was conducted on a station basis to anatomically prepare the student for the inspection, palpation, percussion, and auscultation of the cardiovascular, respiratory, abdominal, and urogenital systems. A total of 23 stations consisting of eight cardiovascular, seven respiratory, and eight abdominal/urogenital stations were designed. Standardized patients, cadavers, skeletons, prosected specimens, x-rays, computed tomography (CT) scans, magnetic resonance imaging (MRI), multimedia programs, and clinical case studies were used as resources. A Likert-type questionnaire was used for student evaluation of the practicum. Most students realized the importance of surface anatomy for a family physician. More than two-thirds thought the practicum improved their understanding of the anatomical basis for clinical examination. The minority of students were stimulated to do further reading on clinical examination. The students' response to their ability to integrate the clinical examination with the radiological anatomy was average. Most students were continuously aware of the appropriateness of the practicum for their future career. We conclude that medical students recognize the importance of anatomy as the basis for clinical examination when exposed to an appropriate integrated presentation format.     

Traditions and peculiarities of clinical anatomy education in Russia

The Russian experience in clinical anatomy education is described in this article. Such training is provided by the Department of Operative Surgery and Topographical Anatomy both during the pregraduate (undergraduate) period for medical students and in the postgraduate period for interns, residents, physicians, and surgeons of different specialties. The teaching of clinical anatomy in the pregraduate period occurs in combination with the study of operative surgery and follows the study of gross anatomy in the Department of Human Anatomy and microscopic anatomy in the Department of Histology, Cytology and Embryology.     

The poor, the Black, and the marginalized as the source of cadavers in United States anatomical education

When the practice of hands-on anatomical dissection became popular in United States medical education in the late 18th and early 19th centuries, demand for cadavers exceeded the supply. Slave bodies and thefts by grave robbers met this demand. Members of the public were aware that graves were being robbed and countered with various protective measures. Since the deterrence of grave robbing took time and money, those elements of society who were least economically and socially advantaged were the most vulnerable. Enslaved and free African Americans, immigrants, and the poor were frequently the target of grave robbing. The politically powerful tolerated this behavior except when it affected their own burial sites. Slave owners sold the bodies of their deceased chattel to medical schools for anatomic dissection. Stories of the "night doctors" buying and stealing bodies became part of African American folklore traditions. The physical and documentary evidence demonstrates the disproportionate use of the bodies of the poor, the Black, and the marginalized in furthering the medical education of white elites.     

Profiles of applicants for junior faculty posts to teach anatomy in the UK: Changing populations of candidates

This study was undertaken to document the popularity of appointments as temporary lecturer in anatomy (TLA) at the University of Manchester during the period 1991–1998, and to profile the applicants for the posts. Data concerning 465 applicants were collated from departmental records and application forms. Prior to 1996, there were about seven applicants per post and most were men who intended to pursue surgical careers. The mean age of the applicants was 26 years, range 22–61 years. Graduates of Manchester University formed 28% of applicants, non‐UK graduates 11%, and 52% possessed qualifications additional to their medical degrees. After 1996, there were fewer applicants, about three per post, who were somewhat older, mean age 30 years, range 21–52 years, and from more diverse backgrounds; 40% were non‐UK graduates. The probable reasons for the decline in popularity of the appointments are explored. Clin. Anat. 12:272–276, 1999. © 1999 Wiley‐Liss, Inc.     

From cradle to grave via the dissection room: the role of foetal and infant bodies in anatomical education from the late 1700s to early 1900s

The preponderance of men in the narrative of anatomical education during the 1800s has skewed the historical perception of medical cadavers in favour of adult men, and stifled the conversation about the less portrayed individuals, especially children. Although underrepresented in both the historical literature and skeletal remains from archaeological contexts dated to the 1800s, these sources nevertheless illustrate that foetal and infant cadavers were a prized source of knowledge. In the late 1700s and 1800s foetal and infant cadavers were acquired by anatomists following body snatching from graveyards, from the child's death in a charitable hospital, death from infectious disease in large poor families, or following infanticide by desperate unwed mothers. Study of foetal and infant remains from the 1800s in the anatomical collection at the University of Cambridge shows that their bodies were treated differently to adults by anatomists. In contrast to adults it was extremely rare for foetal and infant cadavers to undergo craniotomy, and thoracotomy seems to have been performed through costal cartilages of the chest rather than the ribs themselves. However, many infants and foetuses do show evidence for knife marks on the cranium indicating surgical removal of the scalp by anatomists. These bodies were much more likely to be curated long term in anatomical collections and museums than were adult males who had undergone dissection. They were prized both for demonstrating normal anatomical development, but also congenital abnormalities that led to an early death. The current findings show that the dissection of foetal and infant cadavers was more widespread than previous research on anatomical education suggests. This research details the important role of the youngest members of society in anatomical education during the long 19th century, and how the social identity of individuals in this subgroup affected their acquisition, treatment and disposal by elite medical men of the time.     

Retrospective evaluation of undergraduate medical education by doctors at the end of their residency time in hospitals: Consequences for the anatomical curriculum

Reform of the undergraduate medical curriculum, including the debate on which of its parts or subjects are superfluous, is a topic of interest in many countries. On being examined at the end of their specialization period, doctors were asked to grade the relevance of all subjects in the undergraduate curriculum for training to become a medical doctor. The subjects that gained the highest grades were internal medicine, gross anatomy, physical examination course, physiology, and pharmacology. The five subjects graded least relevant were biomathematics, terminology, social medicine, medical physics, and medical chemistry. More than 80% of the doctors expressed interest in special lectures and courses, e.g., in topographic anatomy at the beginning of their postgraduate training. Retrospective evaluations at the end of residency time are helpful “evidence” to be considered in reforming the medical curriculum, and in particular in defining “core” and “optional” parts of the curriculum. The data show that anatomy is graded as highly relevant in the undergraduate medical curriculum by doctors at the end of their postgraduate training. Anat Rec. 249:431–434, 1997. © 1997 Wiley-Liss, Inc.     

Gross anatomy of the head and neck and neuroscience in an integrated first‐year medical school curriculum

The curriculum for first year medical students at the University of Cincinnati has changed. Beginning in the fall of 1998, material in the first year was presented in an Integrated Educational Program. The goal of this program was to provide students with an understanding of the normal structure, function, and development of the human body. The purpose of this report is to discuss the unique integration that occurs in a block offered during the Spring Quarter. The two components of this block are Gross Anatomy of the Head and Neck and Brain and Behavior I. Brain and Behavior I is a new offering combining neuroanatomy, neurophysiology, neurology, and a psychiatry/behavioral component. The unique combinations offered in this block are logical, educationally sound, and have been enthusiastically received by both the students and faculty. Anat Rec (New Anat) 261:89–93, 2000. © 2000 Wiley‐Liss, Inc.     

Undergraduate coursework in anatomy as a predictor of performance: comparison between students taking a medical gross anatomy course of average length and a course shortened by curriculum reform

The performance of students taking medical gross anatomy at the University of California at Davis during a 4-year period (1999-2002) was correlated with prior undergraduate anatomy coursework. Significant correlations were observed between class rank in medical anatomy and taking any undergraduate anatomy as well as the total number of undergraduate anatomy units (P<0.01). Taking human gross anatomy and an anatomy laboratory course were significantly correlated with medical anatomy class rank (P<0.01) as were grades in human anatomy, comparative vertebrate anatomy and anatomy laboratory courses (P<0.05). The medical anatomy course offered in 1999-2000 was 172 hr long, and the course offered in 2001-2002 was 135 hr long, with most of the difference made by decreasing lecture time while sparing the dissection laboratory. The reduction in course length was the consequence of a curriculum-wide cap in weekly contact hours. In the 172-hr medical anatomy course there were significant correlations between the students who took undergraduate anatomy and both class rank and the score on the final examination (P<0.01). These correlations did not exist for the 135-hr course. This may be explained by previous anatomy experiences helping students learn from lecture more than from dissection laboratory, as well as the extra study time available to students in the reformed medical curriculum. Pre-medical students and health science advisors need to consider that the benefits of taking anatomy as an undergraduate may be dependent on the configuration of a medical school's curriculum.     

Books,bones and bodies: The relevance of the history of anatomy in Nazi Germany for medical education today

The history of anatomy in Nazi Germany highlights the consequences to humanity when the destructive potentials immanent to all science and medicine are enabled by an anti-democratic, totalitarian regime. Anatomy presents an example of ethical transgressions by scientists and health care professionals that were amplified in the criminal political climate of the Nazi regime. This can happen anywhere, as science is never apolitical. This article gives a short account of anatomy in Nazi Germany, which is followed by an outline of the tangible and intangible legacies from this history, to then discuss implications for anatomy education today. While Jewish and politically dissident anatomists were forced out of their positions and country by the Nazi regime, the majority of the remaining anatomists joined the Nazi party and used bodies of Nazi victims for education and research. Some anatomists even performed deadly human experiments. Patterns and legacies that emerge from this history can be traced into the present and concern research ethics in general and anatomical body procurement specifically. They shed light on current practices and controversies in the anatomical sciences, including anthropology. It will be argued here that the history of anatomy in Nazi Germany can inform current anatomy education in a concept of anatomy as the first “clinical discipline.” By integrating insights from the history of anatomy into the learning process, anatomy education can model an approach to medicine that includes a full appreciation of the shared humanity of medical practitioners and patients.     

Clinical anatomy and the physical examination Part I: Thorax,abdomen, perineum,and pelvis

This paper by the Educational Affairs Committee of the American Association of Clinical Anatomists (AACA) is a sequel to one published earlier, “A Clinical Anatomy Curriculum for the Medical Student of the 21st Century: Gross Anatomy” (AACA. 1996, Clin Anat. 9:71–99). In that curricular document a number of clinical procedures that apply gross anatomy to current medical practice are cited, including procedures related to the physical examination. This paper describes numerous anatomically based procedures that are performed during a physical examination to demonstrate that (1) gross anatomy forms a fundamental basis for physical diagnosis and (2) such an anatomic basis is delineated in our previously published curricular document. The AACA Educational Affairs Committee also hopes that the examples presented here will serve as a starting point for incorporating elements of the physical examination within a clinical anatomy curriculum in gross anatomy at the medical school level. This paper focuses on the physical examination of the thorax, abdomen, perineum, and pelvis; a subsequent paper will treat the physical examination of the limbs, back, head, and neck. Clin. Anat. 5:332–348, 2001. © 2001 Wiley‐Liss, Inc.     

On the importance of integrating comparative anatomy and One Health perspectives in anatomy education

As a result of many factors, including climate change, unrestricted population growth, widespread deforestation and intensive agriculture, a new pattern of diseases in humans is emerging. With increasing encroachment by human societies into wild domains, the interfaces between human and animal ecosystems are gradually eroding. Such changes have led to zoonoses, vector‐borne diseases, infectious diseases and, most importantly, the emergence of antimicrobial‐resistant microbial strains as challenges for human health. Now would seem to be an opportune time to revisit old concepts of health and redefine some of these in the light of emerging challenges. The One Health concept addresses some of the demands of modern medical education by providing a holistic approach to explaining diseases that result from a complex set of interactions between humans, environment and animals, rather than just an amalgamation of isolated signs and symptoms. An added advantage is that the scope of One Health concepts has now expanded to include genetic diseases due to advancements in omics technology. Inspired by such ideas, a symposium was organised as part of the 19^th International Federation of Associations of Anatomists (IFAA) Congress (August 2019) to investigate the scope of One Health concepts and comparative anatomy in contemporary medical education. Speakers with expertise in both human and veterinary anatomy participated in the symposium and provided examples where these two disciplines, which have so far evolved largely independent of each other, can collaborate for mutual benefit. Finally, the speakers identified some key concepts of One Health that should be prioritised and discussed the diverse opportunities available to integrate these priorities into a broader perspective that would attempt to explain and manage diseases within the scopes of human and veterinary medicine.     

A retrospective and prospective look at medical education in the United States: trends shaping anatomical sciences education

During the last decade of the 20th century and the first decade of the 21st century, curricular reform has been a popular theme. In fact, reform on the current scale has not occurred since the early 1900s, when Abraham Flexner released his landmark report ‘Medical Education in the United States and Canada’. His report, suggesting major changes in how physicians were educated, became the norm and few changes occurred until the last quarter of the 20th century. During this period increased demands on medical school curriculums due to the explosion of knowledge in biomedical sciences and the pressure to add additional clinical experiences increased the momentum for curriculum reform. In 1984 an Association of American Medical Colleges (AAMC) report, ‘Physicians for the Twenty-First Century: The Report of the Panel on the General Professional Education of the Physician (GPEP) and College Preparation for Medicine’, discussed many items related to reforming medical education including the value of integration, increased use of active learning formats, more self-directed learning, improved communication skills and increased problem-solving activities. This was followed by a report released in 1993 entitled ‘Educating Medical Students: Assessing Change in Medical Education – The Road to Implementation’ (ACME-TRI), which identified educational problems by surveying medical school deans, suggested ways to deal with these issues and presented a plan of action. Recently, the Carnegie Foundation for the Advancement of Teaching released ‘Education Physicians: A Call for Reform of Medical School and Residency’ with additional suggestions. At this point the question that might be asked is – Where is all this going and how is it going to affect anatomy education?     

The attitudes of medical students toward the importance of understanding classical Greek and Latin in the development of an anatomical and medical vocabulary

Students on entering medical school are faced with acquiring new, and voluminous, anatomical and medical terminologies. A reason why acquiring these terminologies may be problematic relates to the fact that many terms are derived from classical Greek and Latin; languages nowadays that are rarely taught at school. It might also be supposed that the often reported reduction in exposure to anatomy, and time spent in the dissection room, impairs the students' knowledge and understanding of anatomical relationships, and thus further complicates the acquisition of the terminologies. To date, there have been no studies that have quantified the attitudes of medical students toward the importance of understanding classical Greek and Latin during their medical training. In order to assess these attitudes, this study was undertaken for the newly‐recruited (First Year) medical students and for the Final Year medical students at Cardiff University. They were provided with a brief questionnaire that was devised in accordance with Thurstone and Chave (1951) principles and with ethical approval. One hundred and eighty First Year students and one hundred and nineteen Final Year students responded. Our initial hypothesis was that students throughout the medical curriculum have an unfavorable attitude toward the importance of classical Greek and Latin. This hypothesis was supported by the attitudes of the Final Year students but not by the First Year medical students. While we would still advocate that First Year medical students should acquire some understanding of and have some formal or informal instruction in, classical Greek and Latin as they pertain to medical terminologies, we acknowledge that Final Year students are likely to have become reasonably well‐versed in the origins of medical terminologies without formal instruction. Clin. Anat. 29:696–701, 2016. © 2016 Wiley Periodicals, Inc.     

Virtual reality and cardiac anatomy: Exploring immersive three‐dimensional cardiac imaging,a pilot study in undergraduate medical anatomy education

Cardiac anatomy can be challenging to grasp because of its complex three‐dimensional nature and remains one of the most challenging topics to teach. In light of some exciting technological advances in the field of virtual reality (VR), we sought to test the viability and the assess efficacy of this computer‐generated model for the purposes of teaching cardiac anatomy. Before learning cardiac anatomy, first‐year undergraduate medical students participated in an anatomically correct VR simulation of the heart. Students were randomly distributed into control and variable groups. Each student completed a pre‐intervention quiz, consisting of 10 multiple choice questions with 5 conventional cardiac anatomy questions and 5 visual–spatial (VS) questions. The control group continued to independent study, whereas the variable group subjects were exposed to a 30‐min immersive cardiac VR experience. At the end of the intervention, both the groups underwent a separate post‐intervention 10‐question quiz. Forty‐two students participated in the cardiac VR experiment, separated into 14 control and 28 variable subjects. They scored 50.9% on average on the pre‐intervention quiz (SD = 16.5) and 70.2% on the post‐intervention quiz (SD = 18.7). Compared to the control group, the students exposed to VR scored 21.4% higher in conventional content (P = 0.004), 26.4% higher in VS content (P < 0.001), and 23.9% higher overall (P < 0.001). VR offers an anatomically correct and immersive VS environment that permits learner to interact three‐dimensionally with the heart's anatomy. This study demonstrates the viability and the effectiveness of VR in teaching cardiac anatomy. Clin. Anat. 32:238–243, 2019. © 2018 Wiley Periodicals, Inc.