Undergraduate perspectives on the teaching and learning of anatomy*

The volume of time dedicated to anatomy teaching has steadily decreased in the context of increasingly dense undergraduate curricula. We examine the complex topic of anatomical education from the undergraduate perspective, with a focus on student perceptions, their origins and their potential solutions. A limited dataset suggests students perceive their tuition in anatomy may be suboptimal. Multiple factors (including the intensity of pre‐clinical studies, academic criticism of modern courses, surgical culture and misinformation) may account for the unrest. It is difficult to objectively measure the impact of modified anatomy curriculum on clinical performance and patient safety. While there is a case (on the basis of student perception at least) for reinvigorating elements of undergraduate anatomy education, the modern medical educational framework is here to stay, and students and clinicians must learn to adapt. Anatomy must be linked with contemporary approaches to medical education and it should be integrated, continuous and guided. It is critical that clinicians engage in the teaching of anatomy in the clinical environment and they must be adequately resourced to do so. Graduates must emerge with a core understanding of anatomy, but not an encyclopaedic knowledge of the human form. Undergraduate programme should simply strive to equip their graduates with a foundation for lifelong learning and a platform for safe practice as interns.     

Certain problems of teaching operative surgery and topographic anatomy

The article presents a discussion of different methods of teaching operative surgery and topographic anatomy in medical colleges (prediploma training) and education after diploma.     

Surgical inclination and anatomy teaching at the University of Auckland

BACKGROUND: Medical graduate interest in surgery has declined and medical students are less capable in anatomy than they once were. Declining interest in surgery is because of factors, including growing number of women entering medical school. There has been less emphasis in teaching anatomy at various medical schools in recent years. The aim of this study is to quantify surgical inclination in Auckland medical students to assess whether gender differences exist in surgical inclination and determine confidence in anatomy knowledge and resources used by Auckland medical students. METHOD: Survey design was cross-sectional and included 25-point questionnaire using Likert scale response ranking and tick box replies. Two hundred and eighteen surveys were emailed to functioning addresses of fourth and fifth year students at University of Auckland, School of Medicine, New Zealand. RESULTS: Response rate was 71.6%. Twenty per cent of students were found to be surgically inclined (95% confidence interval, 0.15-0.26). The proportion of surgically inclined men was significantly higher than women (P < 0.05). Thirty-three per cent of all respondents (95% confidence interval, 0.26-0.41) felt their knowledge of anatomy was adequate to practice medicine safely. Textbooks and atlases were most commonly used to learn anatomy (P < 0.05). Radiology was the least commonly used method to learn anatomy (P < 0.05). Eighty-seven per cent (95% confidence interval, 0.81-0.92) of respondents agreed that revisiting dissection during surgical attachments would be helpful. CONCLUSION: Men are significantly more likely to be surgically inclined than women at the University of Auckland. A significantly greater proportion of students felt that their knowledge of gross anatomy was inadequate for safe medical practice. Students use traditional methods to learn anatomy more commonly than radiological methods. The majority of students surveyed would like to revisit cadaver dissection during clinical attachments in surgery.     

Physical examination and radiographic interpretation of carpal anatomy in orthopedic residents and emergency medicine physicians

The purpose of this study was to evaluate carpal anatomy proficiency in orthopedic residents as well as emergency medicine physicians. Orthopedic surgery residents and emergency medicine physicians were tested on their understanding of normal carpal anatomy using a Wrist Anatomy Assessment (WAA) score, which consists of both palpation of carpal bony landmarks and radiographic interpretation of the carpal bones. There were 89 participants in this study. Cohorts of orthopedic residents (n = 20), emergency medicine residents (n = 21), emergency medicine attending physicians (n = 26), and 4th-year medical students (22) were used. Group size was based on 100% orthopedic resident involvement. Total WAA scores (score of 17 = 100% correct) ranged from 2 to 16, with a mean of 8.6. Carpal palpation and radiographic interpretation means were both significantly better in the orthopedic resident cohort (total WAA score, 13.8), compared with either of the emergency medicine groups (resident total WAA score, 7.5; attending total WAA score, 7.2). Orthopedic residents have a better understanding of the clinical and radiographic anatomy of the carpal bones than emergency medicine residents and attending physicians. Future research to test educational interventions to improve carpal anatomy education is warranted.     

The value of surgeons teaching anatomy to first-year medical students

By teaching anatomy well, surgeons can serve as an example to the medical students, who may gain a new perspective about our lives and the rewards of a surgical career. Surgeons can provide clinical adjuncts, offer assistance to the professional anatomists and anatomy course directors, and work with the students early in their curriculum. This system has the potential to benefit everyone.     

The historical importance of the hand in advancing the study of human anatomy

Anatomy is often considered the foundation of medical science and is basic to the education of health professionals. This report will attempt to summarize the history of anatomy from antiquity to modern times. In addition it will highlight the historical importance of the upper extremity and its relationship to the development of human anatomy as a recognized medical science.     

Gross anatomy in medical education

The present state of human gross anatomy in medical education can generally be characterized as the presentation of a large bolus of information that is swallowed and only partly digested during the first year of medical school. The subject is often taught in a depth beyond that which would be relevant to all physicians irrespective of their future professional careers. This condition has resulted from adaptive adjustments to the escalating discrepancy between a rapidly expanding knowledge base in science and technology and the relatively fixed time period for education of a physician. Initially, traditional courses retained their comprehensive character, and new information was simply piled on top of existing departmental offerings. It soon became obvious that there would have to be a reduction in time devoted to established courses and a reciprocal expansion of time to accommodate newly developing sciences. Such adjustments were painful and often led to conflicts about what comprises essential knowledge in medical education. Thus, the curriculum time devoted to human gross anatomy has been significantly reduced to accommodate new knowledge in cellular and sub-cellular structures and other disciplines. That common foundation of knowledge, skills, values, and attitudes essential to all physicians regardless of specialty is ever-changing and often debated by medical school faculty members. However, two facts are generally agreed upon: that today's medical student with a broad but perhaps thin base in science and limited direct clinical experience is not competent upon graduation to assume patient care responsibilities without supervision and that as a result, the formal education of a physician has expanded into the graduate domain.(ABSTRACT TRUNCATED AT 250 WORDS)     

Medical gross anatomy deja vu?

A retired community surgeon examines his newly acquired academic role as a teacher in an anatomy department, participating in freshman medical gross anatomy and senior elective programs. He compares a contemporary course in anatomy with his recollections of earlier personal experiences in medical school. Retiring surgeons may find important avenues of service in contributing to the education and enrichment of medical students.     

The value of surgical history

It remains a rhetorical question whether or not an understanding of surgical history is important to the maturation and continued education of a surgeon. Conversely, it is hardly necessary to dwell on the heuristic value that an appreciation of history provides in developing adjunctive humanistic, literary, and philosophic tastes. Unfortunately, modern medical historians usually hold nonmedical degrees and basically restrict themselves to research concerning medical or public health aspects of social history. Clinical surgical history is increasingly avoided because the professional medical historian has no clinical background. However, practicing surgeons, who can serve as amateur medical historians, have knowledge and experience that place them in a unique position to assess historic facts and direct surgical historic inquiry. It is my belief that if medicine were taught with a greater emphasis on the historic approach, our country's physicians would be better prepared to cope with the health care problems of the future. By increasing the number of surgeons, who as an avocation, research and write about surgical history, our ability to provide better surgical care in our nation's coming years will be enhanced.     

Can preclinical medical students be integrated into the continuing medical education process by instructing prehospital care providers?

OBJECTIVE: To develop a model introducing medical students (MS) to the continuing medical education (CME) process while simultaneously developing a curriculum to enhance the relevant surgical anatomy knowledge base of the advanced prehospital care provider. METHODS: A CME curriculum for teaching human anatomy was developed and approved by the governing state agencies for prehospital education. The curriculum focused on structures relevant to the prehospital care of the trauma patient in a case based format using common scenarios presented by surgery and emergency medicine faculty. Five year-one medical students who completed gross anatomy served as teaching staff and were given a structures list one week prior to the CME course. Human cadavers were prosected by the medical students prior to the CME program under the guidance of the surgical faculty. Course attendees and medical student staff were anonymously surveyed at the end of the program (rating scale 1 = low to 5 = high). Prehospital providers were given a multiple-choice posttest and surveyed at 3 months after the course with regard to applicability to their current practice. Data are means +/- SD. RESULTS: Nineteen licensed practicing paramedics attended the course. All of the paramedics scored above the 85% passing cutoff on the posttest (95. 6% +/- 6.2%). Instructor qualities were rated highly (4.62 +/- 0.49) with no instructor rating less than a 3. MS believed themselves well prepared to teach (5 +/- 0), and spent 2 +/- 0.81 hours in preparation. They were only infrequently faced with questions they were not well prepared to answer (1.25 +/- 0.5) and would uniformly participate in CME offerings in the future (5 +/- 0). The CME program improved the MS view of CME (3 +/- 0), prehospital education (3 +/- 1.4), and the surgeon as educator (3.25 +/- 1.5). At 3 months, the paramedics felt that the CME program significantly impacted the care they rendered (4.37 +/- 0.76), and improved their understanding of injury complexes (4.53 +/- 0.61), and resuscitation (4.26 +/- 0. 73). The cadaver course was uniformly recommended to coworkers (5 +/- 0). CONCLUSIONS: This model provided prehospital care providers direct contact with clinically relevant human anatomy, enhanced their understanding of pertinent anatomy, and positively impacted their patient care. MS were introduced to the CME process and found it to be one with which they would become reinvolved. Furthermore, the MS felt prepared to present human anatomy, met the expectations of the course attendees, improved their understanding of prehospital education, and positively altered their perception of the surgeon as an educator. This process holds promise as both a model for prehospital education and as a tool for integrating MS into the role of allied health educator early in their career.     

A surgeon's view: The decline and perhaps the fall of gross anatomy instruction

In recent years there has been an unfortunate trend to diminish the quality, content and instruction of gross anatomic structure in our medical schools. The preoccupation with cash-generated research has accelerated this decline and deemphasis. Research is necessary but should not be substituted for sound basic and practical instruction. In recent years departments of anatomy have become staffed and controlled by nonphysicians who often seem to have withdrawn from their medical school mission and have attempted to establish research institutes of ultrastructure, histochemistry and cell or experimental biology, and as a result display less than an altruistic and proportional interest in providing useful and medically correlative instruction to our future physicians. To reverse this unfavorable trend, clinicians must again resume their active traditional control of the medical curriculum and education. Clinical correlation of basic gross anatomic information is necessary and can, in fact, be readily attained by using clinicians, particularly surgeons, for anatomy staff and instructional purposes. The major factors contributing to the decline and deemphasis of the study of gross anatomic structure have been reviewed.     

Calling the heart by name: distinguished eponyms in the history of cardiac anatomy

Many outstanding scientists have given their names to anatomic structures through time. Recently the use of eponyms has been at the center of a very interesting debate in the columns of prestigious medical journals. Even if some authors have questioned their adoption, not only do the names of great figures in the history of medicine appear inextricably linked to human body structures but they also have been widely adopted. Eponyms enliven medical study and practice by representing major mnemonic aids for students and learners and opening intriguing scenarios on the history of health. Given that physicians frequently are unaware of exactly "who stands behind" a name, this article presents a reconstruction of how eponyms for cardiac structures have developed through time and provides scientific profiles of the personages after whom heart districts have been named. The article is offered in the awareness that scientists of different countries and different ages have contributed to the elaboration of the knowledge of cardiac anatomy, according to their personal skills and to the health technology available in their particular times and places.     

Endoscopic Sinus Surgery Simulator as a teaching tool for anatomy education

BACKGROUND: Virtual reality simulators provide an effective learning environment and are widely used. This study evaluated the Endoscopic Sinus Surgery Simulator (ES3; Lockheed Martin) as a tool for anatomic education. METHODS: Two medical student groups (experimental, n = 8; control, n = 7) studied paranasal sinus anatomy using either the simulator or textbooks. Their knowledge was then tested on the identification of anatomic structures on a view of the nasal cavities. RESULTS: The mean scores were 9.4 +/- 0.5 and 5.1 +/- 3.0 out of 10 for the simulator and textbook groups, respectively (P = .009). Moreover, the simulator group completed the test in a significantly shorter time, 5.9 +/- 1.1 versus 8.3 +/- 2.0 minutes (P = .021). A survey asking the students to rate their respective study modality did not materialize significant differences. CONCLUSION: The ES3 can be an effective tool in teaching sinonasal anatomy. This study may help shape the future of anatomic education and the development of modern educational tools.     

Medical education: a continuum in disarray

I have addressed the issue of medical education from the standpoint of a person who has been actively involved in the field for more than 30 years. The enthusiasm for technologic advancements and the emphasis on a regulated life with adequate creature comforts has made the teaching of the basics of good medicine, that is, listening carefully to the patient and examining carefully all of the patient, at best, a secondary effort. This has been enhanced by the emphasis in medical schools on research and the results of research, publications which are more often than not counted or weighed rather than read. Suggestions for change include (1) putting the patient first in the health care equation; (2) rewarding teaching and clinical care equally with research; (3) placing real clinicians on medical school faculties; and (4) establishing a national health service in which all medical school graduates must serve in physician-sparse areas for a period of time after graduation, preferably without a single computerized tomography scanner, magnetic resonance imaging unit, or advanced radiologic imaging device within reach.     

Team-based learning methods in teaching topographical anatomy by dissection

Background: While the effectiveness of teaching human topographical anatomy by groups of medical students carrying out embalmed cadaver dissections has been recognized for centuries, the mechanisms by which this teaching is so effective have not been well described. Methods: In the recently reintroduced 7‐week elective anatomy by whole body dissection course for senior medical students at Sydney Medical School, team‐based learning (TBL) principles were used in the course design and implementation. In the 2011 course, 42 senior medical students participated. The effectiveness of TBL pedagogy was assessed by knowledge acquisition and retention and by administration of a questionnaire to evaluate the impact of the principles of this pedagogy. Results: The course produced a marked increase in topographical anatomical knowledge. The median pre‐course assessment score was 9/20 (interquartile range 5) and the median post‐course assessment score was 19.5/20 (interquartile range 1.75). The difference was statistically significant (P < 0.001). There was near universal agreement by students that five key principles of TBL (small groups, instructor selected allocation to groups, regular assessments, inter‐ and intra‐group competitiveness, and prescribed out‐of‐class preparation), contributed to this knowledge acquisition. Conclusion: The application of TBL methodology to teaching human anatomy by dissection enables a large group of students to have small group experiences without a large number of teachers. It results in effective acquisition of topographical anatomical knowledge and appears to provide better acquisition of such knowledge than the previous methods of anatomy teaching to which these students had been exposed.     

Business knowledge in surgeons

BACKGROUND: Surgeons and residents in training receive little, if any, formal education in the economic side of clinical practice during medical school or residency. As medical professionals face shrinking reimbursement, loss of control over health care decisions, and limited resources, surgical specialties must reevaluate the need to teach their members business survival skills. Before designing business related-teaching modules, educators must know the exact gaps in knowledge that exist among surgeons. METHODS: This article reports a survey of 133 surgeons in the Midwest who were asked to rate their knowledge base in 11 business topics relevant to the practice of medicine. RESULTS: The survey showed that the average surgeon perceives himself or herself to be poorly equipped to understand basic financial accounting principles, financial markets, economics of health care, tools for evaluating purchases, marketing, budgets, antitrust and fraud and abuse regulations, and risk and return on investments. CONCLUSIONS: Armed with this data, teaching faculty, health care systems, and medical specialty societies should design business education seminars to better position surgical specialists and trainees to communicate with insurers, hospital administrators, health care organizations, and their own personal financial advisors.     

Trainer-to-student ratios for teaching psychomotor skills in health care fields, as applied to osteopathic manipulative medicine

The hallmark of osteopathic medical education is the inclusion of hands-on instruction in osteopathic manipulative medicine (OMM), which includes palpatory diagnosis and osteopathic manipulative treatment (OMT). This OMM training typically involves a primary instructor presenting theory and techniques with step-by-step demonstrations to a large group of first- and second-year osteopathic medical students. Additional instructors, referred to as table trainers, assist the primary instructor by supervising the students as they practice the presented techniques. To the authors' knowledge, there is no currently accepted standard for a table trainer-to-student ratio in OMM skills laboratories within osteopathic medical schools in the United States. However, through a Google Web search and PubMed literature review, the authors identified published trainer-to-student ratios used in other health care skills training curricula. Psychomotor skills training courses in health care fields typically have a table trainer-to-student ratio of 1 trainer to 8 or fewer students. On the basis of these findings and psychomotor skills learning theory, the authors conclude that this ratio is likely sufficient for OMM skills training.     

Medical education and surgical residency program for general thoracic surgery

We introduced medical education for general thoracic surgery to medical students and a new surgical residency program to instruct residents who aspire to become general thoracic surgeons. It is important to understand the etiology of thoracic diseases, methods of diagnosis for tumorous lesions, anatomy of the interior thorax, surgical therapies and indications for thoracic diseases, and management of perioperative periods in the medical education of general thoracic surgery. According to the new residency program, a surgical resident must complete a super rotating system that consists of the subjects of internal medicine, general surgery, emergency and critical care medicine, anesthesiology, pediatrics, gynecology, and local healthcare for several months each in the first two years. On the other hand, a surgical residency program includes core surgical residencies to train clinical patient-care oriented surgeons and advanced residencies in such areas as thoracic surgery, cardiovascular surgery, pediatric surgery, and digestive organ surgery. Residents who want to become general thoracic surgeons must complete 350 cases of general surgery including at least 120 cases for an operator in the first 4 or more years in core programs. After passing the board for general surgery, they can advance to a subspecialty program for thoracic surgery in the final 3 or more years to pass the board for general thoracic surgery. It is essential to train the general thoracic surgeons who empathize with patients with thoracic diseases and can contribute to overcoming thoracic diseases by practicing evidence- or science-based medicine.     

Endoscopic anatomy of the ulnar nerve: a useful adjunct to teaching anatomy

INTRODUCTION

There has been a shift away from gross anatomy teaching and hands-on cadaveric dissection. This has been replaced by a variety of teaching modalities including problem-based learning, models and prosections, and computer-assisted learning. We aim to pilot a technique of endoscopic visualisation of upper limb anatomy, to produce a video that can be incorporated into anatomy teaching and to assess the video qualitatively as an adjunct to anatomy teaching.

MATERIALS AND METHODS

A single, previously undissected, formalin preserved cadaver was used and views were obtained of the left arm. The video was shown to 10 surgical trainees who were then asked to complete appraisal forms anonymously.

RESULTS

The endoscopic views were thought to be useful and helped the trainees to appreciate the in situ anatomy and potential sites of nerve compression. 70% of respondents would recommend the system to others.

CONCLUSIONS

We feel this represents another method to help in the understanding of a complex area of anatomy in a way that is unique to endoscopy.     

The Time Is Now: Formation of True Transplant Centers

With the advances in the complexity of medical care there is a need to change the way we are organized in order to deliver that care in the most patient‐friendly, efficient manner. This need is perhaps most compellingly manifest in the field of whole organ transplantation. Yet we are trying to deliver medical care with an organizational structure that was developed over 100 years ago when medical practice was considerably different. We argue for the development of a vertically integrated organizational structure in academic health centers for certain disciplines like transplantation. While this new arrangement for medical practice could be applied to many areas of medicine, transplantation is one of the best fields to begin making these changes. True transplant centers would bring avoid fragmentation of care and resources, thus bringing together the medical school and hospital into an integrated organization that would be responsible for all aspects of transplantation such as patient care, research, education and fiscal issues.