Modern Approaches to Teaching and Learning Anatomy

Author(s): John Collins

Source: BMJ: British Medical Journal , Sep. 20, 2008, Vol. 337, No. 7671 (Sep. 20, 2008),
pp. 665-667
Published by: BMJ

Stable URL: https://www.jstor.org/stable/20510877

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Modern approaches to teaching and
learning anatomy
The view that new doctors have inadequate knowledge of anatomy is not supported by
the evidence, argues John Collins, but greater effort is needed to capitalise on the learning
potential of new technologies

Recent reports from the United Kingdom' Media coverage of the introduction of This provides the foundation that will help
and Australia' claim the teaching and learn newer methods for teaching and learning students to develop the logic, inference,
ing of anatomy in universities is in crisis. anatomy has tended to focus on the nega and problem solving needed to diagnose
This is attributed to less time being allocated tive, with little if any discussion of the value and manage patients.
to the subject and decreased opportunities of cadaver dissection." Last year, the Austral Anatomy must be taught and learnt
to dissect cadavers. Although everyone ian reported, "Less than four in ten medi within a context that is clinically meaning
would agree anatomy is important, few cal students agreed they will know enough ful and related to the competencies required
lament the move away from endless hours anatomy to become competent by new medical graduates so
of cadaver dissection and didactic lectures. doctors."2 This was based that students understand
Efficient use of new technology and teach on responses from stu its relevance to their
ing methods should allow better teaching dents to a survey future practice."
and understanding. conducted by the As s e s s m e n t
Australian Medi must similarly
Is anatomy teaching in crisis? cal Students' focus on tasks
The evidence most frequently quoted for Association.7 that resemble
the so called crisis is Raftery's assertion However, half realistic clini
that there has been a "vast increase in of respondents cal problems
claims associated with the lack of anatomi had not started and reward
cal knowledge."3 This claim was based on the clinical com integration and
the finding that "damage to underlying ponent of their application. "'
structures" was the commonest reason for course7 and were Unfortunately,
settlements of claims relating to general therefore not well placed assessments often cen
and vascular surgery.4 Lack of knowl to judge the level of anatomy tre on factual recall of isolated
edge of anatomy is but one cause of such required by a medical graduate. fragments of information, which encour
intra-operative errors, albeit an important ages superficial learning with subsequent
one. And many of the errors are likely to Challenges of teaching anatomy poor retention and application to medical
have been made by surgeons who gradu Those responsible for courses in anatomy problems. I"
ated before changes in the teaching of face daunting challenges. Confronted with
anatomy. A reduced focus on learning and a dwindling number of tutors and reduced Methods of teaching and learning
assessment of anatomy in some postgradu teaching time, they must deliver new cur Although an understanding of anatomy
ate surgical training programmes has been riculums to an expanding and increas is fundamental for clinical practice, many
reported3 and may be important. ingly diverse student population through other topics compete for a place in the cur
a more learner centred approach. This is riculum. The time allocated to anatomy in
Successful teaching and learning in anatomy taking place at a time of changing models of medical school is unlikely to increase, and
The curriculum, teaching, and assessment must delivering education and rapidly expand the focus must therefore move to the cur
encourage the learning of clinically meaningful ing instructional tools such as new imag riculum and methods used for its teaching
anatomy ing and telescopic views of the living body and learning. The time honoured learning
* Prosected cadaver specimens, life models, that are easily accessible on CD-ROMs of gross anatomy through the visual and
radiological images, and telescopic views of and web based resources. The challenge is tactile experience of cadaver dissection,
the living body maximise learning even more formidable given the dearth of supplemented by lectures and tutorials has
* Cadaver dissection should be reserved for empirically tested evidence related to the been added to by other methods. These
those contemplating a surgical career learning, assimilation, and application of include problem based learning and the use
* Departments of anatomy must form closer knowledge of anatomy.8 of prosected cadaver specimens, life mod
links or integration with those in surgery or
els, radiological images, and laparoscopic
radiology
Learning, assimilation, and recall views of the living body and interactive
* All clinical teachers must take greater
The real objective of learning anatomy is to multimedia packages. " 12 Today's students
responsibility for sequential teaching of
anatomy across the continuum of learning
integrate an understanding of normal func are used to receiving information through
tion with recognition of normal structure. new technology and can readily make use

BMJ 120 SEPTEMBER 20081 VOLUME 337 665

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| ANALYSIS

of multimedia resources. So how can we ture, but the rigidity of the tissues limits its effective teaching and learning opportu
ensure doctors have an adequate knowledge use to visualisation. nity. For example, they can provide live
of anatomy? views of the structures in the peritoneal
Life models cavity or knee joint and internal views of
The curriculum The use of life models in the study of the the viscera.
The introduction of new disciplines into living body has been neglected in teaching
undergraduate teaching led to a reduction and assessment. Living anatomy enables Comparison of outcomes between different
in the anatomy curriculum.'3 This reduction the learner to see structures move and func methods
made it vital to identify which aspects of tion,'7 9 particularly in the musculoskeletal Support for dissection as the pre-eminent
anatomy every newly qualified doctor prac system, and to become familiar with impor teaching and learning method is based more
titioner should know. A new core syllabus tant surface landmarks. It also provides on emotive arguments than scientific evi
in anatomy for all doctors developed on students with the opportunity to observe, dence. Descriptive papers and professional
behalf of the Anatomical Society of Great examine, and interact with a living person. opinions are common, but scientific evi
Britain and Ireland attempts to set the stand dence of its superiority is lacking.20 No dif
ard required for safe and effective clinical Radiological imaging ference was found in the level of knowledge
practice.'4 Similarly, specialty colleges such Imaging techniques such as computed of anatomy between those who learned
as surgery are moving to a generic core cur tomography, magnetic resonance imaging, through prosected specimens and those who
riculum for all of their trainees, with the positron emission tomography, and dissected cadavers.20 There are no reliable
addition of more detailed anatomy when ultrasonography have provided fresh studies on long term retention and recall
required for individual specialties.'5 opportunities to present anatomy to medical of anatomical knowledge, and claims that
students and graduates. Cross sectional and today's graduates know less anatomy than
Cadaver dissection functional imaging show three dimensional in the past are unsubstantiated.
Dissecting cadavers helps gain an under anatomical relations as well as help
standing of the three dimensional structure students to understand physiology. Real New approach
of the human body through self discovery time techniques can show processes such Medical education has changed from when
and observations. It also helps to develop as the beating heart. Because images can be newly qualified doctors were allowed to
the spatial reasoning skills necessary to recorded and stored digitally, they can be practise unsupervised.2' Today's focus is on
understand and interpret imaging data.'6 analysed in detail during teaching. continued learning, and all medical gradu
However, dissection of cadavers is expen Computed tomography and magnetic ates must have further education, training,
sive, time consuming, and emotionally dis resonance imaging offer unique teaching and assessment before proceeding to inde
turbing for some students.'7 Furthermore, opportunites. Multidetector computed tom pendent practice.
the preserved tissues don't always provide ography provides clear anatomical detail It is the responsibility of universities to
an accurate impression of the living body. in the axial and reconstructed sagittal and ensure medical graduates have mastered
The role of dissection in developing dex coronal planes. The images can be manipu the fundamental principles and core knowl
terity skills'8 is limited and has been super lated to remove irrelevant tissues such as edge of anatomy necessary to start clini
seded by the more versatile environment of bone, allowing detailed study of particular cal practice (box). Equally, postgraduate
skills laboratories. organs and their relations to the vascular medical colleges or education bodies are
Dissection of cadavers is of value prin anatomy. This applica accountable for making
cipally for those contemplating a career in ton of advanced imaging "The real objective of leaming certain that their gradu
surgery. Anatomical dissection is not a pri is the modem equivalent anatomy is to integate an ates are proficient in the
mary learning method because pupils must of traditional anatomical understanding of normal more detailed anatomy
know in advance what to look for in order dissection. Magnetic res function with recognition of required for a particular
to achieve the greatest benefit. onance imaging provides specialty.
normal structure"
clear images of different The undergraduate
Prosected cadaver tissue intracranial structures and of muscles, ten programme should be principle based
Prosected cadavers provide learners with dons, ligaments, cartilages, and nerves that (start with general anatomy) and problem
pre-dissected material. They maximise the are not available by other means. It can also directed (incorporate clinical anatomy) to
increasingly scarce resource of cadavers and be used to study brain function and cerebral help students develop the capacity to under
teachers and make more time available for blood flow. Positron emission tomography stand and interpret the living anatomy that
teaching, learning, and revision. Wet pros has opened up new methods of studying they will encounter. Prosected cadavers can
ected tissue enables the learner to explore, functional anatomy at a molecular level. enhance this learning experience, but dis
visualise, and understand the inter-relations Telescopic views of internal living anat secting cadavers is beneficial only in spe
of anatomical structures. Plastinated pros omy obtained during diagnostic and thera cialties requiring more detailed anatomy.
ected material is more robust and can be peutic procedures, including minimally Modern radiological imaging and telescopic
handled safely and stored at room tempera invasive surgery, provide a realistic and views of the living body supplemented by

666 BMJ 120 SEPTEMBER 2008 1 VOLUME 337

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 ANALYSIS]

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