Superspecializations in anatomy: A step forward in order to improve medical education and clinical practice

Abstract

The anatomy has been the cornerstone of medical education, since time immemorial.[1] For it lays the foundation of all medical curricula and provides the anatomical basis of clinical practice.[2] Traditionally, anatomy is mainly taught to 1st-year medical students, although the knowledge attained is required by them throughout their clinical careers. Anatomical knowledge is vital for a clinician, helping them identify the embryological and anatomical basis of various diseases. It is also required for proper clinical examination, interpretation of signs and symptoms, and radiological images.[3] The curriculum is designed in such a way that even though it is taught, during the clinical posting of medical students but, the teacher here is the clinician and not an anatomist. This editorial talks about the need for specialized anatomists. For the past 30 years or so, clinicians, particularly surgeons, have felt that there is a definite decline in knowledge of the anatomy of newly passed medical graduates. The students with decreasing knowledge of anatomy show their disability to apply knowledge in diagnosis and problem-solving.[3] Although it is difficult to assess the reason objectively, the possible reasons could be (a) drastic reduction in allocated time for anatomy teaching, (b) poor teacher–student ratio,[4] (c) lack of proper cadaveric dissection, (d) use of new technologies in teaching, (e) too much research work by teachers without proper facilities and guidance,[5](f) nonexposure of teaching faculty to patients care, etc. The proper knowledge of anatomy is the utmost for doctors in order to do the proper and safe clinical practice. The decline in knowledge of anatomy is hazardous not only to medical profession but also to society. Recently, National Medical Commission (NMC) has been constituted in India by an act of parliament known as NMC Act, 2019, which came into force on September 25, 2020, by a gazette notification dated: September 24, 2020, with mission and vision to improve access to quality and affordable, medical education, and ensure availability of adequate and high-quality medical professional in all parts of country.[6] The competencies provided by NMC are well thought and well planned to teach anatomy but difficult to implement properly, due to limited time allocation, late admission, decreased teacher–student ratio, and nonexposure of faculty to clinical procedures and practice. As discussed earlier, the knowledge of anatomy is of paramount importance to successful medical practice. The inadequate anatomical knowledge of clinicians is hazardous for successful clinical practice.[7] Further, nowadays, there is a huge public and media pressure on clinicians to have proper knowledge of anatomy. This is because public interest and knowledge of anatomy has been increased in the recent past due to adequate public exposure through various educational programs run on YouTube and television talking about the structure and functions of the human body. In one of the recent polls, it has been found that about 90% general public think that clinicians should have practical experience of real human anatomy. The inadequate anatomical knowledge for clinicians is hazardous for successful clinical practice.[7] The discrepancy in public expectation and actual knowledge of the clinical anatomy of a clinician may lead to future legal claims. Therefore, it has been thought that the following reforms should be done by the competent authorities. The anatomy should not only be taught to students during 1st year but also during their clinical years subject-wise by specialist anatomists in that field. This is possible only if the anatomists are superspecialized in the area related to a particular clinical subject, namely anatomy in radiology, forensic medicine, general surgery, orthopedic surgery, pediatric surgery, ENT surgery, skull base surgery, cardiac surgery, reproductive biology, and so on. Therefore, it is felt that the time has come when during postgraduation in anatomy, the topic of their thesis should be related to one of the specialties of clinical medicine. There must be a collaboration between the anatomy and the clinical departments. The thesis work should be done in collaboration of the faculty of that particular clinical specialty. After passing their postgraduation these, the concerned students should be awarded, their postgraduate degrees as under: MD Anatomy (Radiology and imaging) MD Anatomy (Forensic science) MD Anatomy (Reproductive biology) MD Anatomy (Orthopedic surgery) MD Anatomy (ENT surgery) MD Anatomy (Skull base surgery), and so on. After getting MD degree in specialized anatomy, these anatomists can, provide clinical anatomy education to students during their clinical years with ease and efficiency. This will not only improve rather greatly enhance the knowledge of the anatomy of clinicians to do the safe and efficient clinical practice.