Why teach anatomy? Anatomists respond

Abstract

From the time of Aristotle, the study of relationships between form and function in the living world has been considered a fundamental part of education in the life sciences (Blits, 1999). That is, some would argue, until recently. Not long ago, almost every biological science graduate was required to demonstrate some skill in dissection and conceptualization of model organisms. Medical students spent fruitful hours with cadavers and tissue slides under the tutelage of anatomy and histology professors, gaining a working knowledge of the human body that served as the basis of their medical education. Today, modern molecular biologists earn impressive degrees, and pursue fundamental questions of developmental genetics and molecular medicine, without ever having taken a single unit of basic histology or development. More alarming is the erosion of medical school gross anatomy courses, from a cornerstone in the first year curriculum to sometimes a 4- or 5-week, multiple-choice survey class with little cadaver time (if any). Often anatomy hours fall victim to additional material in the core medical curriculum focusing on the cutting edge of biotechnology, diagnostic instrumentation, and the ever-complex and growing area of pharmaceutical intervention. That the question “Why teach anatomy?” can, in all seriousness, be asked of anatomists today, and provoke concerned responses from students and faculty alike, is further cause for concern. “It amazes me,” complains one respondent, “that the structure of the human form is being emphasized less and less and that there are even discussions like this.” Perhaps it should be considered a wake-up call to anatomists and medical school curriculum developers around the world that, if we are not careful, medical researchers of the 21st century—the promised Century of Biology—will have little working knowledge of arguably the first and foremost discipline of biology itself. With the dawning of the third millennium upon us, it seems more evident that a lack of adequate anatomy training in education and research will impinge on the ultimate progress of the biomedical research enterprise as a whole. In commenting on this almost offensive question, many respondents were frustrated by diminishing anatomy education hours and choosing priorities for what material should be retained. “[Our university] is in the process of introducing a new modular course [for medical bachelors students]. The anatomy course has been cut by two-thirds and is now integrated with physiology.” In considering the alternative to traditional anatomy education now offered—presentation of fewer topics in greater depth—this distraught anatomist asks “How much is enough?” One could interpret the implied subject of this question as either hours of anatomy education, or the actual cutting thereof from the curriculum. The answer to either question begs for serious value judgements on the part of curriculum and course developers. “Anatomy, especially gross anatomy, should be of [growing] interest in medical education now,” argues another respondent. Given rising costs for treatment in all medical fields, this anatomist suggests that physicians with “a thorough knowledge of anatomy [would be able to] limit the use of expensive techniques of diagnosis” that may otherwise be unnecessary. Indeed, modern physicians may be a bit too quick to order an MRI, CT, or expensive laboratory test when perhaps much data could be gained more rapidly through conventional radiography and the traditional hands-on investigative techniques of an experienced diagnostician. An aggressively litigious society may be responsible for an upswing in use of high-tech, high-cost diagnostics as lawsuit-fearing practices and HMOs strive to cover their “assets.” As health care providers try to squeeze every penny out of scarce insurance dollars and avoid costly malpractice litigation, maybe they will come to realize that improved education of doctors in the basics of anatomy, rather than the hottest new detection system, could in the long run be the most cost-effective approach to improved diagnosis. On the other hand, MRI and CT are medical facts of life. One experienced anatomist points out, “The almost universal use of MRI and CT technology, which is simply anatomy in vivo, should mandate comprehensive anatomical training in the medical curriculum.” The respondent goes on to ask: “Are we, as anatomists, allowing this totally unique opportunity of embracing MRI as in vivo anatomy to slip away?” The most scathing indictment of the current medical education program came from a specialist in vertebrate anatomy who has taught at the medical and undergraduate levels. “The greatest incompetence I see in the medical profession today is a lack of knowledge about the human machine. Much money, time and, trouble would be saved with more emphasis on the structural and functional relationships within the human body.” To blame, in his words, is “the poor teaching of anatomy at the medical school level. This results from the fact that many professors teaching anatomy in medical schools are not really anatomists,” but rather, molecular biologists who teach anatomy without insight or in some cases without so much as ever having had an anatomy course (see Coleman, 1998; Moore, 1998). In the latter case, the quality of instruction may suffer. “The students see [anatomy] as just a bunch of facts, and never really learn what a powerful tool anatomy can be in the practice of medicine. With the right understanding of anatomy it can become one of the most powerful diagnostic tools available to a doctor.” Indeed, one wonders about the anatomical knowledge of a physician who accidentally amputates the wrong foot! If medical schools want to consider reducing or dropping anatomy course hours, this anatomist contends that they should “require all medical school applicants to have an anatomy course as a prerequisite, just as they do [for] chemistry. [In] this way students would come into medical school much better prepared and the medical school anatomy [course] could become advanced and focused. While I am not down playing chemistry, a year of good anatomy is much more important to a potential doctor than a year of chemistry.” Computer-assisted learning environments (CALs) are more often being integrated into the gross anatomy lab and, argues one concerned anatomist, can actually be used to show how useful anatomy is. “CAL programs should enhance ‘hands-on’, ‘eyes-on’ tutor-led gross anatomy teaching, rather than replace it.” Though this space is not an adequate forum to present the current debate on the use of cadavers versus CAL programs and “virtual autopsy” in medical education, much has been written on the subject in this journal (Moore, 1998; Drake, 1998) and elsewhere (e.g., Jones, 1997);. Yet, how many of us would be satisfied to have a physician who learned his or her anatomy from a computer alone? What is crucial is the argument, put forth by this anatomist and many others, that CALs can never fully replace the intellectual, educational and emotional experience afforded to medical students by cadaver dissection and even prosection (Coulehan et al., 1995; Jones, 1997; see also Tschernig et al. [2000] in this issue). Anatomy advocates do not contend that the future of medicine alone is threatened by the diminishing breadth of anatomy education in general. Basic biomedical research also may fall victim to insufficient anatomy training. With the publishing of the complete C. elegans genome sequence in early 1999 and the completion of the human and other organismal genome projects imminent, the thrust of bioscience in the 21st century will be to unlock the complete genetic program—the timing, regulation, and interaction of gene products in the context of the whole model organism or human. In order to succeed, the very same “molecular age” scientists who will decipher an organism's genetic complement will then have to define those molecular data with respect to organismal development, physiology, pathology, and senescence. As stated by one anatomist: “The cell or molecular biologist conducting research at the cellular level, but who cannot recognize the histologic difference between the parotid gland and the pancreas, is self-limited.” “Ultimately, molecular geneticists must learn to interpret gene expression patterns in a mouse or rat or worm, a three-dimensional organism with tissues, organs and segments or limbs that interrelate,” comments a molecular biologist with significant anatomy training. “Full appreciation of development requires more than just a superficial understanding of anatomy. For many [untrained investigators] their only anatomy guide may be an atlas or textbook grabbed off the shelf, a brief skimming of the relevant literature, or that Emeritus Anatomy Professor in the dusty office down the hall. Such a tire patch approach to knowledge in research comes from inadequate grounding in the fundamentals of anatomy and development, and will hurt the modern researcher of the Genome Age in the long run.” With the dawning of the third millennium upon us—actually, the fourth for anatomy as a science—it seems more evident that a lack of adequate anatomy training in education and research will impinge on the ultimate progress of the biomedical research enterprise as a whole. We encourage readers to address this extraordinarily important topic by way of Letters to the Editor. If you wish to comment on this topic more formally, please contact Duane E. Haines (Chairman) or other members of the Editorial Advisory Board, or the Managing Editor, for more information. Don't let the Century of Biology forget whence it came: from a history built upon Anatomy.