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Anatomy teaching in United Kingdom is in crisis, new report says

BMJ 2007; 334 doi: http://dx.doi.org/10.1136/bmj.39080.510394.DB (Published 04 January 2007) Cite this as: BMJ 2007;334:12
  1. Roger Dobson
  1. 1Abergavenny

    Changes at undergraduate and postgraduate levels are needed to reverse a decline in the teaching of anatomy in the United Kingdom, says a leading article in Surgery.

    The article, which was published online on 14 December (www.sciencedirect.com, doi: 10.1016/j.mpsur.2006.11.002), cautions that the number of claims submitted to the Medical Defence Union associated with a lack of anatomical knowledge has increased hugely. “A large proportion of these relate to damage to underlying structures,” it says.

    The article, by Andrew Raftery, a consultant general surgeon at Sheffield Teaching Hospitals NHS Foundation Trust, says that anatomy is experiencing a worldwide decline that may soon lead to it disappearing altogether from undergraduate medical education.

    “The teaching of anatomy to both undergraduate medical students and postgraduates is in decline,” it says. “The traditional teaching of anatomy, based on topographical anatomy taught by didactic lectures, tutorials and dissection of the body with personal tuition, has been largely replaced by a range of other teaching modalities. Reform is being driven by enthusiasm for change rather than by a rational response to the shortcomings of the traditional curriculum.”

    It adds, “The ‘modernist' approach to teaching anatomy depends upon pro-sections (at the best), problem-based learning tutorials, special study modules (student-selected components), CD ROMs and plastic models (at the worst).”

    It says that the old “primary” examination of the Royal College of Surgeons required an intimate knowledge of anatomy. Now membership involves only a multiple choice questionnaire and a viva examination lasting just 10 minutes.

    The article says that at undergraduate level a core curriculum providing an anatomical basis for examination of patients, interpretation of imaging, and safe conduct of basic interventional procedures is needed.

    It says that a common national core curriculum for undergraduates must be agreed: “This must be externally audited or validated. The dissecting room must have a place in both undergraduate and postgraduate education. The cadaver must not be dismissed as an obsolete teaching aid.”

    At postgraduate level, it says, the colleges and schools of surgery must provide exposure to anatomy, with appropriate courses and the resurrection of demonstrator posts.

    It says that candidates should sit a tough examination in anatomy at a very early stage to be certain that they know their anatomy before they start practising on patients. “Anatomy must not be taught at the operating table through the window of the operation. It should be studied and understood before the trainee gets to the operating table.”