Demonstrating anatomy⇓
BMJ 2004; 329 doi: https://doi.org/10.1136/bmj.329.7466.s103-a (Published 11 September 2004) Cite this as: BMJ 2004;329:s103
Abstract
With fierce competition for surgical training posts, many junior doctors consider working for six months as an anatomy demonstrator to help revise for postgraduate exams and to improve their CV. Samena Chaudhry and Jonathan Horsell share their experiences of different posts
The Cambridge experience: Samena Chaudhry
As a senior house officer (SHO) in orthopaedics, whether I was trying to interpret x rays or make it through the consultant's questions in theatre, my knowledge of anatomy always seemed to let me down. I realised that revising for postgraduate exams seemed less of a priority after I'd worked a busy shift. There is also the safety net of “next time round” if you fail.
So I made a decision to focus on the MRCS (membership of the Royal College of Surgeons), and my surgical tutor allowed me to take the next six months out of my rotation to take up a post as an anatomy demonstrator, teaching medical students at Cambridge University.
Our role
The role of anatomy demonstrators in the United Kingdom varies between medical schools and ranges from supervising student-led dissections to small group teaching with prosected specimens. We also help students to understand the clinical relevance of anatomy.
I work with a group of 10 other demonstrators and form part of a wider team which includes retired doctors and surgeons who have been teaching anatomy for many years. Between us we are responsible for all the student-led dissection sessions, which last for more than two hours and run four times a week for each group of students. We also help to organise medical students' exams.
Pre-session briefings
Before each new teaching session, the clinical anatomists who run the course make sure that we are able to teach the students. They expect us to be familiar with the course manual and they review the session with us and stress the important concepts. The challenge is that we are not meant to teach in these sessions, but to enable and facilitate the students to learn for themselves. This is not easy, and dissection sessions can quickly become mini-lectures if we are not careful.
Professional development
Weekly sessions run by the department are geared for demonstrators preparing to sit membership exams and are an extremely useful aid to revision for the MRCS. These teaching sessions involve learning from prosections, as well as viva practice.
Not an easy option
Demonstrating anatomy is good fun but hard work and needs lots of revision. It was embarrassing to find that there were so many areas of the body I did not even remember covering as a medical student. I often felt frustrated at my ignorance about the questions students continually ask. Saying “I don't know” to a first year medical student was a humbling experience.
Away from the hospital
After 18 months of busy hospital life, it has been refreshing to be in such a different environment. It provides fantastic learning opportunities, especially from the retired surgeons we work alongside, who have such a breadth of experience. We've had the chance to learn the anatomy of the human body in great detail and understand many clinically relevant procedures.
Learning how to teach a group of students certainly gets better with practice. It's surprising how being able to share your clinical experiences can make learning anatomy a lot more interesting for the students too. Being in a university department can also give you a chance to do some research.
Unfortunately, the pay is generally not good, so many anatomy demonstrators do locum work in their spare time. Most of the demonstrators at Cambridge work a week of nights every third week as a resident medical officer (RMO) at one of the local NHS hospitals and although this can provide good clinical experience, it disrupts your work pattern as an anatomy demonstrator.
Some demonstrators cover the private Nuffield hospital, working a 1:4 shift pattern. Here, the shifts are generally quiet enough for you to revise or carry on with research projects and there is often the valuable chance to assist general, ENT, orthopaedic, gynaecology, and dental surgeons with operations.
Final thoughts
All in all, I would definitely advise anyone who has completed house jobs to consider anatomy demonstrating rather than getting caught up in the rat race of getting the best SHO jobs, passing exams quickly, and becoming a specialist registrar. Also, becoming an anatomy demonstrator is useful for other specialties, such as radiology and pathology.
The Bristol experience: Jonathan Horsell
Why do it?
I started thinking about doing a job as an anatomy demonstrator when I was a clinical medical student and ashamed about my ignorance of anatomy in theatre and the wards. As I progressed through my house officer year towards a surgical career I realised that to have the confidence to perform surgical operations well required a level of anatomical knowledge that I simply did not have.
I wanted to do as much teaching as possible, but felt that I needed to have a solid understanding of the subject matter first. In Bristol, each demonstrator has 21 hours of student teaching time per week. The students don't do any dissecting themselves so you are essentially giving seven three-hour anatomy tutorials using either your own dissections or prepared prosections on cadaveric material.⇓⇓
Credit: MEDICAL ART SERVICE, MUNICH/WELLCOME LIBRARY
By completing dissections yourself (an opportunity I did not have at medical school), you get to understand the relationship of structures as they actually are in the body. Also, to be able to teach this amount of material requires a lot of preparation and reading. The bonus is that you very rapidly learn large amounts of anatomy and teaching consolidates what you have learnt.
On the job
The majority of our teaching involves presenting prosections as well as radiological material and surface anatomy. As the students progress into their second year the emphasis becomes more clinical, with the teaching programme broken down into systems modules and we introduce some basic clinical examination skills.
A large amount of the work is spent refamiliarising yourself with the material you will be teaching. Medical students can be an inquisitive bunch; their questions are often challenging, and they soon realise when you are out of your depth.
Outside term time our focus shifts to preparing prosections for future sessions. The department also encourages allied medical professions to make use of the facility and we have recently been involved in teaching anatomy courses to physiotherapy students, chiropractors, radiography students, surgical nurse practitioners, and emergency nurse practitioners.
Pay and locum work
We are paid on the senior house officer scale and are employed full time by the university with no outside clinical commitments. We are not encouraged to do locum work and certainly during term time the amount of work to be prepared each week means that there is little scope to do any locum shifts.
Advice to others
I would strongly recommend this job to others. The sense of responsibility in teaching future doctors and dentists and the pride in helping students to understand a topic means that a lot of preparation goes into each different session.
Regular contact with the same students has been rewarding and enjoyable. As medical student numbers increase we are often the only members of department who they see regularly and are often the first point of contact in times of need.
One drawback of teaching within the university setting is that the traditional dates for NHS job changes don't coincide with student terms. In Bristol the demonstrator job runs for six months and so those of us who start in February start in the middle of the second term. This gives us no run-in time and means we have very little chance to familiarise ourselves with the specimens.
Strongly recommended
All in all I would strongly recommend the job. I believe it is a valuable addition to anyone with surgical career plans and will undoubtedly prove highly useful both when I return to clinical practice and with MRCS exams.
Anatomy is so much more easily learnt from cadaveric material than it ever can be from two-dimensional text books, and I hope this greater understanding of anatomy will benefit me in the future.