The Raven Department of Education, at the Royal College of Surgeons of England, holds a conference to raise awareness of the issues surrounding anatomy teaching in the UK; chaired by Mike Baker (BBC Education Correspondent) and attended by a cross-sectional audience of interested parties. Marc Bailey was there representing Cutting Edge.
In the words of Mr Andrew Raftery - chairman of the RCSE Anatomy Project Steering Group 'Anatomy teaching in the UK is in crisis.' As the number of subjects vying for a place on the undergraduate syllabus grows and pressure mounts to spend time teaching communication and interpersonal skills the pendulum has swung so far that core basic sciences such as anatomy and physiology are being woefully overlooked. We heard from Dr Peter Gogalniceanu that the average number of hours spent studying anatomy by medical students in the UK has dropped to just 149 hours throughout their undergraduate careers. Whilst this was seen as adequate by many medical school deans questioned in the Student Anatomy Teaching in the UK (SATUK) survey, surgeons unanimously voted that this was simply not enough. A sentiment echoed by junior doctors, 47% of whom stated that they did not feel their level of anatomy knowledge was safe for clinical practice.
According to Prof Susan Standring - Editor in Chief of Gray's Anatomy and President Elect of the Anatomical Society of Great Britain, the problem has been exacerbated by the rapid increase in medical student numbers whilst the number of appropriately qualified teaching staff is declining rapidly. 'RAE and research, not teaching, is now the providence of the Universities' claimed Mr Raftery, thus inadequate financial support has lead to the closure of anatomy departments and replacement of anatomists with other scientific staff more likely to pursue research.
Prof Standring also raised concerns over the impact of MMC which does not recognise an anatomy teaching post as a valid part of surgical training: 'student demonstrators have been wiped out by MMC, virtually overnight' which according to Mr Raftery goes directly against the purpose of modern medical education which is to teach clinically relevant anatomy. Not only do the medical students suffer without these keen teachers, but the surgical trainees themselves miss out on a vital opportunity to 'catch-up' on their own anatomical education; 'we need demonstrators back!'
Professor Robert Acland - Author of the Internationally renowned Acland's Atlas of Human Anatomy DVD series, made clear once and for all that the human cadaver remains, and will always be 'our fundamental, indispensable resource for teaching and learning anatomy.' A feeling echoed by both medical students and surgeons in SATUK survey. Whilst prosected specimens and computer based packages are excellent tools for augmenting learning, which should be embraced, they cannot and must not replace full human cadaveric dissection. It is also interesting to note, that all five medical schools that dropped anatomy from their syllabus had reinstated it within five years and that throughout the UK student surgical societies are taking on the responsibility of teaching anatomy where there is strong feeling among the students that exposure on their course is inadequate. As Mr Raftery - who also chairs the Medical Students Liaison Committee says: 'the students know what they want.'
Not only is anatomy the 'road map for surgeons' but to quote Mr Alan Moultin - Recent Past President of BACA, it forms 'a building block for clinical practice' across all disciplines. It is vital that all doctors have a working understanding of human anatomy in order to prevent disaster; over a third of all litigious claims against surgeons are due to 'damage to adjacent structures' usually due to an anatomical error often resulting from inadequate gross anatomical knowledge says Prof Harold Ellis.
The sentiments of Prof Ellis were echoed by Ms Sue Besser - Founder of the RCSE Patient Liaison Group. Patients and their families have every right to be concerned if their surgeon lacks the basic knowledge upon which the safety of his patient relies. We owe it to our patients to ensure our newly qualified doctors are adequately prepared for their professional responsibilities and this must include a sound and safe anatomical knowledge.
The consensus at the end of the day was as follows:
There should be a 'core' undergraduate anatomy curriculum for all doctors.