It is undisputed that anatomy still has a role in the process of training doctors and supporting modern medical practice. All medical schools, new and old, still maintain anatomy as a core subject in their curricula. Over the last 20–30 years, all anatomy curricula have been reduced to lessen the factual burden on students and make time for teaching other skills. This reduction will have an effect on the training of future surgeons (and some other specialists) but perhaps it is the specialists', or anatomists', responsibility to provide the necessary training at a later, more appropriate, time in training. Unfortunately, the evidence suggests that the curricula and teaching have diminished too much, to an extent where safety and clinical practice might be compromised. If this is the case, it can be attributed to reduction in resources and the resultant effects on teaching methodology in the modern medical curriculum.
Anatomy has traditionally been delivered at the beginning of medical education to provide a basis for clinical training and practice. A dogmatic support amongst traditionalists for detailed anatomy courses may have been detrimental to the evolution of anatomy as a subject. Reformers regard these teaching methods to be ‘old-fashioned’ and incompatible with modern learning practices possibly without appreciating the many benefits of the traditional approaches.
If old-style anatomy teaching is dead, anatomy needs to reinvent itself as a subject. It should evolve to address the requirements of any subject in a medical curriculum in the 21st century. Some progress has been made. There has been a move from passive, didactic, highly detailed courses towards functionally and clinically relevant courses irrespective of the method of teaching.
For further progress to be made, the traditionalists have to concede that learning large quantities of detailed anatomy is unnecessary for the majority of medical careers, whilst a core of knowledge must be covered and assimilated by all students. Some progress has been made in defining core knowledge.
16 If a core of knowledge is agreed, then its assimilation must be assessed rigorously not only in the first year of medical school but with on-going assessments throughout clinical school and beyond. Acceptance of the concept of core knowledge also requires recognition that this will be inadequate for specialist training. Students entering medical careers which require a more detailed knowledge of anatomy will need access to specialised anatomy training at later stages in their careers. A sustainable solution is for anatomy departments to forge educational and financial links with hospital departments and some medical schools are exploring this option.
26 This would allow vertical integration of anatomy into the medical school curriculum from the first year of medical school, through clinical school and into specialist training, reinforcing the core anatomy by appreciation of its clinical relevance. Involvement of clinical specialists would give them the opportunity to shape the anatomy syllabus according to good clinical practice and advancing techniques, maintain their own knowledge (making them safer practitioners), and help to address the staff shortages in anatomy teaching. The criticisms of specialists about their juniors' lack of anatomical knowledge would be addressed directly and it should produce safer, more competent practitioners, less likely to make mistakes and incur litigation in the future.
How then should students and trainees learn anatomy? First, modernisation should draw on the fact that human anatomy has an innate fascination, not only with medical students and doctors, but with most other healthcare workers and a significant proportion of the general public. Anatomy must shake off the image of being old-fashioned and welcome clinical relevance, the IT revolution, models, body painting, and radiographic images. Anything that stimulates interest in anatomy should be promoted. This, however, does not exclude prosection and dissection as a learning resource and nor does it mean anatomy teaching without appropriate staffing and other resources. The value of new resources such as computer-assisted learning have to be assessed in terms of how much they contribute to the assimilation of core knowledge and student understanding and not in terms of how costeffective or politically appropriate they are.
The challenge should not be to determine supremacy of one methodology over another but to maximise the learning benefit available from the different methods. The purpose of PBL is to develop reasoning skills, enable learning within a relevant context, encourage work-related skills, and promote self-directed learning. Appropriate use of dissection and prosections can meet many of these aims and have additional benefits. The dissection room should not be abandoned when the evidence is that students and trainees who have minimal exposure to dissections often demand dissection/prosectionbased teaching at a later date. It must be established what is core knowledge (at the various stages of medical education) so that standards are not allowed to inexorably decline as more cost-effective solutions are explored.
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