Why low body count is fatal for anatomy

June 6, 2003

Some academics think technology allows anatomy to be taught without cadavers. Others are unconvinced. Claire Sanders reports

The new Medical Sciences Teaching Centre at Oxford University holds a special place for cadavers. Its shiny new labs contain numerous dissecting tables as well as mortuary fridges and a freezer.

By contrast, students at Peninsula Medical School, which opened last September, will learn anatomy through medical imaging and by practising on the living rather than the dead.

There is now huge variation in the teaching of anatomy - something that worries some surgeons and medical academics but excites those keen to take medical education in new directions.

The General Medical Council makes no specific requirements for how to teach anatomy - insisting rather on a strong scientific education. Graeme Catto, president of the GMC and head of the UK's largest medical school Guy's, King's and St Thomas', said: "I think that those medical schools that can offer dissection to interested undergraduate and perhaps particularly postgraduate students are fortunate. The absence of a dissecting room, however, is not a barrier to high-quality medical education."

Andrew Raftery, a consultant general surgeon and a member of the Royal College of Surgeons' council, has long argued that there has been a "dumbing down" of the biological sciences in many medical schools and that anatomy is not taught as well today as it was ten years ago.

"Anatomy cannot be taught adequately without the use of cadavers.

Dissecting a human body is one of the best ways of finding out how it works," he said.

John McLachlan, director of the first phase of the course at Peninsula, disagrees. "We very much want our students to learn in the context in which they will practise and believe that students should see patients as more than corpses brought to life," he said.

Students at Peninsula learn anatomy through expensive mannequins, medical-imaging technology and through living and surface anatomy - which involves examining each other and models.

The school also prepares students for the advances in imaging technology that will take place during their careers. "Hand-held ultrasound scanners provide glimpses inside the body, and the school has uniquely acquired two of these," Dr McLachlan said. "Three-dimensional imaging of patients was used in clinical practice, and this provided outstanding training opportunities."

Dr McLachlan pointed out that doctors who chose to become surgeons went through years of further training. "We are not saying that dissection is inappropriate at that stage," he said. "What we are saying is that undergraduates need to learn the emotional consequences of working with live people rather than dead ones. Most criticism of doctors is about their communication skills - not their clinical skills."

He also argued that encouraging young students to cut up bodies early in their careers could be "challenging" for some of them. "It certainly has an emotional impact, and the evidence that this impact in the early stages of training is helpful is quite mixed," he said. "But I do not wish to be particularly critical of traditional ways of teaching anatomy because it has produced some very good doctors. The point is more to try out new methods and to evaluate them - something that is firmly on our agenda."

At Oxford, Stephen Goss, director of pre-clinical studies, believes strongly that students should learn anatomy on cadavers. "The human body varies enormously, and it is only by learning anatomy on real bodies that students can fully appreciate this. A model can never fully prepare a student for work on real people," he said.

He agreed that students should be introduced to cadavers "sensitively".

"But it seems to us quite unrealistic to train medical students without their learning something about death in a very direct way," he added.

He stressed that students at Oxford also learnt about the latest medical imaging and learnt anatomy by examining their own bodies and those of colleagues.

The first three years of the Oxford course lead to an honours degree in physiological science and the last three are hospital based. But Dr Goss stressed that the first part of the course was not devoid of clinical content: "There are clinical demonstrations in the hospitals, and students make regular visits to GP tutors and see the clinical and personal consequences of illnesses."

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