Arthur F. Dalley
As an anatomist, I am concerned that my science—our field of work and study—is perceived by many as static—even “dead”. I want to see anatomy represented and received in the best possible light—as something which is not primarily an obstacle or an ominous means of screening candidates for various careers, but something that is useful and has sufficient value that it will continue to exist as a subject worthy of study and as a field that a few (hopefully very talented) individuals find sufficiently interesting that they actually select it for the focus of their careers as teachers or researchers.
As a teacher of anatomy for practitioners of the health sciences, it is my impression that most students who complete an undergraduate experience that includes a course in anatomy and physiology believe that anatomy is primarily about the recognition and naming of structures, often on bare skeletons, or on isolated bones or organs (terminology). Anatomy is typically recalled by former students as involving rote memorization of endless lists and tables of terms. All-night study binges often involved such contrivances as flash cards, reproduced tables, and mnemonic devices. Professional training is thus entered with the assumption that the required anatomy course will involve more of the same (perhaps with the addition of a less than pleasant encounter with the dead), and it is approached accordingly. Professional school anatomy instructors must expend much effort trying to dissuade students of this preconception. We encourage them to reason their responses by recalling mental images of structure they have observed rather than by regurgitating facts crammed into short-term memories during last-minute studying.
Although anatomy necessarily involves the learning of many terms (indeed, it is the basic language of medicine), the terms are not in themselves the goal, any more than the learning of any language is about the individual words. The purpose of language is communication—the accurate and meaningful conveying of information. This is also true about that important aspect of anatomy that involves terminology. The new international standard for anatomical terminology, Terminologia Anatomica (Federative Committee on Anatomical Terminology, 1998; reviewed by Whitmore, 1999) is an inexpensive collection of user-friendly anglicized terminology that also includes the classic, Latinized forms. Using this terminology, which is based on logic and reason more than tradition, will be advantageous to all who make the effort to use it. It will also be greatly advantageous if, some day, all anatomy is spoken in the same “dialect.” That information will be best assimilated if the terms and facts are put into a context of function or application, and then its usefulness will be made apparent. Instead, we tend to pile on the terminology and relationships without meaning. When the meaning is learned later, no link is made that acknowledges the role of the more fundamental learning.
Although anatomy is perceived as being about the memorization of terms identifying structures of ever-increasing triviality, the true purpose of anatomy is to recognize normal structure and to realize its role in producing normal function, i.e., to appreciate interdependence of form and function. Anatomy is the basis for understanding normal function; for being able to recognize how normal function may be effected when the anatomy has been altered as the result of developmental defect, disease, or trauma; and for determining how normal or near normal function might be restored. In other words, anatomy is a basis for logic and reasoning, deduction, and problem solving. It is my perception that very few of us are doing a very good job of making the true purpose of anatomy sufficiently evident that it is even recognized. Anatomy courses in medical schools likewise commonly fail to portray the purpose of anatomy. I have on several occasions been told by surgeons that they “don't remember any anatomy,” when I know they practice the application of anatomy meticulously and continuously. In saying this, they are revealing that they, too, remember anatomy as being about a specific set of terms, and they are admitting that outside of those used in their subspecialty, most of those terms are forgotten. They fail to recognize their knowledge of structure and its role in normal function as being anatomy, which has actually become second nature to them, like reading or arithmetic. They seem to think their knowledge was intrinsic. They may or—sadly enough—may not have learned it from an anatomy course.
No place should be more suited for establishing the correct view of anatomy than a course that integrates anatomy and physiology. Unfortunately, such courses often bear this title to describe a disciplinary sequence within the course rather than the integration of concepts throughout the course.
It would be ideal for all undergraduate students to complete their experiences with an understanding of basic anatomical concepts at the expense of memorizing the names (and yes, even the origins, insertions, and individual innervation) of as many structures as possible. These concepts are relatively simple and basic, and they are covered in the introductory chapters of the textbooks. Often we take them for granted, forgetting what it is like not to know, so we fail to cover them at all. Examples of such concepts are listed in Box 4.
BOX 4: Examples of Basic Anatomical Concepts Worth Learning in the Place of Rote Memorization of Terms
the layered and segmental organization of our bodies
group muscle dynamics: synergism, antagonism, isotonic/concentric, isometric and eccentric contraction, etc.) and their organization into functional compartments in the limbs
joint function and motion as a consequence of structure
the effect of denervation on movement and normal resting position
the interaction of muscle, fascia and valved vessels in venous and lymphatic return
understanding what lymph is and how it is produced
the concept of functional (synovial) potential spaces (e.g., peritoneal, pleural, articular, tendinous, bursal)
clarification of the distinction between nerves and the various nerve fibers and fiber types they convey
viewing sectioned material and extrapolating three-dimensional structure from two-dimensional images or serial sections, etc.
the concept of “normal”
The concept of “normal” is particularly important. It is a concept that students who have learned anatomy without the benefit of dissection almost always fail to appreciate. That is, that “normal” in anatomy means the most common variation, and that because of the large number of variations within the normal range, that which is depicted as “normal” may in fact be present less than half the time! I could not find the term “variation” in the indexes of any of the undergraduate anatomy texts I searched.
I would also recommend having students attempt the following exercise in morphology. First, have students view a three-dimensional object with several components, then, require them to describe that structure and the relationship of its components to someone else with words. The description should include anatomical terms of description and relationship, and be composed sufficiently well that the other party can form a vision of—or even draw—the object.
Such concepts may result in a “deep” appreciation of anatomy. A course that aims at covering the entire body, or all of its systems by doing so on a superficial “survey” level combined with the forced memorization of lots of terms and isolated facts usually yields disappointing appreciation and transient “knowledge.” Few students will attain this deeper understanding on their own, even if it has been “mentioned” to them and is available in their textbooks, if a special effort is not made to emphasize concepts in our lectures and instruction, and then to examine in a way that requires demonstration of those concepts. Instead, they will opt to fall back on rote memory and hope for the best in examinations.
In summary, it is my opinion that all undergraduate students should learn that anatomy—rather than a monstrous exercise in taxonomy and etymology that is a prerequisite obstacle to a professional degree—is a working science for problem solving and application in the practice and delivery of quality health care.
Anatomy is a working science for problem solving and application in the practice and delivery of quality health care.
There are data to support assertions for change in approach and content. Compelling evidence is presented in this final installment.