The editors of The New Anatomist have to be congratulated on putting together a complete issue on modern aspects of teaching gross anatomy (Volume 269 Number 2, April 2002). I do not know of any other anatomical society that has placed the focus on teaching aspects so effectively in their own journal. Despite the enormous range of topics under research in anatomy departments, it is the teaching of undergraduate, graduate, and medical students that is the unifying task of all anatomists.

I would like to support the concept that gross anatomy is still an essential basis for the clinical training of medical students (Aziz et al., 2002; Reidenberg and Laitman, 2002). For example, gross anatomy is the basis for most clinical work in the musculoskeletal system (Miller et al., 2002), and here the students learn that the “normal” is only the most common variation of the human body. Therefore, at the Medical School of Hannover, we have fixed all figures from our book on arterial variations (Lippert and Pabst, 1985) on the wall of the dissection room, so that the students are continuously motivated to compare the situation in the corpse with the frequency and pattern of arterial variations in humans in general. In the article by Drake et al. (2002), the enormous variations in total hours for macroscopic, microscopic, and neuroanatomy at medical schools in the United States are documented. It would be of great interest to compare these times with those in other countries and to correlate the results of the exams to these different hours of instruction.

A further aspect that we have repeatedly stressed (e.g., summarized in Pabst et al., 2001) is that we have to evaluate the anatomy courses not only at the end of the formal teaching program in anatomy but also at a much later date, e.g., at graduation (Miller et al., 2002) or after several years of clinical work in hospitals (Pabst et al., 2001). In the latter study, the gross anatomy course was graded by former students as the most important of all courses during the medical curriculum.

I have to point out, however, that there are major differences between countries that should be taken into account when comparing courses and methods of teaching anatomy. For instance, we have approximately 350 first year medical students, who do not have premedical college training that includes histology or comparative anatomy (Miller et al., 2002) but come straight from high school. Therefore, we believe a further important goal of the dissection course is to deal with topics of ethics, including death and dying, and coping with emotional reactions (Tschernig et al., 2000).

One aspect that has only been mentioned in passing in the articles of the special issue of The New Anatomist is the inclusion of much more anatomy of the living, as this is the aspect all medical doctors are confronted with in their everyday routine. Therefore, not only pictures of gastroscopy or projections of organs onto the body surface were included in large numbers in a recent anatomy atlas (Putz and Pabst, 2001) but even more so in an interactive CD-ROM (Putz and Pabst, 2002), in which video sequences were integrated, e.g., on colonoscopy, bronchoscopy, or ultrasound of the heart valves. In Hannover, in parallel with the dissection course, students examine each other. Activities include measuring the range of motion of joints, marking the projection of all major organs on to the body surface, using the otoscope and ophthalmoscope, and also examining the abdomen by ultrasound (liver, spleen, and kidney). For this purpose, we obtained an obsolete ultrasound machine that was still sufficient for our purpose. The first-year medical students participate enthusiastically in such applied, clinically orientated anatomy courses. We would like to suggest that more anatomists take up this type of macroscopic anatomy in general, in addition to the other concepts outlined in The New Anatomist special April 2002 issue to improve gross anatomy teaching.


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