Anatomica, from the desk of kyle
Wednesday, April 7, 2010
Some days I’m up before I strictly have to be. It gives me time to sit on Queen street (our main street) in a coffee shop for a few hours with a morning coffee or two and a copy of The Australian. I did exactly that last Thursday and came across a story “A dangerous dumbing-down”.
Basically the story said a recent study had found that anatomy teaching had been scaled back massively in medical schools, especially 5 year courses, to as low as 56 hours in the whole course. I suspect my course is somewhere near this bottom mark.
My first response was not, surprisingly, to agree or disagree with the authors’ concerns, nor to attack nor defend UWS’ anatomy teaching. I was our MedSoc’s Academic Officer in ‘08-’09, a position I was elected to mainly (I suspect) on the basis of being the loudest complainer. With a few more years of perspective, many of my complaints seem silly in retrospect, and more than 12 months as Academic Officer showed me just how unreasonable the expectations of a cohort of medical students can sometimes be. I think sometimes we, and the public, need to understand that the purpose of medical school is to prepare people to be doctors. When it comes to to what knowledge and skills need to be acquired, at least in technical aspects like anatomy, medical students, having never been doctors, are really not the best judges of whether their course is an adequate preparation. The general public are eminently under-qualified to comment on the quality of most aspects of medical school, or indeed, medical training more broadly.
Knowing that my course has anatomy teaching at the lower end of the range is worrying for me, don’t get me wrong. I am considering, among other things, a surgical career and wouldn’t like to see that door closed to me because of some aspect of my undergraduate training, but I feel it’s almost hubristic to try and advance my own unqualified and unevidenced opinions against the opinions of those with expertise in education or experience in clinical practice.
The implications the professions seem to be drawing from studies like the one this article mentioned (current issue of ANZ Journal of Surgery if you’re interested) is that students may have insufficient anatomy knowledge to pursue certain specialties, the obvious one being surgery. The implicit response from the undergraduate medical education establishment, certainly the ones that the authors of the study proffer, is that anatomy teaching for the purpose of specialist practice should logically be the domain of specialist training. The argy-bargy that ensues is largely predictable.
To my mind, and from my perspective as a student, the issue is one of choice. THis is just one facet of the early streaming vs generalisation debate. Medicine as a subject area is, thankfully, growing. Year on year content grows and consequently the degree of mastery that is achievable over this broad mass of content declines. Put simply no student can know as much depth about topics like anatomy that students knew 50 years ago because there are genuinely new topics like proteomics, epigenetics and neuroplasticity to compete for our time. Furthermore, in topic areas that already existed like oncogenesis, our knowledge has ballooned in recent times. One need only look at a list of psychopharmacological agents (antidepressants, antipsychotics, anxiolitics etc.), of statins or of antihypertensives to know instantly that the amount of knowledge for JMO’s to graduate with is increasing exponentially.
This is important to understand to frame the generalist vs. early streaming tensions. The argument for the early streamers is that as medicine grows broader and more knowledge rich and the level of mastery a student or practitioner can gain over medicine as a whole grows shallower, the level of practice at which one must specialise to practice safely and competently comes much sooner and the degree of subspecialisation grows narrower. The argument for those anti early streaming is that a general knowledge of medicine is required for all doctors and that as medicine grows broader a longer period of time as a generalist is required to acquire this.
In the context of how much anatomy should be for everyone to learn, i.e. how much should be for surgical training to teach and how much should be for med school to teach is a practical one.
Personally I’ve never seen a non-surgeon use their knowledge about the walls of the inguinal canal in clinical practice. Philosophically, I think this is knowledge used only in vocational practice and so belongs in vocational training. But pragmatically it is a prerequisite to enter such programs and so I think we should be taught it in medical school at least to the standard required for successful entry to these programs, even if it’s not entirely pedagogically sound, so as not to curtail our options. Does this compete with and mean I have a lesser knowledge of other subjects? Yes.
Whether this is a bad thing or not, well, like I said at the start I just don’t feel qualified to say, but my gut feeling is that being an outlier, especially on something important like anatomy teaching makes me a little uncomfortable, so I wouldn’t be up in arms if they decided to increase it. But there’s no special reason why you should listen to my opinion, I guess esoteric wonderings about medical education more generally aside, the real question is do you think you are taught enough (if you’re a student) or teach enough (if you’re an educator) about the anatomy of the human body? I’d be genuinely interested to hear what other people think.