Teaching of gross anatomy to medical undergraduates: general practice as a guideline? A synopsis.

The amount of time officially available for the teaching of gross anatomy to medical undergraduates was substantially curtailed during the 1960s, both in the USA and in Europe (Kahn, 1966; Todd, 1968). Since then, this trend has been further enhanced by the expanding introduction of problembased learning (Pallie & Miller, 1982; Albanese & Mitchell, 1993) deplored by many gross anatomists, radiologists and surgeons (Collins et al. 1994; Anderson & Brown, 1996). But a modification of the content of anatomical teaching has become unavoidable, and is a matter for concern—although very little rejoicing—to the professional morphologist involved in teaching. The few studies which have been aimed at defining a suitable core programme were designed to determine the anatomical knowledge required for various clinical specialties (Lippert & Bernsau, 1972; Quast-Ho$ ttge, 1972). These studies showed that the identified knowledge exceeds by far any currently available time for teaching anatomy to medical undergraduates (Lippert, 1974). Against this background, the present study was designed from a different concept, our aim having been to investigate the requirement of anatomical knowledge in general medical practice. The actual paper is a synopsis of the results obtained for 12 topics of systematic gross anatomy evaluated under this criterion. It is an attempt to contribute to a pragmatic solution to a pressing problem. The design of this study is a survey of a representative sample of 7 Swiss general practitioners who were asked to identify—in a complete list of the latest published edition of the Nomina Anatomica (IANC, 1989)—those structures which they considered to be indispensable for their practice. A detailed presentation and discussion of the methods used can be found in the article dealing with the arteries (Fasel, 1993). The current international anatomical nomenclature includes 3248 structures under the 12 topics so far investigated (IANC, 1989). Of these, 744 were considered to be relevant for general practice in medicine by the physicians involved. The consensus of opinion amounted to an average of 91.3% of the structures listed (range: 82.9–97.4%). The 744 entries judged as relevant correspond to 22.9% of those mentioned in the current nomenclature. When the different topics are assessed individually, the results obtained are as follows (Table) : 288 items (i.e. 33.4% of the structures mentioned in the Nomina Anatomica) were considered to be indispensable for the bones, 81 (30.2%) for the respiratory system, 78 (27.9%) for arthrology, 77 (13.2%) for the arteries, 44 (32.6%) for the female and 37 (30.6%) for the male genital organs, 36 (13.1%) for the ear, 36 (9.6%) for the veins, 21 (10.3%) for the cranial nerves, 19 (54.3%) for the meninges, 15 (38.5%) for the endocrine glands, and 12 (17.1%) for the synovial bursae and sheaths. A full enumeration of the relevant structures as determined for each topic separately can be found in the original papers (Fasel, 1993, 1996). The first striking fact to emerge from this investigation is the very high level of agreement reached by the physicians involved, amounting to 91.3% of the structures mentioned in the international anatomical nomenclature (IANC, 1989). The score for the different chapters ranged from 82.9 to 97.4% (see Table). These results suggest that, in spite of assumptions to the contrary, a largely uniform need for macroscopic anatomy within the field of general medical practice does exist. A second noteworthy observation is the relatively small quota of structures that was ascertained to be relevant to general medical practice, namely 22.9% on an average of those listed in the international anatomical nomenclature. The range of this score lay between 9.6 and 54.3% (Table). These numbers draw attention to what is probably a general tendency, and one which might allow a reduction in the amount of information to be taught, without endangering the basic knowledge required for general clinical practice. On the other hand, these results also make it clear that any reduction in the time available for teaching these elementary concepts to medical undergraduates must jeopardise the fundamental training required by any doctor, whether or not he or she intends to specialise. Thus they are surely a sufficient answer to the claim—all too readily accepted today—that macroscopic anatomy is a subject which can safely be dropped from modern medical curricula. With these results as a basis, we are developing an anatomy teaching programme which is to be included in the