Where do I study human anatomy

Medical studies: anatomy as a knowledge base

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Learning on the "original": In the dissection course, students learn structural, functional and topographical relationships. Photos: R. Eggers
The dissecting course is an indispensable component of a modern medical degree. Anatomical training must not be the victim of austerity measures.

Surgeons in England in particular have recently complained about the insufficient anatomical knowledge of their younger colleagues and the growing number of claims for damages that are being asserted because neighboring structures were injured during operations (1, 2). The reason, it is assumed, lies in the inadequate imparting of knowledge of topographical anatomy, as was common in the past during medical studies. As in many other countries, systematic instruction in anatomy was largely abandoned in England. An anatomy without a dissection course means: The students do not have the opportunity to learn structural, functional and topographical relationships from the ground up on the original - the human body.
In Germany, anatomical training has largely retained its high priority within the pre-clinical stage. Nevertheless, there have always been and still are tendencies to reduce it. In order to save costs, chairs have already been reallocated and staff downsized. Future austerity constraints could affect the taxidermy course in particular. On the one hand, the course causes considerable costs. On the other hand, today's decision-makers may not have positive memories of their own dissecting course (box) and consider it dispensable. In the summer of 1984 Lippert complained in the Deutsches Ärzteblatt about the "inhumanity of anatomy" (3). However, anatomy lessons have changed significantly over the past few decades.
A modern medical degree cannot do without the dissection course, also because this course teaches much more than knowledge about the structure of the human body.
The licensing regulations for doctors formulate the goal for the entire medical training to be the "scientifically and practically trained doctor who is capable of self-reliant and independent medical professional practice, for further training and continuous further education". The training is intended to impart basic knowledge, skills and abilities in all subjects that are required for comprehensive health care for the population. The extent to which key competencies have been acquired will also be decisive for later professional success, i.e. “skills, attitudes and strategies that are useful in solving problems and acquiring new competencies in as many content areas as possible” (4). The sooner prospective doctors begin to develop and test such key competencies, the more confidently they will be able to apply and use them.
"Anatomy in the living"
What basic knowledge, skills and abilities can students acquire in anatomy? What role does the anatomist play in imparting specialist knowledge and “soft skills”? If you compare the curricula of yesterday and today, it turns out that the basic structure of anatomical training has not changed that much. Take the University of Lübeck as an example: The main pillars are still the dissection and microscopy courses with accompanying lectures in macroscopic, microscopic and neuroanatomy. However, two measures have led to a significant change in the anatomical curriculum in Lübeck. The dissecting course starts earlier, namely in the first semester, and runs over two semesters. Clinically oriented events have also been added. The anatomy seminar, which is held as “anatomy in the living”, accompanies the dissection course. Through mutual physical examination, the students convert the knowledge they have acquired into practical action. In addition, an experienced clinician holds a lecture hour every week and shows on selected topics how anatomical knowledge is to be applied in the medical routine. In this way, each lesson topic is not only dealt with from the anatomist's point of view, but also repeated and consolidated from the point of view of practical action and medical application.
In order to fully exploit the potential of the dissection course, careful preparation and follow-up of the course content is required. The central control instrument for this is the lecture, not only because the selection of topics and their weighting are made in the lecture, but also because effective interaction with all learners is possible in the lecture hall. The necessary teaching material is presented in manageable learning units, and aids for learning and for practical work in the dissection course are given. The decision as to what the necessary subject matter is is based on the requirements of the state examinations and on what is needed as a basis for further pre-clinical and clinical studies as well as for later professional activity, for example as a general practitioner.
Scripts for the dissecting course are a tried and tested means of bindingly stipulating the subject matter that is considered necessary. In key words, they contain the subject matter that is conveyed in the lectures, prepared by the students and checked in the attestation. The instructions for practical work in the course are described in detail. A well-prepared script that has been agreed with everyone involved and with representatives of the neighboring subjects offers a number of advantages. It defines course content that is checked and adapted from year to year, it delimits clear learning units that are increasingly being developed by the students themselves, and it allows a comparable and therefore fair assessment in the attestation, which is understandable for the examinee. The students know the course and the requirements of the course at an early stage and adapt to it during the semester break.
The core of the anatomical lesson is the dissection course. Introductory events, in which the body donation and the handling of the dead body are explained, allow today's students a careful first contact with "their" corpse, which they will prepare in groups of five students from head to toe. Intensive supervision is guaranteed by the fact that a lecturer accompanies three to four such table groups for a year in the dissection course, including neuroanatomy, and in the "Anatomy of the Living".
Under such conditions, the demanding goals of the license to practice medicine can actually be achieved in anatomical training: Short weekly certificates ensure that the students appear prepared for the course and learn continuously (learn to learn). Working together at the dissecting table allows the supervising anatomists and student tutors to individually check social behavior, the ability to work in a team, manual skills and learning behavior and, if necessary, to correct them using their own example or through conversations (learn handling and consideration). During the preparations, the students learn to transfer the theoretical knowledge and the two-dimensional images from the lecture and textbook to the three-dimensional body, and they immediately recognize that every body is different and that the deviation from the textbook case is normal (learning to transfer). You have to discuss the joint preparation within the group and decide again and again what to remove or how to cut up so that further and deeper insights into the human body are possible (learning to organize and decide). Unexpected views, variations or pathological changes create fascination and arouse curiosity, including scientific curiosity, which motivates to acquire knowledge beyond the necessary subject matter (learning to research). Last but not least, the corpse in the dissecting room is often where the first confrontation with death takes place, which is necessary as a doctor to treat the sick, the dying or the dead with respect (learning to empathize). The commemoration in the fourth semester also contributes to this.
The early start of the dissecting course and the thematic interweaving with "Anatomy in the Living" and with the clinic lecture has two major advantages: Students are encouraged to think and learn in medical dimensions right from the start, and they can already reliably check in the first semester whether the desired study objective corresponds to your ideas.
As described at the beginning, there are increasing voices in England, especially from the ranks of surgeons, who are calling for a return to the dissecting course, because it "not only teaches the language of medicine, but also concepts of biological variations and common pathological changes" (5 ). Anatomy knowledge that was acquired solely through the surgeon's operating window must remain fragmentary. The three-dimensional topography and variability of human bodies can only be understood in the truest sense of the word through one's own preparation on the entire corpse. Anatomical lessons from a single source also mean much more than imparting anatomical knowledge: in anatomy, and especially in the dissection course, students learn skills and abilities that are crucial for their entire professional life. But even after training, the dissecting room is becoming increasingly important in further training and research. Qualified advanced training of all kinds is carried out here on the original, the human body, and new surgical methods are tested and taught. The patients in particular benefit from this. This connection is also known to many medical laypeople, who therefore make themselves available as body donors to the anatomy. The ancient core of anatomical training, the dissection course, therefore forms the basis for modern training and further education in medicine today and in the future.

How this article is cited:
Dtsch Arztebl 2007; 104 (18): A 1221-4


Address for the authors
Prof. Dr. med. Jürgen Westermann
Institute of Anatomy of the
University of Lübeck
Ratzeburger Allee 160
23538 Lübeck


Anatomy yesterday and today

Author Dr. med. Reinhard Eggers on his own dissecting course and today's experience as a lecturer:

Anatomy in the winter semester 1973/74
Humorless lectures with endless lists of vocabulary, the meaning of which was difficult to understand; repulsive the already dissected, cruelly disfigured and almost completely gutted corpse at the first contact in the dissection course, into which we felt brutally pushed. Just don't show any disqualifying weakness. Cramming vocabulary - correct endings were more important in the randomly assessed certificates than understanding the context. Incomprehensible clinical information, demand. “You will only understand that in the clinic anyway, if you even manage the Physikum.” Anatomy seemed to be an additional numerus clausus that was shifted to studies: Those who could not stubbornly learn by heart or endure terrible things had no place in medical studies .

Anatomy in the winter semester 2006/07
The neurologist is giving a lecture on paraplegia. The presentation of the patient with anamnesis is followed by a targeted examination with explanatory notes on examination techniques and findings. CT and MRT images are shown and explained, differential diagnoses are discussed and tips on therapy and prognosis are given. A good and really demanding clinical lecture at the end of the anatomical training. Tanned silence in the attentively listening auditorium, which only dissolves in the final discussion. Lots of clever questions that show that the subject matter has been understood and processed. The students eagerly asking questions just started their third semester five weeks ago, mind you, the third pre-clinical semester of their medical degree.
Raftery AT: Anatomy teaching in the UK. Surgery 2006; 25 (1): 1-2.
Ellis H: Medico-legal litigation and its links with surgical anatomy. Surgery 2002; 20 (8): i-ii.
Lippert H: The inhumanity of medicine and anatomy. Dtsch Arztebl 1984; 81 (36): 2540-2.
Education Commission NRW: "Future of Education - School of the Future" - memorandum of the commission to the Prime Minister of North Rhine-Westphalia, Neuwied, Kriftel, Berlin, Luchterhand 1995; 224.
Ellis H: Teaching in the dissecting room. Clin Anat 2001; 14: 149-51. MEDLINE
1.Raftery AT: Anatomy teaching in the UK. Surgery 2006; 25 (1): 1-2.
2.Ellis H: Medico-legal litigation and its links with surgical anatomy. Surgery 2002; 20 (8): i-ii.
3.Lippert H: The inhumanity of medicine and anatomy. Dtsch Arztebl 1984; 81 (36): 2540-2.
4.Education Commission NRW: "Future of Education - School of the Future" - memorandum of the commission to the Prime Minister of North Rhine-Westphalia, Neuwied, Kriftel, Berlin, Luchterhand 1995; 224.
5.Ellis H: Teaching in the dissecting room. Clin Anat 2001; 14: 149-51. MEDLINE
Medical studies: anatomy as a knowledge base

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