Clinical Anatomy 4:212-215 (1991)

Topographical Anatomy-The Cambridge Experiment

HAROLD ELLIS AND BARI LOGAN Department of Anatomy, University of Cambridge, Cambridge, CBZ 3 DY, England

Teachers of Anatomy throughout the English-speaking world are all too familiar with the current problems they face in teaching gross or topographical anatomy. These include diminution of the available time for practical instruction in the face of an ever-increasing preclinical syllabus, shortage of trained (especially medically qualified) teachers, and controversies concerning the topics to be taught and the most effective means by which this should be done.

Many medical schools have undertaken radical revision of their anatomical teaching, and it might be of interest to give an account of changes which have taken place in recent years in the Dissecting Room of the Department of Human Anatomy in the University of Cambridge.

Hans Kuypers, a distinguished neuroanatomist, transferred from the Chair of Anatomy in Leyden to head the Department in Cambridge in 1986. He found already established and well-organized courses in neuroanatomy and developmen- tal anatomy, but decided that extensive changes were required in the teaching of Topographical Anatomy, with particular emphasis on clinical anatomy. To assist in these changes, Professor Kuypers recruited an experienced Prosector from the Royal College of Surgeons of England (B.L.), appointed in May 1987, and created the post of Clinical Anatomist with the appointment of a retired Professor of Surgery (H.E.) in January 1989.

T h e first task was a complete upgrading of the Dissecting Room. This included extensive redecoration, the formation of three large areas for tutorials and demon- strations, the installation of display panels for charts, a display area for radiographs, and a self-access video area with four machines, each allowing access to two students. Each tutorial bay was also equipped with a large video machine.

Contacts were made with general practitioners and consultant geriatricians throughout the East Anglia region, which has ensured an adequate supply of cadavers for the Department. T h e introduction of the Logan technique (Logan, Received for publication July 10, 1990; revised July 13, 1990.

Address reprint requests to Harold Ellis, Dept. of Anatomy, University of Cambridge, Downing Street, Cambridge, CB2 3DY, UK.

0 1991 Wiley-Liss, Inc.

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1983) for preservation has provided excellent dissection material with absence of the odor so often a feature of dissecting rooms. For an annual class intake of 240 students, 40 cadavers are provided, an allocation of six students per body. Com- mencing at the beginning of the academic year in October, the 1st year students dissect the upper limb during the Michaelmas term (Fall Quarter) while the 2nd year students dissect the head and neck. Separate dissection sessions are allocated to each year. In the Lent (Winter) term, the 1st year students dissect the thorax and abdomen, while the 2nd year dissect the brain in a separate practical classroom. T h e Easter (Spring) term is allocated to lower limb dissection for the 1st year students.

Each student is allocated two sessions of dissection per week, each of two hours duration. In addition, the Department is open on Saturday mornings as an option for further dissection and revision. Each session is initiated by a video demonstra- tion which lasts approximately ten minutes and provides a guide to the day’s dissection. Lecture notes are also provided.

During each dissection period, half the students are called in small groups to tutorial sessions which last approximately 20 minutes. These are given by the Demonstrators on specially prepared prosections, as well as on radiographs, osteo- logical material and cross-section preparations. Each student therefore has a weekly demonstration on the relevant stage of the dissection. In addition, Demonstrators also “patrol” the Dissecting Room to provide assistance to the student dissectors.

Functional Anatomy, which stresses the clinical importance of what is being taught in the Dissecting Room, is the subject of weekly lectures (several of which are given by a radiologist) and are supplemented in the tutorials and by means of wall demonstrations which are changed weekly. Radiological and Surface Anatomy are stressed in the tutorials and are supplemented by practical classes in which, after a video demonstration, students practice surface anatomy on each other in small groups under demonstrators’ supervision. Two clinical demonstrations, rele- vant to the term’s work, are given by Clinicians at Addenbrooke’s Hospital.

T h e practical teaching in the Dissecting Room is under supervision of the Clinical Anatomist (H.E.), supported by members of the Department with experi- ence in the teaching of Topographical Anatomy who also take part in the Functional Anatomy lecture course. Much of the Dissecting Room supervision is performed by the nine University demonstrators, recently qualified medical graduates who are studying for the Primary FRCS. Only one of these is a full-time employee of the Department; the other eight are also employed by local private hospitals, mostly to provide night cover, but they are available for the great majority of the dissection room session and practical classes.

A special feature of the Cambridge undergraduate course is the College supervi- sion (tutorial) system. Each student is assigned an Anatomy supervisor appointed by (and paid by) his or her College and will receive, individually or in small groups, a weekly tutorial, usually supplemented by a weekly essay.

An important part of the work of the Dissecting Room is its postgraduate programme. T h e nine University demonstrators receive intensive tutorials from the Clinical Anatomist in preparation for their Primary FRCS examination. Having obtained this, they are encouraged to undertake research projects in applied anatomy. Recent topics have included, for example, a study of situs invertus, an investigation into the distribution of valves in the gonadal veins, the healing of neonatal scar tissue and the reaction of the fallopian tubes to foreign material.

214 Ellis and Logan

Twice yearly, intensive anatomy courses are given for surgeons in training in the Region and other postgraduate courses are arranged for physiotherapists and chi- ropodists. We now propose to run future anastomosis workshops in the Depart- ment.

T h e individual changes which have taken place in the Dissecting Room at Cambridge over the last few years can hardly be regarded as revolutionary. Indeed, we can be described as conventional in that each of our students dissects the whole body. Most Anatomy Departments will have introduced most, or indeed all, the teaching methods that we employ. Where we feel we have an advantage is that there is one experienced clinical teacher with a full-time commitment to the day to day organization and teaching of topographical and clinical anatomy in the Dissect- ing Room and the practical classes.

What are the advantages of this arrangement?

1. I t ensures that the thrust of our teaching is the relationship between what the students sees in the cadaver and what he encounters in functional living and imaging anatomy in both health and disease.

2. It removes a considerable administrative burden from the Head of Depart- ment, although there is close liaison between him and the Clinical Anatomist through the Teaching committee, the Dissecting Room committee and, of course, informal discussions.

3 . A senior clinician is in an admirable position to arrange close collaboration, both in teaching and research, with clinical departments, especially those of Surgery and Radiology. This has certainly been the case in Cambridge.

4. It provides continuity in the training of demonstrators, for which the Clinical Anatomist is entirely responsible.

5. I t enables on-going research projects to be pursued in Applied and Surgical anatomy.

Of course, there is a snag. This is the considerable disparity between the clinical and pre-clinical pay-scale in the Universities in this country and elsewhere, and there is no way, in the present financial climate, of remedying this. It is therefore difficult to encourage many clinicians (no matter how interested they might be), in pre-clinical teaching, to switch from their own discipline to Anatomy. In the present case, the Clinical Anatomist retired 2 years early from his clinical post and his pre-clinical salary is supplemented by his pension. I t is unlikely that many clinicians would switch to an appointment in a pre-clinical department at an earlier stage in their careers and, indeed, this was borne out by the response to the advertisements for this post in Cambridge.

T h e partial solution to the salary problem would be joint appointments, with clinicians being paid on a sessional basis by either the Health Service or University for their clinical duties and by the University for their pre-clinical sessions. Indeed, this is already being implemented in a number of medical schools. This is certainly helpful in providing a clinical input into pre-clinical teaching but has one serious disadvantage. With the best will in the world, a part-time Clinical Anatomist cannot give the commitment necessary to undertake the roles which we have listed above; at least that is the experience of the Cambridge experiment. I t would seem that the immediate future would depend on persuading clinical teachers to dedicate the last

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few years of their active academic life to undertake the interesting, challenging, and rewarding career of full-time Clinical Anatomists.

Can we measure whether or not this experiment is a success? Obviously we think that it is, but this cannot be regarded as a statement of fact!

Examination results at the end of the pre-clinical course will hardly provide factual data, since obviously we merely examine the students on what we teach them during the course. T h e measure of the efficacy of our teaching will have to await the opinion of our clinical colleagues when they report to us their assessment of the knowledge of our students in the basic biological sciences during their clinical years and, perhaps more importantly, what our future doctors will tell us of the value, or otherwise, of their four terms spent in the Dissecting Room.

With so many departments throughout the world changing their teaching tech- niques, exchanges of ideas and experiences between Anatomy teachers can only be helpful. We certainly have gained much ourselves from conversations with col- leagues and visits to other Medical Schools.

ACKNOWLEDGMENTS We owe a great debt ofgratitude to the late Professor Hans Kuypers, FRS, whose

foresight and imagination were the basis of the changes that we have described. His sudden death, in 1989, was a serious loss to the Department.

REFERENCE Logan, B. 1983 T h e long-term preservation of whole human cadavers destined for anatomical

study. Ann. R. Coll. Surg. Engl. 6533.