Clinical Anatomy 5:488-489 (1992)

EDITORIAL

The Goal of Dissection in Clinically Oriented Teaching

T h e definition of clinical anatomy as evolved by the American Association of Clinical Anatomists is quite simply: the study of anatomy as applied to health care. In contrast, some of my colleagues in Germany believe that clinical anatomy covers all disciplines of anatomy, from cell biology to gross morphology, and some would include experimental research. With such a comprehensive definition there may be no need to add the word clinical to anatomy. However, other colleagues argue that anatomy means all of the above but does not include experimental research. Still others interpret clinical anatomy as the study of organs and tissues by dissection only (so called surgical anatomy or topography).

Thus clinical anatomy may be defined in several ways, and rather than debate the definition further, let us concentrate on two common goals. First, we must meet the urgent need to produce clinically relevant research by the application of classical methodology to the study of morphology. Whenever possible, this work should be experimental and it should be performed in collaboration with clinicians. Second, we must also strengthen our teaching programs. In this editorial, I wish to concentrate on the teaching of clinical anatomy.

T h e use of multimedia (including computer aided instruction) helps students learn anatomy; however, such aids are limited in what they can do. On the other hand, it is the process ofdissecfzon which still presents the best opportunities for the real learning of anatomy. (Tragically, we hear that strong financial pressures to trim the budget are causing two or three American schools to seriously consider the dropping of anatomy dissection altogether.) While deletion of dissection programs may seem to be financially expedient, such moves lose sight of the following four precepts:

1. It is dissection alone which allows us to recognize and relate body structure in three dimensions. Dissection is a complex procedure to learn morphology which requires all of the senses. T h e exercise of dissection provides the feel for the fabric of the body and it improves our manual dexterity.

2. T h e discussion of variations and anomalies found during the dissections Received March 14, 1992; revised March 25, 1992.

Address reprint requests to Prof. Dr. M. von Ludinghausen, Anatomisches Institut der Universitat, Koellikerstrasse 6, D-8700 Wurzburg, Germany.

0 1992 Wiley-Liss, Inc.

Dissection in Clinically Oriented Teaching 489

frequently leads to an interpretation of comparative and developmental anatomy, and also to the explanation of problems encountered in surgery.

3 . T h e examination of the effects of aging, as seen commonly in our laborato- ries, and the manifestations of chronic disease in the body are important to the students’ understanding of anatomy. For example, in severe cirrhosis of the liver one can explain the distribution pattern and function of the portal circulation. In a case of generalized arteriosclerosis one can trace the development and location of that common disease and explore the possible consequences for the heart and entire vascular system. 4. T h e exploration of bodies that have had previous surgery can promote the

development of clinical thinking and understanding if the instructor encourages careful dissection of the surgical site and obtains pertinent clinical information. In these instances, we may choose to recruit clinical specialists to give clinical correla- tions in the laboratory as the findings relate to altered anatomy.

One could argue that the anatomists need not deal with clinical problems, that they should concentrate only on normal anatomy. But why do we have to be so limited? Why not broaden our expertise? If expertise is lacking, we should extend ourselves to understand the morphology in our cadavers as it truly exists. We must try to observe and learn about aging and the common disease processes and surgical procedures. We should realize that our embalmed specimens may even demon- strate some disease changes more clearly than the autopsy specimens, since with falling autopsy rates, the opportunities for the students to see pathology have become limited. Especially in the anatomy laboratory, students are able to study the tissues by manipulation, and specimens with very typical alterations can be preserved for repeated inspection. I t is a pleasure to emphasize that clinicalcorrela- tions are significant components of the postgraduate courses, scientific presenta- tions, and seminars of the annual American Association of Clinical Anatomists meetings.

Although in some schools there is increasing pressure to shorten the time devoted to gross anatomy courses, we must resist further reduction of hours spent in the anatomy laboratory. If the goal of dissection were merely to identify normal structure, it might be possible to substitute prosected material. But if the teaching objective is to demonstrate real clinical anatomy, anatomy as applied to health care, continued encroachments will only further deprive our students of excellent oppor- tunities to become truly good physicians and surgeons.

Michael von Liidinghausen Anatomisches Institut Unzvenitat Wiirzburg Wunburg, Germany