Shortage of bodies bodes ill for medicine

Junior doctors' failure to bone up on anatomy is prompting concern, but some medical schools are pioneering alternative ways to teach the subject, says Melanie Newman.

There are medical students around who would struggle to identify the femur, the Royal College of Surgeons of England's head of anatomy admits.

Vishy Mahadevan said that cases of students unable to name the major bones of the body were mercifully rare. But he admitted being worried that far more medical students had inadequate knowledge of anatomy.

A General Medical Council report in 2003 said that most doctors did not need the detailed anatomical knowledge previously considered vital for all specialties.

"Most people would agree that the old-fashioned method, where everybody had to dissect the entire body, was inappropriate," Professor Mahadevan admitted.

But the rise in the number of medical students since the GMC report, combined with shortages of cadavers, means many doctors, in particular surgeons, believe that standards are under threat.

Dick Rainsbury, the RCS director of education, described a "noticeable and serious decline in the general level of applied anatomical knowledge displayed by junior doctors".

There is agreement among the medical community that all doctors, including GPs and psychiatrists, should have a core knowledge of anatomy.

The matter was discussed at an RCS conference this month. "There was a consensus that at some stage dissection should be used as a medium of instruction," Professor Mahadevan reported.

Peter Gogalniceanu, a first-year house officer and a member of the British Association of Clinical Anatomists, surveyed 174 students. Most believed that anatomy was very important and that dissection was the most useful method of learning. But Mr Gogalniceanu said: "Previous surveys of deans have found that they do not believe anatomy teaching is essential."

The RCS has called for the Department of Health to fund a national campaign to urge people to donate their bodies for medical study. It predicts a 30 per cent shortfall in the number required for the current academic year.

A change in the law is responsible for the decline in numbers, the RCS said. The Human Tissue Act 2004, which came into force last year, means that donors must now have their request witnessed.

Lancaster University's Centre for Medical Education, a collaborative venture with three other universities, does not use cadavers for anatomy training.

Anne Garden, its director, said: "If we were to use them for dissection, we would be in competition with Liverpool's Medical School, as our catchment area for donated bodies is the same - we wouldn't want to put them at risk.

It also means our anatomy teacher can use his time teaching as opposed to policing the Human Tissue Act."

Facilities using human tissues must have a licensed anatomy teacher on the premises whenever they are open. The Lancaster centre can stay open when the teacher has gone home because it uses models and DVDs of dissections.

Peninsula Medical School, a partnership between Exeter and Plymouth universities, was the first school in the UK to teach without cadavers. It uses medical imaging, live patients and models.

John Bligh, its associate dean for education, said: "We were charged by the DH to do something modernising and innovative. There is a lot of expense involved with cadavers, so we looked at the educational gain associated with them." He was unable to find evidence that dissection-based anatomy was more effective than training using imaging. While future surgeons might need to dissect, he said, that could wait till after graduation.

The debate may not be put to rest until assessment data on Peninsula's first students is published. According to Professor Bligh, data collected by the school shows that students' knowledge compared favourably with that of qualified doctors.

"Our students are learning the anatomy they need. The feedback from clinicians is that they know their stuff," he said.

melanie.newman@thes.co.uk

AT THE CUTTING EDGE

Bristol University has a unique mobile anatomy unit that travels around the area visiting schools, colleges, hospitals and science fairs.

The unit contains many of the facilities of the university's new clinical anatomy suite, including a custom-built dissection table with a touch-screen monitor and an overhead operating light, clinical simulators and an image library.

It also houses several unique neuro-anatomical models, dubbed "brain towers" by the anatomy suite's director, Richard Greene.

"Students can add components to the brain, then wire it up," he explained.

DONATION, DISSECTION AND DECEPTION

• The first anatomy textbook, Versalius's De Humani Corpus Fabrica , was published in 1543
• Dissection was at one time a recognised punishment in England: the worst felons were hanged and their bodies dissected
• William Harvey, who discovered the circulation of the blood in 1628, is said to have dissected his father and sister
• Doctors were dependent on executions for a supply of corpses until the Anatomy Act of 1832, which allowed dissection of donated and unclaimed bodies, such as those of paupers who died in hospitals and workhouses
• Burial clubs were once common among poor people, who paid contributions to ensure they had a funeral so anatomists could not claim them
• Today, about 650 bodies a year are donated for medical research in England and Wales, but the Royal College of Surgeons says 1,000 are needed
• Donations fell after the 2001 organ-retention scandals, in which three children's hospitals removed organs from dead children. Donations have not recovered.