The lesson of anatomy
Article Outline
The teaching of a medical discipline, commencing in early education, passes through an “ex cathedra” of instructions, dissertations, and seminars. However, these didactic approaches may not always be accompanied by practical experience. Without accurate observations, discussions, debate, and scrutiny can result in a failure to reveal a “truth.” The scientific methodological approach demands the use of laboratory principles. Both science and culture have advanced by such application. From the onset of medical education, anatomy has been the foundation of differentiating and comprehending the spectrum of physiologic to pathologic states. In short, theory and practice move in concert. For the developing physician, anatomy has traditionally been a discipline. More recent, attention to this topic has decreased. In the past, for some students, the endeavor of studying anatomy was inspirational and for others, a burden. Nevertheless, for the physician and surgeon, anatomical knowledge is essential to acquire, as for the young energetic student who is focusing on surgery. Anatomy to such a student fundamentally gives the foundation and guidance critical to their clinical maturation.
Anatomy is a science that directs the trainee to progressively develop technical skills as well as acquiring dynamic knowledge of surface and internal human morphology. Learning anatomy as it applies to clinical challenges requires a persistent tenacity, willingness to accept repetition, and appreciation of detail as well as variation. Lacking these teachings even for the most gifted student could result in a vacant, sterile, and less than a fully competent surgeon. In the final analysis, the beauty of the “art” of anatomy may not be separable from its application in a surgical milieu.
Acquiring such knowledge engenders professional growth and maturity. The art and science of anatomical studies are a loyal companion and consoler for the engaging physician and surgeon throughout their professional lives. These benefits can come at the most unpredictable moments. Opposite to what one thinks, the nature of anatomy is unpredictable. It changes with the perspective and direction of viewing a specific structure, the level of magnification, and possibly anatomical variations of landmark reference points. Anatomical conundrums during surgery can humble the most talented surgeon. Anatomical perceptions can change from gross viewing, to “mesoscopic” and “microscopic” examination. These can confuse the inexperienced surgeon.
“Beauty will save the world,” Dostoevsky said. We would be short-sighted not to appreciate the enormity of artistic productions throughout the centuries. In the study of anatomy, the aesthetic value enriches the purely scientific value of anatomical tables. It is not perchance that many among the greatest geniuses and artists of history-such as Leonardo da Vinci and Rembrandt van Rijn - have contributed to anatomical sublime drawings and paintings. Vasari also reports in his “Biographies” that other great masters such as Michelangelo Buonarroti trained in figurative arts by performing anatomical dissections [3]. Exercises through anatomical dissections permit us to learn a method that calls one to a rigorous and profoundly demanding routine. The intensity of the pursuit at times can be of a magnitude to stimulate multiple senses. These can be tactile to olfactory, as well as visual, thus precipitating a myriad of both positive and negative cognitive processes. Regardless, for both the mentor and student, the learning experience occurs in unique environs. These anatomical dissections occur free of imposing any risk to a patient. Both knowledge and surgical technique are products of this laboratory exercise. To explore the cadaveric anatomical details and enter surgically forbidden regions in the “in corpore vivi” allows development of skills unavailable in any other form. Such latitude cannot be pursued and investigated on living patients without risk of bleeding and irreversible injury. Thus, it is critical for the surgical beginner to work in an environment conducive to accelerating their learning curve and maintaining a safe and controlled setting. At the dissection table symbolic “opposites” face each other, that is, living and deceased, present and past, emerging technologies in contrast to past traditional approaches and the introduction of the inspired young medical novice to the corpse of elders departed. Albeit these can create a spectrum of mixed emotions, it instigates discussions and sometimes productive disagreements. This can be valuable to a novel clinical diagnosis and treatment. Even ethical discourse can evolve and be of value as a product of this laboratory experience. Ultimately, this engenders a culture of sharing, participation, and maturation for the young doctor.
Dissection rooms reflect and resemble (symbolically) museums. Old and new dissection manuals on table tops, anatomical diagrams covering laboratory walls, reference anatomical books, and articles as well as aged dissection instruments all contribute to the archives collected over time. This history is, to some, intriguing, and arouses valuable historical curiosity. For example, surgeons in the 19th century would complete a cadaveric dissection then move to the delivery room. There was no recognition that their bare hands had been contaminated with dangerous bacteria from the laboratory dissection and was inoculating women during their delivery. Such practices were mentioned by Celine [1] in his graduation thesis on the life of Ignaz Philipp Semmelweiss who defined deaths resulting from puerperal sepsis.
The contribution of classical artists to the study of anatomy is significant. The monumental works of Leonardo da Vinci, Michelangelo, Rembrandt, and others exemplify anatomical detail and its beauty. It denoted the “virtual reality” of its time. Although presently we have advanced our ability to create a new “virtual reality” of anatomy via drawings, photographs, videos, 3-dimensional figures, and computerized simulations, they are still incomplete representations of verisimilitude and authenticity. The study in the anatomical theater cannot be substituted by technology, for it is a unique experience that provides a gamut of inputs. The multisensory stimuli derived from dissection combines present and past cognitive experiences, which may kindle a more accurate and enduring memory. For example, studying a synthetic model does not allow texture, anatomical planes, and true structural relationships to be realistically represented- such as a surgical demonstrable fascial plane. To date, few, if any models match the cadaveric experience in that category.
Legislative difficulties [2] have stimulated seeking anatomical dissections at universities residing in other countries. This has created the conditions to meet with people from other nations. This has encouraged us to visit great schools of anatomy in Europe and North America. These places are like special gymnasiums, cultivating the mind and body. Exposure to exceptional libraries has been an adjunct to the anatomical dissection. Developing bonds and friendships with colleagues has been priceless. This sparks an intellectual exchange and induces a foundation for scholarly professional alliances. Students become teachers; teachers become mentors and pass the torch of learning and knowledge to the next generation, and so forth.
In conclusion, to a teacher to whom we intend to dedicate this essay, Manfred Tschabischer, of the renowned Institute of Anatomy of the University of Vienna, we deeply revere his dedication and professionalism. He has welcomed students and physicians from all corners of the world. His unselfish effort to share his skills is humbling. His hospitality is profound. He keeps a balance between the best of old traditions and remains renovations and innovations. His refreshing attitude for respect of “classical” culture while always maintaining a positive vision to the future is impassioned and motivating. On a lighter and final note, my memories of sharing thoughts with the professor while indulging in glass of beer or white wine on an evening in Heuriger remain memorable, and were the punctuation and finale to the special richness of the total experience. It is a gift to have his friendship.
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The views and opinions expressed in this editorial are those of the Editor-in-Chief, and the views expressed herein are not necessarily those of the Publisher.
PII: S0090-3019(08)00259-0
doi:10.1016/j.surneu.2008.03.015
© 2009 Published by Elsevier Inc.
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