Whitcomb, Michael E. MD
The articles in last month’s journal offer important information and strategies for deans and faculty to consider as they strive to improve the education of medical students at their institutions. This month’s articles are just as useful. Most of them describe educational strategies that schools might consider adopting to enhance their students’ learning. Several relate directly to a major challenge medical schools face: how to ensure that important content relevant to contemporary issues in medicine is adequately represented in the curriculum.
To understand the nature of that challenge, it is worth recalling how curriculum committees often functioned in the past. When a committee had to decide how content about new topics should be incorporated into the curriculum, it was inevitable that at some point, a committee member would suggest that the curriculum was already too overloaded to consider adding anything else. All too often, the other members would agree and decide not to add the content, regardless of how important it might be. Fortunately, that attitude no longer rules the day. In recent years, most schools have successfully introduced new topics, largely by adopting a more integrated curriculum structure that eliminates discipline-specific, departmentally controlled courses.
But the fact remains that not all schools have created an integrated curriculum approach, and that even when a school has done so, the coverage of topics may be inadequate. Two of the articles appearing this month illustrate this. Day and colleagues call attention to the inadequate coverage of musculoskeletal medicine in the curriculum. Given the prevalence of musculoskeletal conditions throughout society, there should be little doubt that this topic should be better covered. In the same vein, Thurston and colleagues discuss the current status of medical genetics in the curriculum, another topic that should receive more attention.
Clearly, just as in the past, it is a real challenge to accommodate all the important content that students should be exposed to. Schools can attempt to address this by using a curriculum management tool to identify content redundancies that can be eliminated to accommodate the introduction of new content. But schools also need to continuously explore how topics can be presented more efficiently, even in the absence of any content redundancies. In that vein, I describe below two of this month’s articles that outline alternate, and more efficient, approaches to teaching gross anatomy.
In many schools, the gross anatomy course, by exposing new students to human cadavers, is viewed as the course that impresses on students the special privileges they will be afforded as physicians. Faculty in those schools tend to view dissection of cadavers as integral to achieving that goal. As a result of the time required for dissection, gross anatomy courses tend to occupy a great deal of time in the first year of the curriculum. Given that, schools challenged with adding new topics to the curriculum should ask themselves several key questions. First, is a dedicated gross anatomy course the best way to achieve the fundamental goal noted above? And second, do students need to engage in the dissection of cadavers to learn gross anatomy?
Drake and colleagues describe how gross anatomy is taught at the Cleveland Clinic Lerner College of Medicine of Case Western Reserve University. The approach employed there challenges the traditional view by eliminating the requirement that first- year students participate in the dissection of cadavers. Students are exposed to specific anatomic content by studying clinical cases that illustrate the relevance of anatomy to specific clinical conditions. And this approach is reinforced throughout the curriculum by presenting relevant anatomic content as students rotate through the various clinical disciplines. The value of this way of teaching anatomy is further demonstrated in the article by Zumwalt and colleagues. They describe how gross anatomy is integrated into a course offered by the department of radiation oncology at the Duke University School of Medicine.
Now, I suspect that many may view the approaches described above with considerable skepticism. Those who do will argue that dissection of human cadavers is a critically important element of the education of medical students. But the fact is that over recent years, many medical schools have changed how gross anatomy is being taught, even though they have retained a discrete gross anatomy course. In many schools, students are no longer required to participate in the dissection of cadavers, and there is no evidence that the students who choose not to do so are somehow disadvantaged.
For that reason, I think the medical education community should acknowledge that dissection of human cadavers by medical students is not an essential element of the general professional education of the physician. It should be made clear to all that schools that do not require dissection are still providing their students a quality education. This point needs to be more generally understood, so that faculty will be more open in thinking about alternate approaches for teaching gross anatomy. The benefits of such openness can extend beyond the enrichment of the curriculum. For example, at present, some schools feel constrained in their ability to respond to the call for increasing medical school enrollments, simply because of an inability to accommodate more students in their dissection laboratories. Needless to say, that would not be a problem if they redesigned the way they teach gross anatomy so that students were not required to participate in dissection exercises.
As I stated at the outset, the articles appearing this month offer a great deal for deans and faculty to reflect on as they strive to improve the education of their students. Both this month’s and last month’s collections, focusing as they do on descriptions of innovations that have actually been adopted by some medical schools, could be valuable resources to help other schools improve substantially the education of their students. For that reason, the journal will continue to publish more reports of established educational innovations in the months ahead.
Michael E. Whitcomb, MD