To the Editor:
We commend ten Brinke and colleagues1 for their recent work on the delivery of undergraduate anatomy teaching. This work adds to a growing body of evidence seeking to objectively evaluate current and experimental teaching interventions for the delivery of anatomy education. Although this work is valuable, we note several issues that were not fully addressed by ten Brinke and colleagues, and we propose a direction for future research in this area.
A shift away from traditional, dissection-based teaching has been observed for some time in the United Kingdom. The Royal College of Surgeons of England recently expressed concerns over reports of poor anatomy teaching in UK medical schools, which may discourage entry into surgical careers and lead to suboptimal surgical skills.2 The value of dissection-based approaches in UK medical schools, and overseas, continues to be debated.
In their study, ten Brinke and colleagues conclude that dissection-based teaching enhances the student learning process. Indeed, our own study previously suggested that students prefer dissection above other teaching methods.3 However, some important considerations are neglected in this objective assessment, which may limit the value of conclusions drawn. First, learning theories are well described in the education literature. Students’ affinity for acquiring and retaining knowledge is likely determined by alignment of intrinsic learning styles and surrounding learning environments. Exploring learning styles may have permitted a more pragmatic understanding of the outcomes described. Second, the aims of anatomical education are not necessarily limited to instilling anatomical knowledge. It may also aim to promote teamwork, enquiring, and critical thinking, and to introduce students to issues of death and end of life.4 These represent important, practical considerations for deliverers of anatomy education.
In addition, we wish to seek further clarification on the intervention described. Traditionally, dissection-based teaching involves removal, instrumentation, and manipulation of human tissue by the student. This is different from prosection, which involves the presentation of pre-prepared specimens or cast models. Are the authors justified in their description of a laparoscopic, dissection-based intervention?
Future studies may wish to perform pragmatic and holistic evaluations of teaching approaches. Conclusions from these studies may offer enhanced conclusions for course managers and curriculum designers.
Stephen J. Chapman, MBChB
Academic foundation doctor, Yorkshire and the Humber Deanery, Leeds, United Kingdom; firstname.lastname@example.org.
Abdul R. Hakeem, MBBS, MRCS
Specialty registrar, Cambridge University Hospitals Foundation Trust, Cambridge, United Kingdom.
1. ten Brinke B, Klitsie PJ, Timman R, Busschbach JJ, Lange JF, Kleinrensink GJ. Anatomy education and classroom versus laparoscopic dissection-based training: A randomized study at one medical school. Acad Med. 2014;89:806–810
2. Jaunoo SS, King TR, Baker RF, et al. A national survey of reasons why students and junior doctors choose not to pursue a career in surgery. Bull R Coll Surg Engl. 2014;96:192–194
3. Chapman SJ, Hakeem AR, Marangoni G, Prasad KR. Anatomy in medical education: Perceptions of undergraduate medical students. Ann Anat. 2013;195:409–414
4. Patel KM, Moxham BJ. Attitudes of professional anatomists to curricular change. Clin Anat. 2006;19:132–141