Here’s an email I received from a surgeon who asked that his name be withheld. I have edited it for length.
I practiced general surgery for 16 years before becoming fed-up with the paperwork, the hours, the unpaid call, the unpaid operations, the contracts, and, eventually, the patients. So, I turned toward teaching anatomy at a medical school.
Over the past 3.5 years, I become increasingly disillusioned with medical education, too. Having lived in a world of "arrogant doctors" being berated by hospital administrators as disruptive, I've had an interesting reflective experience here.
If I hear, one more time, from a PhD, who has never seen, treated, or managed an acutely-ill patient, that "The students need to know THIS (this = piece of anatomical, microbiological, or pharmacological minutiae), I am going to go ballistic. This week, my "colleague" in anatomy said, "It's my job to teach doctors the anatomy they need to know to become doctors." I said, "No, as an MD, it is my job to teach doctors the anatomy they need to know to become doctors. It is your job to LEARN that clinically-relevant anatomy that you need to teach them. It is not my job to re-learn minutiae of anatomy never used in 20 years of practice because "you" know it. This isn't grad school. We're not creating PhD anatomists. If you want me to re-learn, and to teach the anatomical minutiae I've long since forgotten, it isn't going to happen. You're in MY world. I'm not in yours. Go teach at a grad school for a PhD program if you want that. We are training medical doctors. And, you, my friend, have never practiced MEDICINE."
I am also tired of hearing: "Cadaver dissection is the GOLD STANDARD by which anatomy is taught!"
Sure, before the advent of anesthesia.
Today, however, we train medical students with PhD anatomists, then two years later, AFTER first-year anatomy, they walk into the operating room as a know-it-all third-year student who doesn't know what color fat is, what the omentum looks like, that the esophagus doesn't have a serosa, that the appendix can be a bitch to find if it is retroperitoneal or retrocecal, or both—if they even REMEMEMBER what "retroperitoneal" means. Did you know when you do a bowel resection it's important to know the vasa-recti are different lengths in the jejunum and ileum? Which one is longer? Now, why at 2 am, during a bowel obstruction case, would I need to know this? Every medical school PhD anatomist thinks this is important for EVERY doctor to know. THIS CRAP MUST STOP.
The gold standard of anatomy education, today is a living, breathing patient under anesthesia. Anesthesia revolutionized medicine AND surgery and SURGICAL EDUCATION, but why doesn't that flow over to the classroom? Have you ever watched the dissection videos on www.aclandanatomy.com? OMG! I wish I had these BEFORE I ever started my cadaver dissection or walked into an OR!
I learned my anatomy in the operating room. No, wait, I "re-learned" my "clinically-relevant" anatomy in the operating room—from surgeons—not from PhD's.
How to fix this system?
Get rid of part 1 of the boards or change them to reflect CLINICAL-relevance.
Early exposure to LIVE anatomy, FIRST, then go back to a cadaver.
Teaching anatomy with CT scans, MRI's, cross-sections. This is what we look at every day.
When is the last time YOU saw a carcinogenically-embalmed cadaver, rigid, stiff, dried out: How can you teach form/function here?
The gold standard of learning anatomy was given to us years ago by the advent of anesthesia. It isn't the cadaver. And medical education, according to the Flexner report is now 100 years out of date. Get rid of our PhD colleagues in medical schools and replace them with MD's.
And you thought I was cranky?