To reincarnate the anatomist

The American VOLUME 115

Journal

of Surgery

JUNE 1968

NUMBER 6

EDITORIAL

To Reincarnate

the Anatomist

the early history of surgery there are many astonishingly accurate descriptions of surgical exposures and procedures. The Egyptians of antiquity performed many operations, including trephining of the skull, and treated accidental wounds, fractures, and dislocations. The ancient Hindu literature contains a surgical manual of high caliber. Ancient Chinese documents describe operations for cleft lip. The anatomic studies of the medieval Italian schools have long been regarded as classics. The Renaissance provided further stimulus for a re-examination of the subject of anatomy. Knowledge of surgery has reflected the fate of empires rising and falling throughout time. The study of anatomy has been fundamental to advances in medicine and surgery. Present day medical school curriculum allots the first preclinical year for the teaching of anatomy. Too much time is spent in formal anatomy which is taught by anatomists who disregard clinical correlation and functional structure. Applied anatomy is not emphasized in most schools. The student learns by rote, memorizes enough to pass the examinations, and promptly forgets much of what he has learned. His attention is directed to other subjects during the remainder of his years in medical school, with the exception of a fleeting glimpse, now and then, at correlative anatomy. He may never learn to appreciate the astute

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diagnostician’s utilization of fundamental anatomic knowledge. As the young physician continues his education, he expends little effort to develop a knowledge of functional anatomy. Internship training in surgical specialties seldom includes formal instruction in anatomy. Few training programs emphasize the value of trainee time spent at the dissecting table. Yet, many times each day the trainees could well utilize a thorough knowledge of anatomy. When the new physician decides on a surgical career, he is not likely to encounter a formal course in anatomy. This fundamental aspect of medicine is relegated to late hours, a quick preoperative review in the surgical library, a brief view at the operating table, and a frantic rush with old, dusty, anatomy textbooks in preparation for the board examination. A cadaver may be available but is not used. Help is often at hand but is not sought. The senior surgeon spends little time in anatomy instruction in the operating room. He assumes that the surgical resident “knows his anatomy,” a myth that persists after the completion of the residency training program. Many practicing surgeons are “expedient andl’or expectant” anatomists. They do not fulfill the tradition of their surgical forefathers. It would seem to be time to reincarnate the anatomist. To achieve this requires greater participation by the teaching surgeon on the undergraduate, gradu-

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Editorial

ate, and postgraduate levels. He must assume the responsibility of developing a knowledge of correlative anatomy in the medical student. He must insist upon and participate in formal instruction for the surgical resident and he must provide the stimulus and facilities for him to develop active interest in regional and

applied anatomy. Only then will the reincarnation of the anatomist be complete. CHARLES M. EVARTS, M.D. Department of Orthopedic Surgery The Cleveland Clinic Foundation Cleveland, Ohio

American

Jouvnal

of Surgery