Category Archives: Anatomy

True Greys Anatomy Fans Caught This Derek NodVivian Zink - Getty Images

This article contains spoilers from the premiere episode of Grey's Anatomy season 19.

Fans of Grey's Anatomy, rejoice your favorite medical drama is officially back for season 19! Thursday night's premiere introduced viewers to a whole new class of interns, all with different agendas for how they want to advance at Grey Sloan. But one new face actually has ties to a fan-favorite character, and it took a bit of detective work to figure out the shocking twist no one saw coming.

In the first episode of Grey's Anatomy season 19, dedicated viewers met Lucas Adams (Niko Terho), a young man who Meredith Grey (Ellen Pompeo) described as "charming" yet "a bit of a black sheep." His charisma rang true as he prepared to perform surgery with a group of fellow surgeons. While he described the scenario throughout the room, he utters these key words: "It's a beautiful day to save lives."

Sound familiar? As true fans know, a rather dreamy doctor used to say the exact same phrase before performing an operation: Dr. Derek Shepherd (Patrick Dempsey).

Now, you may be wondering how Lucas could've possibly known about Derek's famous quote. As Amelia (Caterina Scorsone) remarks to Meredith, there's a wild connection between the two men. "Derek was a god to him," she begins. "And Lucas was Derek's favorite nephew."

What a way to introduce this twist! Longtime fans were shocked too, and they naturally had to react to this revelation on social media. "My heart literally stopped," one fan wrote on YouTube. "He said it! Derek's line!" another follower excitedly noted. "The fact that the actor who plays Lucas was able to nail the inflection of Patrick Dempseys delivery is wild," a different fan added.

Photo credit: ABC

While Lucas's connection to the Shepherd family may come out of nowhere, there's actually validity to his existence. In fact, Derek actually referred to his large family back in the second episode of the entire series. As he told Meredith in season 1, McDreamy had four sisters (Amelia, Nancy, Kathleen and Lizzie) who are not only "very girly" but had "tons of kids." He clearly made an impression on his nieces and nephews before his death from a car crash in season 11, since another Shepherd family member is seemingly here to stay.

Story continues

Now that we think about it, Grey's Anatomy actually left subtle clues to Lucas's familial ties while promoting season 19. When the character was officially announced back in July, Deadline described the character as "the charming black sheep of his family" and "determined to prove himself as a surgeon, just like many in his family that have come before him." In addition, Instagram further captioned a photo of Lucas as "ready to prove himself as worthy."

From this alone, it looks like Lucas is about to be an important character to watch this season. And we seriously can't wait.

You Might Also Like

See the rest here:
Greys Anatomy Fans Are Having A Meltdown Over The Shocking Derek Shepherd Season 19 Twist - Yahoo Life

Greys Anatomy had a couple return, but their relationship is on the rocks. Owen Hunt (Kevin McKidd) and Teddy Altman (Kim Raver) are back and fans had a lot to say about their bickering.

[Spoiler alert: This article contains spoilers for the Greys Anatomy season 19 Episode 2, Wasnt Expecting That.]

RELATED: Greys Anatomy Cast Reveals Why Its Hard to Imagine the Show Ending

Last season, Owen was outed for illegally giving dying veterans drugs to end their suffering. Teddy found out and told him to stop. But they had a hard decision to make once someone reported Owen.

Teddy said they had to go on the run. They packed their things and season 18 ended with them on a flight.

The premiere of season 19 ended with the married couple returning from going on the run. They hired an expensive lawyer and got the charges dropped.

Wasnt Expecting That showed Teddy is back to her job. But Owen agreed not to do anything without supervision. This meant Teddy would step in to watch him, which led to more bickering between them.

Teddy and Owen vented about their frustrations to other people. Teddy admitted to drinking more while they were away, but she wont leave Owen because hes the father of her children.

Owen said he was miserable while away with Teddy. He tried to surf, hang out with the kids, and write letters to distract himself. Owen claimed he still loved Teddy but knows she resents him at work and at home.

RELATED: Greys Anatomy: Kate Walsh Confirms Addisons Season 19 Return How Many Seasons Has She Been In?

Owen hasnt been loved by fans for a while. So its not surprising some Reddit fans hated these scenes between the couple.

Can Teddy and Owen go at least five episodes in a row without an argument? one fan asked.

Now this is the inevitable conclusion of their relationship if they ever got together like they were never meant to be together and now they are, someone theorized.

Can they just go? another person asked. However, there were some fans who found the scenes fun.

I dunno Im kinda here for Teddy sh***ing on Owen/b****ing at him constantly. Its hilariously satisfying, someone else replied.

On one hand Teddy and Owen arguing is annoying. On the other hand, their marriage would be as toxic as it is, another commenter added.

Owen usually annoys me but theyre actually making me laugh tonight, especially seeing their BS through Yasudas eyes, one person claimed.

The characters are no strangers to divorce. Owen and Cristina Yangs (Sandra Oh) marriage didnt last. Before Owen, Teddy was a widow to Henry Burton (Scott Foley).

Teddy and Owen were friends with a lot of history before getting married. Its unlikely theyll go their separate ways after getting married as recently as season 18. But it looks like theyll have a lot to overcome. Teddy doesnt trust Owen after everything he puts at risk. Theyre also broke after how much money they spent on lawyers. Fans will have to keep watching to see how it will all get resolved.

RELATED: Greys Anatomy Creator Shonda Rhimes Has Mixed Feelings About the Medical Dramas Legacy

Continue reading here:
'Grey's Anatomy' Fans React to Owen and Teddy's Bickering, Call It 'Toxic' and 'Funny' - Showbiz Cheat Sheet

As we get ourselves prepared forGreys Anatomyseason 19 episode 3 on ABC next week, we recognize that Merediths exit is on the horizon. Ellen Pompeo will leave the show, at least as an on-screen presence, following the upcoming eighth episode.

So how is the character going to leave? One of the things weve heard already is that it involves one of her children, which makes a good bit of sense given that any parent should do what they can for their kid even if that means stepping away from a familiar, comfortable world.

Based on the full Greys Anatomyseason 19 episode 3 synopsis below, it could be Zola who gets the ball rolling for Merediths exit in some shape or form:

Lets Talk About Sex Bailey recruits the interns to create a series of social media videos informing teens about sexual health. The videos, filmed at Grey Sloan in front of a group of high schoolers, hit home as a student has medical complications during her visit. Elsewhere, Meredith and Maggie learn something new about Zola on an all-new episode ofGreys Anatomy airingTHURSDAY, OCT. 20(9:00-10:01 p.m. EDT), on ABC.Watch episodes on demand and onHuluthe day following their premieres.

Lets just go ahead and say that were ready to getallsorts of emotional over what happens when it comes to Meredith and Zola. The rest of the story in this episode may be devised largely as a way to get a break from some of that it will be lighthearted in nature, and also show us further whats going on when it comes to Miranda Bailey. Shes got a story this season that should be unique from what weve seen in the past, and lets just say were rather excited about that.

Related Get some other updates on the subject of Greys Anatomy right away!

Share your thoughts and theories below! Once you do just that, stick around there are other updates ahead we do not want you to miss. (Photo: ABC.)

Read the rest here:
Grey's Anatomy season 19 episode 3: The path to Meredith's exit? - CarterMatt

Afghanistan, which has witnessed the worst-ever crisis since the ouster of the democratically elected government, was left abandoned by America nearly 15 months ago, after cutting all ties with the Taliban-led government. However, a top official in the Biden administration believes the US would have maintained a diplomatic presence in Kabul through 2021 and into 2022 prior to withdrawal from Afghanistan.

According to a report by Politico, US Secretary of State Antony Blinken's critical remarks came while recording a documentary for an American pay television network- HBO. The special program will be on-aired on Wednesday. He acknowledged that the administration could not apprehend that the condition would turn more worst than US officials had underscored. According to Blinken, the administration had worked on certain assumptions.

"I believed strongly that we were going to have a robust embassy presence in Kabul certainly through the year [2021], well into the next year," Blinken said in the documentary. "Everything that we planned and did was based on that assumption." The HBO documentary "Year One: A Political Odyssey" which will be premiered on October 19, emphasises how the Biden administration acted with good intentions but did not turn out as satisfactorily as planned. Documentary director John Maggio reportedly said that the Biden administration has analysed all mistakes that led to the humanitarian crisis in Afghanistan and added it tried to rectify all those in the ongoing Russia-Ukraine war.

Earlier last year, when the US pulled its forces, thus pushing the country into a vulnerable state, nearly all Afghans expressed deep concerns about their life. According to a recent survey by Gallups Negative Experience Index, it categorised the country is the unhappiest nation in the world. The report found that people are still facing physical pain, mental stress, mental disorders triggered by poverty and unemployment, anxiety and anger, in the past 1.4 years of the extremist government. The survey claims that 80% of Afghans are worried and disturbed while 74% of the mental stresses induced by poverty are caused by unemployment. A survey conducted last year found nearly 53% of the countrymen wished to leave Afghanistan, citing uncertainties in the Taliban regime.

Read more:
Blinken admits he thought US would have an Embassy in Kabul before troops' withdrawal - Republic World

If you have gone to see a health care provider within the past 15 years, chances are very good that youve seen a model from Anatomy Warehouse, a growing Evanston e-commerce company in the business of health education.

Founded in 2005 by Adam Cordell and based at 1630 Darrow Ave., the company sells detailed, accurate and lifelike models of human and animal body parts and processes to colleges and universities, health-related professional schools, government entities, clinics, health care settings and private businesses all over the world.

Closer to home, the Evanston Township High School biology and health sciences programs have benefited from Anatomy Warehouses donations of gently used anatomy models.

Cordell, a native Evanstonian and a proud ETHS graduate, has 12 employees, most of whom live in Evanston. Cordell said he is especially proud of how they were all able to shift to working from home during the pandemic; no one lost their job or took a pay cut. Everyone stayed healthy and kept working.

Despite the medical nature of their work, no one in the office is a doctor. But over the past 14 years, Liz has probably gone to medical school from what shes learned on the job, Cordell said.

Liz is Liz Huff, who joined the company in 2008 and is director of Operations, managing the customized order process. From 2009-2013 the company was processing orders from eight different websites organized under categories including Halloween costumes, seasonal, school supplies, massage and medical apparel in addition to anatomical models.

But the business sweet spot was anatomical models, and the company gradually exited or sold off the other lines of business.

Doctors often contact Anatomy Warehouse for assistance preparing for complex and unusual surgeries. Cordell and Huff work with suppliers that can produce unique 3D-printed models that are helpful in pre-surgical preparation, allowing the surgeon to view a surgical site from multiple views and practice different approaches. Cranial models are a specialty.

For products that the company develops in-house, Cordell said it relies on a team of external medical professionals to review or contribute to the quality control process.

Medical device companies, pharmaceutical companies and life sciences companies might contact us for anything, Huff said. Weve made trophies. It could be adding a customized logo to the base of a model. It could be developing a completely bespoke training model for demonstrating a surgical technique or an R&D model for testing a new device prior to regulatory approvals.

Both Cordell and Huff said they are much more aware of what their doctors do as a result of their work. Were training future doctors and nurses. Wed better do a good job because we could be their next patient, said Huff.

If youve watched TV shows like Bones or The Walking Dead youve likely seen their work.

Anatomy Warehouse sells moulage, or simulated wounds, used in movie, television and theater productions as well as health training and education, such as disaster training for first responders.

We sell mannequins that can be wirelessly programmed to bleed, vomit and seize, Huff said, all to make the scene or training more realistic.

Cordell and Huff are responsive to what their customers want. Skin tones are available in light, medium and dark. The company embraces adapting models to reflect diversity in bone structure, including skeletons that are not just of European descent.

The medical community has been driven by European men forever, Huff said. But there is a broader selection that we try to represent, and we are pushing our European manufacturers to represent.

Within the last few years the company has updated its product descriptions to eliminate ethnic or geographic references. Faces are described as having masculine features or feminine features instead of being labeled male or female. Its a dynamic space, Huff said. Its our job to listen to our customers and to our community and to have them lead what they feel is the best way to represent those things.

The products also represent different body types. On the mannequin side, there are rescue training mannequins that are specifically focused on water rescue, and they can simulate a realistic weight or a heavier model to be more difficult, Huff said. We also have bariatric models with different weights and proportions.

The companys No. 1 product on the anatomical side is a full-sized male skeleton. On the health care side, IV arms are the sales leader. IV arms are used to teach blood draws, injections, infusions and needle selection. The way to get good at a skill like a blood draw is to practice, repeating the same action, correctly, over and over. A good model enhances that training.

And now Anatomy Warehouse is looking for more space. It hasnt found the right spot yet, but Cordell emphasized how special Evanston is to him and his team.

We really hope we can stay here, he said.

See the original post:
Anatomy Warehouse has Evanston in its bones and a little bit of Hollywood too - Evanston RoundTable

Ana Yoe-Cheng Chang Chan,1 Coen PM Stapper,2 Ronald LAW Bleys,3 Maarten van Leeuwen,2 Olle ten Cate4

1Department of Morphological Sciences, Faculty of Medical Sciences, National Autonomous University of Leon (UNAN-Leon), Leon, Nicaragua; 2Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands; 3Department of Anatomy, University Medical Center Utrecht, Utrecht, the Netherlands; 4Utrecht Center for Research and Development of Health Professions Education, University Medical Center Utrecht, Utrecht, the Netherlands

Correspondence: Olle ten Cate, Utrecht Center for Research and Development of Health Professions Education, University Medical Center Utrecht, Universiteitsweg 98, 3584 CG, Utrecht, the Netherlands, Tel +31.88.75.57010, Fax +31.88.75.53409, Email [emailprotected]

Abstract: The status of anatomy education in undergraduate medical education has dramatically changed over the course of the past century. From the most important and time-consuming component of the preclinical program, anatomy education has reduced in size and status, and yielded in curricular space to accommodate other disciplines and topics. Meanwhile, radiology has become more prominent, as a means to visualize anatomy, not only in clinical care but also in education. For this perspective paper, the authors, all with backgrounds in anatomy, radiology and/or medical education, conducted structured conversations with several academic colleagues with similar backgrounds, reviewed pertinent literature and analyzed the causes of the historical decline of a knowledge domain of medical education, that nevertheless is widely considered essential for medical students and graduates. After this analysis, the authors propose four ways forward. These directions include systematic peer teaching and development of anatomy education as a scholarly domain, further vertical integration with postgraduate medical education, full integration with radiology education, and capitalizing on educational technology. Schools in several industrialized countries have made steps in these directions, which can be further strengthened. In less affluent countries, and in countries with curricula strongly determined by tradition, these steps are less easy to make. To respond to changes in global health and health care, combined with the inevitable technological progress, and international mobility, we believe all schools will move in these directions, slower or faster.

Keywords: anatomy education, radiology education, vertical integration, technology, future

Since Vesalius (15141564), the founder of accurate anatomy texts and drawings, and arguably the father of current anatomy teaching, medical education in the universities has had a strong emphasis on anatomy, if not being its core pillar for centuries. Around the turn of the previous century, two to three years of the preclinical curriculum devoted to morphology (anatomy, histology, and cytology) was considered time well spent, and around 1960, Dutch curricula still contained 225 to 572 hours of anatomy teaching.1 Likewise, in 1901 medical schools in the United States had about 549 hours of anatomy teaching, and by 1955 approximately 330 hours.2 The latter half of the 20th century showed a continuous decrease in the absolute and relative time devoted to teaching and learning anatomy in terms of curricular hours and in time students spend studying anatomy. While the same century has witnessed many changes in medical curricula, often aligning with Hardens SPICES model (more student-centered, problem-based, integrated, community-based, and systematic),3 the decrease in time and effort to acquire anatomical content knowledge stands out. In one Dutch curriculum, the absolute time devoted to anatomy (and other basic sciences) decreased by 60% to about 100 hours in the period between 1990 and 2010,4 in which year Australian/New Zealand medical schools ranged in total hours of anatomy teaching from as low as 56 to as high as 560.5 A similar process happened in less affluent countries. In Nicaragua, by 2019, the medical curriculum contained 102 hours of anatomy teaching,6 a reduction of 68% compared to 320 hours 20 years prior.

Not all knowledge that, in the past, was considered relevant for medicine and patient care is still current. Some knowledge has become irrelevant, outdated, or discovered as incorrect. Regular adaptations in education are thus needed and justified. While new insights and advances in knowledge of basic and clinical sciences have been continuously added, and clinical training has become more prominent, existing components of the medical curriculum must decrease to make space.

However, the decrease in time and attention for anatomy in medical education is in sharp contrast with a universal acknowledgment by practitioners and educators of the importance of anatomical knowledge for physicians.7 In some specialties, particularly surgery, there are serious worries that the decrease of anatomical education has led to a decrease of knowledge that must be supplement with postgraduate anatomical education.79 Gross anatomy is considered an undisputed core component of the medical curriculum.10 Anatomical knowledge is indispensable for adequate physical examination of patients, irrespective of specialty, but it is also a foundation of the language of medicine. If inter-collegial and interprofessional communication cannot use the language rooted in the names of anatomical structures, adequate patient care for a variety of health professionals would be impossible.

The recent decrease in curricular time for the basic sciences includes other domains than anatomy, but the latter is the focus of our current contribution.

Given the continuous decrease, medical educators need to ask themselves the following questions: what may have caused the quantitative decline in anatomy teaching? And, most relevant, what are the ways forward to guarantee adequate quality anatomical knowledge of physicians in the future?

One cause may be the decreased academic status of anatomy in medical schools. Research weighs in on this change of status. Significant anatomical discoveries were made frequently in the 19th and early 20th centuries. In the second half of the last century, anatomical discoveries happened,11 but modestly, research diminished, and education became the primary mission of anatomy departments, which consequently decreased in size, funding, and academic staff. Medical graduates with academic research ambitions are now less likely to choose (gross) anatomy as a career unless education is their passion,6,12 resulting in an often voiced lack of qualified anatomy teachers.13

A legitimate wish to turn fragmented and disconnected courses in the medical curriculum into a coherent program based on clear objectives derived from patient care may be another cause. Horizontal integration (ie, the combined educational contributions of various basic sciences) and vertical integration (the integration of clinical subjects with basic science information) have been hallmarks of modern medical curricula,1416 as well as a legitimate shift from memorization of facts to problem-solving.17 Integration makes the contributions of separate basic sciences less demarcated than discipline-based courses, and an unintended consequence of integrated tests is that they allow students to pass with relatively low scores for minor parts of these integrated tests (ie, such as anatomy), whereas previously the anatomical knowledge had their own tests, which required adequate knowledge to pass the tests.18

Next, the notioncorrect or notthat much of what is learned in medical school is not directly useful in clinical practice may have fueled discussions in curriculum committees when searching for space to incorporate new elements in educational programs. Depending on clinical specialties present around a committees table, clinicians may not always have acknowledged how much time and effort it takes for students to acquire new (anatomical) knowledge.19 Encapsulated knowledge, once acquired, may become tacit in experienced clinicians,20 causing this underestimation.

Finally, the (again legitimate) push toward more and earlier clinical training in the medical curriculum requires space because curriculum lengths hardly ever increase. This space must be found by decreasing components that seem less relevant. In addition, the substantial costs of anatomy education would be lowered, which may have weighed in with considerations to reduce it.

This multifold background is not so much a deliberate restriction of anatomy education because of its irrelevance; instead, this effect rather seems to be a consequence of wishes to integrate and include new topics in curricula and lower the space and cost of anatomy education.

The authors of this opinion article do not intend to judge what is an acceptable amount of anatomy education and acknowledge, as there is a wide variety in the amount of anatomy education in medical curricula worldwide. Instead, looking to the future, they propose to explore ways medical education might adapt to secure that medical graduates and specialists have sufficient anatomical knowledge to provide high quality and safe patient care.

The status of anatomy education will not return to where it came from. De-integration is not likely to happen (in most schools), and an increase in curricular hours or proportion is not foreseen (in most schools). It is also not expected that gross anatomy will become the central area of research as reflected in the past. Consequently, the future of anatomy teaching and learning is likely to be fundamentally different from the past.

To meet this challenge, multiple conversations with a variety of educators at Utrecht University (notably from anatomy, surgery, radiology, family medicine, and veterinary medicine see acknowledgments), both directly before the COVID-19 pandemic and two years later, combined with internal discussions among the authors and references to a selection of pertinent literature formed the basis for this opinion piece. We requested from the colleagues with whom we had the conversations, an informed oral consent to record and transcribe the sessions and use the content as inputs for our analysis and discussions. The authors conducted focused literature searches using electronic databases and virtual libraries of medical education journals; the search terms related to terminology such as anatomy education approaches, future of anatomy education, the continuum in medical education, and integration in anatomy teaching. The analyses and proposals for various perspectives on the way forward are not a direct reflection of the consulted expert opinions only, nor just of the literature, but a vision among the authors that has matured over the past years. The statements in this perspective article are the authors informed opinions rather than representing a research report.

We offer four ways forward.

The introduction of massive near-peer teaching is the least radical but a sound approach that meets both the lack of anatomical staff and is a theory-based educational method.

A constructivist learning principle is that advanced concepts must connect to a learners existing knowledge base, which is a reason to create such a knowledge base of gross anatomy early.

While there is nothing wrong with attempts to make learning as joyful as possible, acquiring new knowledge and skills is often, and for many students, not necessarily pleasant. In cases where the return on the investment of a students effort occurs only in the longer term, there is a phase of mental plowing that is simply unpleasant, requiring stamina. Most top musicians and sporters will recognize this. One way to shorten that period is to engage senior students in near-peer teaching for junior students. Students as teaching assistants have for a long time been part of anatomy education, but that opportunity is usually reserved for a minority of students as an extra-curricular, often paid activity. In contrast, having all students teach anatomy as a mandatory curricular activity for credits would serve several purposes.21 First, it would provide a much faster relevant purpose for applying acquired anatomical knowledge and an antidote against knowledge decay.22,23 Second, teaching, including the preparations for teaching, is considered a highly effective way of learning.24,25 Third, it would enable organizing small-group education, and faculty members role may be limited to guiding peer teachers rather than teaching students directly. Fourth, while many schools recognize the usefulness of teacher training for medical students, only a few have operationalized this.26 Finally, the interest in a teaching career, such as in anatomy, can be stimulated by teaching experience in medical school.27

This model, applied to clinical reasoning training for junior medical students, has been successfully applied at Utrecht University for over 15 years. All final year medical students must attend teacher training, including the teaching of junior medical students. This clinical reasoning course is entirely run by students, with just teacher oversight. It is one of the most highly valued, practical, and low-cost courses in the curriculum.28,29 A similar model might work for anatomy teaching and be cost-effective, even if it does not reduce infrastructure costs.

The focus of anatomy as a domain of educational scholarship fits the development of medical education as a scholarly discipline.3032 Rather than through new anatomical discoveries, the anatomical discipline can distinguish itself in the future through new educational approaches using technology and other means.

Vertical curriculum integration, often translated as early clinical education in the medical curriculum, also encompasses the teaching and learning of basic sciences during later phases of medical education. The divide between undergraduate preclinical and clinical education has always been the focus of vertical integration,16,33,34 but the extension to postgraduate training is a logical next step. Medical specialties differ in need to rely on specialized anatomical knowledge. Surgery, radiology, neurology, gynecology, and orthopedics all require specialized anatomical knowledge bases, which need not be fully required for family medicine, dermatology or psychiatry. Focused clinical anatomy education and assessment in postgraduate training should secure specialty-specific clinical proficiency. The joint anatomy knowledge base that all medical graduates must master should be enough to enable smooth interaction with any clinical consultant, orally and through writing, and should enable anatomical explanations to patients in primary care settings, such as needed for shared decision making, involving discussion of images in an electronic health record.

Vertical integration over a prolonged time, which implies a regular repetition, also serves knowledge retention and has been recommended for anatomy education21 to prevent loss of basic science knowledge.22,35 Baker has stressed the need to employ clinically qualified anatomy teachers to establish vertical integration, which extends beyond the contribution of radiologists in anatomy teaching, as explained in the next section.21 Mandatory clinical and applied anatomy training, incorporated in residency programs, will be needed to guarantee sufficient and appropriate anatomy knowledge for specialists in surgical disciplines, neurology and radiology.

A more radical approach to teaching the morphology of the human body is a complete integration of radiology and anatomy education.

Classic teaching of gross anatomy has relied heavily on corpses for dissection and prosection. The living body has become translucent with the discovery of X-ray imaging in 1895. Given the rapid speed of development in the past decades of modern medical imaging techniques like Ultrasound, Computed tomography, Magnetic Resonance Imaging, and Nuclear Medicine, the specialty of radiology, encompassing all these imaging techniques, has now become the discipline to reveal the gross anatomy of the living body. The primary focus of radiology in patient care is to identify, localize and characterize pathology, but the educational potential of radiology for gross anatomy education is immense. The integration with anatomy teaching is increasing36,37 as the interpretation of medical imaging has become an agreed-upon skill for all physicians.38 This vertical integration of anatomy and radiology within the medical curriculum serves the preparation for the way physicians will interact with anatomy in their practices.21 Increasingly, patients can view their radiological images in patient portals of their hospitals. Explanations will be asked from primary care providers who need to be able to interpret these images to patients, if not as an expert, then at least sufficiently for patient consults. In addition, handheld ultrasound devices are becoming common in primary care practice, and an increasing number of schools acknowledge that using point-of-care ultrasound (POCUS) will be an essential skill for all medical graduates. Chang Chan found that ultrasound imaging is less intuitive for the untrained medical student than other radiological images.39 Interpreting POCUS images is complex and requires extensive practice and special skills; the ultrasounds view does not coincide with the mental image that one develops along the three orthogonal anatomical planes when studying anatomy.39 Nevertheless, there is no reason why junior medical students should not start practicing POCUS to acquire anatomical knowledge that reflects the anatomy they will face in later practice. Many medical schools have incorporated POCUS training, be it yet in a modest sense or with limitations40,41 but there is significant international consensus that medical schools should incorporate it.42 Until half a century ago, first-year medical students in many schools were asked to possess a set of anatomical dissection utensils for gross anatomy, a microscope for histology and cytology, a white coat, and a stethoscope. While the first is no longer the distinctive attributes of a medical student, a tablet computer and a handheld ultrasound device may very well be the attributes of a medical student in the future, as they become increasingly affordable.

Multi-dimensional imaging, using volumetric imaging data acquired with CT or MRI, has been extensively applied in radiological anatomy education in the undergraduate medical curriculum of the University Medical Center Utrecht in the Netherlands, both for teaching and for student assessment.43 As a result of such developments, radiological anatomy is becoming an essential and likely growing component of anatomy teaching in medical schools.

Dissection practicums and lectures, as century-old dominant methods of anatomy teaching and training, have been supplemented with several new approaches in the 20th century, including models, body painting, and early computer-assisted instruction methods. The 21st century has witnessed tremendous development in technological approaches to anatomy teaching.

Dynamic three-dimensional (3D) images, with features of rotation, displacement, zooming, changeable transparency, and allowing virtual dissection, are rapidly appearing on the market and in non-commercial provisions.44,45 A recent randomized study revealed that students using 3D models of hand and foot answered more subsequent test questions correctly and needed less time than students who completed the assignment using anatomical atlases alone.46 Augmented reality and virtual reality techniques are also quickly emerging,47 while discussions about their precise nature and use are still ongoing.48

Life-size virtual dissection tables have emerged in the last decade as an option to replace cadavers and allow students to use their fingers as scalpels to dissect virtually. One study showed how teaching with a virtual dissection table, combined with live cadaver CT scans, appeared more beneficial to acquiring anatomical knowledge than traditional radiological anatomy seminars and conventional anatomy training.49 New technologies will include holographic and haptic techniques, often first developed for surgery but, with increased availability and lowering cost, very well suited for broader education.

The discussion of whether dissection of cadavers will disappear from medical curricula and be replaced by technology, given the excellent simulation models that have emerged and other technology that will appear on the market, is not one of technology only. Dissection of human cadavers of deceased individuals has an important ethical component. Dissection has long been considered an initiation rite for medical students,50 and some schools have elaborated this education to pay tribute to the life of the deceased and the family, regarding the corpse as a silent mentor for the student.51,52

Anatomy education may be at a crossroads in the history of medical training. Curriculum developers will need to carefully weigh a new position of anatomy education for medical students and residents. And learning anatomy simply requires time; decreased time spent on learning anatomy may not be easily compensated by modern educational techniques.53

The proposed directions that we offer, as food for thought, include a clear education foundation of anatomical knowledge in a very early phase, primarily conducted as near-peer teaching by more advanced students who learn through teaching, and an integration of anatomy with radiology education across the subsequent years. In addition, dedicated postgraduate clinical anatomy education geared to the specialty of interest will likely yield a better learning effect than a concentration of anatomy education in the undergraduate phase. In all phases, technology will have an important role. With augmented reality, images created and combined with images derived from advanced 3D models will allow for a just-in-time learning process that can extend across the educational continuum.

Not all innovations in anatomy education will be available for low-resourced countries.54 While some schools in the more industrialized world have made significant steps in these directions, other, more traditional schools, less involved in curriculum modernization, may have difficulty making such radical steps within a short timeframe. While in low- or middle-income countries (LMIC), technology could represent a problem, other dynamics than economic issues may be more of an impediment to change. Even in those countries, basic and easily accessible technological tools are often available. Rather, major curriculum reforms do not happen as they often disrupt existing practices, power structures, and educational philosophies.55 Hofstedes theory of dimensions of national culture, determined by power distance (PD), in uncertainty avoidance (UA) and in the individualism versus collectivism (IDV) and other dimensions,56 provides a useful lens to reveal that LMICs often have high PD and UA and low IDV. Jippes showed how these dimensions can hamper medical curricular changes.57

Technology is not a replacement of the human senses, needed to discern anatomical structures and its aberrations in pathology. For instance, a handheld ultrasound device to first explore parts of the human body may evolve in the near future into an important diagnostic tool for the physical examination of patients, but requires substantial training and should become an indispensable tool for all medical students, as stethoscope and reflection hammer.42 Therefore, training students, teachers, and professionals in using such technology should become a cornerstone of anatomy training. It will be a matter of global social responsibility to provide access to technological innovations to low- and middle-income countries.

We believe that with rapidly increasing international information exchanges, innovations are likely to spread and be picked up much faster than decades ago and schools will generally move in these directions, slower or faster. With this perspective paper we hope to have contributed to this movement.

Ana Yoe-Cheng Chang Chan MD is an assistant professor of anatomy at Department of Morphological Sciences, Faculty of Medical Sciences, National Autonomous University of Leon (UNAN-Leon), Leon, Nicaragua. Coen Stapper MD is a resident of radiology at University Medical Center Utrecht, The Netherlands. Ronald L.A.W. Bleys MD, PhD is a professor of clinical anatomy at University Medical Center Utrecht, The Netherlands. Maarten van Leeuwen MD, PhD is a retired associate professor of radiology at University Medical Center Utrecht, The Netherlands. Olle ten Cate PhD is a professor of medical education at University Medical Center Utrecht, The Netherlands.

The authors wish to thank several colleagues who engaged in conversations about this topic. They include Niek de Wit, Martijn Intven, Manon Horsman, Jelle Ruurda, Dik Rutgers, Daniela Salvatori, Anouk van der Gijp, Stella Mook, Emma Paes, Harold van Rijen, Annet van Royen and Tineke Westerveld. While this was not a qualitative research project, the authors did receive approval to record the conversations from the Netherlands Association for Medical Education Ethical Review Board (NERB#2021.2.8).

All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.

There is no funding to report.

The authors report no conflicts of interest in this work.

1. Custers EJ, ten Cate OTJ. A solid building requires a good foundation: the basic sciences in the Dutch medical curriculum, 18651965. J Int Assoc Med Sci Educ. 2010;20(3):261275.

2. Leung KK, Lu KS, Huang TS, Hsieh B-S. Anatomy instruction in medical schools: connecting the past and the future. Adv Health Sci Educ Theory Pract. 2006;11(2):209215. doi:10.1007/s10459-005-1256-1

3. Harden RM, Sowden S, Dunn WR. Educational strategies in curriculum development: the SPICES model. Med Educ. 1984;18(4):284297. doi:10.1111/j.1365-2923.1984.tb01024.x

4. Keijsers CJ, Custers EJ, ten Cate OT, Th J. A new, problem oriented medicine curriculum in Utrecht: less basic science knowledge. Ned Tijdschr Geneeskd. 2009;153:B400.

5. Craig S, Tait N, Boers D, McAndrew D. Review of anatomy education in Australian and New Zealand medical schools. ANZ J Surg. 2010;80(4):212216. doi:10.1111/j.1445-2197.2010.05241.x

6. Chang Chan AY, Wammes E, Custers EJ, van Leeuwen MS. Comparing medical student interest in gross anatomy learning and teaching across different cultures. J Med Educ Train. 2020;4(2):050.

7. Singh R, Shane Tubbs R, Gupta K, Singh M, Jones DG, Kumar R. Is the decline of human anatomy hazardous to medical education/profession?A review. Surg Radiol Anat. 2015;37(10):12571265. doi:10.1007/s00276-015-1507-7

8. Yammine K. The current status of anatomy knowledge: where are we now? where do we need to go and how do we get there? Teach Learn Med. 2014;26(2):184188. doi:10.1080/10401334.2014.883985

9. Streith L, Cadili L, Wiseman SM. Evolving anatomy education strategies for surgical residents: a scoping review. Am J Surg. 2022;224:681693. doi:10.1016/j.amjsurg.2022.02.005

10. Arrez-Aybar LA, Snchez-Montesinos I, Mirapeix RM, et al. Relevance of human anatomy in daily clinical practice. Ann Anat. 2010;192(6):341348. doi:10.1080/01421590903183795

11. Kumar A, Ghosh SK, Faiq MA, Deshmukh VR, Kumari C, Pareek V. A brief review of recent discoveries in human anatomy. Qjm an Int J Med. 2019;112(8):567573. doi:10.1093/qjmed/hcy241

12. McKuskey RC, Carmichael SW, Kirch DG. The importance of anatomy in health professions education and the shortage of qualified educators. Acad Med. 2005;80(4):349351. doi:10.1097/00001888-200504000-00008

13. Raftery AT. Anatomy teaching in the UK. Surgery. 2007;25(1):12. doi:10.1016/j.mpsur.2006.11.002

14. Williams G. Western Reserves Experiment in Medical Education and Its Outcome. New York: Oxford University Press; 1980.

15. Harden RM, Sowden S, Dunn WR. Educational strategies in curriculum development: the SPICES model. Med Educ. 1884;18:284297. doi:10.1111/j.1365-2923.1984.tb01024.x

16. Wijnen-Meijer M, van den Broek S, Koens F, ten Cate O. Vertical integration in medical education: the broader perspective. BMC Med Education. 2020;20(20):509. doi:10.1186/s12909-020-02433-6

17. Barrows H, Tamblyn R. Problem-Based Learning. New York: Springer Publishing Company, Inc; 1980.

18. Brooks WS, Woodley KT, Jackson JR, Hoesley CJ. Integration of gross anatomy in an organ system-based medical curriculum: strategies and challenges. Anat Sci Ed. 2015;8:266274. doi:10.1002/ase.1483

19. Koens F, Custers EJ, Ten Cate OTJ. Clinical and basic science teachers opinions about the required depth of biomedical knowledge for medical students. Med Teach. 2006;28(3):234238. doi:10.1080/01421590500271183

20. Boshuizen HPA, Schmidt HG. On the role of biomedical knowledge in clinical reasoning by experts, intermediates and novices. Cogn Sci. 1992;16(2):153184. doi:10.1016/0364-0213(92)90022-M

21. Baker KG. Twelve tips for optimising medical student retention of anatomy. Med Teach. 2022;44(2):138143. doi:10.1080/0142159X.2021.1896690

22. Weggemans MM, Custers EJ, ten Cate OTJ. Unprepared retesting of first year knowledge: how much do second year medical students remember? Med Sci Educ. 2017;27(4):597605. doi:10.1007/s40670-017-0431-3

23. Custers EJ. Long-term retention of basic science knowledge: a review study. Adv Heal Sci Educ. 2010;15(1):109128. doi:10.1007/s10459-008-9101-y

24. ten Cate O, Durning S. Dimensions and psychology of peer teaching in medical education. Med Teach. 2007;29(6):546552. doi:10.1080/01421590701583816

25. ten Cate O, Durning S. Peer teaching in medical education: twelve reasons to move from theory to practice. Med Teach. 2007;29(6):591599. doi:10.1080/01421590701606799

26. Zijdenbos I, Fick T, ten Cate O. How we offer all medical students training in basic teaching skills. Med Teach. 2011;33(1):2426. doi:10.3109/0142159X.2011.530309

27. Kloek AT, van Zijl ACM, ten Cate OTJ. How a teaching rotation in medical school affects graduates subsequent careers. Perspect Med Educ. 2016;5(6):325331. doi:10.1007/s40037-016-0302-4

28. ten Cate O, Custers EJ, Durning SJ. Principles and Practice of Case-Based Clinical Reasoning Education: A Method for Preclinical Students (Open Access). Vol. 15. Cham, Switzerland: Springer; 2018.

29. Zijdenbos IL, de Haan MC, Valk GD, ten Cate O. A student-led course in clinical reasoning in the core curriculum. Int J Med Educ. 2010;1:4246. doi:10.5116/ijme.4c18.94a5

30. Crites GE, Gaines JK, Cottrell S, et al. Medical education scholarship: an introductory guide: AMEE Guide No. 89. Med Teach. 2014;36(8):657674. doi:10.3109/0142159X.2014.916791

31. Cleland JA, Jamieson S, Kusurkar RA, Ramani S, Wilkinson TJ, van Schalkwyk S. Redefining scholarship for health professions education: AMEE Guide No. 142. Med Teach. 2021;1(1):128. doi:10.1080/0142159X.2021.1900555

32. ten Cate O. Health professions education scholarship: the emergence, current status, and future of a discipline in its own right. FASEB BioAdvances. 2021;3(7):510522. doi:10.1096/fba.2021-00011

33. Koens NF. Vertical integration in medical education - studies on the required basic science knowledge and the concept of context. Tijdschrift voor Medisch Onderwijs. 2005;24(5):230232.

34. Wijnen-Meijer M, Ten Cate OTJ, Rademakers JJ, Van Der Schaaf M, Borleffs JCC. The influence of a vertically integrated curriculum on the transition to postgraduate training. Med Teach. 2009;31:11. doi:10.3109/01421590902842417

35. Custers EJ, ten Cate OTJ. Very long-term retention of basic science knowledge in doctors after graduation. Med Educ. 2011;45(4):422430. doi:10.1111/j.1365-2923.2010.03889.x

36. Sadler T, Zhang T, Taylor H, Brassett C. The role of radiology in anatomy teaching in UK medical schools: a national survey. Clin Radiol. 2018;73(2):185190. doi:10.1016/j.crad.2017.08.008

37. Jack A, Burbridge B. The utilisation of radiology for the teaching of anatomy in Canadian medical schools. Can Assoc Radiol J. 2012;63(3):160164. doi:10.1016/j.carj.2010.11.005

38. Orsbon CP, Kaiser RS, Ross CF. Physician opinions about an anatomy core curriculum: a case for medical imaging and vertical integration. Anat Sci Educ. 2014;7(4):251261. doi:10.1002/ase.1401

39. Chang AYC, Bogran L, Chavarra E, Robles D, Sotelo N. Radiological anatomy as an alternative approach in anatomy teaching. Perception and performance of medical students. Investig en Educ Mdica. 2022;11(41):2533. doi:10.22201/fm.20075057e.2022.41.21384

40. Russell FM, Zakeri B, Herbert A, Ferre RM, Leiser A, Wallach PM. The state of point-of-care ultrasound training in undergraduate medical education. Acad Med. 2022;97(5):723727. doi:10.1097/acm.0000000000004512

41. Feilchenfeld Z, Kuper A, Whitehead C. Stethoscope of the 21st century: dominant discourses of ultrasound in medical education. Med Educ. 2018;52(12):12711287. doi:10.1111/medu.13714

42. Hoppmann RA, Mladenovic J, Melniker L, et al. International consensus conference recommendations on ultrasound education for undergraduate medical students. Ultrasound J. 2022;14:132. doi:10.1186/s13089-022-00279-1

43. Ravesloot CJ, van der Gijp A, van der Schaaf MF, et al. Support for external validity of radiological anatomy tests using volumetric images. Acad Radiol. 2015;22(5):640645. doi:10.1016/j.acra.2014.12.013

44. Zilverschoon M, Kotte EM, van Esch B, ten Cate O, Custers EJ, Bleys RL. Comparing the critical features of e-applications for three-dimensional anatomy education. Ann Anat. 2019;222:2839. doi:10.1016/j.aanat.2018.11.001

45. Zilverschoon M, Vincken KL, Bleys RL. The virtual dissecting room: creating highly detailed anatomy models for educational purposes. J Biomed Inform. 2017;65:5875. doi:10.1016/j.jbi.2016.11.005

46. Zilverschoon M, Custers EJ, ten Cate O, Kruitwagen CL, Bleys RL. Support for using a three-dimensional anatomy application over anatomical atlases in a randomized comparison. Anat Sci Educ. 2021;19. doi:10.1002/ase.2110

47. Uruthiralingam U, Rea PM. Augmented and Virtual Reality in Anatomical Education a Systematic Review. In: Rea P, editor. Biomedical Visualisation. 1st ed. Cham, Switzerland: Springer Nature Switzerland; 2020:89102.

48. Chytas D, Salmas M, Skandalakis GP, Troupis TG. Augmented and virtual reality in anatomy education: can they be effective if they do not provide immersive experience? Anat Sci Educ. 2022;15(2):431433. doi:10.1002/ase.2119

49. Paech D, Giesel FL, Unterhinninghofen R, Schlemmer HP, Kuner T, Doll S. Cadaver-specific CT scans visualized at the dissection table combined with virtual dissection tables improve learning performance in general gross anatomy. Eur Radiol. 2017;27(5):21532160. doi:10.1007/s00330-016-4554-5

50. Shaffer K. Teaching anatomy in the digital world. N Engl J Med. 2004;351(13):12791281. doi:10.1056/nejmp048100

51. Santibaez S, Boudreaux D, Tseng GF, Konkel K. The tzu chi silent mentor program: application of Buddhist ethics to teach student physicians empathy, compassion, and self-sacrifice. J Relig Health. 2016;55(5):14831494. doi:10.1007/s10943-015-0110-x

52. Chiou RJ, Tsai PF, Han DY. Effects of a silent mentor initiation ceremony and dissection on medical students humanity and learning. BMC Res Notes. 2017;10(1):17. doi:10.1186/s13104-017-2809-0

53. Bergman EM, Prince KJ, Drukker J, van der Vleuten CPM, Scherpbier AJ. How much anatomy is enough? Anat Sci Educ. 2008;1(4):184188. doi:10.1002/ase.35

54. Chang Chan AYC, ten Cate O, Custers EJ, van Leeuwen MS, Bleys RL. Approaches of anatomy teaching for seriously resourcedeprived countries: a literature review. Educ Heal. 2019;32:6274. doi:10.4103/efh.EfH

55. Gale R, Grant J. AMEE medical education guide no. 10: managing change in a medical context: guidelines for action. Med Teach. 1997;19(4):239249. doi:10.3109/01421599709034200

56. Hofstede G. Dimensionalizing cultures: the Hofstede model in context. Online Readings Psychol Cult. 2011;2(1):126. doi:10.9707/2307-0919.1014

57. Jippes M. Culture matters in medical schools. How values shape a successful curriculum change [Doctoral dissertation]. Maastricht University; 2012.

More here:
Are We Facing the End of Gross Anatomy Teaching as We Have Known It fo | AMEP - Dove Medical Press