Prof Chris Ward is right to point out that “softer skills” in the medical course cannot be readily learned in the classroom (Letters, 4 July).
However, the opinion that instead of “memorising lots of anatomy” the subject should be learned as it becomes clinically relevant, may speak of the medical course in the very dim and distant past but not of the present.
Over the past 20 years, anatomy has been cut to the point that it is now merely a tiny fragment of the average medical course, with available surveys suggesting that it amounts to just over three full weeks (120 hours) of tuition. Given a five-year medical course over two semesters of 15 weeks each, it thus contributes to only 2.2% of the entire course. Furthermore, much anatomy is now taught in integrative courses with clinical exposure to ensure clinical relevance.
As concerning is the idea that anatomy only involves memorisation. Practical anatomy (with radiology, surface anatomy, clinical cases, and ultrasound imagery) nowadays emphasises the acquisition of the softer skills by encouraging experiential learning, teamwork, use of clinical instruments and clean working practices, consideration of issues around death (who wants the student to see death for the first time on the ward?), and medical humanities (including ethics and appreciation of the benefit of the creative arts in the culture of medicine).
Advocates of, and apologists for, the four-year medical course have fallen for the mistaken view that “just in time” education can deliver benefits. But, like its economic/business counterpart, it is set to fail. This failure stems from an overly instrumentalist approach where being a learned practitioner is downgraded only in the interests of getting stethoscopes on wards and in surgeries.
There is evidence that laypersons (patients) would downgrade their esteem of the medical profession if they considered that anatomy was not a significant part of the medical curriculum. How much esteem medical authorities and professionals internationally would give UK medical practitioners who only have four years of tuition (involving 2.2% of time given to the normal structure of the human body) should be even more worrying.
Bernard Moxham
Emeritus professor of anatomy, Cardiff University
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