LAUSR

There is much of importance in the letter of Dr. Anthony Berman to reflect upon and also within his earlier opinion piece published in an educational journal (Berman, 2014). I am very grateful for his comments and consequently it is right that attention should initially be drawn to where there is agreement before coming to where it is necessary to part company. I wholeheartedly applaud Dr. Berman’s view that a “curriculum is delivered (and not taught)” and that there is a need for “instructional flexibility.” Furthermore, institutional needs must indeed be recognized locally so that teachers are sensitive to student requirements and different learning styles. Taking these notions on board, in our papers concerned with the development of core syllabuses in the medical course for head and neck anatomy, neuroanatomy and for embryology and teratology (Tubbs et al., 2014; Moxham et al., 2015; Fakoya et al., in press), we were very careful to point out that core syllabuses should “NOT dictate WHEN or HOW the syllabus is delivered.” The International Federation of Associations of Anatomists (IFAA) is consequently clear that it is NOT developing core curricula but core syllabuses. The dichotomy between curricula and syllabuses is important; even if the problem seems to some to be just a matter of semantics. As reported in a article describing the processes involved by the IFAA (Moxham et al., 2014), we deemed it essential to distinguish between a curriculum and a syllabus, acknowledging that there is considerable variation in the use of the terms. Indeed, many definitions of “curriculum” are to be found in the literature and these often make reference to course structure, intended learning outcomes, teacher intentions, and teachingmethods (including the ethos and approach to teaching), student learning styles and strategies, methods of assessment and, underpinning all this, the understandings, attitudes, and skills to be acquired by students by the end of the program and the planned events that will occur during a program (McKernan, 2008; Kelly, 2009). Thus, as Dr. Berman puts it so persuasively and eloquently, a curriculum provides a “roadmap which guides an effective teacher on the educational journey.” We, therefore, ONLY employ the term “syllabus” in a sense used most frequently internationally to mean the list of topics to be covered. This is not however a minor matter. Without a core syllabus there is always the danger of topics being taught that extend well beyond a level of clinical significance or, worse still, ignoring/downplaying those topics that are significant. As an external examiner at many medical schools in the U.K. and abroad, I have first hand experience of this happening! There is furthermore the detrimental possibility of different institutions following markedly different syllabuses (as presently exists for the anatomical sciences; see Drake et al., 2014). This is not just a matter of concern for the medical establishment (whether at a professional, institutional, or educationalist level) but is of greater concern for society in general and for the individual who, as a patient, is a recipient of the medical training within a consumerist culture. Without syllabuses that are generally recognized and internationally accepted, an educational equivalent of the “Tower of Babel” is built where there is a lack of consistency, reliability, and transparency between medical courses in institutions (both within a particular country and between countries) and where consequently the losers will ultimately be both the medical profession and the wellbeing of patients. In terms of embryology and teratology, Dr. Berman correctly draws attention to the findings of Drake et al. (2014) where the average course hours given to embryology in U.S. medical schools is only 16 hr (68 hr SD) with embryology lecture hours averaging 14 hr. This however is something to lament and should not be used as a stick to beat up the notion that a core syllabus in embryology and teratology must be taught/ learned! After all, is anyone prepared to argue that core embryology and teratology are not essential for general medical practice, obstetrics, and pediatrics? Are we oblivious to the increasing concerns of the general public, let alone political and medical authorities, to how environmental factors affect intrauterine life (e.g., the recent publicity relating to the Zika virus)? It seems fair to say that, on the basis of developing clinical competencies, it is more than ever necessary to develop a core syllabus for embryology and teratology for medical studies. There is of course a misconception here. . . the core syllabus need NOT be taught just in an embryology course but can be part of an integrated curriculum and be taught at various stages of clinical training (e.g., with obstetrics, pediatrics, and even community medicine; see Moxham et al., in press). An important point raised by Dr. Berman relates to whether a core syllabus can be devised “democratically”. . . of course it can’t if one restricts oneself to the commonplace political definition of the term “democracy”! However, it can be used as a shorthand to extend the reach beyond just the expert and we are agreed in the IFAA that experts do not have a right to dictate what is taught or not taught or, worse still, have the syllabus written inflexibly (i.e., in “tablets of stone”). While the IFAA’s approach recognizes the importance of the initial