LAUSR

William Hunter, the elder sibling to John, was of the contentious view that one could never justify trying to persuade students ‘that a little anatomy [was] enough for a physician and a little more too much for a surgeon’. Indeed, his often quoted opinion pre-empted and remains at the core of the continuing debate regarding the need for regional, topographical anatomy to be included in the modern medical curriculum. The plight of anatomy as to depth of content, not to mention the why, when, how and who should teach anatomy to medical students, continues to be debated with varying viewpoints regularly expressed both in the international press and in this journal both by senior surgeons and students. Furthermore, in the current era of time-poor, 4-year, problem-based, graduate-entry, medical programmes, students are understandably concerned about what they believe to be the inadequate, unrealistic contact time devoted to the teaching of anatomy and the potential negative impact this may have on their surgical training. This growing disquiet has led to the recommendation for a national, core curriculum in anatomy to be developed to ensure a basic standard of knowledge by Australian medical graduates and to reduce the escalating amount of remedial teaching required to assist students to pass the College General Surgical Science Examination (GSSE) barrier prior to entering surgical training. In this regard, a paradigm shift is essential to clearly define, maintain and promote national standards appropriate to teaching core and advanced anatomy to both medical students and surgical trainees. Anatomy is a recognized, essential medical science, and two contributions in this issue of the journal remind us again of the pivotal, yet ever-changing, role of anatomy in operative surgery and in medical education more broadly. Saniotis and Henneberg highlight the clinical importance of anatomical variants and how they may impact on the interpretation of diagnostic imaging, understanding pathophysiology and predicting surgical outcomes. An example that quickly comes to my mind is the conceptualization of Calot’s cystohepatic triangle as a ‘critical view of safety’ when performing a cholecystectomy. Indeed, there are numerous examples of the quality and depth of knowledge that already exist and are unsurpassed in the classic 19th century descriptions of regional anatomy though sadly these are often misunderstood, misconstrued, unknown or lost in translation. Nonetheless, such descriptive details remain the gold standard, and when further researched and confirmed may have a profound influence on the uptake of new surgical techniques and patient outcomes. In addition, Saniotis and Henneberg remind us that anatomical variants are not rare singular instances, but rather evolving biological consequences requiring a response and the need to adapt to a constantly changing environment with its subtle influence on morphology relevant to surgery. A different objective is addressed in the paper by Farley et al. who promote and advance the theme of consolidating and improving curriculum content in anatomy teaching by emphasizing the application of clinically relevant, novel, imaging-descriptive techniques on surgical practice. This implies a need for a substantial shift in the manner that anatomy course content is taught, including vertical and horizontal integration throughout a 4-year graduate medical programme. Such an approach also provides opportunities for innovative anatomical research, for example, the study of lean psoas muscle mass (sarcopaenia) using computed tomography imaging as a predictor of post-operative outcomes. So where to from here? Undoubtedly, there are many innovative pathways that may be used to enhance student learning and influence the pedagogical nuances of designing course content, teaching methods and how standards should be defined, evaluated and promoted. The Australian and New Zealand Association of Clinical Anatomists has a keen interest in developing appropriate consensus guidelines so as to better promote national standards in the teaching of clinically relevant anatomy to both medical students and graduates. Collaboration between the Australian and New Zealand Association of Clinical Anatomists, the College and universities as integral partners in this endeavour, would be very welcomed, ensure fruition and attain results.