Medical education and hard science

To the Editor: In the lead-up to the description of events at a recent Royal Australasian College of Surgeons (RACS) conference,1 it appears that you do not fully agree with the changes in medical education in Australia and overseas in recent years. Firstly, it should be pointed out that problem-based learning has not “all but displaced didactic teaching”1 in Australian medical schools. Many schools have hybrid courses and a wide variety of teaching methods are used. Secondly, including outcomes such as “communication skills and compassion!”1 in the curricula can hardly be less than desirable. The desired outcomes of medical schools are driven by Australian Medical Council guidelines on the requirements for the safe and competent practice of clinical medicine by a generalised doctor in the intern setting before specialist training.

Individual surgeons, the RACS, and their United Kingdom counterparts2 have lamented the decline in medical students’ anatomical knowledge for generations, even when students were taught 500–700 hours or more of anatomy.3 There is nothing new in this call-cry.

A generalised doctor prepared for internship does not require much of the knowledge that some are lamenting has been lost from medical curricula. The “old” curricula were crowded with excessive amounts of topographical anatomy that was of questionable relevance and seldom taught within a clinical or medical context. The optimal time and context for students to learn detailed topographical anatomy is surely when the knowledge is most relevant and valuable. This is surely during basic and advanced surgical training programs, both administered through the RACS.

There is good evidence that detailed teaching of topographical anatomy in targeted postgraduate surgical training courses is of measurable benefit and greatly appreciated.4,5 Indeed, is it really very suprising that, for example, urological and gynaecological surgeons have a greater interest in the nine branches of the anterior division of the internal iliac artery and the detailed relations of the ureter in the pelvis than 18-year-old first-year or second-year medical students?

It is now the responsibility of surgeons and anatomists to deliver postgraduate programs that address the desired outcomes for RACS training (and the UK equivalent2). We at the University of Western Australia have launched a Graduate Diploma in Surgical Anatomy. A similar course has been in place in Melbourne for some years. Other states can only be encouraged to follow.