Human Anatomy is the Geography of Medical Practice: Scope and Teaching

Abstract

INTRODUCTION Human anatomy is the science that deals with the shape and structure of the human body. It is the foundation of all medical sciences. On the other hand, it represents the language of medicine. Anatomy remains the vital component of medical education. Accurate diagnosis of any changes or alterations in human body systems or organs requires a deep knowledge and understanding of normal anatomy.[1,2] Human anatomy is the oldest medical science. It has a distinguished history as it was considered one of the most prominent biological sciences until the 19th and early 20th centuries. Anatomy began in 1600 BC by the ancient Egyptians. This was demonstrated by the history of the Edwin Smith Surgical Papyrus which showed that the ancient Egyptians recognized the heart and other organs of the body.[3] Meaning of anatomy and aims and means of its study The word “anatomy” originates from the Greek words “ana” meaning “up” and “tome” meaning “cutting”. Anatomy means the science dealing with the structure of the human body not its cutting. Dissection is not a goal but a means of studying anatomy. Determining the exact anatomy of the human body is a milestone for all medical or surgical interventions. Without accurate knowledge, there is no complete medical practice, and this would expose the human being to great risks of making fatal mistakes. It is therefore essential for every member of the medical staff to update the anatomical knowledge.[4] Recognizing the anatomical variations is essential for proper diagnosis and management of related disorders.[5] In the past, the study of anatomy was mainly based on autopsy, but nowadays, using imaging technology, it is easy to see the structure of the body without this autopsy. Other methods of studying anatomy include body images, films, and artificial models that mimic the structure of the human body. Imaging means such as radiographs (x-rays), ultrasonography (US) images, computed tomography (CT) scan, and magnetic resonance imaging (MRI) are another method of anatomical study.[6] Moreover, performing surgeries even through a screen can bring the study closer to the minds of medical students. We always say that when a surgeon works in the operating room in an anatomical way, it means that he is on the right track. Is the title of science with the word “anatomy” correct and compatible with the goals of science? The word “anatomy” that means dissection or cutting is a misnomer to the meaning and aim of the science study. Dissection is not the study but one of its methods. At the present time, the methods of studying anatomy have developed significantly, allowing study from mere examination through anatomical autopsy to the use of sophisticated techniques. Therefore, using the word “anatomy” to describe science can mislead its scientific understanding and conflict with other sciences such as forensics. Such misconceptions are common among general populations and even some members of medical staff. This leads to confusions about the goals from anatomical sciences’ study.[4] On the other hand, the morphology also means study of the size, form, and structure. The two terms “anatomy and morphology” are used almost synonymously.[7] Scopes of anatomical sciences Human anatomy is the biological science that deals with the normal structure of body and its function and abnormal or pathological deviation. The anatomy, in its broadest concept, includes the following sciences: Gross anatomy “or Macroscopic anatomy”: It is the study of human structure with the naked eyes “without use of magnifying devices”, including clinical, surgical, and surface anatomy and anatomical variations.[1,4] Microscopic anatomy: The structure is investigated using microscopes including histology, cytology, ultrastructure, and molecular cell biology.[1,4] Developmental anatomy “or Embryology”: It is the science dealing with gametogenesis, fertilization, cloning, stem cells, in-vitro fertilization, embryogenesis, and prenatal and postnatal changes.[1,4] Radiological anatomy: It is study of anatomy using radiography “X-ray”, “US”, “CT” scan, “MRI”, and nuclear medicine imaging.[6] MRI represents a good, accurate, noninvasive resource for the study of human anatomy.[8] Functional anatomy “or Physiological anatomy”: It is the relating structure to function and vice versa that is essential because the anatomy and physiology refer to or mirror each other.[9] The studies of structure and function are closely inter-related; the separation between the two sciences is somewhat artificial.[7] Anatomy represents geography for physiology.[10] We can add that anatomy is the geography of all medical sciences and disciplines. Pathological anatomy “or abnormal anatomy”: This is science to detect any deviation from the normal anatomy and thus diagnose diseases either by revealing the shape of the organs or the structure of the cells and tissues.[11] Genetics: It is the science that studies genes and inheritance.[1,4,12] Anthropology: It is the study of human beings clarifying the differences in structure in-between different races and their physical development.[13] Anatomy teaching In recent decades, there has been a great development and a qualitative shift in the teaching of anatomy due to the change in concepts and understanding, in addition to the introduction of new technologies that have enabled us to follow many details that we did not know before. In the past, the teaching of anatomy was mainly based on the dissection and use of cadavers. Dissection has been used in medical schools around the world for more than 400 years. During that period, such learning using cadavers was believed to have many advantages including understanding the components of body systems in real bodies and preparing medical students to face death.[14] However, we believe that actual anatomy learning can also be achieved through radiology and other imaging modalities. In this regard, we agree with the other authors that imaging anatomy is a form of living anatomy and is of great importance in teaching.[15] Furthermore, facing death can be gained through clinical practice rather than through seeing corpses. Relying on dissection in anatomy education should not interfere with the study of living bodies through medical imaging and endoscopy. These methods can add to the classical teaching based on autopsy. Anatomical autopsy has been a model used for teaching human body structure since the Renaissance and the defining experience for teaching medicine since the 16th and 17th centuries. Thereafter, autopsies appeared regularly in medical training, although often in an informal and semi-formal fashion.[16] However, the continued use of cadavers is uncertain in the near future. There is a potential dearth of cadavers used for learning anatomy due to the current reluctance of medical institutions to accept them.[17] This is in addition to the restriction of the use of cadavers even for the purpose of medical education by government authorities in some countries because of lack of donors. With the advent of new technologies, anatomy teaching resources have taken great leaps in the 21st century. The traditional preclinical basic study method of anatomical autopsy is now supplemented by multimedia, high-quality imaging methods, three-dimensional modeling, and integrated problem-based clinical learning. However, it has been suggested that dissection remains the cornerstone of education because through it medical students acquire some independent skills with clinical correlates.[18] In this respect, radiology has been used to bridge the gap between basic and clinical sciences.[19] Shortfalls in cadavers can be made up through anatomical autopsy videos along with online laboratories using computer models such as those used during the COVID-19 pandemic.[20] Three-dimensional physical models are also an affordable and effective way to teach anatomy. They can provide a practical tool for upgrading learners’ knowledge of gross anatomy at a low cost.[21] Recently, artificial intelligence (AI) has gained a lot of interest in anatomy education especially in times of lockdown adopted during the COVID-19 pandemic. Through this AI, huge amounts of data are stored in a machine learning model and retrieved when needed. Although highly effective, AI remains with some limitations that may include cost of the server, training of faculty to operate and maintain the AI server, and development of tools.[22] Other authors suggested that the cadaver laboratory remains a significant advantage over multimedia simulators.[23,24] They added that even with computerized improvements, the possibility of direct contact with anatomical tissues and structures cannot yet be replaced. The best approach is the proper association of the traditional method with other modern resources for maximum educational benefit. Who should teach anatomy? As mentioned before, anatomical science represents the corner-stone for all other medical sciences and guide for clinicians in diagnosis and management of different cases. Therefore, we can say “no anatomy study is without clinical correlations and vice versa, that is, no clinical application without anatomy knowledge”. Parallel to thin line, anatomist must have a clinical background. Therefore, the anatomist should be a medical graduate. Anatomy is not a solid science, that is; its study is not just learning knowledge but such information must be organized to serve the clinicians in their different specialties. Without a good clinical orientation, the anatomist could not share in the applied research, and hence study of human anatomy loses so much of its critical importance in medical practice.[1,4,25] CONCLUSIONS It is concluded that the title of science with the word “anatomy” is confusing and misleading to understand the aims of science study. We also emphasize that anatomical study is vital to understanding all other basic medical and clinical sciences. Without a precise anatomical knowledge, the clinicians are not so efficient. Human anatomy is very comprehensive in its research scope. Therefore, the anatomists should have a clinical background to intensify the benefits of anatomy study and research. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.