A 50-year-old man lies prepped and draped on the operating table, the hiss of the ventilator almost strangely in synch with the gentle strains of the cardiac surgeon's favourite Mozart sonata. At a nod from the anaesthetist, the surgeon puts scalpel to skin and before long the chest is open and cardiac bypass graft surgery ready to begin.
At the other end of the table, another surgical team works deftly to remove the saphenous vein that will replace the clogged anterior descending coronary artery. Pointing at the glistening and beating heart, the surgeon turns to a group of final-year medical students observing the procedure, and asks: "What is this structure?"
"The liver, sir," they reply.
Admittedly, I've taken a touch of artistic licence with this story, related in a front-page news story bemoaning the rise of “touchy-feely” subjects in modern medical curricula. Unfortunately, the comments aren't attributed to any particular individual, but presumably came from one of the anonymous and horrified senior doctors interviewed for the story.
So, which of the following would you say best explains the above scenario?
- From the back of the pack, the students' goggles had completely fogged up and, barely able to see even a hint of green, they panicked and took a blind, if idiotic, guess;
- the students had a wicked, if self-destructive, sense of humour;
- the group of students, sufficiently intelligent to get into medicine and make it through to final year, were invited to watch a HEART operation. But once in the CARDIAC theatre, they all agree that the liver is a supradiaphragmatic organ that also happens to pulsate;
- an ageing and anonymous surgeon, convinced that anatomy has insufficient weight in the modern medical curriculum, gilds the lily a bit to make his point.
You decide, but given that a five-year-old would probably pick a beating organ in the chest as the heart, my money's on 4. Yet the penultimate answer makes better headlines, and there's no shortage of ageing white male specialists ready to argue the merits of the way they did it in their day.
In the words of the president of the Australian and New Zealand College of Anaesthetists, the real worry is that "the people who aren't coming to [specialist medicine colleges] for further education, but go out practising as doctors or GPs, may not necessarily have as much knowledge as they should have". Ouch!
His pathology counterpart, Dr Stewart Bryant, says we risk "going back to the Middle Ages". "Do we want to go back to believing that malaria is caused by bad air?" he asked, somewhat bizarrely, in an interview with The Australian.
And the Australian Doctors' Fund - a group established in 1989 whose founding and current chair is orthopod Dr Bruce Shepherd - issued a public statement last year demanding that all medical students take part in anatomical dissection.
In defence of their curricula, university deans say compulsory and time-consuming anatomical dissections are neither necessary nor the most efficient method of learning anatomy in today's world of 3D imaging and virtual anatomical tutors.
They're right: and furthermore, where's the evidence - and I don't mean operating room hearsay - that newer graduates are less competent doctors than their predecessors?
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