P S Medical College, Karamsad - 388325, Dist. Anand, Gujarat, India
Three hundred medical students were questioned regarding their views on anatomy as a subject and future career option. A questionnaire with 12 statements was given to these students and their answers were compiled. The results of this study were encouraging. 97% of students consider anatomy as an essential pillar of medical sciences. A vast majority (91%) felt that a sound knowledge of anatomy helped them in their clinical rotations in hospitals. However, more than half termed anatomy as difficult to understand and three-fourth agreed to the question that the duration of teaching anatomy should not be limited to one year. Though 47% placed anatomy at par with clinical subjects, only few compared teaching anatomy as favorable as treating a patient. In India, lack of job opportunities and adequate research facilities limits the uptake of anatomy as a career option. Even with a modified curriculum only one third were willing to become an anatomist. A formal course in teaching was welcomed by most in case they sought to become anatomist.
Key words: Anatomy, students, opinion, career option, teaching period.
Medical career starts with dissection of human cadavers. The initial exposure to a dead body causes emotional shock to the students (Abramson S, 1991, Evan R et al, 1992 & Finkelstein P et al 1990) though gradually they adopt a professional attitude and accept dissection as an aid to study the body structure, Yeager V L, (1996). Dissection not only teaches anatomy but also makes us aware of many other aspects of life, which has been beautifully described by various authors (Cahill DR et al 1990, Charlton R et al 1994, Druce M et al 1994, Horne DJ et al 1990, Penny JC 1984). Cahill and Dalley (1990) mention that study of gross anatomy provides an opportunity for reflection in the intrinsic values of life and creates empathy for future patients. It teaches the value of human life, Weeks SE et al, (1995). Mutyala (1996) mentions that dissection enhances the skill of thinking in a logical manner, which helps in all aspects of medicine. Therefore, it is in the first year of medical college that a positive approach towards the subject can be built. It has been studied that the inclination towards a particular specialty is determined by complex interacting variables e.g. personality of individuals, Mowbray RM, (1990) & Walton HJ (1969), quality of teaching in medical college, clinical competence, Kelley A et al, (1995), future career aims etc. In the present time anatomy is chosen as a career by very few students. It is often noted that graduates with lower ranks in postgraduate entrance tests pick anatomy as a last resort.
There is a shortage of teachers in medical colleges at a global level. The number of medically qualified teachers in preclinical subjects is continuously decreasing, Schockley DG, (1986).
This is particularly severe in the specialty of anatomy especially in India. There is an urgent need to enhance awareness amongst students regarding available job opportunities and research possibilities in the subject of anatomy.
The present study has been designed to evaluate the opinion of medical students regarding anatomy as a subject, application in various clinical fields and finally its usefulness as a future career option.
The present study was conducted in P.S.Medical College, Karamsad, Gujarat, India. A random sample of three hundred medical students were taken from those willing to participate in the study. This included 250 undergraduates and 50 postgraduates of various disciplines. Each student was explained the objective of the study and a questionnaire containing 12 items was given to them. The options for answering the questionnaire were in four categories namely, strongly agree, tend to agree, opinion not formed and disagree.
There was complete anonymity as no names or numbers were mentioned. The data collected was then analysed.
The following important areas were covered in the questionnaire
The results are given in Table - I.
|Item No.||Strongly Agree||Tend to Agree||Neutral||Disagree|
|1.||Anatomy is not just study of body structure by dissection, it is an important pillar of medical sciences||232||77%||58||20%||6||2%||4||1%|
|2.||It is difficult to understand and retain anatomy||50||17%||130||43%||43||14%||77||26%|
|3.||I am benefited from knowledge of anatomy later in my clinical terms||181||60%||93||31%||20||7%||6||2%|
|4.||Every good clinician needs to have a sound knowledge of anatomy besides the clinical specialties||210||70%||72||24%||12||4%||6||2%|
|5.||The time allotted for teaching anatomy in the present curriculum is one year and it is not adequate||119||40%||82||27%||48||16%||51||17%|
|6.||I would like to take up anatomy as a career if better research facilities and job opportunities are provided||36||12%||53||18%||97||32%||114||38%|
|7.||I would like to be an anatomist if a modified integrated curriculum with other clinical specialties is introduced||43||14%||61||21%||106||35%||90||30%|
|8.||Graduates with low ranks in the postgraduate entrance examination take up anatomy for further studies||31||10%||92||31%||116||39%||61||20%|
|9.||An anatomist lacks clinical knowledge and thus wastes his time becoming a doctor||25||8%||56||19%||93||31%||126||42%|
|10.||Anatomy as a discipline has a low status within the medical field||19||6%||51||17%||89||30%||141||47%|
|11.||Teaching anatomy to students and making them overcome their difficulties gives as much satisfaction as treating a patient rolling in pain||47||16%||62||21%||92||30%||99||33%|
|12.||I would welcome a formal course in teaching while training to become an anatomist||56||19%||123||41%||102||34%||19||6%|
As depicted in the table, anatomy was considered a base pillar of medical science by 97% and 94% feel that to be a good clinician knowledge of anatomy is necessary. Though 60% agreed that it is difficult to learn, 91% agreed that they benefitted from the subject later in clinical postings. Majority (67%) agreed with the statement that one year was not enough to learn anatomy. Only 30% students agreed to take up anatomy as a career as opposed to 38% who disagreed and the rest could not form an opinion. With introduction of modified curriculum 35% were willing to become anatomists and still 30% disagreed with the option. 42% did not agree that becoming an anatomist was waste of degree of doctor though 27% agreed with the same.
Though 41% agreed to the fact students with low ranks took up a career in anatomy at least 47% disagreed that as a specialty it had a low status in medical field.
As regards statement on professional satisfaction the response was almost equally divided. While 37% agreed that teaching anatomy was equally satisfying as treating a patient, 33% did not agree to this and upto 30% had no opinion. A formal course of teaching during training of anatomists was welcomed by 60% students.
In India the total duration of graduating years are five and half. Out of these the first year is scheduled for teaching the pre-clinical subjects, anatomy being one of them. Later there is either very little or no attention paid to the anatomical aspects while discussing aetiopathogenesis of a clinical case. Thus anatomy tends to loose its credibility as it is not a part of day to day curriculum, Chevrel JP, (1995). It is important to note that in our study a vast majority (97%) of students agreed that anatomy was an important pillar of medical sciences. As Monkhouse (1992) has stated that anatomy encompasses many aspects of the morphological basis of medicine and provides a structural framework for development of clinical logic. This study also highlights that about 90% of students felt that a good clinician needs to have a sound knowledge of anatomy. Further, it also helped them in their clinical rotations.
Pabst (1993 and 1994) has published two interesting studies using questionnaires circulated to final year medical students. In his institution anatomy is taught in 1st semester. In the earlier study (1993) more than 60% (60-80%) of students thought that anatomy was taught adequately in 1st semester with more than 90% of students expressing interest in idea of reinforcement of the subject by lectures during clinical studies. 75% of all students stated that they would actually have participated in specialized clinical dissection course during their clinical curriculum. In his second study 94% of students graded that gross anatomy teaching was "essential". Thus all previous studies similar to ours have rated the clinical relevance of anatomy very high.
Medical students fear anatomy and up to 60% students felt that it is a difficult subject. As mentioned in results majority (67%) agreed that the time allotted for teaching the discipline, which at present, is one year is not enough. This indicates the need to reevaluate the curriculum and to increase the duration of time allotted to the subject.
In medical profession non-clinical teaching specialties are opted for by very few students, Schumacher CT, (1964). The fresh graduates do not even mention anatomy as a choice for postgraduation, Souif HE, (1992) & Tolani B, (1991). The present study also highlights this fact. Only 12% strongly felt that anatomy could be opted for as a career and a further 18% tended to agree to consider this option. The introduction of a modified integrated curriculum only increased the positive response marginally from 30% to 35%. All the above facts indicate that though the usefulness of the subject is appreciated by the medical students, very few would pursue it further. This predicts a further decline in trained anatomists. A teacher of anatomy cannot be replaced by modern teaching techniques, Chevrel JP, (1995). Therefore, our study indicates an urgent need for immediate measures to improve the situation.
One of the major criteria in selection of a subject as a career is the financial status accorded to it (Anand BK, 1992, Anantraman V et al, 1995, Galazika Sim S et al, 1994 & Koivusilla L et al, 1995). Inadequate financial returns are associated with professions involving pre and para clinical subjects. This has been reported from other countries e.g. America (Abramson S, 1991). Though in our study only 23% of total students agreed with the statement that anatomy had a lower status in medical field, only one third were actually willing to opt for it in future as mentioned above.
In India there are inadequate jobs and research opportunities for anatomists. Though it is said that major job of anatomists is to teach students and requires that they be available to students always, Anantraman V et al, (1995), the experience in subject is mainly determined by the research done. Research opportunities can be improved by attaching cytogenetic, hormone assay laboratories with the department of anatomy. This will help to increase patient interaction with anatomists. With the advent of CT scan and MRI, trained anatomists would be required as cross sectional anatomy experts.
Limited job opportunities also means that the only option left for a qualified anatomist would be clinical practice. However, it is seen that the confidence to treat any ailment goes down with the years and this is aggravated by lack of knowledge of advanced clinical methods and increased public awareness, Ellis JR, (1994). In our study however , 42% did not agree to the statement that a qualified anatomist lacks knowledge comparable to a clinician.
A medical doctor with a specialist degree in anatomy may be an unskilled teacher. A formal training course for teaching may benefit him. 60% of students agreed to this statement.
This was a cross-sectional study amongst a group of medical students in Gujarat, India. A preliminary evaluation of the opinion of medical students as regards anatomy was obtained. Our study suggested a positive attitude of medical students towards anatomy as a subject but only few of these students were ready to pursue it as a career.