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AAMC Files Brief Supporting U-Michigan Admissions Policy AAMC Panel Defining Physician Roles Within Bioterrorism Education Innovations in Medical Education: "Teaching - and Learning - Through Collaboration" Wanted: More Anatomy Instructors Viewpoint: Avoiding Faculty Burnout A Word from the President "A Day in the Life of a Medical Student"
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Wanted: More Anatomy InstructorsInstitutions explore ways to cope with shortages
Gross anatomy, one of the most fundamental of medical school disciplines, could soon face a dearth of instructors, according to a recent survey. More than 80 percent of anatomy-related department chairs participating in a survey administered by the American Association of Anatomists (AAA) anticipated having "great" or "moderate" difficulty finding qualified gross anatomy teachers in the next five years. The reason for the difficulty in recruiting gross anatomy faculty can be explained by trends dating back at least a couple of decades, says Robert McCuskey, Ph.D., one of the AAA survey organizers, and the head of the cell biology and anatomy department at the University of Arizona College of Medicine. "Graduate students in anatomy departments have lost interest in gross anatomy courses over the years," he explains, in part because recent advances in the sciences have caused the study of anatomy to become increasingly focused on its molecular and cellular aspects. This has led many graduate students to choose to pursue careers in the fields of cell and molecular biology. "Many graduate programs, in order to successfully recruit graduate students, have responded to this trend by dropping the requirements for them to take or participate in the teaching of all of the anatomical disciplines in order to get a Ph.D.," says Dr. McCuskey. "Whereas about three decades ago all of the Ph.D.'s coming out of departments of anatomy would have been exposed to gross anatomy, nowadays, with the change in focus in these departments, it is possible for many to graduate without having taken gross anatomy." In addition to the waning interest in the discipline at the graduate level, medical schools have also steadily decreased the amount of gross anatomy teaching in their curricula, says John Fallon, Ph.D., current AAA president and Harland Winfield Mossman professor at the University of Wisconsin. "There's so much information that needs to be presented to medical students that something of the 'old' needs to be reduced to make space for the 'new,'" he says. "In addition to this fact, the amount of detail about the [gross anatomy discipline and other basic sciences] that was considered necessary during the first half of the 20th century is no longer thought to be needed to teach medicine." The composition of medical schools' basic science faculty has changed over the years, becoming increasingly "cellular and molecular," says Dr. McCuskey. Responding to this trend, some departments have recruited junior faculty with cell or molecular biology backgrounds, requiring them as part of the hiring agreement to learn gross anatomy in a crash summer course or over a couple of years. This type of fellowship training is taking place in schools like the Medical College of Georgia, where a program was established to explicitly support Ph.D. students who otherwise would not acquire the skills to teach gross anatomy. Quality could improveConsidering current tendencies, many in the academic medicine community think that the "mix of individuals" teaching gross anatomy in the near future will be much different, and much more diverse than what was pres- ent in medical schools in the latter half of the 20th century. "For the past several decades, those teaching anatomy have been individuals who actually received Ph.D.'s in the discipline," explains Darrell Kirch, M.D., senior vice president for health affairs and dean of the Penn State University College of Medicine and CEO of the Milton S. Hershey Medical Center. "Because research careers no longer focus on things like anatomy, we have fewer people seeking Ph.D.'s in that area. That means medical schools have to start looking elsewhere." Despite his projection of a substantial reduction in the number of gross anatomy instructors with Ph.D.'s in the field, Dr. Kirch argues that the quality of such teaching will only improve in years to come. "The most exciting development in this area is the way in which computer-based technology can serve as an adjunct to traditional teaching," he says. "As has happened in other areas, technology can dramatically enhance teaching, enabling students to do essentially three-dimensional simulated dissections, among other things. I don't ever see the technology totally replacing the teaching that uses the actual human body, but it will make it much more effective." Advances in the field of computer imagery notwithstanding, many worry that such technology will not properly fill the teaching gap, and that the shortage of anatomy instructors must be dealt with promptly. Some medical schools have come up with creative solutions for this problem, such as hiring physical anthropologists to teach gross anatomy. "Physical anthropologists have a lot of the anatomy background needed to teach in medical school, even though their background is related to other types of studies," explains Richard Drake, Ph.D., professor and vice chair of anatomy at the University of Cincinnati College of Medicine. Coming up to speed"Because they already have a good background in anatomy, they just have to be brought up to speed on the clinical aspects of the discipline, relating the anatomy they already know to the clinical situation in humans. Certain schools, such as Case Western Reserve University and Johns Hopkins, are using those individuals now. I actually use one physical anthropologist here at the University of Cincinnati to teach in my course," Dr. Drake says. He adds that the use of academics from outside of the basic sciences to teach gross anatomy should not be a cause for concern, as long as they have a good command of the information as it relates to clinical situations. In the quest for more potential instructors, some have talked about the possibility of tapping into international medical graduates (IMGs). Recent developments affecting this country's healthcare system, along with changes in the United States Medical Licensing Examination (USMLE) that have made it more difficult for IMGs to obtain U.S. medical licensure, could turn them into a promising pool of instructors, says Wojciech Pawlina, M.D., associate professor of anatomy at the Mayo Medical School. In a symposium organized by the Association of Anatomy, Cell Biology, and Neurobiology Chairpersons earlier this year, Dr. Pawlina listed the main reasons why IMGs could be good candidates for anatomy teaching positions in U.S. medical schools: IMGs have extensive training in anatomy, with foreign medical curricula allocating 300 to 350 hours to gross anatomy; the great majority of faculty hired by anatomy departments in Europe and Asia have M.D.'s; and many physicians in Europe and Asia choose to specialize in one of the basic sciences. The fact that the disparity in pay scales between clinicians and anatomists has been narrowing, together with current managed care and malpractice concerns, could make this professional option more attractive to IMGs today than it was a few years ago. Dr. Kirch sees the value in Dr. Pawlina's argument. "In many other countries, anatomy is typically taught by physicians, as opposed to Ph.D.s," he says. "That means that there's a pool of people out there who have M.D.'s in other countries and who could view teaching anatomy here as a potential career path. I think that would present great opportunities for some of them in this country." More incentives neededBut not all in the academic medicine community embrace this option readily. "Looking at IMGs to use them as future anatomy instructors is a capitulation," says Dr. Fallon. "I believe that there's a population of people who are trained in the United States as scientists and physicians and who could teach anatomy." The AAA survey that highlighted the difficulty of anatomy departments in finding instructors also concluded that there are a significant number of U.S.-trained graduate students who could serve as teachers of anatomy in medical schools. The results showed that while 37 percent of such departments require students to take a course in gross anatomy, only 11 percent require them to also teach it. Despite this, an average of five graduate students per department either have or will receive training in gross anatomy, and two students out of that group intend to teach gross anatomy. "When you add the numbers, this means that there are approximately 200 people who might serve as anatomy teachers," says Dr. McCuskey. A larger potential pool exists, he continues, but the trend has been for graduate students to go off on their postdoctoral training and not teach. "This means that we're losing people during their postdoctoral training, as they get jobs in research and other more attractive fields." Some incentives are needed, argues Dr. McCuskey. Grant initiatives by institutions like the National Institutes of Health that include training in the instruction of systems biology or morphological sciences, as well as research, could help attract more students into the field, he says. Another type of incentive that can properly address the situation should take place at the ground level, he adds. "If schools provided financial support for a portion of these students' time for teaching activities during the postdoctoral years, it would help. This could be done at the private level, since institutionally, it's a modest investment. If each dean's office decided to invest, let's say, $20,000 a year to subsidize the training of teachers in gross anatomy or to reinforce the teaching skills of postdocs, it would not only address the immediate staffing problem of the teaching institution, but it would also provide an expanded pool for the entire country." By Suria Santana |
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