Is it Time to Let the Standing “Anatomical Man” Lie Down Supine?
Early in the course of one’s life as an undergraduate medical student, one gets exposed to the basics of human anatomy. This exposure invariably begins with an introduction to topographical anatomy. Looking back, every medical doctor would recall the human figure (usually, a man…. Allow me to call him the “anatomical man”) in a standing posture with the upper limbs by the side of his body and palms facing forwards. From this “man” one learns the fundamental terms such as ‘superior’, ‘inferior’, ‘anterior’, ‘posterior’ and so on. These terms as well as the position of the various organs and structures in relation to each other in the supine posture get imprinted ever so strongly in the minds of a doctor in the making with the passage of time.
I still remember my formative years as an undergraduate medical student when our teacher began teaching the anatomy of the perineum. My understanding of human anatomy, which was seemingly progressing fairly smoothly up to that point suddenly seemed to hit an inexplicable (at that point in time) obstacle. Comprehending the perineal anatomy in the lithotomy position needed mentally tilting the anatomical man(or woman) to a standing position first and then back to the lithotomy position. This was akin to finding one’s way out of a cruise ship that had capsized and turned turtle! At the end of it, I can now frankly confess that perineal anatomy was never as clearly understood by me as the anatomy of the rest of the human body. During my surgical training and thereafter, I realized that learning perineal surgery as well as teaching perineal surgery to others was never satisfactory. The lithotomy position and worse still, the jackknife position tested my imagination to the limits.
I could notice that the students were experiencing difficulties very similar to what I had gone through as a student of anatomy. With the advent of imaging techniques such as ultrasonography, CT scanning and MRI, cross-sectional anatomy in the supine position has truly arrived and got established.It is now “superior” vs “cephalad” and “inferior” vs “caudad”. The students invariably have to still imagine the anatomy from a standing “anatomical man” and then mentally extrapolate to the supine position. This, in all probability may add to the stress of learning. In this scenario, should we continue to teach regional and topographical anatomy based on the standing “anatomical man” or, is it time that we let the ”anatomical man” (or woman) to lie down supine?
After all, our dear old friend must be tired of standing for too long!
About the Author: Aroon Kamath is a retired general surgeon from Puttaparthi, Andhra pradesh, India. He retired as an Assistant Professor in surgery at the Father Muller Medical College, Mangalore, in India. He has been interested in teaching as well as medical quiz. He can be reached at : email@example.com
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