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Is it Time to Let the Standing “Anatomical Man” Lie Down Supine?

Submitted by on August 9, 2012 – 12:32 AM 18 Comments

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 protected]

About this article:  This article is competing for the JPMS International Medical Writing Contest 2012 for the theme: Medical Education

To learn more about the contest and to participate in it, follow this link: http://blogs.jpmsonline.com/writing-contest/

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  • Jagesh50

    Very innovative thinking.

  • Latha

    Really some information to ponder about.Will the Supine man wake up?

    • Jagesh50

      You meant wake up to realities of the new world and occupy the place?

  • Kalaiselvan

    Some bit of original thinking here!

    • Aroon kamath

      Thank you very much sir. Very encouraging comment which I truly appreciate.

    • Aroon kamath

      Thank you Sir!

  • Shenoi.

    Anatomical evolution or revolution Dr.Kamath ! Well written, but then much more needs to be done  but these seem early steps..Best wishes.

  • Prathviz

    Well written Dr.Kamath ,have to agree it was nerve cracking to get the terminology and the mental picture right in the first year.Its good of you to have thought about it.

  • Nanditan

    this is something most interesting in the blog.. shoudld get the first prize

    • Aroon kamath

      Thank you sir.

  • Ramachandran.

    Good presentation,quite original with a sense of humor.

    • Aroon kamath

      Thank you very much sir.

  • Tauro LF

    Well written article Dr. Kamath. It is easy to write but difficult to recollect these terminologies. i too had same difficulties like you during my student days. the topic is appropriate to discuss.

    • Aroon kamath

      Thank you very much sir.

  • Dr. J.Dasgupta

    I appreciate your thoughts on the change of the anatomical position. But that standing position is only utilized for demonstrating “Surface markings” of certain viscerae & certain anatomical areas – not during “dissections” , when the architecture of the human body is registered in our brains. And on the basis of this , we practise our profession – in future.

    • Soumyadeep

      all descriptions in surgery and anatomy books are based on the standing position. This becomes tard difficult to recollect and rework on this.What you say is profundly wrong Dr.Dasgupta

    • Aroon kamath

      Dear Dr. Dasgupta, Thank you for your views. It is heartening to see that you had learnt anatomy the right (supine) way. If all students were to remember the relationship of various organs to each other from their recollection of anatomy as they saw in a supine ‘body’ in a dissection hall, that would be really wonderful.

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