Why Teach Anatomy?
Tommy Boone and William T. Boone, Jr.
The College of St. Scholastica
Duluth, MN 55811
“The best way to speak the truth is to know it clearly, believe
it implicitly, love it sincerely, live it courageously, and proclaim it zealously.”
-- Clifton J. Allen
THE
EMPHASIS ON anatomy education has changed from what it used to be.
Students no longer study anatomy in the form of kinesiology as has been the
case years earlier. At the College of St. Scholastica, our kinesiology
course hasn’t changed. We continue to teach functional (or applied)
anatomy throughout the entire semester. A great strength of our anatomy
education is the commitment by faculty to the belief that exercise physiologists
should know anatomy and physiology, not just physiology. This approach
has worked well in several academic settings where students have been taught
with and without cadaver dissection.
Since we are comfortable with years of teaching anatomy,
since we understand its value to a comprehensive understanding of the human
body, and since we believe in supplementing the students’ exercise physiology
education with anatomy, we were surprised to find that many exercise physiologists
simply are not interested in anatomy. Instead, they are interested
in physiology! Exercise physiology laboratories are complete with all
kinds of equipment to measure physiological responses at rest and during
exercise. This closed-out mentality regarding anatomy is less than
flexible thinking that is built solidly on thinking from a generation ago.
In other words, “Why Teach Anatomy?”
Equally important, is there something different today with
our students? Do they know anatomy well enough that we don’t have to
teach it? Or, is it that physiology is more akin to research and, since
everyone has been taught to value research, we therefore value physiology
over anatomy? This latter point has several interesting implications.
Research is important, but so is anatomy. Publications are important,
but so is being an educated professional. What to do? First,
it is important to come to an understanding of the problem before us.
If we are to continue to teach very little anatomy, what will it ultimately
mean a decade from now? Second, if we are to value the contribution
of anatomy to maintain a robust education, what are we going to do?
How do we address this issue? We believe it is necessary to keep anatomy
in the exercise physiology curriculum.
While we expect members of ASEP to play an integral role
in promoting anatomy, we have decided to begin the process by writing this
article and charting the direction of our mission. From the beginning,
what do we know? One of the hallmarks of physical education is the
kinesiology course (which is anatomy when properly taught). In the
past, anatomy was alive, and it was required. No one believes a student
could graduate as a physical educator without knowing applied anatomy.
The idea itself goes back for many years [1-3].
In time, with the negative thinking about what is physical
education, its leaders felt compelled to come up with a different name.
Physical education became kinesiology (i.e., the science of movement).
From activity to science, physical educators became known as kinesiologists.
Of course, the public wasn’t fooled. Regardless of the title, kinesiologist
or physical educator, the earlier understanding had not changed. Only
the physical educator thought change had come about. Later, physical
educators, who believed their rightful title is “kinesiologists” became concerned
once again with the public’s perception of their work. This resulted
in the title now known as “exercise science” in place of kinesiology.
Of course, many other departments, consistent with their institutional inertia,
adapted to a variety of other department titles and academic degrees [4].
In the aftermath of the gross lack of leadership that set
up at random the identification of dozens of titles and academic degrees,
we have not only exercise science programs but, literally, dozens of other
programs without meaningful job opportunities. These programs also
have little to no serious emphasis on anatomy. Why? We believe
that part of the answer lies in the increased emphasis on biomechanics.
Obviously, while the physical educators were in a state of confusion, those
with an interest in sports biomechanics wrote their own books and methods
of analyzing human motion [5-7]. Their influence has had a significant
effect on what was applied anatomy. They introduced a new technological
point of view with instant data collection techniques. Obviously, cadavers
do not provide instant data, and the “School of Human Performance” or whatever
the title might have been, is certainly not set up for cadaver dissection.
Hence, the problem becomes apparent. The luxury of
an anatomy education and its application to musculoskeletal and/or health
and fitness training programs doesn’t exist without the original intent,
understanding, or familiarity with the subject. In other words, the
purpose of anatomy was pushed aside for the teaching of biomechanics.
This thinking presents a major twist in the physical educator’s position
regarding structure. In many ways, it’s hard to understand why this
spectacular turn of events was allowed. As a result, the typical kinesiology
course in many programs was divided into two areas of study (i.e., anatomy
and biomechanics). In other programs of study, the biomechanics course
replaced anatomical concepts and, why not? Memorization is bad, right?
While there is an obvious value in the study of biomechanics,
it doesn’t answer anatomical questions per se. The ability to think
3-dimensionally about structure is the opportunity to see anatomy in real
time, either at rest or during motion. The biomechanics course, on
the other hand, requires a significant engagement of technological equipment.
In our opinion, this is why anatomy is more applicable to everyday conditions.
Therefore, it should be an integral part of our academic programs.
The benefits are obvious and have been for many years.
Without an anatomy education, there is little opportunity
to understand structure. Similarly, without a physiology education,
there is little opportunity to understand function. Hence, this
is our point: If there is very little anatomy being taught, then we
must not value the anatomical conceptualizations of the human body.
This ought to come as a surprise to all of us, but it doesn’t. Zoom
in and think about it. Meaning, have you looked closely at what our
students are not getting when anatomical concepts and insights are not in
the curriculum? In our opinion, there is a significant volume of information
that our students should know but are not being taught. Rather, it’s
all about physiology. After all, physiology is part of the “exercise
physiology” title. There are no academic programs and/or professional
titles for the “exercise anatomy” professional.
The idea of studying anatomy at the same intensity as physiology
appears to exist in the minds of only a few exercise physiologists.
Even more alarming, when anatomy is required, it is our opinion that exercise
physiology faculty lack the preparation (or worst yet, care or passion) to
teaching anatomy. Of course, in all fairness to exercise physiologists,
the question is also being asked of anatomists. Paalman [8] points
out “that the structure of the human form is being emphasized less and less….”
Is it enough to teach anatomy with interactive functional anatomy software?
This brings up another interesting question. “Why is
there less emphasis on anatomy today than a few years ago?” Is it related
to the medicine’s reliance on magnetic resonance imaging (MRI), computed
tomography (CT), and positron emission tomography (PET)? Most patients
would expect medical doctors to have a thorough knowledge of anatomy.
They would be surprised to find out just how little anatomy education many
medical doctors have. They would even be more surprised to learn that
the “interactive DVD-Rom Drive” is replacing the anatomy lab.
Our impression is that today’s medical doctors have come
to think that the “best education” results from the hot ticket items that
are expensive ways to diagnose illnesses and dysfunctions. This isn’t
true for all physicians, but it is the truth for many. Rather than
walk away from an anatomy education with the ability to visualize 3-dimensional
anatomical relationships, new modalities and imaging technologies (including
the interactive functional anatomy DVDs) have become a permanent feature
in ascertaining the anatomy of a human person. The familiarity with
significant real-time hands-on dissection experiences has been put aside
for course-specific-assisted instruction (CAI) modules [9].
We believe that exercise physiologists need anatomy.
An exercise physiology curriculum built solely or primarily on a physiology
education is not enough. That is, one without the other is no longer
acceptable. As college teachers, we recognize our responsibility to
the exercise physiology students by not marginalizing their education.
Our commitment therefore is to a complete and comprehensive education.
The marginalizing of anatomy (i.e., reduction in laboratory hours and/or
the rationale for substituting various imaging technologies in place of cadaver
dissection) must be corrected. An anatomy education is both a privilege
and a duty. It is also a daunting task. It should not be replaced
by distance-learning programs or by interactive 3-D animations, regardless
of the advertisements that the digital format and quick-search DVD facility
will save time and/or costs. Is it true that using either Macintosh
or PC computer anatomical software will save time when revising and preparing
for lectures and presentations [10]? No doubt to some degree it will,
but the issue is whether it should replace the teacher and, where possible,
the actual hands-on opportunity to dissect cadavers.
It behooves us, as exercise physiologists, to use whatever
forum we have to embrace, to learn, and to share a new way of thinking about
anatomy. It is up to us as ASEP exercise physiologists to realize our
power as professionals. We have a history of experiences in anatomy,
its benefits, and its application to the human at rest and during exercise.
Our first responsibility in the 21st century is to capture the original intent
in teaching anatomy to prepare the student. Second, and particularly
important to the emerging professional status of exercise physiologists as
healthcare professionals, is to integrate anatomy into the otherwise predominately
physiology curriculum. Interestingly, this brings us back to the question:
“Why teach anatomy?” Ten points bear directly on this issue.
First, much of what exercise physiology is about today and
will continue into the future is “fitness” and, in general, physical development.
Without anatomical information, it is next to impossible to ensure that the
student will engage clients in safe and effective fitness programs.
This has already become self-evident with personal trainers with little more
than a weekend warrior certification. This overall approach to personal
training defined by certifications having nothing to do with an academic
degree is meaningless and potentially harmful. We have found that professionals
are historically linked to a professional education found on college campuses
throughout the United States, not from for-profit organizations. There
are many examples that illustrate our point (such as nursing, physical therapy,
occupational therapy, dietitian professionals with direct links to college
academic programs).
Second, the vast majority of undergraduates think it is logical
to teach anatomy. They are confused when the curriculum doesn’t require
them to take an anatomy course. This is a valid concern. It also
directly influences the quality of the students’ education upon entering
graduate school. Without a detailed knowledge base of human anatomy
with specific implications to the public sector, the students are at a distinct
disadvantage. And, if anatomy isn’t taught in graduate school, which
is a very likely possibility, the exercise physiology student without such
prior experiences is, in essence, self-taught when it comes to examples where
an anatomical orientation, information, and application could make a difference
in the client’s health and fitness.
Third, it is our experience that other professionals expect
our students to have a formal education on the structure (as well as the
function) of the human body. Indeed, when the rationale is presented
to get rid of anatomical instruction for more ECG courses or more physiology
courses, they are equally as confused as we are. We believe that it
is up to the exercise physiology faculty to identify the courses that are
necessary for a comprehensive exercise physiology education. The argument
to not teach anatomy doesn’t hold water. It is a weak point of view.
Fourth, we believe that instruction in anatomy must be part
of the doctorate degree. The fact that it isn’t is a significant part
of this overall problem. Where are doctorate prepared exercise physiologists
learning functional (or gross) anatomy? A strong argument can be made
that they are not being taught anatomy. Logically, this is also an
important reason why kinesiology has been rendered a back seat position to
biomechanics or exercise physiology related courses. There appears
to be no organized academic effort to develop educators with a strong emphasis
in anatomical knowledge and/or instructional skills. This failure to
do so, particularly at the doctorate level, will become increasingly problematic
in the future.
Fifth, in time, perhaps, not too far in the future, neither
faculty nor students may perceive anatomy as an integral part of the exercise
physiology students’ education. After all, we believe that we are close
to that point of view at the present time. If this is true (i.e., perception
becomes truth), students may feel that the study of anatomy is a waste of
time [11]. This would be an unfortunate side effect of our failure
to teach anatomy, to demonstrate its value, and to encourage its application.
In short, it is a failure in faculty responsibility to address with specificity
the educational curriculum of exercise physiology. All exercise physiology
students should not only have the anatomical knowledge base, but as importantly,
the philosophical position of anatomical relevance to the practice of exercise
physiology. Again, we believe this view is consistent with faculty perspectives
in other healthcare professions.
Sixth, it is reasonable to expect exercise physiology faculty
to want their students to enter the public sector with specific skills and
knowledge that will ensure a safe and effective practice. Anatomy is
an important part of this knowledge. While we believe it is in jeopardy
in many programs of study, it is possible to regain the traditional hands-on
anatomy. Even during our recent advances in technology, we believe
there is room for a rigorous lecture-based-problem-solving approach to anatomy.
High-tech visuals are great adjuncts to the teacher’s responsibility, but
we argue that such alternatives are just that – alternatives to actual teaching!
Similarly, we would not expect exercise physiologists to substitute the metabolic
cart for actual learning guided by the teacher in everyday classrooms.
Virtual experiences that describe anatomy are just that – virtual.
They are not real interactions between the students and the teacher.
Today’s educators ought to work at understanding this point, particularly
with the emphasis on distance learning, take-home tests, and other technologically
driven methods that have taken the place of many teachers.
Seventh, where students have had the opportunity to dissect
and study cadavers, regardless of the standard arguments of not wanting to
touch dead, preserved specimens [12], more frequently than otherwise, they
take from the experience sensitivity and constructive appreciation for hands-on
interaction with real world anatomy. Of critical importance is the
fact they now understand that anatomy is not consistent with the usual belief
of rote memorization of meaningless structural details. This means
that anatomy can be taught using well-planned and effective 3-dimensional
instructional exercises [13]. There are also a variety of other teaching
strategies (such as case-driven inquiry-based analysis and problem-based
group work).
Eighth, why teach anatomy? The most obvious answer
is because the musculoskeletal system is our very foundation for function.
To not understand structure is to set our emerging profession up to fail
and, yet this may not be true for other professions who have ranked the musculoskeletal
system at the bottom of the body systems for typical anatomy and physiology
courses [14]. We are surprised by their ranking that places the nervous
system first followed by the cardiovascular system second. Fluid, electrolyte,
and acid-base, collectively, was third, the immune system was fourth followed
in descending rank by the respiratory system, the endocrine system, and musculoskeletal
system. This recent trend to teach less anatomy and, in particular,
to minimize discussion of detail (such as origin, insertion, and functions)
is a serious academic problem for this reason (among others): “We have
been dealing with this dilemma as we redesign our A&P curriculum….This
revision was prompted by complaints from our Nursing School that the students
were not well-prepared for their pathophysiology class and by a request to
bring our courses in line with those at other state institutions so that
students could transfer credits more easily.” [12]
Ninth, we believe that anatomy is useful and has value.
How else could an exercise physiologist know the specifics of “why” and “why
not” to perform certain weight lifting exercises? How about flexibility
exercise? Surely, knowledge of anatomy is important and, by knowledge,
we mean more than just the identification of osteological landmarks and,
yes, more than just the origin or a muscle without truly understanding the
implications of the landmarks. Our view is that college teachers must
not forget to teach the names of structures but, most importantly, place
the greatest emphasis on the “language of anatomy”. By language, we
mean the ability to reason through relationships by recalling mental images
in a very specific 3-dimensional presentation of actual form and function
[15].
Tenth, anatomy, when properly taught as a language, communicates
human function based on structure. If we were to avoid teaching the
musculoskeletal system, we would fail to grasp the link between dysfunction
and abnormal structure that results from various diseases, musculoskeletal
traumas, or developmental defects. Here, we are defining anatomy as
more than origins and insertions and/or specific osteological terms.
These are important aspects of learning anatomy but, most importantly, is
the language itself. The ability to think visually, to see through
layers of skin, fat, fascia, muscle, nerves, and so forth to solve a problem
or to recognize a possibility. This anatomical concept (or way of thinking)
should be the equivalent of a common thread in how college teachers teach
anatomy and in the learning process itself on behalf of the students.
In summary, we are hopeful that the “ten” reasons why anatomy
is important has convinced the reader. As exercise physiologists, however,
we are aware of the challenges before us. We are not interested in
pushing for more memorization or all-night study binges. This article
is about something that has a unique value to the total education of the
exercise physiologist. It is about thinking and reasoning through anatomical
relationships using mental images, not from the regurgitation of facts.
Anatomy is therefore, when properly understood, the classic example of telling
a story from stored mental relationships. The perceptual sense of the
3-dimensional structures gives rise to the basis for a logical and rational
explanation and purpose in studying anatomy. It is our opinion, therefore,
that all exercise physiology students should have a course in anatomy.
The anatomical backdrop to understanding human motion is imperative if we
are to prepare our students as healthcare professionals.
.
References
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