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Embryology and Teratology in the Curricula of Healthcare Courses

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ANATOMICAL EDUCATION Eur. J. Anat. 21 (1): 77-91 (2017) Embryology and Teratology in the Curricula of Healthcare Courses Bernard J. Moxham 1, Hana Brichova 2, Elpida Emmanouil-Nikoloussi 3, Andy R.M. Chirculescu 4 1Cardiff School of Biosciences, Cardiff University, Museum Avenue, Cardiff CF10 3AX, Wales, United Kingdom and Department of Anatomy, St. George’s University, St George, Grenada, 2First Faculty of Medicine, Institute of Histology and Embryology, Charles University Prague, Albertov 4, 128 01 Prague 2, Czech Republic and Second Medical Facul- ty, Institute of Histology and Embryology, Charles University Prague, V Úvalu 84, 150 00 Prague 5 , Czech Republic, 3The School of Medicine, European University Cyprus, 6 Diogenous str, 2404 Engomi, P.O.Box 22006, 1516 Nicosia, Cyprus , 4Department of Morphological Sciences, Division of Anatomy, Faculty of Medicine, C. Davila University, Bucharest, Romania SUMMARY Key words: Anatomy – Embryology – Education – Syllabus – Medical – Dental – Healthcare Significant changes are occurring worldwide in courses for healthcare studies, including medicine INTRODUCTION and dentistry. Critical evaluation of the place, tim- ing, and content of components that can be collec- Embryology is a sub-discipline of developmental tively grouped as the anatomical sciences has biology that relates to life before birth. Teratology however yet to be adequately undertaken. Surveys (τέρατος (teratos) meaning ‘monster’ or ‘marvel’) of teaching hours for embryology in US and UK relates to abnormal development and congenital medical courses clearly demonstrate that a dra- abnormalities (i.e. morphofunctional impairments). matic decline in the importance of the subject is in Embryological studies are concerned essentially progress, in terms of both a decrease in the num- with the laws and mechanisms associated with ber of hours allocated within the medical course normal development (ontogenesis) from the stage and in relation to changes in pedagogic methodol- of the ovum until parturition and the end of intra- ogies. In this article, we draw attention to the need uterine life. Complementary studies relate to the to provide within medical and dental curricula a formation and maturation of the gametes universally accepted terminology for embryology (gametogenesis), fertilization and fecundity, and and teratology, to develop core syllabuses and, in such phenomena as parthenogenesis, cloning, addition to providing professional training, to follow superfecundity, superfoetation (i.e. reproductive the practice of university education in taking stu- anatomy). The term ‘general embryology’ can be dents to the frontiers of knowledge. We also dis- employed to indicate the early development of the cuss different ways of teaching and assessing em- embryo from the ovum until the formation of the bryology and teratology, preferring to see the em- primordia of systems and organs (early organo- ployment of practical methodologies, and we high- genesis). The term ‘special embryology’ may be light problems related to the poor attitudes of stu- used to follow the development of the foetus after dents towards the perceived clinical relevance of organogenesis has begun. Comparative embryolo- embryology and teratology. gy compares development across species. Howev- er, other than to demonstrate consistent aspects of mammalian development, comparative embryolo- gy is rarely taught nowadays to students in Corresponding author: Professor Bernard J Moxham. Cardiff healthcare courses. School of Biosciences, Cardiff University, Museum Avenue, Embryology and teratology should play a Cardiff CF10 3AX, Wales, United Kingdom. Phone: +44 (0)29 20874031; Fax: +44 (0)29 20875964. E-mail: [email protected] Submitted: 11 October, 2016. Accepted: 8 November, 2016. 77 Anatomical Education significant part in healthcare education, in terms of tology. We will concentrate on issues that centre understanding prenatal life, of grasping how the around four areas: organization of the mature human body has devel- • establishing a terminology for embryology and oped, and of providing essential information for teratology; general medical practice, obstetrics and pediatrics. • defining relevance and core knowledge in Students should also have an appreciation of the embryology and teratology; genetic and environmental factors that produce • understanding the importance of university congenital malformations in order to be able to education as well as professional training; understand differences between inherited, ac- • putting the teaching of embryology and tera- quired, and so-called multifactorial malformations. tology in the correct context for the healthcare Early development also has an influence on age- professions. related diseases, not least because donor tissues might have to be screened for genetic and congen- TERMINOLOGY FOR EMBRYOLOGY AND TER- ital abnormalities. Furthermore, there is now the ATOLOGY possibility of investigating, and treating, foetuses by drugs, genetic engineering or intra-uterine sur- Without an internationally-accepted terminology gery. Indeed, such developments are leading to a we are not able to agree on important issues of new specialty in medicine, prenatal medicine, communication across the world and between sci- which is devoted to embryonic and foetal diseases ence and the clinic. At present, responsibility on a 1 (including abnormal development) . worldwide basis for the reviewing of terminologies Embryological research is probably one of the in the anatomical sciences resides with the Inter- most productive areas for investigation within the national Federation of Associations of Anatomists 2 anatomical sciences , contributing significantly to (IFAA) and this organisation has set up several the practical and theoretical backgrounds in life terminological groups under the auspices of the sciences and medicine. Much research these days IFAA’s Federative International Programme for is at the molecular level but we are of the opinion Anatomical Terminology (FIPAT) 6. FIPAT has that healthcare disciplines must not be overly re- made rapid progress across a wide front and one ductive and should not lose sight of ‘the whole of its groups is concerned specifically with embryo- body’. Indeed, morphology is increasingly relevant logical terminology, the Terminologia Embryologi- to the development of molecular science, by plac- ca being published in 2013 7. This group was head- ing the manifestations of gene expression, cell sig- ed by John Fraher (Ireland) with 4 advisors: Bruce nalling and the processes of cell physiology in con- Carlsen (USA), Darrell Evans (United Kingdom 3 text, in real time, in cells and tissues . To provide and Australia) , Hans ten Donkelaar (Netherlands) , an example, integration of molecular and genomic and Christoff Viebahn (Germany) . processes within embryology is a key element for Terminologia Embryologica deals with the entire fertility treatments and also for developing in vitro human intra-uterine period up until birth and pres- fertilisation therapies. ently excludes postnatal development. The first Despite the importance of embryology both clini- part of the terminology is a ‘naming of parts’ (the cally and scientifically, it often seems that, alt- early stages of embryogenesis being followed by hough many universities have within their faculty a terms related to the development of the systems). significant number of embryologists, such academ- The second part of the terminology arranges the ics are generally developmental biologists who events chronologically and employs the Carnegie have little interest in system-based, descriptive Stages for the embryonic period. Terminologia human embryology. Nevertheless, it would be ex- Embryologica was formulated according to the pected that developmental biologists wish fervently principles set out for the development of the termi- for their students to understand the finer points of nologies for gross anatomy, histology, neuroanato- their research , and indeed a university education my, anthropology, and oral anatomy. In particular, requires that students are taken to the frontiers of Latin is central to FIPAT’s way of working – “The 4 knowledge . However, it cannot be expected that Latin term is the formal, official version. It enables undergraduate students from healthcare disci- translation into any vernacular and provides an plines requiring tuition in embryology and teratolo- exact point of intersection for communication gy can deal effectively with material that is beyond across disciplines, languages, countries, regions ‘core knowledge’. and associations” 7. Some have criticized this prin- Remarkably, while there is a vast literature con- ciple , since they argue that the use of Anglicized cerning the teaching of gross anatomy to students terms offers a better basis for translation, for publi- 5 within the healthcare professions , to date there cation of research papers and books, and for dis- has been little discussion concerning the teaching cussions at international meetings. However, of embryology and teratology. In this article, we FIPAT holds to the view that, for terminologies to intend to provoke debate as a contribution to en- remain universal, prominence should not be given suring that undergraduate students have appropri- to a language currently in use since other linguistic ate education and training in embryology and tera- communities might reject a terminology if it is con- 78 B. J. Moxham et al. strued as furthering ‘linguistic
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