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The Place of Neuroanatomy in the Curriculum

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The Place of Neuroanatomy in the Curriculum The Teaching of the Anatomical Sciences Eur. J. Anat. 19 (2): 215-228 (2015) REVIEW The place of neuroanatomy in the curriculum Bernard J. Moxham 1, Odile Plaisant 2 and Diogo Pais 3 1Cardiff School of Biosciences, Cardiff University, Cardiff, Wales, United Kingdom and Department of Anatomy, St. George’s University, St George, Grenada, 2Université Sorbonne Paris Cité, URDIA EA 4465, Paris, France, 3Depart- ment of Anatomy, NOVA Medical School (Faculty of Medical Sciences), New University of Lisbon, Lisboa, Portugal SUMMARY often been reported that the brain remains one of the least understood organs in the body 1. Given Increasingly, with major changes taking place the huge volume of neuroscience research being worldwide in health care studies courses (including undertaken, it is not surprising that many universi- medicine and dentistry), there is a need to critically ties have, within their anatomy faculty, a significant evaluate the place, timing, and content of compo- number of neuroscientists and it is therefore not nents that used to be grouped collectively under surprising that such academics fervently wish their the banner of ‘anatomy’. This is certainly true for students to understand the finer points of their re- neuroanatomy where there are so many new re- search findings. Indeed, it is almost axiomatic that search developments that it is difficult to keep a university education requires that students are pace with changes in the subject and where clini- taken to the frontiers of knowledge and that they cal relevance, for the present time and for the fu- gain some appreciation of research endeavour ture, is a major consideration. In this chapter we from their teachers 2. However, the quantity of re- emphasise the need to provide a universally ac- search in neuroscience being undertaken is so cepted terminology, to outline core syllabuses for great that it cannot be expected that undergradu- medicine and dentistry and to review how syllabus- ate students from whatever discipline that requires es might develop for other health care courses, for tuition in neuroanatomy can extend their experi- science and psychology courses, and to make a ence beyond core material. Nevertheless, in con- case for neuroanatomy courses to follow the prac- trast to a voluminous literature concerning the tice of university education in hinting at the fron- teaching of gross anatomy to students in the tiers of knowledge as well as providing profession- health care professions 3, to date there has been al training. little discussion concerning the role of neuroanato- my in these professions. Key words: Anatomy – Neuroscience – Education In this paper, we intend to tackle issues that re- – Syllabus – Medical – Dental quire further debate as a contribution to ensuring that undergraduate students appropriately have INTRODUCTION both education and training in neuroanatomy. Here we concentrate on issues that are pertinent Within the anatomical sciences, neuroanatomical to medical students, dental students, other health research is nowadays probably one of the most care studies, science students, and psychology productive area for investigation, although it has students. Regardless of the discipline, it seems to us that debate should centre around four matters: • Establishing an acceptable terminology for * Corresponding author: Bernard J. Moxham, Cardiff School neuroanatomy. of Biosciences, Cardiff University, Museum Avenue, Cardiff • Defining relevance and core neuroanatomical CF10 3AX, Wales, United Kingdom. Phone: +44 (0)29 20874031; Fax: +44 (0)29 20875964. E-mail: [email protected] Submitted: 12 March, 2015. Accepted: 7 April, 2015. 215 Preclinical anatomy teaching knowledge. development of the terminology is on going, the • Understanding the importance of university reader is referred to the FIPAT website for further education as well as professional training. information and guidance 4. • Putting the teaching of neuroanatomy in the correct context within a course. NEUROANATOMY FOR MEDICAL STUDENTS Before dealing with specific health care courses, We begin with discussion of the teaching of neu- we will deal with matters relating to terminology roanatomy for medical students not just because since this is common to all. of the importance of this profession to the human condition in general and the individual’s health in NEUROANATOMICAL TERMINOLOGY particular but because many of the topics covered under this heading will be similar for other courses Presently, the International Federation of Associ- dealing with health care or at least will have a res- ations of Anatomists (IFAA) has responsibility on a onance. In the past, it was a firmly held principle worldwide basis for the reviewing of terminologies that, before being placed in front of patients, there in the anatomical sciences (under the auspices of needed to be a substantial period of time (2 to 3 the IFAA’s Federative International Programme for years usually) when the students were acquainted Anatomical Terminology (FIPAT)) 4. One of the sub with the scientific basis of medicine. Thus, the -groups of FIPAT is concerned specifically with model was established that the healthy body was neuroanatomical terminology. This is a new group the first object of study subsequently followed by within FIPAT that aims to provide the scientific interpretation of this knowledge to appreciate how community with a terminology within the next few disease produced abnormalities. This model is years. This group is following the principles set exemplified by the findings in the Flexner Report in 5 out for the development of other terminologies for the USA (1910) . gross anatomy, for embryology and for histology. However, medical schools are increasingly shift- In particular, eponyms are not recommended, alt- ing their emphasis away from this principle and hough it is appreciated that this in itself might be at towards “basic medical training” that is utilitarian variance with neurological terms used in the clinic. and, in this respect, towards what is deemed to be 6 Consequently, it is recognised that there needs to of “clinical relevance” . The drivers for emphasis- be a coming together of the anatomical terminolo- ing medical training and clinical relevance seem to gies with clinical usage. This is a long-term aim us to arise partly from social and political needs, but clearly, without the congruence of scientific partly from appreciation that increasingly students and clinical terminologies, there will remain prob- wish to engage with clinical matters at the outset of lems for educators within the field of neuroanato- their studies, and partly from trends in medical ed- my. This potential “Tower of Babel” is being unfor- ucation. In terms of neuroanatomy, since much of tunately built yet higher as a result of the various the research presently being undertaken seems to biomedical scientific disciplines using different ter- be complex and occasionally speculative it can minologies. To indicate the present ‘disorder’ with- appear to medical course organisers as being not in neuroanatomical terminology, there is a lack of yet of core clinical relevance. As a consequence, agreement as to whether terms should reflect the and given the wealth of new knowledge available embryological origin of a structure/region or wheth- in other disciplines, a downgrading of the amount er the historical names given to the mature nerv- of neuroanatomy taught to medical students might ous system should be retained. be expected. In this regard, it is well documented Presently, the FIPAT group dealing with neuro- that there has been a decline in anatomical educa- 7 anatomical terminology is headed by Hans ten tion within medical courses worldwide . Indeed, Donkelaar (The Netherlands) with 4 advisors: Jo- within the USA contact hours for gross anatomy nas Broman (Sweden), Paul E. Neumann has fallen from an average of 170 hours in 2002 to (Canada), Luis Puelles, (Spain), Alessandro Riva approximately 150 hours in 2012. By contrast, the (Italy), and Shane Tubbs (USA). In the mission of situation for the teaching of neuroanatomy in the FIPAT it is stated that: “The central objective of USA has not been so dramatic, contact hours de- FIPAT in the coming years must be to aim for a creasing from 95 hours to 83 hours from 2002 to standardised anatomical terminology across the 2012. Comparing 2009 with 2012, contact hours health sciences, thereby facilitating efficient infor- increased with lecture hours remaining essentially 8 mation exchange, and indeed more effective pa- the same with an increase in laboratory hours . tient management”. Latin is central. To FIPAT’s activities – “The Latin term is the formal, official Defining clinical relevance and core version. It enables translation into any vernacular neuroanatomical knowledge and provides an exact point of intersection for There is no doubt that much neuroanatomical communication across disciplines, languages, research is scientifically challenging and generates countries, regions and associations”. Since the much excitement in both the scientific and general communities. It is thus potentially of great benefit 216 B.M. Riederer et al. both to neuroscience and to clinical medicine. lution lies in providing research-linked teaching in Nevertheless, the amount of neuroanatomical in- selected areas or leaving higher-level content to formation presently being generated is beyond the postgraduate studies is a matter of some debate. requirements of the medical undergraduate
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