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The role of the anatomy demonstrator after modernizing medical careers

We would like to comment on the interesting article by Lockwood and Roberts (2007), discussing the future role of the anatomy demonstrator in the light of the changes within postgraduate medical training as part of Modernizing Medical Careers (MMC). We wholeheartedly agree with the advantages of surgical trainees gaining experience as an anatomy demonstrator and in particular with their suggestion that ‘‘the incorporation of these posts within MMC would enhance the new postgraduate training programs’’ and prevent the reported decline in anatomical knowledge of medical students and surgical trainees (Lockwood and Roberts, 2007). Before the new surgical training programwas introduced in August 2007, the curriculum of the Intercollegiate Surgical Curriculum Project originally supported the concept that trainees should be exposed to human anatomy as part of their Core Training for Surgery in General (CT) at ST1 and ST2 and levels (Intercollegiate Surgical Curriculum Programme, 2007). Unfortunately, there are very few anatomy demonstratorships that are an integral part of CT at present. However, universities and medical schools have found ways of meeting the needs of surgical trainees and students in the absence of a formal training structure for postgraduate anatomy. At Imperial College London, trainees are offered regular teaching and prosection of human anatomy as part of their education program toward the Intercollegiate MRCS (IMRCS). They are paid at a competitive hourly rate. They can either participate on their days off on their clinical rota, or using study leave. The anatomy demonstrators also are taught on aspects of surgical anatomy that are relevant to their clinical practice and the IMRCS. Our demonstrators have access to the facilities that our students use, such as prosected specimens and the online computer-assisted learning community that teach gross and clinical anatomy. It is well documented in this journal and others that demonstrating as part of CT is highly regarded by both trainers and trainees and improves the confidence and knowledge of anatomy of trainees (Gossage et al., 2003; Older, 2004; Ramsey, 2005; Gupta et al., 2008). MMC stresses the achievement of competencies (Department of Health, 2003; Modernizing Medical Careers, 2007) and for trainees in surgical disciplines, this involves the trainee not only being able to operate safely, but also to understand the surgical and anatomical principles of the procedure (Intercollegiate Surgical Curriculum Programme, 2007). An appropriate level of knowledge to allow safe surgery can only be achieved by the formal study of human anatomy. It is possible, however, within the constraints of the limited training budgets, the significant changes imposed by MMC, and the European Working Time Directive to offer a teaching program in human anatomy as well as prevent a dearth of high-quality teaching of the subject in undergraduate preclinical medical degrees. However, for this to succeed, there must be adequate funding and substantial cooperation with the local deanery, postgraduate schools of surgery, and the local University’s anatomy department.