A Core Syllabus in Anatomy (EJA)

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A core syllabus in anatomyfor medical students - Adding common

sense to need to knowThe Education Committee of the Anatomical Society of Great Britain and Ireland

Prof. S. M cHanwell 1 BSc PhD Prof. M. Atkinson 2 BSc PhDDr. D.C. Davies 3 BSc PhD Dr. R. Dyball 4 ScDProf. J. Morris 5 BSc MBChB MD MA FMed Sci Prof. C. Ockleford 6 FRCPath, DScProf. I. Parkin 7 MBChB Prof. S. Standring 8 PhD, DSc

Dr. S. Whiten9

MA PhD Dr. J. Wilton10

BSc, MA, PhD1- Oral Biology, 5 th Floor, School of Dental Sciences, Newcastle University, Dental School, Framlington Place, New-

castle upon Tyne NE2 4BW, UK 2- Department of Biomedical Science, University of Sheffield, Addison Building, Sheffield, S10 2TN, UK 3- Department of Basic Medical Sciences, St Georges University of London, Cranmer Terrace, Tooting, London,

SW17 0RE, UK 4- University of Cambridge, Anatomy Building, Downing Street, Cambridge, CB2 3DY, UK 5- Department of Physiology, Anatomy and Genetics, University of Oxford, South Parks Road, Oxford OX1 3QX, UK 6- Clinical Anatomy Learning Centre, Centre for Medical Education, Department of Medicine, Faraday Building, Lan-

caster University, LA1 4YW, UK 7- Cuschieri Surgical Skills Centre, Level 5 Ninewells Hospital, Dundee, DD1 9SY 8- Department of Anatomy and Human Sciences, Kings College London, Guys Campus, London SE1 1UL9- Bute Medical School, St. Andrews Fife, KY16 9TS Scotland 10- Human Anatomy Centre, Department of Physiology, Neuroscience and Development, University of Cambridge,

Downing Street, Cambridge, CB2 3DY

Eur J Anat, 11 (Supplement 1): 3-18 (2007)

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Correspondence to:Prof. S. McHanwell. Oral Biology, 5th Floor, School of Dental Sciences, NewcastleUniversity, Dental School, Framlington Place, Newcastle upon Tyne NE2 4HH, UK.E-mail:[email protected]

SUMMARY

A satisfactory knowledge of topographicalanatomy is one of the key foundations of safeand effective medical practice. Existing cur-riculum guidelines in the UK and Ireland

from bodies including the General MedicalCouncil, the Medical Council of Ireland andScottish Doctors do not provide detailed guid-ance on curriculum content in respect of indi-vidual subjects. This paper describes a coresyllabus in anatomy developed by theAnatomical Society of Great Britain and Ire-land detailing the level of knowledge that webelieve should be the minimum expected of arecently-qualified medical graduate in the UKand Ireland about to embark upon their twoyear Foundation training.

Key words: Medical education Anatomy Curriculum

INTRODUCTION

Anatomical knowledge remains one of thecornerstones of modern medical practice andfor healthcare and allied professions including,dentistry and dental care professions, physio-therapy, radiography and human communica-tion sciences. Knowledge of topographicalanatomy is essential for those performing clin-ical examinations, is crucial for developingworking diagnoses and is also required for car-rying out many clinical procedures safely andeffectively (Fig. 3). The advent of sophisticat-ed imaging techniques has only served to


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increase the importance of anatomical knowl-edge (Fig. 2). This is because many of thesetechniques require a thorough understandingof structure for a full interpretation andexploitation of the information they contain(Fig. 1). Consequently, anatomy is now of increasing importance for a wider range of clinical practice than previously and thereforeis still a key subject in professional medical,dental and healthcare education.

It has been argued that in the past studentswere overloaded with facts, but were not ade-quately prepared for effective communicationwith patients. This has been addressed in

many Medical Schools by the introduction of problem-based, self-directed and patient-cen-tered learning which at the same time shiftslearning away from factual recall towards abroader range of activities including clinicalskills. However, common sense dictates that

there must be a necessary minimum of factualknowledge in basic medical disciplines toallow a medical practitioner to examine theirpatients effectively and to undertake simpleprocedures safely. It follows that this coreknowledge should be the same, whateverteaching approaches are adopted within a cur-riculum.

S. McHanwell, M. Atkinson, D.C.Davies, R.Dyball, J. Morris, C. Ockleford, I.Parkin, S.Standring, S.Whiten, J

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Figure 1. Transverse section of the thorax of an embalmed cadaver at vertebral level T4. The section is viewed in the same way as CT scansare viewed i.e. from below.

Figure 2. CT Scan of the thorax at vertebral level T4. Figure 3. Teaching surface anatomy and clinical skills at the ButeMedical School, St Andrews.


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Increased emphasis on preventative medi-cine has meant that, for example, publichealth, epidemiology, care in the communityand communication skills have assumed moreimportance in medical practice. Emergingdisciplines such as genetics and molecular

biology also command a place in curricula.Consequently, medical curricula have beenredesigned to accommodate these subjects. Atthe same time concerns have been widely-expressed that medical curricula are over-bur-dened with content with one consequence of this over-loading being that it limits the scopefor creative and enquiry-based activities. Med-ical undergraduate courses have not changedsubstantially in length in the last century.Therefore, as the content of the curriculumhas grown by addition of new topics withouta compensatory change in the overall length of the course, changes have had to be made else-where. In many cases this has been achievedby reductions in number of hours available forbasic sciences in general, and anatomy in par-ticular, leading to reduction in anatomicalcontent of curricula. Anatomy is often parti-cularly targeted for reduction because it hasbeen frequently depicted as the mere rotelearning of excessive detail and it cannot bedenied that in the past too little thought has

been given to which facts were required forsafe and effective practice. Anatomy is there-fore an attractive target for those who depictolder medical curricula as being over-bur-dened with an undue emphasis placed uponlearning content. Morley (2003) has describedthis older approach to designing professionalcurricula as imparting knowledge to studentsjust in case it might be needed even thoughmuch of it is unlikely to be deployed by themin their future careers.

It could be argued that the reduction in theanatomy taught during undergraduate train-ing and the Foundation years may not matterif the teaching of additional anatomy isdeferred to a later stage of training and onlyfor those who require the extra necessarydetail. However, concerns continue to be artic-ulated about the consequences that reductionsin anatomy in the initial phases of training arehaving upon understanding of the subject.The first concern is pedagogic. Anatomy is a

sequential subject in which basic knowledgeacquired early is subsequently elaboratedupon. Consequently, without the secure foun-dation that is derived from gaining a three

dimensional understanding of the generalfunctional organisation of the body, it can bedifficult, even in a spiral curriculum whereknowledge is revisited during the course, toappreciate the whole. Furthermore, the frag-mentation of basic science, including anato-my, that can accompany the adoption of anenquiry-based curriculum may hinder a fullunderstanding of the subject (Weatherall,2000, 2006). The second concern derives fromthose engaged in postgraduate education, whoperceive that the anatomical knowledge of those entering postgraduate training has beensubstantially reduced. This means thattrainees do not have a sufficient foundation onwhich to develop to the standard expected atpostgraduate level. Thirdly, there are a num-ber of reports documented in the literature of increases in medical errors arising from inade-quate knowledge of anatomy (Ellis, 2002;Goodwin, 2000; Monkhouse and Farrell,2002). These errors are frequently made atjunior level and are associated with significantmorbidity and mortality leading to a rise inlitigation. Finally, students themselves areoften acutely aware of problems with theirown anatomical knowledge. Prince et al.(2003, 2005) reported that in a sample of stu-dents from the Netherlands, the students

confidence in their own levels of anatomicalknowledge varied significantly and this couldbe related to the amount of anatomy teachingthey had received.

In its document Tomorrows Doctors(1993) revised in 2002, the General MedicalCouncil (GMC) set out the principles uponwhich medical curricula are designed andagainst which they are accredited. The recom-mendations in their document set out a frame-work for course design to achieve the required

objectives and are, by design less precise intheir detail than some of their predecessors.These documents from the GMC are out-comes- and competency-based and one of thekey recommendations is that the burden of factual information in undergraduate medicalcurricula be substantially reduced. Sometime after the publication of these GMC doc-uments, the Quality Assurance Agency forHigher Education in the UK whose functionis to assure the quality of Higher Education

within the whole of the UK also set out aseries of benchmarks for medical education.The difficulty with both these approaches isthat they lay out syllabus content in all sub-

A core syllabus in anatomy for medical students - Adding common sense to need to know

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jects including anatomy, only in the most gen-eral of terms, with insufficient detail for cur-riculum planning. At the same time there hasbeen a more general trend to view profession-al knowledge as unstable, more disposable,transferable and delivered just in time mov-

ing away from the view that professionalknowledge was something acquired early in acareer for later deployment (Morley, 2003).The consequence of these pressures has been toreduce the time devoted to many subjects inthe curriculum without adequate considera-tion being given to the effects this might haveon the understanding of the subject of anato-my as a whole.

Whilst recognising that it may be hard toobtain universal agreement on the details of

the core knowledge required, we here attemptto establish a necessary minimum of anatomi-cal knowledge for all future newly-qualifiedmedical practitioners. All doctors (and med-ical students at the stage appropriate to thecourse they are following) should have theexpertise outlined below. In our view it wouldbe inappropriate to allow someone withoutsuch knowledge and understanding to workindependently with patients. There have beena number of recent reviews describing the

increase in litigation in surgical practiceresulting from a lack of appropriate anatomi-cal knowledge (Ellis, 2002; Goodwin, 2000;Monkhouse and Farrell, 2002). In addition ithas often been observed in litigation cases thatproblems can arise consequent upon a practi-tioners failure to explain to patients the fullrisks of a procedure because of their own lackof understanding and appreciation of the pos-sible complications. This has led to litigationon the basis of a failure to obtain properly

informed (Kahan et al, 2001; Kidder, 2002;Lynn-McCrae et al., 2004). Clearly, effectivecommunication requires not only communica-tion skills, but also the possession of theappropriate knowledge and understanding toinform that communication.

There have been a number of previousattempts to define a core syllabus in anatomyin the USA and Europe (Educational AffairsCommittee, American Association of Anatomists, 1996; Griffioen et al., 1999; Kil-

roy and Driscoll, 2006). However, the syllabidefined by these documents are highlydetailed either because they are aimed at a dif-ferent level or targeted upon a more spe-

cialised audience for a more particular pur-pose. In our view, it is not realistic or necessaryto expect that such syllabi, valuable as theyare, could ever be adopted into an undergrad-uate medical curriculum in their present for-mat. Therefore, the Anatomical Society of

Great Britain and Ireland through its Educa-tion Committee, has initiated this project todesign an anatomical syllabus defining theminimum knowledge outcome expected intopographical anatomy, (excluding histologyor embryology), in a graduating medical stu-dent in the UK and Ireland.

The Royal College of Surgeons of Englandorganised a meeting, in March 2007, to dis-cuss the effects that reductions in anatomyteaching within the undergraduate curricu-

lum were having upon the medical profession.One of the key consensus points to arise fromthat meeting was the need to define a coreundergraduate syllabus in anatomy for all doc-tors. It is timely, therefore, that this projecthas reached its completion shortly after thatmeeting and we offer this document as a con-tribution to that debate.

METHODOLOGY

This syllabus was drafted by the authors,the majority of whom are members of theEducation Committee of Anatomical Societyof Great Britain and Ireland. The authors arepractising teachers of anatomy with experi-ence of a wide range of curricula, involved incurriculum design in their own institutionsand with extensive cumulative experience of other curricula through external examining.The Education Committee of ASGBI includesmembers of the British Association of ClinicalAnatomists.

An initial version of this document wasposted on the Anatomical Societys website forcomment and we thank all those who respond-ed. The present document has been circulatedfor consultation and comment amongst themembers of the Anatomical Society of GreatBritain and Ireland. An earlier version of thedocument was approved at a meeting of theCouncil of the Society in 2006.

The document is laid out in broad regionalterms. It starts with a broad general statementwhich includes surface anatomy, the interpre-tation of standard clinical images, and the


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importance of the knowledge for understand-ing of common pathologies. This is followedby a more detailed specification of the topo-graphical knowledge required to meet thesegeneral aims.

After qualification, most doctors will expe-

rience anatomy either as surface anatomy (Fig.3) or clinical images (Figs. 1 and 2), thoughadvances in computing mean that, increasing-ly, the latter can be rendered as 3-D recon-structions. By the use of the term standardclinical images in the subsequent text weimply the following: standard P-A and lateralradiographs of all parts of the body with spe-cial views of clinically critical areas (e.g. open-mouth view of odontoid process); contrastradiographs of the vascular, alimentary, pan-creato-biliary, urinary and female reproductivesystems; axial CT and MRI series through thehead and trunk, midline sagittal images of thehead, spine and pelvis, and coronal and sagit-tal views of shoulder, hip, knee and ankle;nuclear images of the skeleton and thyroid;ultrasound images of pregnancies, kidney, gallbladder, liver, and heart; and endoscopic viewsof the tracheo-bronchial tree, the alimentarytract, and the knee joint.

SUMMARY OF THE CORE SYLLABUS

We present here a summary of the detailedsyllabus that follows to provide curriculumplanners with a more concise form of wordsthan the full syllabus allows.

LanguageIn order to communicate effectively with

colleagues, graduates must understand anduse accepted anatomical language to describethe normal structure of the body.

Vertebral columnMedical graduates should be able to recog-

nise characteristic features of vertebrae fromthe five regions of the vertebral column,understand how the spine as a whole movesand how its normal curvatures develop and arestabilised. They should be able to interpretrelevant clinical images to distinguish devia-tions from normal. They should understandthe organisation of the contents of the verte-bral canal i.e. the meninges, spinal cord,

spinal nerve roots, spinal nerves and their par-ticular relationships to the vertebrae and theintervertebral joints. This knowledge formsthe basis for the understanding of common

spinal pathologies e.g. back pain, prolapse of an intervertebral disc, injuries to the spinalcord, nerve, and whiplash injuries and theirconsequences for the remainder of the body. Itis also necessary for the safe performance of procedures such as lumbar puncture, regionaland epidural anaesthesia. Medical graduatesshould have sufficient knowledge of surfacefeatures and muscle groups to perform anexamination of the back. They should have aworking knowledge of dermatomes andperipheral nerve distribution, the functions of major muscle groups and their innervation inorder to perform a basic neurological examina-tion of the limbs and trunk.

Upper limbMedical graduates should be able to recog-

nise the major palpable and imaging featuresof the bones of the upper limb, be aware of thesites of common fractures (clavicle, humerus,distal radius and scaphoid) and the complica-tions that might result from them. Theyshould be aware of the factors that influencethe stability of the shoulder, elbow, wrist andinterphalangeal joints and understand thenature and consequences of common injuries(e.g. shoulder, elbow and finger dislocation).

In order to perform clinical procedures safe-

ly and effectively, graduates should be able todemonstrate the course, key relations and dis-tribution of the main neurovascular structuresof the upper limb, be able to demonstratemajor pulse points (e.g. subclavian, brachialand radial), the position of major veins (forvenous access) and know the common sites of peripheral nerve injury and their likely func-tional effects (brachial plexus lesions, axillary,radial, ulnar and median nerve lesions). Theyshould be able to explain the anatomical basisof common conditions of the upper limb (e.g.rotator cuff injuries, carpal tunnel syndrome)and how infection might spread in the limb.They should be able to describe the organisa-tion of the axillary lymph nodes and the lym-phatic drainage of the breast and explain theirsignificance in relation to metastatic spread of breast cancer and melanoma.

ThoraxMedical graduates should be able to

demonstrate the major palpable and radiolog-

ical features of the thoracic wall, and describethe anatomy of the intercostal spaces, thediaphragm and the functional anatomy of ven-tilation. They should know the extent of the


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pleural cavities and the anatomy of the lungs(including their lymphatic drainage and itsrole in the metastatic spread of lung cancer),the main divisions of the mediastinum andtheir contents and the anatomy of the heartand great vessels of the thorax, including theirsurface projections. They should be aware of the anatomical basis of common congenitalcardiac abnormalities, heart murmurs andtheir effects. They should understand thefunction and arrangement of the coronaryarteries and the position and function of theheart valves. They should know the course of major structures passing between the neck andthorax and those which pass through thediaphragm between the thorax and theabdomen. This knowledge forms the basis of understanding pneumothorax, lung and pleu-ral disease, coronary artery and valve surgeryand in referred pain from the distribution of the phrenic and intercostal nerves. Theyshould have a working knowledge of surfaceanatomy of the thorax, be able to undertake anexamination of the heart and lungs and inter-pret standard diagnostic images. They shouldbe aware of the possible complications wheninserting central venous lines and where toplace a chest drain for simple and tensionpneuomothorax and for cardiac tamponade.

AbdomenMedical graduates should be familiar with

the anatomy of the anterior and posteriorabdominal walls and the inguinal region, theextent of the peritoneal cavity and the anato-my and key relationships of the oesophagus,stomach, small and large intestines includingthe appendix, liver, gall bladder, pancreas,spleen, kidneys, ureters and adrenal andsuprarenal glands. They should understandthe arterial supply and venous drainage to theintestine in relation to arterial occlusion,strangulation, intestinal surgery, the portalcirculation and the effects of portal hyperten-sion, and the lymphatic drainage and innerva-tion of the abdominal organs in relation tometastatic spread of cancer and abdominalpain. This knowledge forms the basis of understanding of surgical incisions, referredpain from the abdominal viscera (especiallythe gall bladder and appendix) and how thesub-hepatic and sub-phrenic spaces may be

implicated in the spread of infection. Theyshould have a working knowledge of surfaceanatomy and be able to undertake an examina-tion of the abdomen and of the inguinal canal

for hernias. They should be able to interpretstandard diagnostic images of the alimentary,pancreato-biliary and urinary tracts.

PelvisMedical graduates should be familiar with

the anatomy and positions of the ureters, blad-der, urethra, rectum and anal canal, the struc-ture of the pelvic floor, and the anatomy of continence, the anatomy of the external andinternal genitalia in males (scrotum, testis, vasdeferens, seminal vesicles, prostate, penis) andfemales (ovaries, uterine tubes, uterus, cervix,vagina, labia, clitoris). They should be able todescribe the peritoneal relationships, and sup-ports of the pelvic viscera to understandectopic pregnancy, prolapse and suprapubiccatheterisation. They should understand thearterial supply, venous drainage and the lym-phatic drainage and innervation of the pelvicorgans in relation to metastatic spread of can-cer. Graduates should be able to interpret rele-vant standard diagnostic images and havesufficient anatomical knowledge to be able toperform rectal and vaginal examinations, uri-nary catheterisation in both males and females,and obtain a cervical smear in females.

Lower limb

Medical graduates should be able to recog-nise the major palpable and imaging features of the bones of the lower limb, be aware of thesites of common fractures (neck and shaft of femur, tibia and fibula) and the complicationsthat might result from them. They should beable to explain the factors that influence thestability of the hip, knee and ankle joints, thecommon ligamentous injuries and be able totest for ligament integrity. In order to performclinical procedures safely and effectively, gradu-ates should be able to describe the course anddistribution of the main neurovascular struc-tures in the lower limb (e.g. to avoid damage tothe sciatic nerve when making an intramuscu-lar injection,), be able to demonstrate majorpulse points (e.g. femoral, for arterial bloodsampling, popliteal, posterior tibial and dor-salis pedis), the position of major veins (forvenepuncture, venous access by cut down andassessment of varicose veins) and the commonsites of peripheral nerve injury and the possiblefunctional effects of such damage (e.g. sciatic

and common peroneal nerve at neck of fibula).They should have a working knowledge of sur-face anatomy, dermatomes and peripheral nervedistribution, the functions of major muscle


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groups and their innervation in order to per-form a basic neurological examination of thelower limb. Graduates should understand theorganisation of inguinal lymph nodes and howthey relate to the lymphatic drainage of thelimb, trunk skin and perineum. They should beaware of the organisation of the deep fascia of the lower limb and its relevance to compart-ment syndromes, how blood is returned to theheart from the legs and how failure of thismechanism may cause the development of vari-cosities, deep vein thromboses and embolism.

Head and NeckMedical graduates should be able to recog-

nise the major palpable and imaging featuresof the skull and cervical spine in order to beable to interpret relevant medical images. Toperform clinical examination of the head andneck graduates should be familiar with theposition, key relationships, neurovascular sup-ply, venous and lymphatic drainage of the fol-lowing major structures: course anddistribution of the cranial nerves, ear andpharyngotympanic (Eustachian) tube, eye,eyelids and conjunctivae, nasal cavity andparanasal air sinuses, oral cavity and tongue,tonsils, soft palate, pharynx, salivary glands,larynx and trachea, thyroid and parathyroid

glands and the contents of the carotid sheath.Medical graduates should be able to describethe fascia and fascial spaces of the neck in rela-tion to the spread of infection. This knowl-edge is necessary for understandingconductive and sensorineural deafness, otalgiaand the likely sources of referred pain to theear, facial nerve palsy, epistaxis, quinsy, dys-phagia, upper airway obstruction, infantilestridor, sinusitis, vocal cord paralysis andhoarseness, cervical swellings, and salivarygland swellings. Medical graduates shouldhave sufficient anatomical knowledge to beable to manage the airway, insert an endotra-cheal or nasogastric tube, and perform a tra-cheostomy and laryngotomy. They shouldhave a working knowledge of surface anatomy,cranial nerve distribution, the functions of major muscles of the head and neck and theirinnervation in order to perform a basic neuro-logical examination.

Neuroanatomy

Medical graduates should understand theblood supply and venous drainage of the brainand spinal cord, the arrangement of themeninges, the pattern of the major dural

venous sinuses, subarachnoid space, ventricu-lar system and the production, circulation anddrainage of cerebrospinal fluid. They shouldunderstand the position, organisation, connec-tions, vascular supply, venous drainage andkey relations of the main parts of the brain andspinal cord including the cerebral cortex,internal capsule, cerebellum, basal ganglia,thalamus, hypothalamus and brainstem. Theyshould be aware of the key relations and com-ponents of the white matter, including themain motor and sensory pathways of the brainand spinal cord. This knowledge is necessaryfor interpretation of standard diagnosticimages, an understanding of stroke and recog-nition of the signs and symptoms of commonneurological disorders and intracranial haem-orrhages.

For all structures, the emphasis should beon those that are commonly damaged orinvolved in interventional procedures. For themusculoskeletal system, the emphasis shouldbe on the principal palpable and radiologicalfeatures of the bones, commonly damaged lig-aments, functional muscle groups (avoidingunnecessary details of their attachments) andtheir innervation by segmental spinal nerves.For the cardiovascular system there should bea good knowledge of the heart and emphasis

on pulse points and commonly damaged siteson arteries, access points on veins, and a soundunderstanding of the lymphatic drainage of tissues. For the peripheral nervous system theemphasis should be on supplies to areas of skinand muscle groups by both segmental spinalnerves and peripheral nerves.

Anatomical TermsA medical graduate should be able to:

1. Define and demonstrate the followingterms relative to the anatomical position:medial, lateral, proximal, distal, superior,inferior, deep, superficial, palmar, plantar,anterior/ventral, posterior/dorsal, rostral,caudal.

2. Describe the following anatomical planes:axial / transverse / horizontal, sagittal andcoronal.

3. Define and demonstrate the terms used todescribe the movements of the limbs andvertebral column: flexion, extension, lateralflexion, pronation, supination, abduction,

adduction, medial and lateral rotation,inversion, eversion, plantarflexion, dorsi-flexion, protraction, retraction and circum-duction.


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the functional and possible pathologicalconsequences of its dislocation.

12. Describe the anatomy of the elbow joint.Demonstrate the movements of flexionand extension, identify the musclesresponsible for these movements and sum-

marise their main attachments and somat-ic motor nerve supply.13. Describe the anatomy of the superior and

inferior radio-ulnar joints. Explain the move-ments of supination and pronation; identifythe muscles responsible for these movementsand summarise their main attachments andsomatic motor nerve supply.

14. Describe the anatomy of the wrist.Describe and demonstrate movements atthese joints and name and identify themuscle groups responsible for the move-ments. Describe the relative positions of the tendons, vessels and nerves at the wristin relation to injuries.

15. Name and demonstrate the movements of the fingers and thumb. Describe the posi-tion, function and nerve supply of themuscles and tendons involved in thesemovements, differentiating between thosein the forearm and those intrinsic to thehand.

16. Explain the main types of grip (power,precision and hook) and the role of themuscles and nerves involved in executingthem.

17. Describe the position and function of theretinacula of the wrist and the tendonsheaths of the wrist and hand. Explaincarpal tunnel syndrome and the spread of infection in tendon sheaths.

18. Explain why and describe where the axil-lary, musculocutaneous, radial, medianand ulnar nerves are commonly injured

and be able to describe the functional con-sequences of these injuries.19. Explain the loss of function resulting from

injuries to the different parts of thebrachial plexus.

20. Demonstrate how to test for motor andsensory nerve function. Describe theanatomical basis of: the assessment of cutaneous sensation in the dermatomes of the upper limb, tendon jerk testing of biceps and triceps and comparative

strength tests.21. Describe the anatomy of the axillarylymph nodes and explain their importancein the lymphatic drainage of the breast

and the skin of the trunk and upper limband in the spread of tumours.

22. Interpret standard diagnostic images of the upper limb and be able to recognisecommon abnormalities.

ThoraxA medical graduate should be able to:

1. Demonstrate the main anatomical land-marks of the thoracic vertebrae, ribs andsternum.

2. Describe the anatomy of the jointsbetween the ribs and vertebral column,the ribs and costal cartilages and the costalcartilages and sternum. Explain the move-ments made at those joints during venti-lation and the differences betweenventilatory movements in the upper and

lower chest.3. Describe how the boundaries of the tho-racic inlet and outlet are formed by thevertebrae, ribs, costal cartilages and ster-num.

4. Describe the surface projection, attach-ments and relationships of the diaphragmand the structures that pass through it.Explain the movements it makes duringventilation and the motor and sensorynerve supply to it and its pleural and peri-

toneal coverings.5. Explain the anatomy of the intercostalmuscles. Describe a neurovascular bundlein a typical intercostal space and outlinethe structures its components supply.

6. Explain the movements involved in nor-mal, vigorous and forced ventilation anddescribe the muscles responsible for thesemovements.

7. Demonstrate the surface markings of theheart and great vessels, the margins of thepleura and the lobes and fissures of thelungs.

8. Summarise the anatomy of the bronchialtree and bronchopulmonary segments;explain their functional significance inrelation to inhalation injury.

9. Describe the blood and nerve supply andlymph drainage of the lungs. Describe thestructures in the hilum and the mediasti-nal relations of each lung.

10. Describe the arrangement and contents of the superior, anterior, middle and posteri-

or parts of the mediastinum.11. Identify the major anatomical features of each chamber of the heart and explaintheir functional significance.


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12. Describe the structure and position of theatrio-ventricular, pulmonary and aorticvalves and describe their role in the pre-vention of reflux of blood.

13. Describe the origin, course and mainbranches of the left and right coronary

arteries and discuss the functional conse-quences of their obstruction.14. Understand the anatomical course of the

spread of excitation through the chambersof the heart and describe the placement of ECG electrodes for its clinical assessment.

15. Demonstrate the arrangement of thefibrous and serous layers of the pericardi-um in relation to cardiac tamponade.

16. Describe the course of the ascending aorta,the arch of the aorta and the descending

thoracic aorta. Name their major branchesand the structures they supply.17. Describe the origins, course and relation-

ships of the brachiocephalic veins, inferiorand superior venae cavae and the azygosvenous system.

18. Describe the origin, course and distribu-tion of the vagus nerve and its branchesand the phrenic nerves on both the rightand left sides of the thorax. Explain themechanism of referred pain and where

pain is referred from thoracic organs.19. Describe the composition and function of the sympathetic chains and splanchnicnerves. Describe their composition andfunction.

20. Describe the course and major relations of the oesophagus within the thorax.

21. Describe the course and major relations of the thoracic duct and the other lymph sys-tems within the thorax, and explain theirmedical significance.

22. Demonstrate the surface markings of theheart and the position and site of ausculta-tion of the four major valves

23. Demonstrate the surface projections of themargins of the pleura and the lobes andfissures of the lungs.

24. Identify major thoracic structures on stan-dard diagnostic images and be able torecognise common abnormalities.

Abdomen

A medical graduate should be able to:1. Demonstrate the bony and cartilaginouslandmarks visible or palpable on abdomi-nal examination.

2. Demonstrate the descriptive regions of theabdomen and common incision sites.Demonstrate the surface projections of theabdominal organs.

3. Describe the anatomy, innervation andfunctions of the muscles of the anterior

and posterior abdominal walls. Discusstheir functional relationship with thediaphragm and roles in posture, ventila-tion and voiding of abdominal / thoraciccontents.

4. In relation to direct and indirect inguinalhernias, demonstrate the anatomy of theattachments of the inguinal ligament; theanatomy of the superficial and deepinguinal rings and how the anteriorabdominal wall muscles form the inguinalcanal. Describe the contents of theinguinal canal in both males and females.

5. Describe the relationship between thefemoral canal and the inguinal ligamentand the anatomy of femoral hernias.

6. Demonstrate the positions of the liver,pancreas, spleen, kidneys, stomach, duo-denum, jejunum and ileum of the smallintestine, caecum, appendix, ascending,transverse, descending and sigmoid partsof the colon and the rectum.

7. Describe the organisation of the parietaland visceral peritoneum; its lesser andgreater sacs, mesenteries and peritonealligaments. Explain the significance of the variable attachment of the ascendingand descending colon to the posteriorabdominal wall.

8. Summarise the functional anatomy of thesmall bowel mesentery; its structure, loca-tion and vascular, lymphatic and neuralcontent.

9. Explain the nerve supply of the parietaland visceral peritoneum and the role of the visceral peritoneum in referred pain.

10. Describe the functional anatomy of thestomach, its position, parts, sphincters,blood and nerve supply and key relationsto other abdominal organs.

11. Describe the duodenum, its parts, posi-tion, secondary retroperitoneal attach-ment, blood supply and key relations withother abdominal organs and their signifi-cance in relation to peptic ulcer disease.

12. Describe the regions of the small and largeintestine, including the anatomy of theappendix. Describe the anatomical varia-tions in the position of the appendix and


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explain their significance in relation toappendicitis.

13. Describe the position and form of the pan-creas and its relationships to other abdom-inal organs. Discuss the significance of these relationships in relation to pancre-

atitis and biliary stone disease.14. Describe the position and form of theliver, the lobes of the liver and their keyanatomical relations. Explain the peri-toneal reflections of the liver and itsmovement during respiration. Summarisethe functional anatomy of the portal vein,the portal venous system and portal-sys-temic anastomosis and their significancein portal hypertension.

15. Describe the position and form of the gallbladder and biliary tree; their relations inthe abdomen and the significance of theserelations in relation to gall bladderinflammation and biliary stones.

16. Describe the position and form of the kid-neys and ureters. Demonstrate their rela-tionships to other abdominal and pelvicstructures and discuss the significance of these relations in relation to urinarystones.

17. Describe the relations of the suprarenal(adrenal) glands and their functionalanatomy.

18. Describe the position (in relation to theribs) and form of the spleen in relation toits palpation through the abdominal walland its key anatomical relationships withother abdominal structures. Explain thesignificance of these relationships in rela-tion to trauma, chronic infections and dis-orders of the haematopoetic system.

19. Describe the origins, course and majorbranches of the abdominal aorta, coeliacaxis, superior and inferior mesentericarteries and their major branches, therenal and gonadal arteries. Explain thesignificance of the blood supply from theabdominal aorta to the spinal cord in rela-tion to abdominal aneurysm repair.Demonstrate the origins, course andmajor tributaries of the inferior vena cava.

20. Describe the anatomy of the lymph nodesinvolved in lymph drainage of abdominalviscera and its significance in relation to

spread of malignancy.21. Interpret standard diagnostic images of the abdomen and recognise commonabnormalities.

PelvisA medical graduate should be able to:

1. Describe the skeletal and ligamentouscomponents of the pelvis, the anatomy of the pelvic inlet and outlet and recognisetheir normal orientation. Explain sex dif-

ferences in pelvic skeletal anatomy andhow these change during development.2. Demonstrate the palpable anatomical

landmarks of the iliac, ischial and pubicbones in the living and on the bones andidentify them on medical images.

3. Demonstrate the points of attachment of the muscles of the abdominal wall andthose of levator ani.

4. Describe the functional importance of thepelvic floor musculature, its midline

raph and the structures passing throughit in males and females.5. Describe the anatomy of the bladder, its

base and ureteric openings. Explain howits position changes with filling and preg-nancy and its relationship to the overlyingperitoneum.

6. Describe the anatomy of the urethra;explain the anatomy of its different part inmales and females in relationship to conti-nence and catheterisation.

7. Describe the innervation of the bladderand its sphincters and the mechanism of micturition

8. Describe the anatomy of the scrotum,testis, epididymis and their normal fea-tures on clinical examination. Explain thesignificance of their arterial supply in rela-tion to torsion, their venous drainage inrelation to varicocoele and their lymphat-ic drainage in relation to tumour spread.

9. Describe the structure and course of thespermatic cord and vas deferens.

10. Describe the anatomy of the prostategland, seminal vesicles and their anatomi-cal relations. Describe the normal form of the prostate when examined per rectumand changes in relation to hypertrophyand malignancy.

11. Describe the position and form of theovary, uterine tubes, uterus, cervix andvagina and their anatomical relationships,including any peritoneal coverings.Describe the changes that occur in the

uterus and cervix with pregnancy.12. Describe the origin, course and relationsof the uterine, ovarian and testicular arter-ies.


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13. Describe the origin, course and branchesof the pudendal nerves and the sites of nerve block during childbirth.

14. Describe the innervation and mechanismsinvolved in erection of cavernous tissue inmale and female and emission and ejacula-tion in the male.

15. Describe the anatomy of the sigmoidcolon and rectum and their anatomicalrelationships including peritoneal.Explain the anatomy of the anal canal, thefunctional anatomy of the anal sphinctersand their role in faecal continence.

16. Describe the blood supply and venousdrainage of the distal bowel; the supplyfrom the superior rectal (inferior mesen-teric), middle rectal (internal iliac) andinferior rectal arteries (from pudendal toanal canal only), and portal-systemicvenous anastomosis. Describe the vascularanal cushions and explain their role incontinence.

17. Describe the anatomy of the ischio-analfossa and explain its potential involve-ment in abscesses, anal glands and fis-sures.

18. Describe the structure of the penis, scro-tum and its contents, the clitoris andvulva. Describe the arterial supply to and

venous drainage from the penis. Explainthe anatomy of the perineal membraneand superficial perineal pouch in relationto the accumulation of fluids in the male.

19. Describe the lymphatic drainage of thepelvis

20. Interpret standard diagnostic images of the pelvis and be able to recognise com-mon abnormalities.

Lower LimbA medical graduate should be able to:

1. Recognise the major features and surfacelandmarks of the pelvis, femur, tibia, fibu-la, ankle and foot. Demonstrate their pal-pable and imaging landmarks. Appreciatewhich bones and joints are vulnerable todamage and what the consequences of such damage could be.

2. Describe the close relations of the bonesand joints (e.g. bursae, blood vessels,nerves ligaments and tendons), which maybe injured in fractures or dislocations and

predict what the functional effects of suchdamage would be.3. Describe the fascial compartments enclos-

ing the major muscle groups and explain

the functional importance of these com-partments and their contents in relation tocompartment syndromes.

4. Demonstrate the origin, course andbranches of the major arteries that supplythe hip, gluteal region, thigh, leg, ankleand foot. Explain the functional signifi-cance of anastomoses between branches of these arteries at the hip and knee.

5. Demonstrate the locations at which thefemoral, popliteal, dorsalis pedis and pos-terior tibial pulses can be felt.

6. Demonstrate the course of the principalveins of the lower limb. Explain the role of the perforator vein connections betweenthe superficial and deep veins and thefunction of the muscle pump for venousreturn to the heart. Describe the sites of venous access that can be used for cut-down procedures in emergencies.

7. Outline the origin of the lumbosacralplexus and the formation of its majorbranches.

8. Describe the origin, course and function of the sciatic, femoral, obturator, commonperoneal and tibial nerves, sural andsaphenous nerves and summarise the mus-cles and muscle groups that each suppliesas well as their sensory distribution.

9. Describe the structure and movements of the hip joint. Summarise the musclesresponsible for these movements, theirinnervation and main attachments.

10. Describe the structures responsible for sta-bility of the hip joint and their relativecontribution to maintaining the lowerlimb in different positions.

11 Describe the structures at risk from a frac-ture of the femoral neck or dislocation of the hip and explain the functional conse-quences of these injuries.

12. Describe the boundaries of the femoral tri-angle and the anatomical relationships of the femoral nerve, artery, vein and lymphnodes to each other and to the inguinalligament, with particular regard to arteri-al blood sampling and catheter placement.

13. Describe the anatomy of the gluteal (but-tock) region and the course of the sciaticnerve within it. Explain how to avoiddamage to the sciatic nerve when givingintramuscular injections.

14. Describe the structure and movements of the knee joint. Summarise the musclesresponsible for these movements, theirinnervation and main attachments.


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15. Describe the close relations of the kneejoint including major bursae and explainwhich structures may be injured by trau-ma (including fractures and dislocation) tothe knee.

16. Identify the factors responsible for main-taining the stability of the knee joint.Describe the menisci, ligaments and thelocking mechanism close to full extension.Explain the anatomical basis of testswhich assess the integrity of the cruciateligaments.

17. Describe the boundaries and contents of the popliteal fossa.

18. Describe the anatomy of the ankle joint.Explain the movements of flexion, exten-sion, plantarflexion, dorsiflexion, inver-sion and eversion. Summarise the musclesresponsible for these movements, theirinnervation and their main attachments.

19. Describe the factors responsible for stabil-ity of the ankle joint, especially the later-al ligaments, and explain the anatomicalbasis of sprain injuries.

20. Describe the arches of the foot and thebony, ligamentous and muscular factorsthat maintain them.

21. Describe the movements of inversion andeversion at the subtalar joint, the muscles

responsible, their innervation and mainattachments.22. Describe the anatomical basis (nerve root

or peripheral nerve) for loss of movementsand reflexes at the knee and ankle resultingfrom spinal injuries, disc lesions and com-mon peripheral nerve injuries. Describethe dermatomes of the lower limb and per-ineum used to assess spinal injuries

23. Describe the structures at risk to a fractureof the femoral neck or dislocation of thehip and describe the functional conse-quences of these conditions.

24. Describe the lymphatic drainage of thelower limb and its relationship to tumourspread.

25. Discuss the structures of the lower limbthat may be used for autografts.

26. Interpret standard diagnostic images of the lower limb and be able to recognisecommon abnormalities.

Head and Neck

A medical graduate should be able to:1. Demonstrate the position, palpable andimaging landmarks of the major bones of the skull, including the frontal, parietal,

occipital, temporal, maxilla, zygoma,mandible, sphenoid, nasal and ethmoidbones. Demonstrate the palpable positionof the hyoid bone, thyroid and cricoid car-tilages, lateral mass of the atlas and thespine of C7. Demonstrate the major sutur-al joints and describe the fontanelles of thefetal skull.

2. Describe the boundaries, walls and floorsof the cranial fossae.

3. Identify the external and internal featuresof the cranial foraminae and list the struc-tures that each transmits.

4. Demonstrate the position of the anteriorand posterior triangles of the neck definedby the sternum, clavicle, mandible, mas-toid process, trapezius and sternocleido-mastoid.

5. In the posterior triangle, demonstrate theposition of the spinal accessory nerve, theroots and trunks of the brachial plexus,the external jugular vein and subclavianvessels in relation to penetrating necktrauma.

6. In the anterior triangle, demonstrate theposition of the common, internal andexternal carotid arteries, the internaljugular vein and vagus nerve, the trachea,thyroid cartilage, larynx, thyroid and

parathyroid glands. Explain their signifi-cance in relation to carotid insufficiency,central venous line insertion, emergencyairway management and diagnosis of thy-roid disease.

7. Describe the location and anatomical rela-tions of the thyroid and parathyroidglands, their blood supply and the signif-icance of the courses of the laryngealnerves.

8. Demonstrate the origin, course and majorbranches of the common, internal andexternal carotid arteries and locate thecarotid pulse.

9. Describe the courses of the accessory,vagus and phrenic nerves in the neck.

10. Identify the major structures passingbetween the neck and the thorax. Describethe courses and important relationships of the subclavian arteries and veins.

11. Describe the anatomy of the scalp, namingits individual layers. Describe the bloodsupply of the scalp and its significance in

laceration injuries.12. Demonstrate the extracranial course of thebranches of the facial nerve. Summarisethe muscles of facial expression supplied


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by each branch and describe the conse-quences of injury to each branch.

13. Describe the intracranial and intrapetrouscourse of the facial nerve and the relation-ships of its major branches to the middleear in relation to damage of the nervewithin the facial canal.

14. Describe the anatomy of the temporo-mandibular joint. Explain the movementsthat occur during chewing and describethe muscles involved including theirinnervation. Explain what occurs in ante-rior joint dislocation and relocation.

15. Describe the origin, function and majorbranches of the sensory and motor compo-nents of the trigeminal nerve.

16. Describe the origins and summarise thecourses and major branches of the facial

and maxillary arteries, including thecourse and intracranial relations of themiddle meningeal artery and its signifi-cance in extradural haemorrhage.

17. Describe the relationship of the termina-tion of the facial vein (draining into theinternal jugular vein) and the mandibularbranch of the retromandibular vein (sup-plying facial muscles controlling the angleof the mouth) to the submandibular glandand related upper jugular lymph nodes inrelation to exploration of this area.

18. Describe the key anatomical relations of the parotid, submandibular and sublin-gual salivary glands, the course of theirducts into the oral cavity and their auto-nomic secretomotor innervation. Appreci-ate the narrow points of the ducts inrelation to salivary stone impaction.

19. Demonstrate the major features andboundaries of the oral cavity and sum-marise its sensory innervation.

20. Describe the functional anatomy of the

tongue, including its motor and sensoryinnervation and the role of the extrinsicand intrinsic muscles. Explain the devia-tion of the tongue after hypoglossal nerveinjuries.

21. Describe the anatomical arrangement andfunctional significance of the lymphoidtissue in the tonsils, pharyngeal, and pos-terior nasal walls.

22. Describe the muscles that compose thepharyngeal walls and move the soft palate;summarise their functions and nerve sup-

ply. Describe the components of the gagreflex.23. Describe the hyoid bone and cartilages of

the larynx. Explain how these structures are

linked together by the thyrohyoid,cricothyroid, and quadrangular membranes.

24. Describe the intrinsic and extrinsic laryn-geal muscles responsible for closing thelaryngeal inlet, controlling vocal cordposition and tension. Explain how thesemuscles function during phonation, laryn-geal closure, the cough reflex and regula-tion of intrathoracic pressure.

25. Describe the origin, course and functionsof the motor and sensory nerve supply of the larynx and the functional conse-quences of injury to them.

26. Describe the stages of swallowing and thefunctions of the muscles of the jaw, cheek,lips, tongue, soft palate, pharynx, larynxand oesophagus during swallowing.

27. Describe the location, actions and nerve

supply of the intrinsic and extra-ocularmuscles and apply this knowledge toexplain the consequences of injury to thenerve supply of these muscles.

28. Describe the anatomy of the eyelids, con-junctiva and lacrimal glands. Explaintheir importance for the maintenance of corneal integrity.

29. Describe the functional anatomy of theexternal auditory meatus, tympanic mem-brane, ear ossicles and auditory tube,together with their major anatomical rela-tions.

30. Describe the bones of the nasal cavity andthe major features of the lateral wall of thenasal cavity. Describe the major arteriesthat supply the lateral wall and nasal sep-tum in relation to nosebleeds.

31. Name the paranasal sinuses, describe theirrelationships to the nasal cavities and sitesof drainage on its lateral wall and explaintheir innervation in relation to referredpain.

32. Describe the arrangement of the duramater, and its main reflections within thecranial cavity and their relationship to themajor venous sinuses and the brain itself.

33. Describe the arrangement of the venoussinuses of the cranial cavity; explain theentrance of cerebral veins into the superi-or sagittal sinus in relation to subduralhaemorrhage, and how connectionsbetween sinuses and extracranial veinsmay permit intracranial infection

34. Describe the relationships between the

brain and the anterior, middle and poste-rior cranial fossae.35. Describe the anatomy of the motor and

sensory nerves to the head and neck and


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apply this to a basic neurological assess-ment of the cranial nerves and upper cer-vical spinal nerves.

36. Describe the sympathetic innervation of the head and neck and the features andcasual lesions in Horners syndrome.

37. Demonstrate the positions of the externaland internal jugular veins and the surfacelandmarks that are used when inserting acentral venous line.

38. Describe the arrangement of the lymphat-ic drainage of the head and neck, themajor groups of lymph nodes and thepotential routes for the spread of infectionand malignant disease.

39. Interpret standard diagnostic images of the head and neck and be able to recognisecommon abnormalities.

NeuroanatomyA medical graduate should be able to:

1. Define the terms rostral and caudal, ante-rior / ventral and posterior / dorsal in rela-tion to the nervous system.

2. Define the terms grey and white matter,fasciculus, tract, commissure, pathway,chiasm, decussation, nucleus, ganglion,and cortex.

3. Identify the major divisions of the brain:

the cerebral hemispheres, diencephalon(thalamus, hypothalamus and epithala-mus), midbrain, pons, medulla oblongataand cerebellum.

4. Identify the major sulci and gyri of thecerebral hemispheres (lateral, central andpost-calcarine) and summarise the posi-tion of the frontal, parietal, occipital andtemporal lobes.

5. Describe the areas of cerebral cortex sub-serving major special functions; motor

(including motor speech); sensory; visual;auditory (including sensory speech);memory and emotion (medial temporal hippocampus, amygdala); decision mak-ing, social behaviour (orbitofrontal).Explain the manifestations of related dis-orders.

6. Summarise the position of the major com-missure (corpus callosum) and ascendingand descending tracts (internal capsule,cerebral peduncles, pyramids),

7. Describe the blood supply to the brainand explain the functional deficits occur-ring after stroke involving individualcerebral arteries.

8. Describe the anatomy of the arachnoidand pia mater and ventricular system.Explain the formation, circulation anddrainage cerebrospinal fluid.

9. Describe the origins, courses and func-tions of the cranial nerves.

10. Describe the neural pathways sub-servingthe special senses.

11. Summarise the structure of the cerebel-lum, the connections and functions of theprincipal cerebellar inputs and outputs.

12. Summarise the locations, connections andfunctions of the basal ganglia (caudate,putamen, globus pallidus, subthalamicnucleus and substantia nigra). Explain themanifestations of related disorders.

13. Summarise the functions and connectionsof the thalamus.

14. Describe the anatomy and major functions(endocrine, autonomic) of the hypothala-mus and pituitary gland. Explain themanifestations of related disorders.

15. Describe the principal components of thelimbic system, hippocampus, amygdala,prefrontal cortex, nucleus accumbens), thepathways connecting them and their func-tion.

16. Discuss the position and major functionsof the ascending aminergic systems (nora-

drenaline, dopamine, and serotonin) andcholinergic systems.17. Describe the positions within the spinal

cord of the dorsal column, anterolateral(spinothalamic) and trigeminothalamicascending tracts, the spinocerebellar andthe corticospinal and extrapyramidaldescending tracts. Describe the sites atwhich synapses occur in these pathways.

18. Explain the anatomical basis of neurologi-cal assessment.

19. Identify the major features of the brain oncoronal, horizontal and sagittal sectionsand standard diagnostic image and be ableto recognise common abnormalities.

DISCUSSION AND CONCLUSIONS

We have set out in this document a suggest-ed core syllabus in anatomy for medical stu-dents in the UK and Ireland. It should beemphasised that we are trying to set standardsnot impose them. Existing guidelines from, forexample, the GMC and Scottish Doctors arevaluable for course designers who are trying todefine core knowledge but are, in them-


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selves, not sufficiently detailed to allow thosewho teach anatomy to set a syllabus. The pur-pose of this document is to suggest a core of anatomical knowledge that will equip studentsin the UK and Ireland for safe and effectiveclinical practice. Inevitably the suggestionsreflect the background and understanding of its authors. Some will feel that there are otherthings that should be included and that someof suggestions ought to be excluded. Wewould welcome any such comments either toany of the authors or via the website of theAnatomical Society of Great Britain and Ire-land as we view this syllabus as one which willevolve over time. The next stage of this projectwill be to validate our syllabus using a Delphiapproach (Fischer, 1978) and that will be thesubject of a future publication.

All those who design courses in UK andIrish medical schools, whether systems-basedor integrated curricula, problem-based or sce-nario-led teaching, should ensure that theirmedical students learn in such a way that theybecome generally familiar with the anatomysummarised in this document. This knowl-edge base is necessary for safe and effectiveexamination and diagnosis of a patient. Thesyllabus we have described defines the knowl-edge we would expect to see newly qualifiedmedical graduates attain by the end of theircourse so that they can examine, diagnose andperform minor procedures safely and effective-ly. An important corollary of this is that sucha standard of knowledge should be expected atthe relevant level of examination, regardless of the teaching and learning methods used andthe methods of assessment employed. Thissuggested minimum should serve as thebenchmark for anatomical knowledge. Wehope that colleagues will take up this syllabus

and use it to inform the planning of this keyfoundation of medical practice within theirundergraduate medical curricula. At the sametime we would emphasise that more and dif-ferent anatomical knowledge will be requiredwhen a qualified doctor moves into almost anyspecialised training. This approach can besummed up as what is needed, when it isneeded our document only refers to that

point which all aspiring doctors must pass;that of the initial qualification in medicine.

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EDUCATIONAL AFFAIRS COMMITTEE , A MERICAN ASSOCIATION

OF CLINICAL ANATOMISTS (1996). A clinical anatomycurriculum for the medical student of the 21 st century:gross anatomy. Clin Anat , 9: 71-99.

ELLIS HJ (2002). Medico-legal litigation and its links withsurgical anatomy. Academic.

FISCHER R (1978). The Delphi method: a description,review and criticism. J Acad Librarianship , 4: 64-70.

GENERAL MEDICAL COUNCIL (1993). Tomorrows Doctors:Recommendations on Undergraduate Medical Educa-tion. London: GMC.

GOODWIN H (2000). Litigation and Surgical Practice in theUK. Brit J Surg , 87: 977-979.

GRIFFIOEN FMM, D RUKKER J, H OOGLAND PVJM andGODSCHALK M (1999). General plan anatomy objectivesof the teaching of anatomy/embryology in medical curri-cula in the Netherlands. Eur J Morphol , 37: 228-325.

KAHAN SE, GOLDMAN HB, M ARENGO S AND RESNICK MI(2001). U ROLOGICAL MEDICAL MALPRACTICE . J U ROL,165: 1638-1642.

KIDDER TM (2002). Malpractice Considerations in Endosco-pic Sinus Surgery. Curr Opin Otolaryngol Head Neck Surg ,10: 14-18.

KILROY D and D RISCOLL P (2006). Determination of therequired anatomical knowledge for clinical practice inemergency medicine: national curriculum planningusing a modified Delphi technique. Emerg Med J , 23:693-696.

LYNN -MACRAE AG, LYNN -MACRAE RA, E MANI J, K ERN RCand C ONLEY DB (2004). Medicolegal Analysis of InjuryDuring Endoscopic Sinus Surgery. The Laryngoscope, 114:1492-1495.

MONKHOUSE WS and F ARRELL TB (1999). Tomorrows Doc-tors: Todays Mistakes? Clin Anat , 12: 131-134.

MORLEY L (2003). Quality and Power in Higher Education.Maidenhead, Berkshire: Open University Press andSociety for Research into Higher Education.

PRINCE KJAH, V AN MAMEREN H, H YLKEMA N, D RUKKER J, SCHERPBIER A JJA and VAN DER VLEUTEN CPM (2003).Does problem-based learning lead to deficiencies inbasic science knowledge? Med Educ , 37: 15-21.

PRINCE KJAH, S CHERPBIER AJJA, V AN MAMEREN H,DRUKKER J and V AN DER VLEUTEN CPM (2005). Do stu-dents have sufficient knowledge of clinical anatomy?

Med Educ , 39: 326-332.SCOTTISH DEANS MEDICAL CURRICULUM GROUP (2002). The

Scottish Doctor.W EATHERALL DJ (2000). Medicine in the new millennium.

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Documents

A Core Syllabus in Anatomy (EJA)