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educationEngrossing AnatomyBy Anne KavanaghAlmost 60 years ago, Selvyn Bleiferheld a human heart in his handsand knew he was going topursue cardiology. “I remember itvividly,” he says.Bleifer was a first-year medicalstudent at UCSF in a course many citeas a rite of passage: gross anatomy.The Class of 1955 graduate can stillsharply recall his initial foray into theanatomy lab – bodies stretched out onmetal tables, the wafting odor ofpreservatives, a classmate quicklyfainting. And later, that beautiful heart.“You can look at a picture of one,”he says, “but it’s different having it inyour hands.”At the time, gross anatomy hadchanged little since the school’sinception in the late 1800s, and wouldchange little for the next half-century.But in 2001 advances in medicineand education would bring sweepingalterations to the teaching of anatomyat UCSF.An ancient disciplineAnatomy has perhaps the longesthistory as a discipline in medicaleducation. Yet Hippocrates neverdissected a human body. Neitherdid the esteemed Greek physicianClaudius Galen (A.D. 131-200), whoseinfluential but often erroneous writingson anatomy came from dissectingcats and pigs. Human dissection wasforbidden in most societies until 1240when a Roman emperor permittedit in order to better train doctorsand aid public health. By the early14th century, human dissections –mostly of executed criminals – werebeing conducted at leading Europeanuniversities.In 1865, the California Legislatureapproved a dissection law permittingpauper bodies to be studied byaccredited physicians. At TolandMedical College, the precursor tothe UCSF School of Medicine,highlights included “many opportunitiesfor performing autopsies inSan Francisco’s advantageousdissecting climate.” Early on grossanatomy assumed importance,evolving into a 400-hour, six-monthcourse. Four students shared onecadaver. Over time, new medical fieldsand findings transformed othercourses, but gross anatomy heldfirmly to its roots.Doing away with dissectionsThen in 2001 the School of Medicineintroduced a completely redesignedcurriculum. It promoted integration ofdisciplines, an early introduction ofclinical concepts, and expedited entryinto patient care. Eight “block”courses organized around centralthemes or systems constituted the first18 months. Gross anatomy wasintegrated into the introductoryprologue block and instruction wasreduced from about 250 hours to 60.To save time, the school decidedto use previously dissected cadavers,or prosections. Twelve students wouldgather around a body and a facultymember, who would lecture for twohours while pointing things out. “Itturned into a one-way informationhighway,” says Kimberly Topp, PT,PhD, a longtime UCSF anatomyprofessor who is now chair of theDepartment of Physical Therapy andRehabilitation Science. “The students’eyes would glaze over.”A second problem: fitting in allpertinent body parts and functions.“The first year, there wasn’t enoughtime for the head and neck,” saysTopp. “Then the head and neck wasadded, but there wasn’t time for upperand lower limbs. So only upper limbswere covered.”Something else was lost, too,something elemental and profound.“You need the hands-on experience ofworking with a human body,” saysAllan Basbaum, PhD, chair of theDepartment of Anatomy. “It signifies:Welcome to the real world. You aredealing with someone who has died.”Laying on of the hands, againAfter two years of prosections,Basbaum charged Topp withrevamping the anatomy curriculum.She focused on making the learningmore interactive, peer-driven andintegrated. As such, dissectionsbecame paramount once again. “Thecadaver is really the students’ firstpatient, and they need to learn asmuch as they can from it,” she says.Today 110 hours are devoted toanatomy. Students spend eight weeksin the prologue block dissectingaspects of the entire body as anintroduction – the “10,000-foot view”as one student describes it.2 | fall 2009
Then they go back and tackle theindividual organs in the blockpertinent to that organ’s system.The heart, for example, isdissected when they are studyingthe cardiovascular, pulmonaryand renal systems. This allows forunderstanding in context, explainsTopp. “If you are learning aboutEKG, it’s best to put the anatomytogether with everything there is toknow about the heart, includingphysiological assessment andUCSF anatomy lab, 1950s“You need the hands-onexperience of workingwith a human body.It signifies: Welcometo the real world. You aredealing with someonewho has died.” – Allan Basbaummedical treatment.” Opportunitiesto practice clinical procedures suchas suturing and inserting a chesttube have also been added.Five to six students are assignedone cadaver for the duration andmostly left on their own to proceed,with guidance from circulatingfaculty. “They have to figure outhow to work together,” says Topp.“That in itself is so importantbecause medicine today is a veryinteractive practice.”Though far from the timeintensivetradition that most Schoolof Medicine alumni experienced,Basbaum is confident the educationremains effective. “I don’t think weare hurting the training of studentsby cutting back,” he says. “Theydon’t need to know every detailupfront, such as all the digitalnerves. If they are going to becomehand surgeons, then they cango back and learn them.” Toppconcurs, “Immersion is great ifyou are going to be an anatomyinstructor. But if you are going tobe a physician, I’m not sure it’sthe best way to learn anymore.”And both say that despiteadvances in computer simulation –and the expense of obtaining andmaintaining cadavers – dissectionwill stay. “It is absolutely a definingexperience,” says Basbaum.A body of knowledgeIt certainly was for MatthewSchechter, now in his second yearat UCSF. “In that very first week ofmedical school, you are suddenlyand forever different from thenon-medical community,”he says. He and his five lab-mateswere assigned a well-muscled andtattooed cadaver. “I was surprisedat the humanity. It’s hard todescribe.” They named him Mick.Over the ensuing months, theygrew to know Mick intimately,and one another. “You can’t spend10 hours a week hovering over acadaver together and not bond,”he laughs. Schechter says thekinesthetic and emotionalexperience of dissecting a bodycreated an understanding that nocomputer or prosection ever could.“I liken it to the difference betweenreading a map of a city and walkingthough it,” he says. “For the rest ofmy career, whenever I’m faced withanatomy, it’s Mick I’ll picture. Notsome abstract concept of vessels,but his vessels. He gave me the giftof knowledge.”Honor your favorite professor!To find out how, contactCarrie Smith, director of developmentand alumni relations,at 415/476-6341 orcsmith@support.ucsf.edu.The UCSFWilled BodyProgramIt’s one last way to be useful.That’s one reason why peopledonate their bodies to the UCSFWilled Body Program, says AndrewCorson, the program’s coordinator.And it is indeed useful.UCSF receives about 300donated bodies a year through theWilled Body Program.Since its inception in 1947 theprogram has supplied cadavers forUCSF’s medical and dentalprograms. Today it also suppliescadavers for UCSF pharmacy andphysical therapy programs and foranatomy programs at the Cal Stateand community college systemsand private universities throughoutnorthern California. The WilledBody Program also supportsresearch projects such as thetesting of new orthopedic devices,surgical procedural training, alliedhealth education and postgraduatemedical education.About 60 percent of donationsare committed in advance of deathby individuals; the rest comethrough families of the deceased.The bodies come from all overnorthern California, from San LuisObispo to the Oregon border.“Medicine has changed by leapsand bounds, but the fundamentals– the human body and how itworks – have not changed,” saysCorson. “People will always needto know the essentials, and theWilled Body Program is helpingkeep that foundation solid byserving as stewards to donors.Their selfless final act makes sucha difference in our world.”medical alumni magazine | 3
Page 1: MedicalAlumniM A G A Z I N Efall 20
Page 6 and 7: IMPROVING PATIENT SAFETY“First,Do
Page 8 and 9: medicine’: You have to take it ju
Page 10: COVER STORY: first womenBy Kate Vol
Page 13 and 14: DianeWara, MDFirst associate dean f
Page 15 and 16: MAA President Larry Lustig, MD ’9
Page 17 and 18: Your MEDICAL ALUMNI ASSOCIATIONDear
Page 19 and 20: physician in San Francisco since 19
Page 21 and 22: 1980sn Ronald Tamaru, MD ’82, wri
Page 23 and 24: UCSF is grateful to the many alumni

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