“I’m obviously stressed about my test on the pelvis and lower extremity on Monday, so I keep having to tell myself that it’s going tibia ok.” A smile gleamed across my face as I read this text message. Through my (regretfully) sporadic interactions with a few of my closest friends, I have recently had the opportunity to relive some of what I experienced exactly one year ago in the infancy of my medical school experience. Aside from revisiting the humerus world of anatomy puns, it has allowed me a second chance to reflect upon those first few months of school during what was undeniably some sort of hazing process: Gross Anatomy.
This past summer I stumbled across an International Business Times article outlining Microsoft’s HoloLens (1). This technology was being hailed as the future of medical education in anatomy and had been tested at Case Western Reserve School of Medicine. I was intrigued. The video released with the article demonstrated a holographic re-creation that exquisitely represented the intricacies of the human body. Students could directly interact with the hologram, removing structures layer by layer, as the information revealed itself right before student’s eyes in the most efficient manner imaginable. Thrilled by the idea of a tool to drastically accelerate learning, leaving time for reinforcement and retention, I became very enthusiastic about this new technology. But, there was undoubtedly an underlying resentment about the fact that this tool was not part of my experience. Immediately, I flashed back to the countless hours of reading anatomy notes containing descriptions of three dimensional relationships with sentences such as “the bony pelvis’ obliquity causes it to have an oblique axis directed from anterosuperior to posterinferior. As a result, its anterior and posterior walls are really anteroinferior and posterosuperior walls.” ….Excuse me? Combing through the anatomy notes was accompanied by hours attempting to correlate these obscure descriptions with drawings in textbooks. Memorizing spatial relationships was something I struggled with initially in medical school; it unquestionably required a focused effort to train my brain to approach information in new ways. I sat watching this video, thinking of the hours I would have saved if I could have just interacted with this three dimensional model instead of reading notes in preparation for anatomy lab. Would I have learned more in dissection if this HoloLens model was a supplement to my education? Would this have made me a better physician in the future? As I emerged from my self-indulgent-Millennial-diva moment wondering why the Case Western kids had the holographic Charizard (2) and I didn’t, I finished reading about this potential paradigm shift in medical education. I was hit with the statement that “the top priority is creating a full digital anatomy curriculum;” that is, to transition away from the need for cadavers (3). This is where they lost me.
Despite the infinite grueling hours spent perfecting our drawings of the brachial plexus or learning all the branches of the external carotid artery, these were far from the most important lessons learned in anatomy. To eliminate student interactions with cadavers would eliminate some of the most profound lessons I learned in anatomy lab. Your cadaver is your first patient, the first human you begin to understand from the inside out, the first patient to cause you endless frustration, and the first patient to allow you the privilege of learning from. To exclude this from medical curriculum would be a tragic disservice to the humanistic side of medicine. I was astounded by the fact that I knew so much about an individual, simply from viewing the anatomy of the cadaver is was dissecting; I knew this individual smoked, I knew he had severe cardiovascular disease for his age, I could see the consequences of his adrenal tumors, and the consequences of his lifestyle mirrored in his thin, wasting body. I appreciated his love for Looney Tunes in examining his tattooed arms. Yet, I did not know his name or his life. What I did understand was the privilege we have as students and future physicians to appreciate the human condition and its physical manifestations on such a multidimensional level. And I don’t mean the dimensions of 3D technology, but rather the complexities that accompany what it means to treat a patient.
The most powerful impression that I was left with one year ago when I completed Gross Anatomy is the reason I would discourage strictly digital medical education. In surveying the room of cadavers one quickly realizes that people are not always by the book, real anatomy does not always reflect the picture-perfect representation in a textbook. A part of me believes that the purpose of this course, as the initiation into medical school, was to convey the profound lesson that each patient is remarkably unique and should always be treated as such. I recall countless hours back and forth comparing textbook to cadaver, only to be met with confusion and frustration when the professors effortlessly located structures in seconds. In retrospect, this served a purpose. There is an art to medicine that can only be known after years of experience, years of treating patients, and years of being open to continuous learning. We were only just beginning. The lessons we learned in anatomy lab were in humility, and the acknowledgement that there is a very long road ahead. This particular pursuit of knowledge is not always textbook, nor can be recreated with a computer, it must be organic and humanistic…and tibia honest, since stepping out of that last day of anatomy one year ago, that understanding has stayed with me everyday.
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References
- http://www.ibtimes.co.uk/microsoft-hololens-company-reveals-what-it-feels-like-use-augmented-reality-helmet-1510256
- Obligatory nerdy Pokemon reference
- http://case.edu/hololens/