It’s been an incredibly long time since I last wrote a blog post on doc2doc and so apologies – I plan on being much more regular in the near future.

It’s frustrating as a pre-clinical medic. There’s lots of science, lots of boxes to tick and lots of intense academic material to pack into your head. I suppose this depends very much on the course your doing (whether it is PBL, purely academic etc...) but nonetheless – it’s a lot.

I became a bit disheartened with this volume of information, but there was one subject that I found intensely relevant to clinical practice – Anatomy. It may seem obvious, but as I started learning to clerk and examine patients in the beginning of my 2^nd year I found it essential to understand the principles of anatomy. There was one situation, in a Cardiology week, where we were asked to palpate the apex beat and such terms as ‘5^th intercostal space’, ‘angle of Louis’ were thrown around. When practising this simple clinical technique, I realised that both me and my colleagues could probably do with a bit more anatomy practice!

In this blog, I’m going to talk about a strategy for learning anatomy in a ‘clinical’ manner.

Step 1 - Activate the Filter

I would hazard to say that Anatomy and Histology are my two favourite disciplines in medical school. There’s lots of incredibly interesting material and I can easily digress into some weird and wonderful abnormality or relevant medical history – this isn’t good when you want to learn what is useful.

Ask yourself two questions:

1.    What do I need to know?

2.    What’s nice to know?

Focus on what you ‘need’ to know. It’s no use knowing about the multiple variations in the branches ascending aorta if you don’t understand what the main branches are in the first place.

Step 2 – Learn in a Clinical Fashion

I find many anatomy texts frustrating in this manner. You want to be able to...

·         Identify a structure (get an anatomy atlas)

·         Describe what it does (get on the tinterweb)

·         Identify its clinical relevance (textbook of medicine)

I always ask myself these three questions when I’m learning a new topic in anatomy. I have a general rule that if the structure I’ve found doesn’t tick the last box – then it’s probably nice to know but not useful.

Step 3 – Put it into context

It’s important to practice ‘using’ the anatomy you learn. This may be in the context of a clinical examination in clinical years but it’s also possible as a pre-clinical medic to recognise the importance of certain structures to clinical scenarios. I like to use the following...

·         Writing case studies based on the knowledge gained in lectures, wider reading and experience

·         Looking at radiology (an excellent resource is ‘radiopaedia’)

·         Looking at pathology pots (your medical school will have them somewhere!)

I’ve found this ‘3 step’ strategy has helped me to collate knowledge from other disciplines, practice recognising important clinical symptoms and has made it exciting to study anatomy. To put it into context, I’ve given an example below. I hope you’ve found this useful.

Lucas Brammar, 12^th May 2012.

Topic – Circle of Willis

http://www.meddean.luc.edu/lumen/MedEd/Neuro/neurovasc/ImageFiles/ar_10.jpg

Step 1 – Filter

·         Need to understand the arteries supplying the circle of willis, its construct and main branches.

·         Nice to know some of the abnormalities that can occur in this region

Step 2 – Clinical Anatomy

·         Make sure I can identify the circle of willis and its branches using an anatomy atlas, online tutorials etc.

·         Make sure I can explain that the circle of willis is an arterial anastamosis that supplies blood to the brain.

·         Circle of Willis is clinically important in stroke (emboli, ruptured anyeurisms etc) and subarachnoid haemorrhages (Berry Anyeurisms)  

Step 3 – Context

·         Case study – 45 y/o female presenting with sudden onset ‘severe’ headache (subarachnoid haemorrhage)

·         Radiology – angiography of the carotid arteries and circle of willis.