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

16 Pages·2007·3.33 MB·English

Rev. from Eur J Anat, 11 (Supplement 1):3-18 (2007)
A core syllabus in anatomy
for medical students - Adding common
sense to need to know
The Education Committee of the Anatomical Society of Great Britain and Ireland
Prof. S. McHanwell1 BSc PhD Prof. M. Atkinson2 BSc PhD
Dr. D.C. Davies3 BSc PhD Dr. R. Dyball4 ScD
Prof. J. Morris5 BSc MBChB MD MA FMed Sci Prof. C. Ockleford6 FRCPath, DSc
Prof. I. Parkin7 MBChB Prof. S. Standring8 PhD, DSc
Dr. S.Whiten9 MA PhD Dr. J.Wilton10 BSc, MA, PhD
1- Oral Biology, 5thFloor, 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 George’s 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, King’s College London, Guy’s Campus, London SE1 1UL
9- Bute Medical School, St.Andrew’s Fife, KY16 9TS Scotland
10- Human Anatomy Centre, Department of Physiology, Neuroscience and Development, University of Cambridge,
Downing Street, Cambridge, CB2 3DY
SUMMARY Key words: Medical education – Anatomy –
Curriculum
A satisfactory knowledge of topographical
anatomy is one of the key foundations of safe
and effective medical practice. Existing cur- INTRODUCTION
riculum guidelines in the UK and Ireland
from bodies including the General Medical Anatomical knowledge remains one of the
Council, the Medical Council of Ireland and cornerstones of modern medical practice and
Scottish Doctors do not provide detailed guid- for healthcare and allied professions including,
ance on curriculum content in respect of indi- dentistry and dental care professions, physio-
vidual subjects. This paper describes a core therapy, radiography and human communica-
syllabus in anatomy developed by the tion sciences. Knowledge of topographical
Anatomical Society of Great Britain and Ire- anatomy is essential for those performing clin-
land detailing the level of knowledge that we ical examinations, is crucial for developing
believe should be the minimum expected of a working diagnoses and is also required for car-
recently-qualified medical graduate in the UK rying out many clinical procedures safely and
and Ireland about to embark upon their two effectively (Fig. 3). The advent of sophisticat-
year Foundation training. ed imaging techniques has only served to
Correspondence to:
Prof.S.McHanwell.Oral Biology, 5th Floor, School of Dental Sciences, Newcastle
University, Dental School, Framlington Place, Newcastle upon Tyne NE2 4HH, UK.
E-mail:[email protected]
3

A core syllabus in anatomy for medical students - Adding common sense to need to know
Increased emphasis on preventative medi- dimensional understanding of the general
cine has meant that, for example, public functional organisation of the body, it can be
health, epidemiology, care in the community difficult, even in a spiral curriculum where
and communication skills have assumed more knowledge is revisited during the course, to
importance in medical practice. Emerging appreciate the whole. Furthermore, the frag-
disciplines such as genetics and molecular mentation of basic science, including anato-
biology also command a place in curricula. my, that can accompany the adoption of an
Consequently, medical curricula have been enquiry-based curriculum may hinder a full
redesigned to accommodate these subjects. At understanding of the subject (Weatherall,
the same time concerns have been widely- 2000, 2006). The second concern derives from
expressed that medical curricula are over-bur- those engaged in postgraduate education, who
dened with content with one consequence of perceive that the anatomical knowledge of
this over-loading being that it limits the scope those entering postgraduate training has been
for creative and enquiry-based activities. Med- substantially reduced. This means that
ical undergraduate courses have not changed trainees do not have a sufficient foundation on
substantially in length in the last century. which to develop to the standard expected at
Therefore, as the content of the curriculum postgraduate level. Thirdly, there are a num-
has grown by addition of new topics without ber of reports documented in the literature of
a compensatory change in the overall length of increases in medical errors arising from inade-
the course, changes have had to be made else- quate knowledge of anatomy (Ellis, 2002;
where. In many cases this has been achieved Goodwin, 2000; Monkhouse and Farrell,
by reductions in number of hours available for 2002). These errors are frequently made at
basic sciences in general, and anatomy in par- junior level and are associated with significant
ticular, leading to reduction in anatomical morbidity and mortality leading to a rise in
content of curricula. Anatomy is often parti- litigation. Finally, students themselves are
cularly targeted for reduction because it has often acutely aware of problems with their
been frequently depicted as the mere rote own anatomical knowledge. Prince et al.
learning of excessive detail and it cannot be (2003, 2005) reported that in a sample of stu-
denied that in the past too little thought has dents from the Netherlands, the students’
been given to which facts were required for confidence in their own levels of anatomical
safe and effective practice. Anatomy is there- knowledge varied significantly and this could
fore an attractive target for those who depict be related to the amount of anatomy teaching
older medical curricula as being over-bur- they had received.
dened with an undue emphasis placed upon In its document “Tomorrow’s Doctors”
learning content. Morley (2003) has described (1993) revised in 2002, the General Medical
this older approach to designing professional Council (GMC) set out the principles upon
curricula as imparting knowledge to students which medical curricula are designed and
‘just in case’ it might be needed even though against which they are accredited. The recom-
much of it is unlikely to be deployed by them mendations in their document set out a frame-
in their future careers. work for course design to achieve the required
objectives and are, “by design less precise in
It could be argued that the reduction in the
their detail than some of their predecessors”.
anatomy taught during undergraduate train-
These documents from the GMC are out-
ing and the Foundation years may not matter
comes- and competency-based and one of the
if the teaching of additional anatomy is
key recommendations is that the “burden of
deferred to a later stage of training and only
for those who require the extra necessary factual information in undergraduate medical
detail. However, concerns continue to be artic- curricula be substantially reduced”. Some
ulated about the consequences that reductions time after the publication of these GMC doc-
in anatomy in the initial phases of training are uments, the Quality Assurance Agency for
having upon understanding of the subject. Higher Education in the UK whose function
The first concern is pedagogic. Anatomy is a is to assure the quality of Higher Education
sequential subject in which basic knowledge within the whole of the UK also set out a
acquired early is subsequently elaborated series of benchmarks for medical education.
upon. Consequently, without the secure foun- The difficulty with both these approaches is
dation that is derived from gaining a three that they lay out syllabus content in all sub-
5
S.McHanwell, M.Atkinson, D.C.Davies, R.Dyball, J.Morris, C.Ockleford, I.Parkin, S.Standring, S.Whiten, J.Wilton
jects including anatomy, only in the most gen- cialised audience for a more particular pur-
eral of terms, with insufficient detail for cur- pose. In our view, it is not realistic or necessary
riculum planning. At the same time there has to expect that such syllabi, valuable as they
been “a more general trend to view profession- are, could ever be adopted into an undergrad-
al knowledge as unstable, more disposable, uate medical curriculum in their present for-
transferable and delivered just in time” mov- mat. Therefore, the Anatomical Society of
ing away from the view that “professional Great Britain and Ireland through its Educa-
knowledge was something acquired early in a tion Committee, has initiated this project to
career for later deployment” (Morley, 2003). design an anatomical syllabus defining the
The consequence of these pressures has been to minimum knowledge outcome expected in
reduce the time devoted to many subjects in topographical anatomy, (excluding histology
the curriculum without adequate considera- or embryology), in a graduating medical stu-
tion being given to the effects this might have dent in the UK and Ireland.
on the understanding of the subject of anato- The Royal College of Surgeons of England
my as a whole. organised a meeting, in March 2007, to dis-
Whilst recognising that it may be hard to cuss the effects that reductions in anatomy
obtain universal agreement on the details of teaching within the undergraduate curricu-
the core knowledge required, we here attempt lum were having upon the medical profession.
to establish a necessary minimum of anatomi- One of the key consensus points to arise from
cal knowledge for all future newly-qualified that meeting was the need to define a core
medical practitioners. All doctors (and med- undergraduate syllabus in anatomy for all doc-
ical students at the stage appropriate to the tors. It is timely, therefore, that this project
course they are following) should have the has reached its completion shortly after that
expertise outlined below. In our view it would meeting and we offer this document as a con-
be inappropriate to allow someone without tribution to that debate.
such knowledge and understanding to work
independently with patients. There have been
a number of recent reviews describing the METHODOLOGY
increase in litigation in surgical practice
This syllabus was drafted by the authors,
resulting from a lack of appropriate anatomi-
the majority of whom are members of the
cal knowledge (Ellis, 2002; Goodwin, 2000;
Education Committee of Anatomical Society
Monkhouse and Farrell, 2002). In addition it
of Great Britain and Ireland. The authors are
has often been observed in litigation cases that
practising teachers of anatomy with experi-
problems can arise consequent upon a practi-
ence of a wide range of curricula, involved in
tioner’s failure to explain to patients the full
curriculum design in their own institutions
risks of a procedure because of their own lack
and with extensive cumulative experience of
of understanding and appreciation of the pos-
other curricula through external examining.
sible complications. This has led to litigation
The Education Committee of ASGBI includes
on the basis of a failure to obtain properly
members of the British Association of Clinical
informed (Kahan et al, 2001; Kidder, 2002;
Anatomists.
Lynn-McCrae et al., 2004). Clearly, effective
communication requires not only communica- An initial version of this document was
tion skills, but also the possession of the posted on the Anatomical Society’s website for
appropriate knowledge and understanding to comment and we thank all those who respond-
inform that communication. ed. The present document has been circulated
There have been a number of previous for consultation and comment amongst the
attempts to define a core syllabus in anatomy members of the Anatomical Society of Great
in the USA and Europe (Educational Affairs Britain and Ireland. An earlier version of the
Committee, American Association of document was approved at a meeting of the
Anatomists, 1996; Griffioen et al., 1999; Kil- Council of the Society in 2006.
roy and Driscoll, 2006). However, the syllabi The document is laid out in broad regional
defined by these documents are highly terms. It starts with a broad general statement
detailed either because they are aimed at a dif- which includes surface anatomy, the interpre-
ferent level or targeted upon a more spe- tation of standard clinical images, and the
6
A core syllabus in anatomy for medical students - Adding common sense to need to know
importance of the knowledge for understand- spinal pathologies e.g. back pain, prolapse of
ing of common pathologies. This is followed an intervertebral disc, injuries to the spinal
by a more detailed specification of the topo- cord, nerve, and whiplash injuries and their
graphical knowledge required to meet these consequences for the remainder of the body. It
general aims. is also necessary for the safe performance of
After qualification, most doctors will expe- procedures such as lumbar puncture, regional
rience anatomy either as surface anatomy (Fig. and epidural anaesthesia. Medical graduates
3) or clinical images (Figs. 1 and 2), though should have sufficient knowledge of surface
advances in computing mean that, increasing- features and muscle groups to perform an
ly, the latter can be rendered as 3-D recon- examination of the back. They should have a
structions. By the use of the term ‘standard working knowledge of dermatomes and
clinical images’ in the subsequent text we peripheral nerve distribution, the functions of
imply the following: standard P-A and lateral major muscle groups and their innervation in
radiographs of all parts of the body with spe- order to perform a basic neurological examina-
cial views of clinically critical areas (e.g. open- tion of the limbs and trunk.
mouth view of odontoid process); contrast
Upper limb
radiographs of the vascular, alimentary, pan-
creato-biliary, urinary and female reproductive Medical graduates should be able to recog-
systems; axial CT and MRI series through the nise the major palpable and imaging features
head and trunk, midline sagittal images of the of the bones of the upper limb, be aware of the
head, spine and pelvis, and coronal and sagit- sites of common fractures (clavicle, humerus,
tal views of shoulder, hip, knee and ankle; distal radius and scaphoid) and the complica-
nuclear images of the skeleton and thyroid; tions that might result from them. They
ultrasound images of pregnancies, kidney, gall should be aware of the factors that influence
bladder, liver, and heart; and endoscopic views the stability of the shoulder, elbow, wrist and
of the tracheo-bronchial tree, the alimentary interphalangeal joints and understand the
tract, and the knee joint. nature and consequences of common injuries
(e.g. shoulder, elbow and finger dislocation).
In order to perform clinical procedures safe-
SUMMARY OF THE CORE SYLLABUS ly and effectively, graduates should be able to
demonstrate the course, key relations and dis-
We present here a summary of the detailed
tribution of the main neurovascular structures
syllabus that follows to provide curriculum
of the upper limb, be able to demonstrate
planners with a more concise form of words
major pulse points (e.g. subclavian, brachial
than the full syllabus allows.
and radial), the position of major veins (for
Language venous access) and know the common sites of
In order to communicate effectively with peripheral nerve injury and their likely func-
colleagues, graduates must understand and tional effects (brachial plexus lesions, axillary,
use accepted anatomical language to describe radial, ulnar and median nerve lesions). They
the normal structure of the body. should be able to explain the anatomical basis
of common conditions of the upper limb (e.g.
Vertebral column rotator cuff injuries, carpal tunnel syndrome)
Medical graduates should be able to recog- and how infection might spread in the limb.
nise characteristic features of vertebrae from They should be able to describe the organisa-
the five regions of the vertebral column, tion of the axillary lymph nodes and the lym-
understand how the spine as a whole moves phatic drainage of the breast and explain their
and how its normal curvatures develop and are significance in relation to metastatic spread of
stabilised. They should be able to interpret breast cancer and melanoma.
relevant clinical images to distinguish devia-
Thorax
tions from normal. They should understand
the organisation of the contents of the verte- Medical graduates should be able to
bral canal i.e. the meninges, spinal cord, demonstrate the major palpable and radiolog-
spinal nerve roots, spinal nerves and their par- ical features of the thoracic wall, and describe
ticular relationships to the vertebrae and the the anatomy of the intercostal spaces, the
intervertebral joints. This knowledge forms diaphragm and the functional anatomy of ven-
the basis for the understanding of common tilation. They should know the extent of the
7
S.McHanwell, M.Atkinson, D.C.Davies, R.Dyball, J.Morris, C.Ockleford, I.Parkin, S.Standring, S.Whiten, J.Wilton
pleural cavities and the anatomy of the lungs for hernias. They should be able to interpret
(including their lymphatic drainage and its standard diagnostic images of the alimentary,
role in the metastatic spread of lung cancer), pancreato-biliary and urinary tracts.
the main divisions of the mediastinum and
Pelvis
their contents and the anatomy of the heart
and great vessels of the thorax, including their Medical graduates should be familiar with
surface projections. They should be aware of the anatomy and positions of the ureters, blad-
the anatomical basis of common congenital der, urethra, rectum and anal canal, the struc-
cardiac abnormalities, heart murmurs and ture of the pelvic floor, and the anatomy of
their effects. They should understand the continence, the anatomy of the external and
function and arrangement of the coronary internal genitalia in males (scrotum, testis, vas
arteries and the position and function of the deferens, seminal vesicles, prostate, penis) and
heart valves. They should know the course of females (ovaries, uterine tubes, uterus, cervix,
major structures passing between the neck and vagina, labia, clitoris). They should be able to
thorax and those which pass through the describe the peritoneal relationships, and sup-
diaphragm between the thorax and the ports of the pelvic viscera to understand
abdomen. This knowledge forms the basis of ectopic pregnancy, prolapse and suprapubic
understanding pneumothorax, lung and pleu- catheterisation. They should understand the
ral disease, coronary artery and valve surgery arterial supply, venous drainage and the lym-
and in referred pain from the distribution of phatic drainage and innervation of the pelvic
the phrenic and intercostal nerves. They organs in relation to metastatic spread of can-
should have a working knowledge of surface cer. Graduates should be able to interpret rele-
anatomy of the thorax, be able to undertake an vant standard diagnostic images and have
examination of the heart and lungs and inter- sufficient anatomical knowledge to be able to
pret standard diagnostic images. They should perform rectal and vaginal examinations, uri-
be aware of the possible complications when nary catheterisation in both males and females,
inserting central venous lines and where to and obtain a cervical smear in females.
place a chest drain for simple and tension
pneuomothorax and for cardiac tamponade. Lower limb
Medical graduates should be able to recog-
Abdomen
nise the major palpable and imaging features of
Medical graduates should be familiar with the bones of the lower limb, be aware of the
the anatomy of the anterior and posterior sites of common fractures (neck and shaft of
abdominal walls and the inguinal region, the femur, tibia and fibula) and the complications
extent of the peritoneal cavity and the anato- that might result from them. They should be
my and key relationships of the oesophagus, able to explain the factors that influence the
stomach, small and large intestines including stability of the hip, knee and ankle joints, the
the appendix, liver, gall bladder, pancreas, common ligamentous injuries and be able to
spleen, kidneys, ureters and adrenal and test for ligament integrity. In order to perform
suprarenal glands. They should understand clinical procedures safely and effectively, gradu-
the arterial supply and venous drainage to the ates should be able to describe the course and
intestine in relation to arterial occlusion, distribution of the main neurovascular struc-
strangulation, intestinal surgery, the portal tures in the lower limb (e.g. to avoid damage to
circulation and the effects of portal hyperten- the sciatic nerve when making an intramuscu-
sion, and the lymphatic drainage and innerva- lar injection,), be able to demonstrate major
tion of the abdominal organs in relation to pulse points (e.g. femoral, for arterial blood
metastatic spread of cancer and abdominal sampling, popliteal, posterior tibial and dor-
pain. This knowledge forms the basis of salis pedis), the position of major veins (for
understanding of surgical incisions, referred venepuncture, venous access by ‘cut down’ and
pain from the abdominal viscera (especially assessment of varicose veins) and the common
the gall bladder and appendix) and how the sites of peripheral nerve injury and the possible
sub-hepatic and sub-phrenic spaces may be functional effects of such damage (e.g. sciatic
implicated in the spread of infection. They and common peroneal nerve at neck of fibula).
should have a working knowledge of surface They should have a working knowledge of sur-
anatomy and be able to undertake an examina- face anatomy, dermatomes and peripheral nerve
tion of the abdomen and of the inguinal canal distribution, the functions of major muscle
8
A core syllabus in anatomy for medical students - Adding common sense to need to know
groups and their innervation in order to per- venous sinuses, subarachnoid space, ventricu-
form a basic neurological examination of the lar system and the production, circulation and
lower limb. Graduates should understand the drainage of cerebrospinal fluid. They should
organisation of inguinal lymph nodes and how understand the position, organisation, connec-
they relate to the lymphatic drainage of the tions, vascular supply, venous drainage and
limb, trunk skin and perineum. They should be key relations of the main parts of the brain and
aware of the organisation of the deep fascia of spinal cord including the cerebral cortex,
the lower limb and its relevance to compart- internal capsule, cerebellum, basal ganglia,
ment syndromes, how blood is returned to the thalamus, hypothalamus and brainstem. They
heart from the legs and how failure of this should be aware of the key relations and com-
mechanism may cause the development of vari- ponents of the white matter, including the
cosities, deep vein thromboses and embolism. main motor and sensory pathways of the brain
and spinal cord. This knowledge is necessary
Head and Neck
for interpretation of standard diagnostic
Medical graduates should be able to recog- images, an understanding of stroke and recog-
nise the major palpable and imaging features nition of the signs and symptoms of common
of the skull and cervical spine in order to be neurological disorders and intracranial haem-
able to interpret relevant medical images. To orrhages.
perform clinical examination of the head and For all structures, the emphasis should be
neck graduates should be familiar with the on those that are commonly damaged or
position, key relationships, neurovascular sup- involved in interventional procedures. For the
ply, venous and lymphatic drainage of the fol- musculoskeletal system, the emphasis should
lowing major structures: course and be on the principal palpable and radiological
distribution of the cranial nerves, ear and features of the bones, commonly damaged lig-
pharyngotympanic (Eustachian) tube, eye, aments, functional muscle groups (avoiding
eyelids and conjunctivae, nasal cavity and unnecessary details of their attachments) and
paranasal air sinuses, oral cavity and tongue, their innervation by segmental spinal nerves.
tonsils, soft palate, pharynx, salivary glands, For the cardiovascular system there should be
larynx and trachea, thyroid and parathyroid a good knowledge of the heart and emphasis
glands and the contents of the carotid sheath. on pulse points and commonly damaged sites
Medical graduates should be able to describe on arteries, access points on veins, and a sound
the fascia and fascial spaces of the neck in rela- understanding of the lymphatic drainage of
tion to the spread of infection. This knowl- tissues. For the peripheral nervous system the
edge is necessary for understanding emphasis should be on supplies to areas of skin
conductive and sensorineural deafness, otalgia and muscle groups by both segmental spinal
and the likely sources of referred pain to the nerves and peripheral nerves.
ear, facial nerve palsy, epistaxis, quinsy, dys-
Anatomical Terms
phagia, upper airway obstruction, infantile
stridor, sinusitis, vocal cord paralysis and A medical graduate should be able to:
hoarseness, cervical swellings, and salivary 1. Define and demonstrate the following
gland swellings. Medical graduates should terms relative to the anatomical position:
have sufficient anatomical knowledge to be medial, lateral, proximal, distal, superior,
able to manage the airway, insert an endotra- inferior, deep, superficial, palmar, plantar,
cheal or nasogastric tube, and perform a tra- anterior/ventral, posterior/dorsal, rostral,
cheostomy and laryngotomy. They should caudal.
have a working knowledge of surface anatomy, 2. Describe the following anatomical planes:
cranial nerve distribution, the functions of axial / transverse / horizontal, sagittal and
major muscles of the head and neck and their coronal.
innervation in order to perform a basic neuro- 3. Define and demonstrate the terms used to
logical examination. describe the movements of the limbs and
vertebral column: flexion, extension, lateral
Neuroanatomy
flexion, pronation, supination, abduction,
Medical graduates should understand the adduction, medial and lateral rotation,
blood supply and venous drainage of the brain inversion, eversion, plantarflexion, dorsi-
and spinal cord, the arrangement of the flexion, protraction, retraction and circum-
meninges, the pattern of the major dural duction.
9
S.McHanwell, M.Atkinson, D.C.Davies, R.Dyball, J.Morris, C.Ockleford, I.Parkin, S.Standring, S.Whiten, J.Wilton
4. Define the terms somatic and visceral when bones that are commonly damaged
used to describe parts and systems (e.g. (scaphoid and lunate) and predict func-
somatic and visceral motor systems) of the tional impairment following such dam-
body. age.
2. Describe the close relations of the bones
Vertebral Column
and joints (e.g. bursae, blood vessels,
A medical graduate should be able to:
nerves ligaments and tendons), which may
1. Describe the main anatomical features of a be injured by fractures or dislocation and
typical vertebra. Identify the atlas, axis, predict what the functional effects of such
typical cervical, thoracic, lumbar verte- damage might be.
brae and sacrum and recognise their char-
3. Describe the fascial compartments delim-
acteristic features.
iting the major muscle groups of the
2. Describe the structures, regions and func-
upper limb. Explain the functional impor-
tions of the vertebral column. Describe
tance of those compartments and their
the range of movement of the entire verte-
contents.
bral column and its individual regions.
4. Describe the origin, course and distribu-
Explain what makes spinal injuries stable
tion of the major arteries and their
and unstable.
branches that supply the shoulder, arm
3. Describe the anatomy of intervertebral
and forearm in relation to common sites of
facet joints and intervertebral discs.
injury. Explain the importance of anasto-
Explain the role of the discs in weight-
moses between branches of these arteries
bearing by the vertebral column and give
at the shoulder and in the upper limb.
examples of common disc lesions, and how
5. Demonstrate the sites at which pulses in
they may impinge upon spinal nerve roots
the brachial, radial and ulnar arteries may
and / or the spinal cord.
be located.
4. Describe the anatomy of a spinal nerve
6. Describe the courses of the main veins of
(e.g. as exemplified by a thoracic spinal
the upper limb; classify and contrast the
nerve, including its origin from dorsal and
functions of the deep and superficial veins.
ventral spinal roots, its main motor and
Identify the common sites of venous access
cutaneous branches and any autonomic
and describe their key anatomical rela-
component.
tions. Explain the relationship between
5. Identify the principal muscle groups and
venous and lymphatic drainage channels.
ligaments of the vertebral column and
7. Describe the organisation of the brachial
surface features in order to be able to per-
plexus, its origin in the neck and continu-
form an examination of the back, discuss
ation to the axilla and upper limb.
their functional role in stability and
8. Describe the origin, course and function of
movement of the vertebral column and
the axillary, radial, musculocutaneous,
describe the anatomical basis of back pain.
median and ulnar nerves in the arm, fore-
6. Describe the anatomical relationships of
arm, wrist and hand. Name the main
the meninges to the spinal cord and dorsal
muscles and muscle groups that these
and ventral nerve roots, particularly in
nerves supply as well as their sensory dis-
relation to root compression and the
tribution. Predict the consequences of
placement of epidural and spinal injec-
injury to these nerves and describe how to
tions. Describe the anatomy of lumbar
test their functional integrity.
puncture.
9. Describe the boundaries of the axilla. List
7. Interpret standard diagnostic images of
its contents, including the major vessels,
the vertebral column and be able to recog-
parts of the brachial plexus and lymph
nise common abnormalities.
node groups.
Upper Limb 10. Describe the movements of the pectoral
A medical graduate should be able to: girdle; identify the muscles responsible
1. Describe and demonstrate the main for its movements and summarise their
anatomical landmarks of the clavicle, main attachments and somatic motor
scapula, humerus, radius and ulna. Recog- nerve supply.
nise the bones of the wrist and hand and 11. Describe the factors that contribute to the
their relative positions, identify those stability of the shoulder joint and explain
10
A core syllabus in anatomy for medical students - Adding common sense to need to know
the functional and possible pathological and the skin of the trunk and upper limb
consequences of its dislocation. and in the spread of tumours.
12. Describe the anatomy of the elbow joint. 22. Interpret standard diagnostic images of
Demonstrate the movements of flexion the upper limb and be able to recognise
and extension, identify the muscles common abnormalities.
responsible for these movements and sum-
Thorax
marise their main attachments and somat-
A medical graduate should be able to:
ic motor nerve supply.
1. Demonstrate the main anatomical land-
13. Describe the anatomy of the superior and
marks of the thoracic vertebrae, ribs and
inferior radio-ulnar joints. Explain the move-
sternum.
ments of supination and pronation; identify
2. Describe the anatomy of the joints
the muscles responsible for these movements
between the ribs and vertebral column,
and summarise their main attachments and
the ribs and costal cartilages and the costal
somatic motor nerve supply.
cartilages and sternum. Explain the move-
14. Describe the anatomy of the wrist.
ments made at those joints during venti-
Describe and demonstrate movements at
lation and the differences between
these joints and name and identify the
ventilatory movements in the upper and
muscle groups responsible for the move-
lower chest.
ments. Describe the relative positions of
3. Describe how the boundaries of the tho-
the tendons, vessels and nerves at the wrist
racic inlet and outlet are formed by the
in relation to injuries.
vertebrae, ribs, costal cartilages and ster-
15. Name and demonstrate the movements of
num.
the fingers and thumb. Describe the posi-
4. Describe the surface projection, attach-
tion, function and nerve supply of the
ments and relationships of the diaphragm
muscles and tendons involved in these
and the structures that pass through it.
movements, differentiating between those
Explain the movements it makes during
in the forearm and those intrinsic to the
ventilation and the motor and sensory
hand.
nerve supply to it and its pleural and peri-
16. Explain the main types of grip (power,
toneal coverings.
precision and hook) and the role of the
5. Explain the anatomy of the intercostal
muscles and nerves involved in executing
muscles. Describe a neurovascular bundle
them.
in a typical intercostal space and outline
17. Describe the position and function of the
the structures its components supply.
retinacula of the wrist and the tendon
6. Explain the movements involved in nor-
sheaths of the wrist and hand. Explain
mal, vigorous and forced ventilation and
carpal tunnel syndrome and the spread of
describe the muscles responsible for these
infection in tendon sheaths.
movements.
18. Explain why and describe where the axil-
7. Demonstrate the surface markings of the
lary, musculocutaneous, radial, median
heart and great vessels, the margins of the
and ulnar nerves are commonly injured
pleura and the lobes and fissures of the
and be able to describe the functional con-
lungs.
sequences of these injuries.
8. Summarise the anatomy of the bronchial
19. Explain the loss of function resulting from tree and bronchopulmonary segments;
injuries to the different parts of the explain their functional significance in
brachial plexus. relation to inhalation injury.
20. Demonstrate how to test for motor and 9. Describe the blood and nerve supply and
sensory nerve function. Describe the lymph drainage of the lungs. Describe the
anatomical basis of: the assessment of structures in the hilum and the mediasti-
cutaneous sensation in the dermatomes of nal relations of each lung.
the upper limb, tendon jerk testing of 10. Describe the arrangement and contents of
biceps and triceps and comparative the superior, anterior, middle and posteri-
strength tests. or parts of the mediastinum.
21. Describe the anatomy of the axillary 11. Identify the major anatomical features of
lymph nodes and explain their importance each chamber of the heart and explain
in the lymphatic drainage of the breast their functional significance.
11
S.McHanwell, M.Atkinson, D.C.Davies, R.Dyball, J.Morris, C.Ockleford, I.Parkin, S.Standring, S.Whiten, J.Wilton
12. Describe the structure and position of the 2. Demonstrate the descriptive regions of the
atrio-ventricular, pulmonary and aortic abdomen and common incision sites.
valves and describe their role in the pre- Demonstrate the surface projections of the
vention of reflux of blood. abdominal organs.
13. Describe the origin, course and main 3. Describe the anatomy, innervation and
branches of the left and right coronary functions of the muscles of the anterior
arteries and discuss the functional conse- and posterior abdominal walls. Discuss
quences of their obstruction. their functional relationship with the
14. Understand the anatomical course of the diaphragm and roles in posture, ventila-
spread of excitation through the chambers tion and voiding of abdominal / thoracic
of the heart and describe the placement of contents.
ECG electrodes for its clinical assessment. 4. In relation to direct and indirect inguinal
hernias, demonstrate the anatomy of the
15. Demonstrate the arrangement of the
attachments of the inguinal ligament; the
fibrous and serous layers of the pericardi-
anatomy of the superficial and deep
um in relation to cardiac tamponade.
inguinal rings and how the anterior
16. Describe the course of the ascending aorta,
abdominal wall muscles form the inguinal
the arch of the aorta and the descending
canal. Describe the contents of the
thoracic aorta. Name their major branches
inguinal canal in both males and females.
and the structures they supply.
5. Describe the relationship between the
17. Describe the origins, course and relation-
femoral canal and the inguinal ligament
ships of the brachiocephalic veins, inferior
and the anatomy of femoral hernias.
and superior venae cavae and the azygos
6. Demonstrate the positions of the liver,
venous system.
pancreas, spleen, kidneys, stomach, duo-
18. Describe the origin, course and distribu-
denum, jejunum and ileum of the small
tion of the vagus nerve and its branches
intestine, caecum, appendix, ascending,
and the phrenic nerves on both the right
transverse, descending and sigmoid parts
and left sides of the thorax. Explain the
of the colon and the rectum.
mechanism of referred pain and where
7. Describe the organisation of the parietal
pain is referred from thoracic organs.
and visceral peritoneum; its lesser and
19. Describe the composition and function of
greater sacs, mesenteries and peritoneal
the sympathetic chains and splanchnic
‘ligaments’. Explain the significance of
nerves. Describe their composition and
the variable attachment of the ascending
function.
and descending colon to the posterior
20. Describe the course and major relations of
abdominal wall.
the oesophagus within the thorax.
8. Summarise the functional anatomy of the
21. Describe the course and major relations of
small bowel mesentery; its structure, loca-
the thoracic duct and the other lymph sys-
tion and vascular, lymphatic and neural
tems within the thorax, and explain their
content.
medical significance.
9. Explain the nerve supply of the parietal
22. Demonstrate the surface markings of the and visceral peritoneum and the role of
heart and the position and site of ausculta- the visceral peritoneum in referred pain.
tion of the four major valves
10. Describe the functional anatomy of the
23. Demonstrate the surface projections of the stomach, its position, parts, sphincters,
margins of the pleura and the lobes and blood and nerve supply and key relations
fissures of the lungs. to other abdominal organs.
24. Identify major thoracic structures on stan- 11. Describe the duodenum, its parts, posi-
dard diagnostic images and be able to tion, secondary retroperitoneal attach-
recognise common abnormalities. ment, blood supply and key relations with
other abdominal organs and their signifi-
Abdomen
cance in relation to peptic ulcer disease.
A medical graduate should be able to: 12. Describe the regions of the small and large
1. Demonstrate the bony and cartilaginous intestine, including the anatomy of the
landmarks visible or palpable on abdomi- appendix. Describe the anatomical varia-
nal examination. tions in the position of the appendix and
12