Essential Anatomy for Required Clerkships: A Clinical Perspective

INTRODUCTION: Recent changes in undergraduate medical education (UME) include greater integration of basic and clinical sciences and a shorter preclinical curriculum. Kern's six-step approach to curriculum development first identifies a problem and then conducts a needs assessment. A problem identified in previous studies was a gap in anatomical knowledge as learners transitioned to clerkships. The purpose of this study was to focus solely on the perspective of clinical faculty in clerkships that are required by at least 50% of U.S. medical schools (AAMC, 2021) regarding the essential anatomy content for clinical practice. We hypothesized that clinicians in Family Medicine (FM), Emergency Medicine (EM), and General Surgery (GS) would rate anatomical structures in each region higher than Internal Medicine (IM), Pediatrics (PD), OBGYN (OB), Neurology (NU), and Psychiatry (PS). METHODS: A survey was distributed to clinical faculty at 38 institutions in the U.S. and Canada. The survey asked participants to rank anatomical structures from seven body regions on a 1-4 Likert-scale (4=essential, 1=not important). The 3 and 4 rating response frequencies for each structure formed a basis for classifications of importance: structures rated 3 or 4 by ≥75.0% were essential, 50.0-74.9% more important, 25.0-49.9% less important, and 0.0-24.9% not important. Kruskal-Wallis non-parametric 1-way ANOVA determined if differences existed between clerkships. RESULTS: A total of 606 clinicians completed the survey: EM (N=40), FM (N=110), GS (N=85), IM (N=152), PD (N=80), OB (N=73), NU (N=47), PS (N=19). FM rated anatomical structures significantly higher than at least one other clerkship (p=0.006) in all regions. For all body regions, EM (p=0.005) and GS (p=0.002) rated anatomical structures higher than at least one other clerkship except for the back (EM and GS), and head and neck (GS). Combining the 606 responses, all anatomical structures were classified as essential or more important except the spinal meninges, neurovasculature of the thoracic wall, vessels of the face, the thymus, pelvic and cervical fascia, and lymphatics of the back, upper limb, and lower limb. CONCLUSIONS: Clinicians within FM, EM, and GS consistently rated anatomical structures significantly higher than clinicians within other required clerkships. The majority of anatomical structures were considered essential or more important across all seven regions by respondents in the eight required clerkships. Significance/Implications: Devising a curriculum that explicitly addresses the gap in anatomical knowledge for learners transitioning to clerkships should be considered a priority for anatomy education. In this study, clinicians that teach within the required clerkships provided a curricular roadmap of the most essential anatomy for clinical practice. The data from this study can assist educators in focusing anatomical learning in the medical curriculum to the most essential content in order to best prepare their students for the required clerkships and future clinical practice.