Interview with Professor Peter Abrahams, Warwick Medical School
Published May 2011
Anatomy lessons used to make up a quarter of medical students' timetables in their first few years. Nowadays it is more like ten percent. The time allocated to learning the mechanics of the human body has been reduced to make space for new subjects - genetics, microbiology and sociology for example - and expensive dissecting facilities have not been scaled up in line with the increasing number of trainee doctors. Peter Abrahams, Professor in Clinical Anatomy at the University of Warwick, has been thinking up new methods for teaching anatomy in order to overcome these two short comings. He is currently developing an iPhone app, 'Abrahams - Aspects of Anatomy', that will provide access to more than twenty 3D podcasts, each three to four minute long, concentrating on various parts of the body. “Every single structure is worded in text and in voice. The more different ways the information is communicated, the more you are going to learn,” explains Prof Abrahams. There will be a test following each video to quiz the user on their knowledge.
How can you examine someone if you don’t know what is beneath your finger tips? The people that know more end up doing less harm.
Perhaps it is because the subject matter and technique has not changed for over 500 years that such innovative developments in teaching techniques are possible: “The body stays the same and the technique of dissection is not significantly different from the time of Leonardo Da Vinci. We still use a scalpel and forceps, our magnifying glasses might have got a bit better, but it takes many years to learn the details of the body. Surgeons tend to specialise now and know their particular area intricately but don’t know as much as the general anatomist.” Prof Abrahams also works as a GP in the NHS and finds that his understanding of the body is a powerful diagnostic tool: “If someone came to me with a knee pain I can very quickly examine most structures in the knee and establish what was causing the problem even without an x-ray.” He makes a direct correlation between his knowledge of anatomy and his diagnostic competence as a doctor. It is this that motivates him to open up access to anatomical know-how: “It is a foundation stone for all health professionals. How can you examine someone if you don’t know what is beneath your finger tips? The people that know more end up doing less harm.”
While medics’ understanding of anatomy has decreased, the general public have never been better informed, largely thanks to the Dr Gunther von Hagens’ wildly popular Body Worlds exhibitions. The first exhibition, which displayed a variety of plastinated human bodies, was held in Tokyo in 1995 and the show continued to tour Northern America, Europe and Asia, expanding to display animal bodies as well. Over 20 million people have visited these exhibitions worldwide. Dr von Hagens invented and patented a revolutionary technique for preserving bodies which works by drawing water molecules out of the cells and replacing them with polymer resins. It is a modern process of mummification: “If you leave a plastinated prosection in a box it would still be there in a thousand years. They were able to preserve bodies in Egypt because of the dry climate; this process works because the water molecules are reconstituted within the cells.” Von Hagens' Institute for Plastination has several explicit aims which include improving the awareness of medical issues amongst the general public. The consequences of smoking, for example, can be powerfully demonstrated by looking at smokers' lungs, which are black. Some people find the concept of using the bodies of human beings in this way problematic but thousands of people sign up to donate their bodies to the Institute: “The individual must sign documents of consent. Previously plastinated body parts have been imported from China but there were worries that the documents were not always legitimate. Some imports could have been the body parts of executed criminals. The Human Tissue Authority, which regulates English anatomy departments, has licensed imports from the Plastinarium but now won’t sanction imports from China.”
Some people find the concept of using the bodies of human beings in this way problematic but thousands of people sign up to donate their bodies to the Institute.
Technological advances mean that images of the inside of human bodies have become increasingly sophisticated. Prof Abrahams often works with radiologists as they have the tools to produce incredibly detailed pictures from scans. This cannot compare, however, to first-hand experience of the real thing for young doctors. Thankfully the West Midlands Strategic Health Authority provided £1.5 million pounds of funding that enabled Warwick Medical School to purchase about two hundred of Von Hagens’ prosections. They have proven to be effective teaching aids: “The students’ reaction has been very positive. I went out to Germany to talk to the dissectors about what we wanted. I requested several versions of each part of the body so that no two prosections are identical. Each prosection is carefully planned to display a different set of structures.” It takes around fifteen hundred hours to prepare a complete cadaver, which is partly why the process is so expensive. Coloured plastinates are injected into the arteries and veins and the specimens are intricately prepared to ensure the clear display of the significant anatomical structures: blood vessels, nerves, muscles, joints and tissue boundaries. The prosections do not decay - there is no smell - but they do show wear and tear over time. Prof Abrahams is currently working with Warwick Manufacturing Group and the radiology department at University Hospital of Coventy and Warwick, looking at using Additive Layer Manufacturing to make exact 3D replicas so that each class will have several plastic replicas to make use of.
Spending so much time in close quarters with the human body must effect the way you perceive health issues: “I am a somatic doctor. If someone has mental health issues I refer them to a psychiatrist. Alternative therapies that use ‘energy flows’ etc. to explain ailments have no place in evidence based medicine. I am not against them I just perceive health problems in fairly concrete terms. I think most surgeons do, it is part of your mind set.” Prof Abrahams shares Von Hagens’ conviction that we could all benefit from better understanding the material reality of medical conditions.
* The videos used in this article were produced in January 2009. The videos that will feature in the apps are updated, complete with additional content and simulations.
Professor Peter Abrahams is Professor of Clinical Anatomy at Warwick Medical School. He trained at the Middlesex Hospital Medical School after doing VSO teaching (Peace Corps) in the jungles of Borneo. He is a Fellow of Girton College Cambridge and is a Professor at St. Georges University, Grenada. Peter has worked as an educational and anatomical consultant for WHO, Geneva, setting up a new school in Beersheba and has examined and lectured doctors and surgeons in Africa, the Middle East, South East Asia, the USA and throughout Europe. In 2006 The AACA recognized Peter Abrahams as an international clinical anatomist, teacher, author and family doctor, and awarded him as "Honored member status". Thrilled to be nominated by students Peter won a (WATE) Warwick Award for Teaching Excellence after only a year on campus and more recently in 2008 won First prize at the BMA Book Awards in the Basic and Clinical Science section for the Mcminn 6th Ed of his "Clinical Atlas of Human Anatomy + DVD ". You can find out more about his publications on his Amazon page.
View the entire series on the WMS website.