Educational Strategies
Integrating Gross Anatomy into a Clinical
Oncology Curriculum: The Oncoanatomy
Course at Duke University School of Medicine
Ann C. Zumwalt, PhD, Lawrence Marks, MD, and Edward C. Halperin, MD, MA
Abstract
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The amount of time devoted to teaching
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gross anatomy to medical students is
declining. This topic remains critically
important for some medical students,
especially those seeking training in
anatomy-laden specialties. The authors
describe a course currently offered in the
department of radiation oncology in the
Duke University School of Medicine,
developed in 2005, that expands anatomy
education into the medical school clinical
years.The aim of the course is to help
reinforce anatomy knowledge in the
clinical context of radiation oncology
priorities and concerns, as well as to provide
A gross anatomy course and cadaveric
dissection are long-standing traditions
in medical education. Students learn
anatomy while confronting death; they
also learn how to work cooperatively
within their peer group.1–3 The hours
allotted to gross anatomy during the
basic sciences years of medical school
have decreased steadily over the past
century.2,4,5 Because of this trend and
the sheer quantity of information that
students must attempt to learn in gross
anatomy, up to 71% of residency
directors report that incoming residents
Dr. Zumwalt is a research associate with joint
appointments in the Department of Biological
Anthropology and Anatomy and in Gross Anatomy
and Anatomical Gifts, Duke University School of
Medicine, Durham, North Carolina.
Dr. Marks is professor and residency program
director, Department of Radiation Oncology, Duke
University School of Medicine, Durham, North
Carolina.
At the time this article was written, Dr. Halperin
was professor of radiation oncology, vice dean, and
associate vice chancellor for academic affairs, Duke
University School of Medicine, Durham, North
Carolina.
Correspondence should be addressed to Dr.
Zumwalt, Box 3170, Department of Biological
Anthropology and Anatomy, Duke University
Medical Center, Durham, NC 27710; telephone:
(919) 668-6417; fax: (919) 684-8034; e-mail:
(azumwalt@duke.edu).
Academic Medicine, Vol. 82, No. 5 / May 2007
direct visualization and palpation of human
cadavers, thus enabling the understanding
of complex three-dimensional and anatomic
principles. The audience for this course
consists of medical students rotating
through and the residents and clinical
faculty in the department of radiation
oncology. Anatomists and radiation
oncology residents together present
monthly didactic lectures, clinical case
presentations, and cadaver-based
demonstrations about the relationships
between a tumor’s anatomic location
and its symptoms, patterns of spread,
and treatment considerations.
need at least a refresher course in gross
anatomy.4
Concern about adequate anatomy
preparation is most pronounced in
specialties that rely more heavily on
anatomic knowledge.4 Given that the
trend of decreasing hours dedicated to
anatomy in the basic science years shows
no signs of reversing, one way by which
some medical schools have addressed this
dilemma is by supplementing medical
students’ anatomy education during their
clinical years. This approach allows those
students with interest in anatomy-laden
fields to reinforce their knowledge in the
context of focused, clinically relevant
scenarios. In this article, we present and
evaluate a model for one such approach
that has been adopted at the Duke
University School of Medicine, in which
anatomists and members of a clinical
department, radiation oncology,
collaboratively direct and teach an
anatomy course to students and other
individuals in that department.
Background and Context
Radiation oncology is one nonsurgical
specialty in which knowledge of gross
anatomy and of the patterns of spread of
malignancies is critically important.6 – 8
Radiation oncologists typically need to
Anonymous surveys were distributed to
course participants to assess the three
components of the course. Survey results
indicate that the participants found the
anatomy lectures, clinical case
presentations, and dissection presentations
all to be interesting, relevant, and of high
quality. This course is therefore favored by
students, residents, and faculty as a way to
supplement gross anatomy education
during training for a specialty in which
anatomy knowledge is essential.
Acad Med. 2007; 82:469–474.
decide which regions of the body are to
be treated with radiation therapy (RT)
and to design RT fields to optimally
irradiate target tissues. They must
simultaneously understand the
relationship between the target tissues
and surrounding normal structures for
two reasons: to design treatment beams
that minimize the radiation dose to
critical normal structures near the tumor,
and to understand how the surrounding
anatomy dictates the patterns of cancer
spread so that RT can be delivered to the
likely areas of tumor extension. Routine
clinical practice relies heavily on
diagnostic imaging such as computed
tomography (CT), magnetic resonance
imaging (MRI), and positron emission
tomography (PET). Students and
residents must typically relearn gross
anatomy in the context of these medical
images to correlate the three-dimensional
(3D) anatomy they learned in the gross
anatomy class with the anatomy
observable on these two-dimensional
(2D) images.
In July 2005, we developed a course
entitled Oncoanatomy and integrated it
into the curriculum for medical students
and residents in the department of
radiation oncology at the Duke
University School of Medicine. The
motivations for developing this course
469
 Educational Strategies

were twofold. First, as described above,
radiation oncologists must understand
the complex anatomy of many body
regions. The detail and scope of
information that students usually retain
after their initial gross anatomy class is
usually inadequate for this purpose.4 This
course was developed to help reinforce
anatomy knowledge in the clinical
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anatomic information was routinely
incorporated into clinical evaluations and
decisions.
A faculty member and the chief resident
in radiation oncology then met with the
anatomists to formulate an educational
program for incorporating anatomy into
the radiation oncology curriculum.
structures demonstrates common
patterns of cancer spread and the
rationale for subsequent treatment
planning. Some examples are shown in
List 1.
Course logistics and content
The audience to whom this course is

context of radiation oncology priorities Together, they identified common directed is the population of medical
and concerns. Second, direct clinical scenarios wherein gross anatomy students rotating through the department
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visualization and palpation of human
cadavers provides a unique means for
understanding complex 3D and anatomic
principles, and we believe that this
approach is superior to computer-
assisted imaging-based tools. However,
because clinical work relies on image-
based tools,3 oncologists must be able to
translate the 2D images they see in CT,
MRI, and PET scans into the reality of
complex 3D anatomy. We hope that by
improving their comprehension of 3D
anatomic relationships, the course will
help the participants more proficiently
assess 2D diagnostic images.
Development of the
Oncoanatomy Course
This course was collaboratively developed
by members of the department of
radiation oncology and the department
of biological anthropology and anatomy.
To familiarize themselves with the issues
and objectives of radiation oncology, the
anatomists, who are basic science faculty,
first attended several of the radiation
oncology department’s “traditional” case
conferences. These 30- to 60-minute
conferences are prepared by a resident
or medical student with guidance from
senior residents or faculty. The student
uses slides and illustrations from
operative specimens or intraoperative
procedures to present a particular
question or issue about the management
of a patient he or she has seen. The
literature pertinent to this question is
presented and discussed in an interactive
manner in which the medical staff asks
the students and residents questions.
Members of the radiation oncology
clinical faculty also provided several
educational sessions for the anatomists,
addressing basic principles of oncology
(e.g., cancer biology, tumor staging,
treatment approaches) and the anatomic
underpinnings of radiation oncology.
One of the anatomists shadowed a
radiation oncologist in the clinic for
about 12 hours to observe firsthand how
instruction would enhance the students’ of radiation oncology, who are required
understanding of the disease process and to attend any oncoanatomy session that
the implications for RT field design. meets during their rotation. Because
These clinical scenarios were ones in radiation oncology is an optional clinical
which understanding the 3D relationship rotation for medical students at Duke,
between the tumor and adjacent normal the number of students in any given
List 1
Examples of Clinical Scenarios with Anatomic Correlates for Oncoanatomy
Sessions
1. Cancer in the pancreas/biliary tract: Discuss a patient presenting with painless jaundice.
Evaluation leads to the diagnosis of cancer of the head of the pancreas, or a tumor in the
common bile duct
Gross anatomy correlates:
● Anatomy of the biliary tree and its proximity to the pancreas
● Proximity of the pancreas to the kidney and liver and implications for radiation
techniques
● Proximity of pancreas to celiac plexus and spinal cord and implications for presentation
of pain
● Nodal drainage to the celiac vessels and implications for resectability
● Whipple operation and other pancreas resection approaches
2. Tumor obstruction of superior vena cava: Discuss a patient whose presenting
complaint is shortness of breath and who is found to have dilated neck and arm veins.
Subsequent evaluation reveals small cell cancer and a mediastinal mass
Gross anatomy correlates:
● Proximity of superior vena cava to other intrathoracic structures, in particular the node-
bearing areas of the mediastinum
● Collateral circulation occurs through the azygous system, which enters the superior vena
cava
● Demonstrate that collateral circulation may vary depending on whether the azygous
system is patent. If the superior vena cava obstruction is inferior to the azygous insertion,
the collateral flow will extend to the lower body
● Review the location of the veins versus arteries in the chest, including where central lines
are placed
3. Cancer of the prostate: Patient presents with urinary hesitancy and frequency. Exam
reveals an enlarged prostate; biopsy of a palpable nodule is positive for cancer. Discuss
therapeutic options and how the toxicities of each relate to the local anatomy
Gross anatomy correlates:
● Proximity of prostate to bladder; hence, risk of bladder injury from radiation therapy,
particularly with interstitial catheters
● Proximity of prostate to rectum; hence, risk of rectal toxicity from external-beam
radiation therapy
● Proximity of small intestine relative to pelvic nodes, and the impact of elective nodal
irradiation on small bowel
● Review the surgical approaches to the prostate and associated normal tissues of concern
for each

470 Academic Medicine, Vol. 82, No. 5 / May 2007


rotation is small (usually two to four
students), but most of these students
are particularly interested in radiation
oncology as a potential specialty.
Several students have attended many
oncoanatomy sessions as they were
involved in longer-term activities in the
radiation oncology department, such as
longitudinal clinics or research projects.
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The residents in the department are
strongly encouraged to attend, and the
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entire clinical faculty is also invited.
The only requirement for completion of
the course is attendance (e.g., there are
no textbooks or tests).
The course meets monthly in a one-hour-
long time slot that is dedicated to the
traditional case conference during other
weeks. Because there are few conflicts
with patient responsibilities at this time,
attendance is typically high, with 100% of
the two to four medical students, 80% to
100% of the seven to nine residents, and
several of the clinical faculty in the
department attending. Faculty attendance
to any given session is dictated primarily
by the topic being covered that day, but
approximately 70% of the clinical faculty
in the department of radiation oncology
have attended at least one session.
The topic for any given session is cancer
of a particular location in the body. Each
topic is selected on the basis of the
available cadaveric material and
prevailing interests in the department
at that time. For example, once the
first-year gross anatomy students had
completed their dissections of the head,
we were able to use the same cadavers to
study the presentation and spread of
cancer of the nasopharynx. Similarly,
when a particularly interesting case
involving a parotid gland tumor was
being treated by physicians in the
department, we took the opportunity to
explore the anatomic considerations
relevant to this treatment.
In each session, one radiation oncology
resident and one anatomist prepare
lectures, and two or three other anatomists
prepare dissection demonstrations. In
preparation for each presentation, the
resident discusses with the anatomists the
clinical and anatomic factors that are
pertinent to understanding the behavior
and treatment of the disease. These
discussions normally occur about two
weeks before the scheduled class session.
The anatomists then supplement their
Academic Medicine, Vol. 82, No. 5 / May 2007
knowledge using textbooks and online
resources to become more familiar with the
disease process. Total preparation time is
approximately 5 to 20 hours for each
individual, with the variation resulting
from differences in the level of familiarity
and complexity of the topics and variation
in the extent to which detailed cadaver
dissection is required for a particular
demonstration.
The format for each oncoanatomy
session is as follows:
1. A 10- to 15-minute presentation by
the anatomist on the anatomic region
in question and the relevant
embryology and comparative anatomy
using anatomic and medical
illustrations.
2. A 10- to 15-minute case presentation
by a radiation oncology resident.
These presentations include a review
of the patient’s history and diagnostic
imaging, a description of the tumor
staging, and a discussion of common
symptoms at presentation and how
they relate to the gross anatomy.
3. Thirty to 40 minutes of instruction
using specially prepared cadaveric
specimens.
Both 10- to 15-minute presentations are
informal didactic lectures that occur in a
small conference room adjacent to
the gross anatomy lab. After the
presentations, the group moves into the
anatomy lab, where the class divides into
two groups of 5 to 10 individuals per
group, depending on class attendance
that day. The anatomists present two to
four cadaver dissections to each of these
groups. These dissections are more
focused and extensive than is typical for a
gross anatomy class, to illustrate the
anatomy relevant to the disease and its
patterns of spread. Each presentation
lasts 10 to 15 minutes, after which the
groups rotate to the next demonstration.
For example, in the session addressing
adenocarcinoma of the pancreas, three
separate dissections were presented. One
anatomist presented dissection number
one, and a second anatomist presented
dissections two and three.
1. The stomach and bowel were removed
to provide an anterior view of the
pancreas in situ. The proximity of the
duodenum to the pancreas was readily
apparent in this view, as was the
intraperitoneal location of the first
and fourth parts of the duodenum
Educational Strategies
versus the retroperitoneal location of
the second and third parts of the
duodenum.
2. The stomach, duodenum, pancreas,
and liver were demonstrated along
with the porta hepatis and the major
vessels of the area. This dissection
demonstrated the close proximity of
the pancreas to the duodenum, porta
hepatic, and liver, illustrating the ease
with which pancreatic cancer may
spread to nearby organs.
3. The GI tract and its associated vessels
were removed and were demonstrated
from the posterior view to illustrate
the proximity of these vessels to the
pancreas and other organs. These
relationships are important because
the spread of pancreatic cancer to the
surrounding soft tissues and
lymphatics often can explain the
patient’s symptoms and determines
the resectability of the cancer.
Access to cadavers
The oncoanatomy course uses the
cadavers that the first-year medical
students have previously dissected,
thereby making further use of these
valuable resources. We use these bodies
during the months in which the gross
anatomy class is ongoing and for a
number of months after the course ends.
Eventually, the cadavers are dissected
beyond the point of being useful. In
addition to the gross anatomy cadavers,
three extra cadavers per year are set aside
from Duke’s anatomical gifts program for
use in the oncoanatomy course as well as
in several other advanced anatomy
courses.
Course assessment
We distributed a confidential survey to
18 individuals, all of whom had attended
the conferences in the first six months
they were offered (July to December
2005); our research was exempt from IRB
approval. All individuals (seven medical
students, seven residents, and four
faculty) responded to the survey.
Respondents may have attended up to six
sessions. At the time when the surveys
were distributed, sessions had covered
cancers of the nasopharynx, pancreas,
cervix, gastroesophageal region, and the
superior sulcus of the lung (Pancoast
tumor). Because of the medical students’
rotation schedules, most of the students
had only attended one of the six sessions
that had occurred at the time the survey
471
 Educational Strategies

was distributed. Most residents had attended? (case study, anatomy lecture, three parts of the course for all sessions as
attended all of the sessions, and the dissection) well as in the overall impressions of the
faculty had attended between one and respondents (Table 1). The faculty
four sessions. ▪ On a scale of 1 to 10 (1 ⫽ useless, 10 ⫽ ranked the relevance of the class to their
very useful), how would you rate the work somewhat lower than did the
The survey sought to assess the course relevance to your work of the topic(s) medical students and residents (faculty:
both qualitatively and quantitatively. The discussed in the oncoanatomy sessions 8.6 out of 10; students and residents: 9.8
first two questions on the survey listed below? out of 10).
identified the respondent’s rank (medical
▪ Please tell us about anything that you
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student / resident / faculty / other) and

the session(s) that they attended. In the found to be particularly useful or Discussion
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subsequent questions, the respondents interesting in the session(s) you have

attended. In this paper, we describe one approach
ranked the anatomy lectures, clinical by which anatomy knowledge may be
case presentations, and dissection reinforced for clinicians training in
Survey responses
presentations separately. They responded anatomy-laden fields. The course offered
for each individual class session and also Table 1 presents the survey results
at Duke, oncoanatomy, marries the skills
for the course overall. The survey divided by the session topics, and Table 2
and knowledge of anatomists with
questions were: presents the survey results divided by the
questions that are specifically relevant to
rank of the respondent. The medical
▪ On a scale of 1 to 10 (1 ⫽ no interest, students who responded to the survey
radiation oncology. By providing focused
10 ⫽ very interested), how would you had attended one session each, so the
lectures and dissection presentations that
rate your interest in the following parts are relevant to the treatment of particular
data presented in Tables 1 and 2 are the
of the sessions? (case study, anatomy cancers, we believe that we both
averages of the students’ responses, which
lecture, dissection) strengthen the medical students’ anatomy
refer to different individual sessions. All
knowledge and reinforce the rationales
▪ On a scale of 1 to 10 (1 ⫽ unsuccessful, data in Table 2 refer to the average
for the treatment of these cancers for all
10 ⫽ very successful), how would “overall” rating by each group, except the
participants.
you rate the quality of the following data for the responses by the medical
presentations? (case study, anatomy students.
Course assessment
lecture, dissection)
On average, the respondents ranked their Our findings from the survey were
▪ On a scale of 1 to 10 (1 ⫽ none, 10 ⫽ a interest in and the quality and relevance very encouraging. Qualitatively, the
great deal), how would you rate the of all parts of the course 9.6 on a scale of comments from participants have largely
amount of new knowledge that you 1 to 10. The dissection presentation was been positive. The quantitative results,
gained in the session(s) that you consistently ranked the highest of the although based on a small sample size,

Table 1
Participants’ Satisfaction, by Session Topic (Tumor Site), with Oncoanatomy
Course, Department of Radiation Oncology, Duke University School of Medicine,
January 2006*
Superior
sulcus Gastro-
Participants’ rating of: Nasopharynx (Pancoast) esophageal Pancreas Cervix Overall†
Interest in the session
...................................................................................................................................................................................................................................................................................................................
Clinical case study 8.3 9.2 9.6 9.0 9.6 9.5
...................................................................................................................................................................................................................................................................................................................
Anatomy lecture 9.3 9.3 9.9 9.2 9.7 9.8
...................................................................................................................................................................................................................................................................................................................
Dissection presentation 9.8 9.7 10.0 9.3 9.8 10
Quality of the session
...................................................................................................................................................................................................................................................................................................................
Clinical case study 8.4 9.2 9.6 9.0 9.6 9.5
...................................................................................................................................................................................................................................................................................................................
Anatomy lecture 8.5 9.3 9.8 9.2 9.8 9.8
...................................................................................................................................................................................................................................................................................................................
Dissection presentation 9.8 9.7 10.0 9.3 9.8 10
Amount of new knowledge covered
by the session
...................................................................................................................................................................................................................................................................................................................
Clinical case study 8.3 7.8 8.4 6.9 7.8 8.6
...................................................................................................................................................................................................................................................................................................................
Anatomy lecture 8.0 7.7 8.7 7.2 7.9 9.3
...................................................................................................................................................................................................................................................................................................................
Dissection presentation 9.3 8.2 8.8 7.6 8.1 9.6
Relevance of the topic to their work 9.2 9.5 10.0 9.0 9.1 NA
* Each session was rated individually (on a scale of 1 to 10, where 1 ⫽ low, 10 ⫽ high) by those attending that
session. Data shown are the average results from seven medical students (second- to fourth year), seven
residents/fellows, and four faculty members, and are organized according to the sessions assessed.
†
Overall refers to the individual’s opinion of that aspect of the course overall.

472 Academic Medicine, Vol. 82, No. 5 / May 2007

 Educational Strategies

The oncoanatomy course is not designed

Table 2 to convey new anatomic or clinical
Participants’ Satisfaction, by Rank, with Oncoanatomy Course, Department of knowledge but, rather, to reinforce these
Radiation Oncology, Duke University School of Medicine, January 2006* concepts in a different and effective
Medical students Residents/fellows Faculty manner. This goal was reflected in
Participants’ rating of: (n ⴝ 7) (n ⴝ 7) (n ⴝ 4) participants rating their interest in the
Interest in the session presentations somewhat higher than the
.........................................................................................................................................................................................................
Clinical case study 9.4 9.0 9.1 amount of new knowledge they gained
.........................................................................................................................................................................................................
from the course. This is reinforced by the
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Anatomy lecture 9.7 9.6 9.2

......................................................................................................................................................................................................... comment of one faculty member: “While
Dissection presentation 10.0 10.0 9.4
I may have ‘known’ the data presented,
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Quality of the session the dissections gave me a ‘new view.’

.........................................................................................................................................................................................................
Clinical case study 9.3 9.0 9.2 When I (took) anatomy as a medical
.........................................................................................................................................................................................................
Anatomy lecture 9.6 9.5 9.1 student I had no idea that it would be
.........................................................................................................................................................................................................
Dissection presentation 9.9 10.0 9.4 relevant to my career—so it is good to
take a look at things ‘inside out’ and
Amount of new knowledge
covered by the session relearn how it is all connected.”
.........................................................................................................................................................................................................
Clinical case study 7.1 7.8 8.3
......................................................................................................................................................................................................... When we examined the results of the
Anatomy lecture 7.4 8.3 8.4 survey in the context of the respondents’
.........................................................................................................................................................................................................
Dissection presentation 8.0 9.0 8.7 rank, the students, residents, and faculty
Relevance of the topic to seemed to have similar levels of interest
their work 9.7 9.9 8.6 in the class (Table 2). The faculty rated
* Each session was rated individually (on a scale of 1 to 10, where 1 ⫽ low, 10 ⫽ high) by those attending that
the sessions as being slightly less
session. Data shown are average results according to respondents’ ranks. applicable to their work than did the
students and residents. Presumably,
this reflects the fact that faculty have
were also favorable. Every assessment first-year gross anatomy courses unless
specialized in areas that do not
of participant interest and class they are pursuing a specialty that has
always correspond to the topics of the
quality received very high rankings. a surgical component. Despite this,
oncoanatomy sessions, whereas students
Unfortunately, we did not assess the radiation oncologists must have a
and residents have not yet narrowed their
students’ knowledge before and after thorough and confident appreciation for
focus. Interestingly, the faculty and
taking the course. Given the relatively anatomy because they must not only
residents reported that they gained
small number of students attending understand the patterns of cancer spread; slightly more new knowledge in the
each session, and because each session they also must appreciate what healthy sessions than the students did. This
typically included a different pair of tissues are nearby and adjust their may be attributable to the fact that the
students, the value of such an assessment radiation prescriptions accordingly.6 – 8 students had taken gross anatomy more
would be limited. However, the The dissection presentations are a unique recently than had the faculty and
consistently high attendance rates and resource for the advanced medical residents.
positive qualitative feedback from students, residents, and faculty in
participants encourage us to perceive this radiation oncology because they provide Benefits of advanced anatomy courses
course as successful. Additionally, faculty observers with the opportunity to again
who often choose not to attend the The format in which members of the
study anatomy in 3D, which is otherwise anatomy and radiation oncology faculty
typical conferences have made special difficult using textbooks or online
efforts to attend the oncoanatomy teach together in the same classroom has
resources. Additionally, by observing the brought about some unexpected benefits.
sessions that are relevant to their anatomy in the context of clinical points
specialties; we perceive that such efforts The relatively informal environment and
relevant to their daily work, the students small-group format of the dissection
reflect the positive reputation the course
find the information more relevant, presentations have led to unplanned
has in the department.
memorable, and interesting. As one “teaching moments” that benefit
We recognize the potential shortcomings medical student commented, “The members of both departments, in
of the quantitative survey that was used, anatomy lecture followed by dissection addition to the medical students for
which was not previously tested for was very informative. It all made a lot whom the course was originally designed.
validity or consistency. This survey was more sense than it did first year, when I During the dissection presentations,
intended not to represent a rigorous had much less clinical knowledge.” members of the radiation oncology
scientific study but to provide some Residents who have been actively treating faculty have spontaneously contributed
quantitative assessment of the course. patients for a number of years have information based on their clinical
One interesting aspect of the survey commented that seeing various anatomic experiences to the lessons planned by the
results is that the dissection presentation regions in the cadavers in the context of anatomists. This information has further
was consistently ranked the highest of the particular cancers not only has reinforced enabled the anatomists to see anatomy
three course components. Most students their knowledge of anatomy, it has also from the clinician’s perspective.
do not have the opportunity to observe underscored the rationale behind various Conversely, the anatomists’ expertise has
anatomy in 3D after completion of their treatment approaches. allowed them to prepare and present

Academic Medicine, Vol. 82, No. 5 / May 2007 473

 Educational Strategies
creative dissections that demonstrate
clinical concepts in ways that the
radiation oncology staff would not have
considered.
Conclusions
The oncoanatomy course has been a
success. Attendees find it interesting and
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useful, and ongoing sessions continue
to be well attended by enthusiastic
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audiences. The success of the course is
attributable to a positive collaborative effort
between members of the radiation
oncology and biological anthropology and
anatomy departments as well as strong
support from the medical school
administration. This course may be a
positive model for other courses focused on
supplementing gross anatomy education
Teaching and Learning Moments
Too Many Cooks Spoil the Broth
The task was an easy one: to participate
in a role-play exercise, in which we
would attend to our patient, a SimMan
mannequin complaining of chest pain.
There were seven of us assigned to
this task, chosen from among the 40
tutors being briefed on a forthcoming
simulation module for final-year,
undergraduate students. We had
almost a century and a half of medical
and surgical expertise between us.
Having been certified in Basic Cardiac
Life Support within the past year, I was
selected to play the role of code leader. I
was, of course, a little uncomfortable
with having my colleagues witness any
faux pas on my part (and having the
performance video-recorded for
posterity to boot!), but I reminded
myself that I had usually handled
codes whilst on call, albeit years ago,
with aplomb and facility.
What followed, alas, was a completely
lackluster performance. Used to having
nurses on hand to assist us, the
doctors-turned-nurses of our team had
474
in other departments in which anatomic
knowledge is important, such as surgery
(of all types), radiology, gastroenterology,
and obstetrics– gynecology.
Acknowledgments
This study was funded by the Duke University
School of Medicine.
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Thankfully, the SimMan sessions we
subsequently conducted were far
more successful. We of the “not-so-
magnificent seven” were heartened
by the fact that our disastrous
session provided us not only with
amusing anecdotes to regale our
colleagues and students with, but
also very useful lessons for all. It was
true, we realized, too many cooks
do spoil the broth. Extending the
analogy further, the leader, or head
chef, has to provide clear guidance
and masterful instructions to his sous
chefs in order to create a culinary
feast. Fortunately for us all, the dish
of humble pie we were served turned
out to be tasty indeed!
Erle C. H. Lim, MD, and
Raymond C. S. Seet, MD
Dr. Lim is associate professor, Yong Loo Lin School of
Medicine, National University of Singapore, Singapore.
Dr. Seet is assistant professor, Yong Loo Lin School of
Medicine, National University of Singapore, Singapore.
Academic Medicine, Vol. 82, No. 5 / May 2007