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Anatomy Training: The Foundation of Good Surgery
A key element of resident surgical training is the Dissection Course, led by Dr. Louise Mawn, whose specialty is orbital and reconstructive surgery. “The bedrock of surgery is understanding anatomy,” explains Dr. Mawn. “You can’t put a traumatized eye ‘back to right’ when you don’t know the underlying structure and how things attach. And the best way to teach anatomy is through classic dissection.”
Dr. Mawn has taught the four-day course ever since she joined the Vanderbilt Eye Institute faculty in 1998. She got the idea from the University of Ottawa, where she did her fellowship: “The residents from Ottawa really seemed to stand out from the rest because they had taken this course.”
She presented the idea to Dr. Denis O’Day, then Chairman of the department, who supported it from the beginning. Dr. O’Day’s enthusiasm was shared by Dr. Art Dalley, the Director of Medical Gross Anatomy; with this combined University support, the course has continued for the last 12 years.
Anatomy of a Course
First the residents dissect the ocular and soft tissue around the eye, looking at the superficial features –the eyebrows, eyelids, and the tearing system. Then, they dissect the cranial nerves that serve the visual system; six of the total twelve cranial nerves impact the eye.
The eye socket is dissected, all the surrounding muscles that affect the eye, and the orbital connective tissue. The residents then dissect optic nerves with pathology and without. By dissecting the optic nerve, they are able to see the connection between the optic nerve and the carotid arteries.
The residents study the aesthetic and functional factors of the eye – “to better understand why when tendons and soft tissues are disrupted we want to put them back the way they were.” They also dissect the inferior oblique muscle and venous and arterial systems.
Coloring within the Lines
Dr. Mawn reviews clinical examples throughout the course to reinforce the anatomical points. She also has the residents color in the various components of the eye on blackand-white drawings.
“Many of the residents think it’s childish at first, but I believe multi-sensory education is much more likely to be remembered than didactic,” she says. The course represents a personal investment for residents, because it takes them away from their clinical work, but Mawn thinks the benefit outweighs the time spent if it makes them better clinicians.
“Knowledge of the anatomy makes residents better surgeons and much safer surgeons,” says Dr. Mawn. “Outcomes are better, surgical results are better. It really all boils down to better patient care. When you’re able to touch that next generation of physicians, that’s when you touch more people.”