I hated anatomy when I studied medicine, and yet, bizarrely, I now find myself going back to my old medical college to give lectures in practical applications of anatomy to students in their first year.

The problem, and my reason for writing this, is that I give the talk only to a self selected group of 50 students. Each year has 250 students; most get virtually no exposure to anatomy. Absolutely none of them will get any teaching in neuroanatomy. Does this mean that the first computed tomography scan on the brain they see will just be a poor quality black and white photo of a walnut?

But why should anyone want to study anatomy? Lets ignore the embryonic surgeons—theyre easy to spot; often male and doodling Ferrari 550s or BMW Z8 sketches on the corner of their otherwise blank notes. Why should the rest of us, wholl spend the rest of our careers tending only to patients with their skin intact, want to cram our heads with this stuff?

It has been known since Michelangelos time that knowledge of anatomy is needed for the study of medicine, and some basic anatomy is still vital to the practice of good medicine in virtually every field. Although I dont think this is in doubt, I do believe that hoping a session of half an hour as part of the study module on locomotion will be enough is, frankly, naive.

I would be the first to argue that long pure anatomy lectures out of context are capable of inducing sleep—you have to know why youre learning something if youre going to retain the maximum amount of information. This is why the new style curriculums are so much better than the old school model of “two years of lecture based basic sciences before being allowed near a patient” that I endured. So, yes, teach limb anatomy as part of locomotion, or whatever orthopaedics, rheumatology, and accident and emergency are called at your medical school; but teach it well. Make it practical, make it fun, show examples of what happens when it gets disrupted; whether by trauma or by disease processes.

This context based anatomy provides a good grounding for sound clinical practice. Most medical graduates will spend some time in the emergency department, and this would be dangerous without some solid knowledge of limb anatomy. There isnt the time, nor the personnel, available to teach this while on the job. The teaching in emergency medicine is all about what goes wrong but is based on the understanding that students know what it was meant to look like first!

Moving away from emergency medicine, how necessary is a reasonably detailed knowledge of how its all put together as opposed to just how it works? Having been asked to write this I rang my mother, a retired general practitioner, to ask her whether she felt anatomy was still useful. “Of course, how else do you understand referred pain?” From the subphrenic abscess to the retrocaecal appendix, medicine is littered with examples where the site of pain is remote from the cause. Most symptoms and especially signs of disease are more easily understood in their anatomical context. “And I wouldnt have been able to practise properly without understanding the bodys lymphatic drainage, whether for metastases or infection.” Its only by imagining not knowing what goes on under the skin that you realise how vital in day to day practice this understanding is.

I would give two more contexts where having a good anatomical grounding makes the addition of specialist knowledge possible. Firstly, back in hospital—imaging. We all use images, from the humble chest x ray film to the ultrasound scan. Being able to make sense of these tests weve ordered, or the reports on their findings, requires a sound understanding of anatomy. In most trusts at night it will be the junior doctor on call who will have to make the first interpretation of the images ordered. This can be easily taught in the case of the possible ankle fracture in the emergency department, but it is virtually impossible to understand a computed tomography scan of the brain without some background neuroanatomy.

Secondly—nerves and nerve supply. These tricky little blighters spend their whole time going wrong in a wide variety of ways. From more straightforward palsies to complex pictures such as early multiple sclerosis, knowing what should happen and what youre seeing could have arisen informs the tests you order and the specialist opinion you seek. I dont think its fair or appropriate to expect all this to be learnt while “on the job” as a preregistration house officer or senior house officer or while studying for postgraduate exams that already have failure rates of over 60%.

Lets keep the basic building blocks of anatomy in the undergraduate curriculum but teach students in a way that puts them straight into their clinical contexts and allows students to keep adding more knowledge throughout their careers, depending on which branch of medicine they choose to pursue. Anatomy may be old fashioned—its as old as we are—but it remains vitally relevant to the study of medicine.