Q&A: John T. Hansen, Ph.D.

Admissions dean discusses the art and science of medicine and anatomy lab

John T. Hansen, Ph.D., the University of Rochester School of Medicine and Dentistry’s associate dean for admissions since 1996, has seen thousands of applicants to the School over the years and he knows what they want. A professor in the Department of Neurobiology and Anatomy and a former chair of the department, Hansen maintains a special interest in the role of anatomy in medical education. He was a member of the committee that designed the School’s Double Helix curriculum that weaves basic science and clinical work throughout all four years of medical school. Hansen, who came to Rochester in 1985 from the University of Texas Health Center at San Antonio to direct the course in anatomy, has authored several medical textbooks, including Netter’s Atlas of Human Physiology, Essential Anatomy Dissector and Netter’s Clinical Anatomy. He also is co-author with Philip Rubin, M.D., of TNM Staging Atlas.

Q: About a dozen years ago, you helped design the Human Structure and Function course. What is different about this course?

A: At most medical schools, anatomy and histology are first semester courses and physiology is second semester. As a result, students have to wait four to six months to learn how the kidney or the heart works physiologically.

For example, in our course, students learn the embryology, the gross anatomy, microscopic structure and cardiovascular and renal physiology all in the same contiguous time slots so they can think across disciplinary boundaries the way they are going to as physicians, instead of thinking in disciplinary silos. This approach takes away the artificial boundaries of anatomy, histology and physiology. It makes eminent sense. It’s really a natural way to relate function and structure.

How can you look at a nephron under a microscope and dissect a kidney in the anatomy lab and then have to wait four months to find out what a nephron and a tubule or collecting duct does physiologically? It’s the same thing with the heart. You look at the heart and it’s a wonder, but unless you understand the physiological dynamics going on in each heart chamber and all the pressure changes associated with systole and diastole during the cardiac cycle, how can you appreciate the complexity of the cardiovascular system? Our students get to understand this dynamic from the development level all the way up to the adult anatomy and physiology.

Q: What is valuable in designing the Human Structure and Function course the way you did?

A: Everything microscopic or macroscopic starts to make sense once you understand the function. These elements of embryology, histology, anatomy and physiology all play out in the objectives of the weekly problem-based learning classes so students can think across boundaries and across those disciplinary lines and see them as the whole, not as parts pasted together artificially.

It is wonderful in anatomy lab to hold a heart or kidney, or any other organ in your hand, and know the students understand the functional relationship. Or for a physiologist to talk about what goes on in the stomach or the heart, and know the students have already seen these organs and looked at them microscopically, often within just the past day or two. It’s a natural extension of learning for them, not a leap of faith.

No one learns this material on the first pass. You keep coming back in later courses and in more advanced ways throughout medical school and graduate training. There are planned redundancies that help you begin to understand and retain important material. You review for the board exams and then you’re in the clinic and you start thinking about basic science in a different way. Patients are people with real symptoms of things going on and often exhibit multi-system diseases. Even with our first-year students working with preceptors in the community, it drives home the importance of learning and using basic science in this context. They think of the heart not only as an evolutionary wonder, which it is, but they also think of it in relation to hypertension and how this disease process changes the morphology and the physiology of the system. They start thinking dynamically about interrelationships as first-year students. The science is not theoretical. Students see their patients and the medications they are taking and start putting it all together in a way that is more natural and relevant than when the disciplines were relegated to separate silos. The way it happens at Rochester is spectacular and our students are evidence of that. Our students can’t imagine that it is not taught this way everywhere. Fortunately, the trend is catching on, but it is nice to be at the vanguard.

Q: Rochester stands out in this integrated approach to teaching anatomy, histology and physiology. Why is that?

A: A lot of anatomy programs try to integrate anatomy with histology, but very few in the country integrate anatomy and histology with medical physiology. The reason it doesn’t happen at most schools is because it means two or three departments have to coordinate their efforts. They have to give and take. They have to work together and usually those departments have different research and teaching approaches. Anatomy is largely qualitative and visual while physiology is much more quantitative. Merging these disciplines can be a tough act to pull off.

It has worked well here because our faculty are inherently very collaborative. We have a
lot of common research interests among pharmacology, physiology and neurobiology, and anatomy. The fact that we have research collaborations, that we respected each other’s areas of investigation even though we had different approaches to teaching, has helped make it work out beautifully. Some schools try to merge anatomy and histology, and that’s a major task for them, but they aren’t even thinking about including physiology, and that’s a shame.

Q: Is this course a selling point for choosing Rochester?

A: Students want to come here because they like the curriculum. They see the medical students here are happy with the curriculum. The faculty who teach are very devoted and are excellent teachers who are learning-centered. Now, integrate the basic science with the clinical experience that happens in the afternoons-the two strands of the Double Helix basic-it is a natural for them.

Rochester has the Double Helix and the biopscychosocial model, which means a holistic and open-ended approach to medicine and the patient. The applicants sit outside our admissions office and see a portrait of George Engel, and they know we’re the home of the biopsychosocial model. The students know they will learn the science of medicine in Rochester, but they also will learn the art of medicine. We’re fondly known, and I wear this as a badge of honor, as the liberal arts of medical schools because this is the place where the art and science of medicine come together from day one. Our students start thinking holistically about the patient, all the factors that surround a patient’s life; everything is placed in a much larger context and they get a broader view.

Collegiality is an offshoot of the biopsychosocial model. The research collaborations of John Romano and George Engel had a halo effect that can be seen in many of our teaching and research faculty. It’s an attitude. It’s about looking at things in the largest context possible. If you approach education that way, in a liberal arts mode, there is no limit to what you can learn. You open your mind. You meet new people, and experience new ideas and approaches. It all builds upon itself.

Q: Do you think the traditional anatomy course and dissection lab will disappear from medical school curriculums because of advancements in digital technology?

A: I don’t think we’ll see changes, at least in the immediate future. I don’t know what the finances are going to be for any medical school in the future, but schools are not abandoning traditional anatomy. Most schools still adhere to a good dissection course and have a viable anatomical gift program to support it.

Yes, things are digitized and online and they are wonderful adjuncts, but they are no replacement for a cadaver. I think most clinicians would tell you the same thing. Anatomy plays a key role in the mindset of a beginning medical student. It is the one thing they are thinking about as they start as a first-year student. How will I react? How will I deal with this? It is one of the most lasting memories of their undergraduate medical education.

Anatomy traditionally has been taught by a devoted group of faculty who value excellence in teaching. You have to be a committed teacher. It is the most time intensive basic science course. It is physically demanding to be in anatomy lab. It is emotionally draining for students and faculty, but it is such a rich learning experience. Students don’t just learn anatomy. They learn resilience. They learn about physical and emotional stamina. They learn to work as a team, perhaps for the first time. They have to work together and support one another. It’s an intensive learning environment but it is also a positive learning environment. There is no doubt this is real experience. You are in medical school and your commitment to learn must be genuine.

Yes, we have flat screen TVs and access to radiographic images and videos on a computer. But they can’t replace dissection. You learn manual skills-how to handle a scalpel and forceps, a dissecting scissors, a Striker saw-in the anatomy lab. The experience helps you become a better physician in a lot of different ways beyond simply learning the anatomy. You learn how to learn under stress and how to deal with your emotions, while at the same time supporting those around you. Computer simulations can’t convey the difficulty encountered in teasing out a nerve or preserving an artery in an obscured dissection field.

Medical school is four years long. We have an explosion in many fields. We have molecular biology and molecular genetics. There is something new every day. You have to find more efficient ways to convey information and better ways to teach future physicians to learn on their own. But I think students would feel they got cheated if they didn’t have the traditional anatomy lab. I feel sorry for those who don’t get to do the whole dissection because they are missing out not only on the anatomy but on all the other skills this unique laboratory experiences teaches.