Volume 16 Number 3, SPRING 1999

reflections of a master anatomist

In his 50 years

of teaching, Robert Chase has seen

much change -- including

the transformation of the course in human dissection

from a macho rite of

passage to a spiritual encounter.

EACH YEAR, STANFORD'S FIRST-YEAR ANATOMY CLASS HOLDS A CEREMONY WITH POETRY READINGS, MUSIC AND SPEECHES BY STUDENTS -- ALL TO HONOR THE CADAVERS THEY HAVE SPENT THE LAST 10 WEEKS SCRUTINZING. SOMETIMES, EVEN THE FAMILIES OF THOSE WHO PROVIDED THEIR BODIES FOR STUDY ATTEND. That students feel the need to express this gratitude says a great deal about the transformation of medical training, according to surgeon Robert Chase, MD, who has taught anatomy and surgery for 50 years. He remembers when dissecting a cadaver was considered a macho rite of passage. Not only has that attitude waned, says Chase, but there has been a revolution in who enters medical school, what they learn, and how they learn it.

After nearly 20 years at Yale, Chase came to Stanford in 1963 to become chairman of the department of surgery, a post he held for 11 years. He is now the Emile Holman Professor of Surgery, emeritus, and continues to teach anatomy to undergraduates and medical students. Chase says he's reached the stage of his career when one is likely to harvest awards -- he has received seven in just the last year, including the Pettee Award from the University of New Hampshire, his undergraduate alma mater. "It's sort of like an awake wake," he says, a quip he credits to Stanford heart transplant pioneer Norman Shumway, MD, PhD.

The ceremonies students organize for the cadavers symbolize an increasing compassion in medical education, Chase says. "Even at the earliest level of medical school, there's much more attention to what I call the humanistic approach to medicine and health care -- a higher level of sensitivity, a willingness to listen to the patient," he says.

At the same time, the composition of the student body has changed dramatically. Once overwhelmingly white and male, today's classes are ethnically diverse and enroll as many women as men. Chase sees a connection between these two trends. "I think this new level of understanding and sensitivity is at least in part attributable to the fact that we have more women in the mix," he says.

Whatever their backgrounds, today's doctors-in-training must absorb more information than ever before. As a result, Chase's specialty of anatomy, which used to be the two-year foundation course, has been compressed into ten weeks. Though some anatomical details are no longer taught, Chase says this doesn't mean that dissection has been devalued. Quite the opposite. Most students still nominate anatomy as one of their most valuable classes, he says.

As medicine has gone high tech, medical education has followed, and Chase has long advocated computers in the classroom. In the mid-1980s he helped found a computer-teaching laboratory that evolved into SUMMIT, a School of Medicine program that develops instructional software. Working with SUMMIT, Chase has created "The Anatomy Lesson," an interactive CD-ROM to teach human anatomy, and he is working on several other projects that will use 3-D graphics.

At first, not all of Chase's colleagues shared his enthusiasm for computers. "In the early days, particularly, there was the fear that we were going to be replaced by computers." Faculty skepticism faded, he says, once his colleagues saw that the computer was intended as an adjunct to traditional teaching, and that it offered a better way to organize and present visual information by adding animation, sound, and interactivity. Even Chase sees limits to what computers will accomplish for education. "I think that as an additional tool for learning, the computer is excellent. But I don't think it will replace other modes of learning, including laboratory dissection in human anatomy, at least not in the foreseeable future."

Though Chase approves of most of the changes to medical education, in his view one is definitely detrimental: the diminishing funds available to teaching hospitals. Chase notes that shrinking budgets haven't forced any cutbacks in teaching at Stanford -- yet. But he warns that continued losses will inevitably undermine physician training and that doctors will have to take action.

Medicine's monetary struggles don't seem to have tarnished its image among would-be doctors, Chase says. The quality of applicants to Stanford continues to rise, and Chase says he is excited about the attitude he observes in new students. "They are so bright, unspoiled, fresh and responsive." -- MITCH LESLIE