He felt that it was necessary to have an Anatomy Textbook along the lines of the American ones that taught the essentials on the subject, he explains to me, in a relaxed conversation, the day after the official presentation of the new Human Anatomy Textbook.
As the American and Portuguese cultures follow slightly different forms of teaching, the need to create something from scratch grew, he continued. And despite the fact that all medical student knows English, the ease of learning material in their own language was also a strong argument.
António Gonçalves Ferreira is Full Professor of Anatomy, a Neurosurgeon and the Director of the University Clinic of Neurosurgery at the Faculty of Medicine of the University of Lisbon.
He had been thinking about writing a textbook for over 30 years. As proof that dreams are like big trees, they need time to grow. Faced with a proposal from a publisher, he realized that the challenge was tempting, but just as serious.
He was fully aware that it was still necessary to document the general anatomy for students and that, despite the existence of the five volumes of the late Professor Esperança Pina, there was a certain excess of detail of the “great treatises on Anatomy”, as he says, that were not necessary for young people to be in contact with Anatomy for the first time.
Writing such a textbook required involving the best players. So it happened, he drew a first sketch, with the premise that the country’s Coordinators of Anatomy of the Medical Schools had to be involved. The seed was sown and germinating in fertile ground. It took years to happen, but from the moment that the Anatomy Lecturers of his generation could react with supreme authority, they would not only water the idea, but also feed it. They became the co-authors of a Textbook that was acclaimed by all Medical Schools in the country.
Maria Amélia Ferreira, Professor of Anatomy and former director of the Faculty of Medicine of Porto, Artur Águas, Director of Anatomy at ICBAS and António Carlos Miguéis, Full Professor in Coimbra, signed the Textbook that had the tripartite coordination of Gonçalves Ferreira, Lia Neto, currently Coordinator of Neuroanatomy, and Ivo Furtado, all Professors at the Faculty of Medicine.
So, an easily transportable book was born which, although more empathetic for the new target, maintained a mandatory rigor for the level of requirement of a medical student. There was yet another condition stipulated by Gonçalves Ferreira, that the cost of this new book was below
€100, a limit that he placed on the publisher Jaime Cacella de Abreu, also present in the official presentation.
From this book, we also know that the model used for the various explanatory situations emerged through the hands of an old colleague and friend, Professor Isabel Ritto, from Fine Arts. We also know that illustrator Pedro Afonso was hired, and he created and adapted, in a very patient way and through error and new resolution, the more than 800 images contained in this Textbook.
And as a good guide for directing the knowledge of students, this great script of the human body has, at the end of each chapter, standard questions, which may be asked in exams and allow ongoing self-assessment. But always close to the concerns of applicability to the real situation, there are also some notions applied to clinical practice.
Telling the story of this Textbook would be an interesting topic that would suffice to speak with Professor António Gonçalves Ferreira, but knowing that we speak of Anatomy when we speak of this book, it was impossible not to take a peek at the evolution of the times and of the discipline itself that everyone has heard of at any time, even if not a medical person.
The same places, a few years later.
The Anatomy Theatre, the place where the Human Anatomy Textbook was launched, was the same place where student António did his first exams on the same subject.
Even in those times, dozens of students were grouped together in that same space to observe the dissections of corpses preserved in such an archaic way that when remembering those times, he still makes an expression of profound discomfort, referring to it as a "Dantesque moment".
From the time he came into contact with Anatomy as a young student, he explains that the notion of the living was not very palpable, as there was not much image development, only some ultrasounds or simple X-rays.
For all the counterpoints he observed and experienced, Gonçalves Ferreira always wanted to make Anatomy something more stimulating, since when he was a student, there was an endless obligation to memorise topics that later had no useful applicability.
How do you see your year 1 students when they get to you for their first class?
Gonçalves Ferreira: I see them as I saw myself back then. I remember perfectly standing there, there were an absurd number of students and there was no room for everyone. I was in the Amphitheatre, which at the time was called the Anatomy Amphitheatre. Now it is called the José António Serrano Amphitheatre, and I was there in the back row. I remember listening to the Professor, who said that “Anatomy is not just a matter of memory, but also of reasoning” and added something like, “some of you, the best, will be able to work with me later and be my teaching assistants". What is funny is that I took that message completely in my heart, I decided that I was going to be part of that group.
As soon as that? Why? Did you realise that you had the right profile for that at the age of 18?
Gonçalves Ferreira: You know that profiles are built, we can even have a profile that makes things easier for us, but in the case of Anatomy, you really need to know a lot about it to leave an imprint.
So this is achieved by studying a lot?
Gonçalves Ferreira: Yes, by studying a lot. But you know, it was in Anatomy that, before me, teaching was done through peer teaching, that is, the older students were junior assistants and taught the younger ones. However, in those days, the older students did not gain extra credits. Students with a grade of 16 or higher in Anatomy were invited to be junior assistants. And we accepted this role of junior assistants on a voluntary basis, for a certain time, and it was during this time of classes that the older lecturers were fine tuning us. And that is how I got here.
Which books were used to study anatomy in those days?
Gonçalves Ferreira: We had to read huge treatises. A book called Rouvière, completed by an even older one, the Testut, where the Heart was studied. And when we talk about volumes, Testut had about 7. At the time, it was an absolute content overload. In my year 1 of the medical degree, I couldn't go on holiday, because it was unthinkable in July for someone to pass the first exam, the Professor himself warned us about it. We came for the exam in September and things went well.
When did you first came across Anatomy of the living, of the real?
Gonçalves Ferreira: Just in the clinical years. When we got to the clinical years we did not about the reality of patients, a rare number of top students knew a little more, but not much more. A short time after the end of my degree, CT scans appeared, allowing us to see the inside of the intracranial cavity, then Magnetic Resonance Imaging appeared, showing fantastic things about the functioning of the brain itself and everything in much more detail. And it was precisely at that time that I realized that it was necessary to make a revolution in Anatomy and teach the true Anatomy that a modern doctor needs to know.
Anatomy is the subject with the highest number of assistants and junior assistants, why?
Gonçalves Ferreira: Because they are all clinicians with part-time contracts. I always wanted my assistants to be good clinical anatomists, and why? The anatomy we teach in the medical degree should be very practical and not theoretical book anatomy. It becomes richer when taught by clinicians, because they teach it applied to diseases and real situations. But it is not easy, because they are very involved in parallel activities that occupy a large part of their agenda, not allowing them to manage time for their teaching careers.
We have 28 classes and each Assistant has 2 classes, which means there are 14 Assistants. In General Anatomy, which is taught over the two semesters of year 1, and in Neuroanatomy of the 2nd semester, of year 2, another 14 Assistants are needed. Except for rare exceptions, in cases where one works more. But there is more, such as the difficulty in going over all the necessary topics taught in the theoretical classes in the practical classes. Despite the reform of teaching intended to lighten the weight of Anatomy, the truth is that to allow more time for students to study, class times have been reduced. Whereas in the past students had two classes of two hours each per week, now they have two hours per week. Even if the schedule was heavier, the truth is that it was also more comprehensive regarding content. Currently there are fewer hours of human contact and practice, which allows more time for individual study. As it is, for all content to be taught in real time, it means that an entire system of the human body needs to be taught in a week, that is, in just two hours.
Anatomy is as popular as feared by those who start their medical degree. Why is that?
Gonçalves Ferreira: Anatomy is a subject that, no matter how simplified it may be, and has been greatly simplified over time through the various educational reforms, it is always a "dense" subject. I always say in the first class that "you don't need to know Anatomy very much, just that you know the whole Anatomy". What I mean by this is that you don't have to know the details of everything, but you can't leave an anatomy chapter unaddressed. A doctor has to know the whole Anatomy, the whole body. It is in this sense that I insist on this aspect that they have to know all areas. But I know that it is difficult for students to follow all practical classes.
Is it possible to teach a whole system in two hours, in one class?
Gonçalves Ferreira: It is a great deal of knowledge, even if it omits the details. This requires students to study subjects that were not addressed in class. This is a huge challenge. Theoretical classes are of great importance here, as they allow exploring the subjects and transmitting the first more general notions. Thus, those who attend the theoretical classes, do not show up at the practical classes looking so lost.
What are the things that future doctors need to know today?
Gonçalves Ferreira: They need to know the general configuration of all organs in all systems. They must know some specifics and details; with regard to nerves and blood vessels, for example, it is important to know that they have very different characteristics. It is also very important to learn Anatomy that can be applied to the knowledge of the clinical practice. And that means that students who have just graduated have to know how to interpret a CT scan or an IMR. We have insisted that students have an integration that allows them to learn anatomy through serial sectioning, such as CT scans and IMRs, which are done like this, in the last few years. Sometimes there is a three-dimensional construction, but a doctor has to know how to see it through serial sectioning. This is the sectional anatomy that has to be taught.
In your presentation of this new Textbook you said at one point "this book is not meant to be a treatise, but a textbook ". Who needs to read the treatises then if not the students?
Gonçalves Ferreira: Treatises are reference books, not systematic study works for students.
Will this be the Textbook adopted by the Faculty from the next academic year?
Gonçalves Ferreira: I very much hope so, as it was written with that purpose in mind. But there is something unprecedented, which is that this book managed to bring together the consensus of the country’s Faculties and that attests the quality of the work and a certain consensus on the contents of Anatomy for medical teaching in Portugal.
Is this Textbook enough for our students to be good?
Gonçalves Ferreira: It is enough. It even has some expendable content.
On 20 November, the Anatomy Textbook finally saw the light. In the Students’ Association of the Faculty of Medicine alone, 81 books have already been sold and in total, the country has reached 250 sales. This Textbook costs €80 and students have a 20% discount on that amount. For those who want to buy it, it is already on sale throughout the country, in bookstores of all Students’ Associations of Medical Schools and directly through Prime Books. As of March 2021, it will enter the global book market.