Sticking to Traditions

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LETTER TO THE EDITOR

Sticking to Traditions: Anatomy Education and Research in Pakistan

To the Editors, Anatomical Sciences Education: The last two decades have seen astounding advancements taking place throughout the life sciences, including anatomy. Arguably, this is the result of overcoming the dogmatic and bureaucratic divisions between subjects and utilizing an interdisciplinary approach (NRC, 2009; Sharp et al., 2011). The integration of molecular biology, bioinformatics, molecular evolution, and genetics with anatomical sciences substantially hones our understanding of normal and abnormal anatomy to a much finer resolution than ever previously conceived (Ko, 2001; Bard, 2005 ; McMahon et al., 2008). This integrative approach is so profound that new subdisciplines of anatomy, such as anatomics, have been proposed (Bard, 2005). Broadly speaking, the discipline of anatomics focuses on the development of anatomical knowledge within computer-based resources, namely bioinformatics (Bard, 2005). With this new subdiscipline of anatomy at work, it is not surprising that recent editions of anatomy, histology, and embryology textbooks are often laced with information gathered from the fields of genomics, cell, and molecular biology, and modern imaging techniques (Drake et al., 2015; Pawlina, 2015; Sadler, 2015). However, this approach to the anatomical sciences may not be well appreciated in most medical education institutes in Pakistan. Currently, there are 135 medical and dental institutes in Pakistan, both public and private, which are accredited by the regulatory body known as the Pakistan Medical and Dental Council (PM&DC, 2015). Needless to mention, all of these institutes teach human anatomy as a major component of their medical curricula, and many of them offer postgraduate research programs for masters (M.Phil.) and doctoral (Ph.D.) degrees in anatomy. By and large, a nation’s academic training programs drive the nature and quality of its research and scientific achievements, which in turn are manifested in terms of research publications. Based on this notion, we reviewed all medical research journals published nationwide in Pakistan and approved by the Pakistan Medical and Dental Council, the conAdditional Supporting Information may be found in the online version of this article. *Correspondence to: Dr. Mushtaq Hussain, Bioinformatics and Molecular Medicine Laboratory, Dow Research Institute of Biotechnology and Biomedical Sciences, Dow University of Health Sciences, Ojha Campus, Suparco Road, Karachi-75280, Pakistan. E-mail: [email protected] Received 15 July 2015; Accepted 31 July 2015 Published online 00 Month 2015 in Wiley (wileyonlinelibrary.com). DOI 10.1002/ase.01562 C 2015 American Association of Anatomists V

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tents of which are available online until June 2015 (PM&DC, 2015). From a total of 20,358 articles, we determined that the subject of anatomy constituted a very small proportion of the medical research produced in Pakistan (see Supporting Information). Of these 20,358 published papers, only 189 (approximately 1%) were affiliated with anatomy departments from the different medical institutes of the country. Of these, most were based on various histological findings related to animal models subjected to different chemical agents (n 5 86; approximately 45%). Our review did not find any studies related to comparative anatomy or comparative embryology. In contrast to the publications found in the subject (anatomy) specific international journals, our nationally published research in anatomy seems to lack an integrative approach with molecular biology and genetics. There is thus a noticeable paucity with regards to Pakistani-driven research questions in the field of anatomy. Consequently, the total research output of Pakistani anatomists is proportionally outnumbered when compared to other allied medical sciences. Why aren’t anatomists in Pakistan using the tools and approaches of modern day genetics and molecular biology in their research? Perhaps the answer lies in the manner anatomy is currently taught in the country’s medical institutions. Few Pakistani anatomists hold Ph.D. degrees in these respective fields (Memon, 2009), and the current breed of anatomy faculty in most medical institutes in Pakistan are not trained to incorporate the molecular context of anatomy in their teaching. A better understanding of genetics and molecular biology can be profoundly insightful in any anatomy curriculum, especially when dealing with embryological and congenital anatomical anomalies (Ko, 2001; McMahon et al., 2008). Indeed, most of the recent editions of the currently utilized embryology textbooks are laced with such content (Sadler, 2015). However, these sections are not emphasized, and in most cases they are not discussed during teaching sessions, thus rendering them seemingly irrelevant to students. This results in a perpetual cycle of apprehension and alienation among medical graduates when it comes to such subjects as molecular biology, bioinformatics, genomics, and genetics. This gap may further widen over time and become more conspicuous among anatomists, particularly as the nature of their teaching and research becomes more focused on traditional anatomical education. Furthermore, research initiatives which may be designed to bridge this gap between conventional anatomy and other contemporary fields will have to work even harder to overcome such growing barriers between disciplines. This limits the necessary motivation required to pursue the adoption of an interdisciplinary approach to anatomy education and research. The current picture of anatomy education and research in Pakistan demands immediate attention to correct these shortcomings. Anat Sci Educ 00:00–00 (2015)

We suggest that one method of tackling these problems is to organize workshops, refresher courses, and seminars to allow the current and future anatomists of Pakistan to develop a better working understanding of molecular biology and genetics pertinent to their field. Further, cross-disciplinary efforts could be organized for anatomists to engage in research with broader interdisciplinary themes. Nazia Shahab, M.B.B.S. Department of Anatomy Dow International Medical College Dow University of Health Sciences Karachi, Pakistan Khalida Perveen, M.B.B.S., M.Phil. (Anat.) Department of Anatomy Dow International Medical College Dow University of Health Sciences Karachi, Pakistan Mushtaq Hussain, Ph.D. (Gen., Genom., Syst. Med.)* Bioinformatics and Molecular Medicine Laboratory Dow Research Institute of Biotechnology and Biomedical Sciences Dow University of Health Sciences Karachi, Pakistan

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LITERATURE CITED Bard JB. 2005. Anatomics: The intersection of anatomy and bioinformatics. J Anat 206:1–16. Drake RL, Vogl AW, Mitchell AWM. 2015. Gray’s Anatomy for Students. 3rd Ed. Philadelphia, PA: Churchill Livingstone Elsevier Inc. 1192 p. Ko MS. 2001. Embryogenomics: Developmental biology meets genomics. Trends Biotechnol 19:511–518. McMahon AP, Aronow BJ, Davidson DR, Davies JA, Gaido KW, Grimmond S, Lessard JL, Little MH, Potter SS, Wilder EL, et al.; GUDMAP Project. 2008. GUDMAP: The genitourinary developmental molecular anatomy project. J Am Soc Nephrol 19:667–671. Memon IK. 2009. Anatomy education faces challenges in Pakistan. Anat Sci Educ 2:193–194. NRC. 2009. National Research Council. A New Biology for the 21st Century. 1st Ed. Washington, DC: The National Academies Press. 112 p. URL: http://download. nap.edu/cart/download.cgi?&record_id512764 [accessed 7 July 2015]. Pawlina W. 2015. Histology, Text and Atlas with Correlated Cell and Molecular Biology. 7th Ed. Philadelphia, PA: Wolters Kluwer Health. 984 p. PM&DC. 2015. Pakistan Medical & Dental Council. The Statutory Regulatory & Registration Authority for Medical & Dental Education and Practitioners for Pakistan. Islamabad, Pakistan: Pakistan Medical & Dental Council. URL: http://www.pmdc.org.pk/MedicalandDentalColleges/tabid/333/Default. aspx [accessed 10 June 2015]. Sadler TW. 2015. Langman’s Medical Embryology. 13 Ed. Philadelphia, PA: Wolters Kluwer Health. 424 p. Sharp PA, Cooney CL, Kastner MA, Lees J, Sasisekharan R, Yaffe MB, Bhatia SN, Jacks TE, Lauffenburger DA, Langer R, et al. 2011. The Third Revolution: The Convergence of the Life Sciences, Physical Sciences, and Engineering. 1st Ed. Washington, DC: Massachusetts Institute of Technology. 34 p. URL: http://web.mit.edu/dc/policy/MIT%20White%20Paper%20on%20Convergence. pdf. [accessed 7 July 2015].