Anatomy is the very foundation of surgical practice. For centuries, it has equipped surgeons to understand the human body, plan surgical operations, and manage surgical pathology with safety and precision. Simply put, surgery relies on understanding anatomy—diagnosis, technique, and evaluation are all closely tied to anatomical knowledge. The intercollegiate Membership of the Royal Colleges of Surgeons (MRCS) examination recognizes this by making surgical anatomy a central theme. Candidates must be able to not only recall detailed spatial relationships, but must be able to apply this knowledge in clinical scenarios.
Unlike some other specialties that focus on biochemical or pharmacological frameworks, a surgeon’s practice relies almost entirely on their understanding of anatomy. Safe dissection, gentle tissue handling, and operative planning rely on an accurate identification of anatomical structures. Every stage of safe surgery depends on this understanding. The planning of a skin incision requires recognition of surface anatomical landmarks and underlying anatomical structures. During surgical exposure, a surgeon must anticipate the planes of dissection, anatomical variations, and nearby structures that might be at risk. Control of surgical complications such as bleeding necessitates precise identification of vessels and their branches or tributaries, while plastic reconstruction of anatomy requires an appreciation of tissue vascularity and biomechanics. Complications, when they occur, are often the result of an inadequate understanding or appreciation of anatomical nuances. Thus, anatomy is not merely an academic subject, but a safeguard for patient safety and a determinant of operative success.
In the modern era, surgical education has undergone a profound transformation with the advent of imaging, simulation, and minimally invasive techniques. Nevertheless, anatomy remains unchanged as the foundation upon which new technologies are applied. Minimally invasive surgery such as laparoscopic and robotic surgery, for example, demand even greater understanding of three-dimensional anatomical relationships and orientation, often with limited tactile feedback. In trauma and emergency surgery, rapid decisions based on anatomical judgment often determines the difference between life and death. In short, the central role of anatomy at the heart of surgical training reflects its ever present relevance.
Anatomy in the MRCS Examination
The intercollegiate MRCS examination, conducted by the four surgical Royal Colleges of the UK and Ireland, serves as a benchmark for the progression of surgical trainees. Its purpose is to ensure that all candidates possess the knowledge, skills, and professional attributes required for safe progression into higher surgical training. Among its core domains, anatomy occupies a prominent place.
Structure of Assessment
In the (written), anatomy is tested through single-best-answer multiple choice questions in two areas – applied basic sciences and principles of surgery in general. These questions are designed not simply to assess rote memorization but to examine the candidate’s ability to integrate structural detail with clinical relevance. Topics include the surgically applied regional anatomy of the whole body (, and ) including relevant surface anatomy and cross-sectional anatomy as related to modern imaging, with a focus on important anatomical relationships, and the application to common operative approaches at this level.
In the (objective structured clinical examination), anatomy is further assessed in a practical format. Candidates may be asked to identify structures on images of prosections, bones and models, interpret radiological images, demonstrate surface anatomy on living models, or explain the consequences of surgical injury to specific structures. This multimodal assessment underscores the applied and clinically relevant nature of anatomical knowledge.
Educational Rationale
The prominence of anatomy in the MRCS reflects several important aspects of safe surgical care:
- Patient Safety – Ensuring that surgeons in training can avoid harm through precise anatomical understanding.
- Operative Competence – Equipping trainees with the knowledge required to perform procedures competently and confidently.
- Clinical Correlation – Encouraging integration of anatomy with physiology, pathology, clinical presentation and radiology to reflect real-world surgical practice.
- Foundation for Lifelong Learning – Providing a framework upon which more advanced, specialty-specific anatomy can be built in higher surgical training.
Thus, the MRCS does not view anatomy as an isolated subject but as a living body of knowledge that needs to be continually applied and refined.
Surgical examiner’s perspective
From an examiner's perspective, attending the MRCS Anatomy Examiner Training Day at the Royal College of Surgeons of Edinburgh, part of the College’s , reinforced the critical importance of anatomy in surgical assessment. Observing the examination team, led by Kirsten and Amanda, along with Professor Ross Jones (Course Director) and Emeritus Professor Gordon Findlater, highlighted the depth of expertise and commitment brought to anatomical teaching. The goal of the training day was to revisit and review the breadth and depth of anatomy knowledge required by candidates for the MRCS OSCE, particularly in relation to those regions of anatomy outside the examiners’ own day-to-day specialty interests.
My prior experience as an anatomy demonstrator, which involved teaching and anatomical prosections, served as a reminder of the importance examiners place on practical, applied anatomical knowledge for safe surgical practice.
The way forward
Anatomy is indispensable to the training and practice of safe surgery. It underpins every aspect of operative care, from incision to closure, and remains the ultimate safeguard against iatrogenic harm. The MRCS examination, by giving anatomy such prominence, reflects its status as a core competence for safe surgical practice. Mastery of anatomy is not an academic hurdle but a professional necessity for all those involved - surgeons in training, surgeons in practice and surgical examiners!
The Wade Programme in Surgical Anatomy
was established by the Royal College of Surgeons of Edinburgh (ºìÐÓÊÓƵ) in 2012 to support the study of surgical anatomy throughout surgical training, from undergraduate study to consultant practice. More information about the programme and its educational foundation can be found in the following online publication: .
Authors
Mr. Lasitha B Samarakoon BS BM MºìÐÓÊÓƵ MMed ChM FFSTEd FEBS FRCSGlasg FºìÐÓÊÓƵ
Consultant General Surgeon. University Hospitals of Leicester NHS Trust, Leicester, United Kingdom.
Ross A. Jones BSc MSc PhD MBA MBChB MRCS FAS
Professor of Anatomy. The Royal College of Surgeons of Edinburgh, Edinburgh, United Kingdom.