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Clemente's Anatomy

Dr. Carmine D. Clemente – a fixture at UCLA for more than 50 years – literally wrote the book on modern anatomy, and he continues to help chart the direction of the discipline into the 21st century.
- By David Geffner

THUMB THROUGH ANY DICTIONARY and the definition of anatomy usually centers on the “structure” of living things. Certainly, the 16th-century Flemish physician Andreas Vesalius, whose intricately detailed illustrations of dissected cadavers dared to break with the ancient Greek anatomist Galen and earned him the title “father of modern human anatomy,” wouldn’t quibble with that. But “anatomy” – from the Greek ana, up or through, and tome, a cutting – has, like medicine itself, been dissected into so many specialized branches that any mention today of framework without clinical relevancy is unlikely.

UCLA has a lot to do with that. Anatomy’s current role in medical education traces back to a handful of UCLA scientists who sought to link structure and function within that most complex of machines: the human body. In the school’s early years in the 1950s, department chair Dr. Horace Magoun was embracing anatomical advances like electron microscopy and radiobiology, establishing a forward momentum that still thrives today. One visit to anatomy’s new integrative-design center, where an entire human skeleton is being created with 3-D computer animation, reveals the future is happening right now at UCLA.

Dr. Carmine Clemente - educator, author, researcher, emeritus professor of anatomy and neurobiology at UCLAAs for those anatomy pioneers still on campus, one name stands out. Dr. Carmine D. Clemente had just received his Ph.D. from the University of Pennsylvania when Dr. Magoun asked him to come to Westwood five decades ago. How essential has this 79-year-old educator, author and researcher remained to both the David Geffen School of Medicine at UCLA and to the broader medical community? Last year, Dr. Clemente received the Association of American Medical Colleges Alpha Omega Alpha Distinguished Teacher Award, even though he technically retired 13 years ago. (Dr. Clemente is an emeritus professor of anatomy and neurobiology and has been annually recalled to teach first-year students. His 1973 book, Anatomy: A Regional Atlas of the Human Body, is one of two revered anatomical texts, the other being Gray’s Anatomy, whose U.S. edition was given an overhaul by Dr. Clemente in 1985.)

There is also the series of 42 short films on dissection Dr. Clemente created with two UCLA students in the early 1960s, and the more than 200 papers published along the way. From 1976-1987, Dr. Clemente was the director of UCLA’s Brain Research Institute, and he also lays claim to being the first medical educator at UCLA to create lecture notes for his students (back in 1980). He taught anatomy to surgical residents at King/Drew Medical Center every Monday evening for 36 years, and has presided over the American Association of Anatomists, the premier organization of both clinical and research anatomists. A more impressive list of medical benchmarks can’t be found but rattling off career highlights only makes this cheerful scientist blush. After all, Dr. Clemente is still busy helping UCLA redefine the boundaries of anatomy.

“The first day I came here was memorable, but for all the wrong reasons,” he says with a sly grin while seated in his office in the Center for the Health Sciences. “I had driven 3,000 miles from Philadelphia, expecting to start work at this vast medical complex. When I came down Wilshire Boulevard, all I saw was the old VA Hospital. The lady at the front desk there said she was unaware UCLA had a medical school!” When a resident in whites said he thought one had started up near Bullocks, the young post-doc thought, “Oh, my goodness, what have I gotten myself into if a department store is more well-known than the medical school?” In 1952, the medical center Dr. Clemente imagined would change his life turned out to be little more than an old Army Quonset hut. “My heart just sank,” he remembers. “Dr. Magoun could see I was disconsolate, so he took me over to a window and pointed to this enormous hole in the ground with steel girders. ‘Now don’t you worry, my boy,’ he smiled. ‘We’ll have some space for you at UCLA.’” Like his new boss, and most of his colleagues, Dr. Clemente’s interest in anatomy stemmed from his passion for brain research. His dissertation was on the regeneration of nerve fibers in the spinal cords of adult mammals, and much of his early research focused on the transplantation of neural tissue in the human central nervous system. He remembers how Dr. Magoun was often teased about having the finest collection of neurophysiologists ever seen in a department of anatomy. “We had three areas to teach in those days,” Dr. Clemente recalls. “Neurology, microscopic and gross anatomy. Since there were so many neuroscientists, the need was for gross anatomists, and that’s where I went. I loved getting to know the first-year students. Gross anatomy is the first time they get to know their own bodies.”

Illustration Skeleton courtesy of Drs. Shelley Mettern and Jonathan WiscoDISSECTION OF AN EMBALMED HUMAN CADAVER and its subsequent observation with the unaided eye – i.e., gross anatomy – is at the core of medical education, and Dr. Clemente brought modern technology into the teaching process. “We used to demonstrate with a prosected specimen (a body already dissected by a faculty member), with only a portion of the class at the table,” he recalls. “Two of my students, Herb Harwick (M.D. ’64) and Lou Mahoney, came to me with the idea of making dissection films as study aids. Lou was one of the best dissectors in the class, and Herb had an uncle in Hollywood who knew lighting. I edited all the films, which were 10 minutes long and in color, and added the voice-overs. By the time we finished, they were in 171 schools around the world!”

Dr. Clemente credits his popularity at UCLA to “having made a nice book with really good pictures.” But Dr. Charles Slonecker, a former chief of anatomy at the University of British Columbia and a past president of the American Association of Anatomists, says Dr. Clemente’s teaching aids stand alone. “Carmine resurrected the old Sobotta drawings, which were used in Germany many years ago, and grouped them by regions of the body,” Dr. Slonecker notes. “He had a genius for knowing what plates to include in his book and how to present the material in a clear and relevant way.”

The 2006 recipient of the Glaser Award (the highest-paying honor in education) also maintained a lifelong respect and empathy for his students. Dr. Clemente tells a story about a first-year dental student from the former Soviet Union who, upon entering his grossanatomy lab, began weeping uncontrollably at the sight of so many cadavers. “I gently took the young woman into the hallway and patiently explained about the willed-body program Dr. Magoun had begun in the 1950s,” he recalls, “and how each specimen was a public- spirited citizen who voluntarily willed his or her body toward science. I urged her to go home, and return when she was ready. I promised to help her through the dissection process until she was comfortable.” Dr. Clemente says the young woman was still emotional when she came back. But in a few weeks she became one of the best dissectors in the class, and today she is a dentist.

Listening to how students want to be taught is a legacy Dr. Clemente passed down to the current anatomy faculty. His former student, Dr. Robert Trelease, was the first professor in the medical school to use computer presentations, employing a 3-D animation of a surgical repair of a cleft palate to instruct residents more than 20 years ago. Dr. Trelease, who once ran the anatomy program, talked about the benefits of dissection in the context of computer teaching aids in a 2002 Newsweek article about UCLA medical school’s embrace of high technology.

Like Dr. Clemente with his dissection movies four decades ago, and Dr. Trelease with his PowerPoint presentations to teach anatomy years before the technique became commonplace, Dr. Shelley Metten, vice chair of programmatic instruction and director of the Division of Anatomy for the Department of Pathology and Laboratory Medicine, knew when she took over the program three years ago that technology was the key to keeping her students engaged. A switch to a system-based curriculum, which distributes anatomy instruction throughout the first year according to the body system being studied, meant lab time, already half of what it was when Dr. Clemente was chair of the department, would be halved again, and Dr. Metten needed something new to motivate her students. “This generation is more likely to review study materials on a computer than to read an assigned chapter in a book,” she explains. “We hired professional animators to create computer-based 3-D study materials, and then completely redesigned the lab experience.”

Dr. Metten says in a typical anatomy class, one-third of the students take to dissection, one-third are neutral and the remaining third would rather be somewhere else. It was that last third she wanted to reach. She made the decision to provide each anatomy group of five students an already-dissected cadaver to study. “Having students work with bodies that have already been dissected for them was a big change but it fit well with the way the medical school has evolved into a system-based curriculum,” she notes. “It allowed us to have groups of five students interacting with the computer material that related directly to what they saw on their tables. The end result was more lab time learning anatomy.”

HELPING TO IMPLEMENT DR. METTEN’S CHANGES was neuroanatomist Dr. Jonathan Wisco, fresh off a postdoctoral fellowship at Massachusetts General Hospital that featured high-resolution structural imaging. For the past two summers, Dr. Wisco asked second-year students to voluntarily come in and pre-dissect specimens for the incoming class. “The only aspects of a traditional anatomy course that have been removed for the first-year students are the laborious tasks of creating skin fl aps, clearing fat and defining structures,” Dr. Wisco notes. ”Using the prosections and new interactive computer materials, every student is palpating structures and learning the moment he or she walks in the door.” Radiology has been another new area of integration. Under the direction of Dr. Michael Zucker, emeritus professor of radiology, first- and second-year students now learn anatomy through hightech clinical-imaging techniques, like CT scanning, MRI and ultrasound. “Dr. Metten had been talking to LuAnn Wilkerson [dean of medical education] to see how we could introduce radiology early on in the curriculum, given how integral it’s become to all specialties of medicine,” Dr. Zucker notes. “Students in the past could enter their residencies with little or no exposure to radiology, but that’s just not acceptable these days. Imaging technology has revolutionized the way medicine is practiced.”Dr. Zucker says anatomy and radiology complement each other to such a degree that the teaching track is parallel. “We introduce first-year students to the different modalities – CT, MRI, plain film, etc.,” Dr. Zucker points out. “And they correlate the scans with what they see in the gross lab. In the second year, they correlate each modality [of radiology] with specific body pathologies.”

Dr. Zucker, who has taught radiology at UCLA since 1990, says in his day, anatomy was mainly geared toward future surgeons, who would use their skills for specific, but limited, areas of the body. “What’s so essential about this program is that physicians today need to know more anatomy than we ever did. Even if they’re not the primary interpreters, they’re ordering up scans and talking with the radiology lab and patients. We can now see more of the body than we ever could, and that means knowing more anatomy.”

Drs. Metten, Zucker, Wisco and Trelease all say Dr. Clemente’s presence on campus will help add to the new curriculum’s success. Whether it’s bringing a dermatologist into the gross lab to supervise first-year students doing skin biopsies (later integrated in histology lab) or teaching third-year OB/GYN clerkships how to dissect the pelvis, Dr. Clemente has, in Dr. Metten’s words, been a “guiding infl uence.” Prominent anatomists outside UCLA, like Dr. Slonecker, agree. “Not only can Carmine still identify where the need for anatomy in education is greatest, but he also remains at the cutting edge of how the science stays relevant to training future doctors.” Dr. Slonecker says Dr. Clemente has led the charge to reacquaint surgical residents with basic anatomy, while also directing the move toward clinical integration in the introductory years. “This field is filled with competitive personalities, but Carmine is warm and congenial with everyone,” adds Dr. Slonecker. “It’s obvious why each new generation loves him.”

DR. CLEMENTE’S COLLEGIAL PERSONALITY is never more apparent than when he’s showing off his office library. As he threads through stacks of antiquarian texts, his passion for anatomy, and teaching, rings clear. “The Sobotta figures I was presented with [to create A Regional Atlas of the Human Body] were superb and timeless,” he says, fingering the most recent version of his own primer. “And this,” Dr. Clemente sighs, holding up the U.S. version of Gray’s Anatomy he edited some 20 years ago (based upon the original 1858 version by British anatomist Henry Gray, created for an audience of medical students and physician-surgeons), “was a true labor of love. Every single paragraph was brought up to date.”

3-D skeleton courtesy of Drs. Shelley Metten and Jonathan WiscoShifts in medicine have altered anatomy’s emphasis over the years, prompting many to decry “love’s labors lost.” Dissection has been truncated, and basic sciences like biochemistry, physiology and anatomy have taken a back seat to clinical problem solving. Dr. Clemente, who says his last great goal in anatomy is to help Dr. Metten shepherd UCLA through its current wave of change, calls the progression a natural one. He says that unlike when he began his teaching career (where first-year students would spend 300 hours a year in the gross lab), anatomy’s role today is to create a language-base for clinical medicine. It’s a way for students to verbalize what they will one day diagnose and treat, as well as a means to reintroduce to young doctors, about to finish their medical- school experience, the specific anatomy that will impact their upcoming residencies.

“Times change,” Dr. Clemente says philosophically, “but younever have to apologize about teaching the human body to medical students.” He leans forward, touching a spot where his right wrist meets the base of his hand. “You know there are three major nerves that feed into the hand, and they spread into many different branches. If you feel at the end of the radius, and go down the size of a half dollar, you’ll find the recurrent branch of the median nerve. It supplies the muscles of the thumb. The median nerve goes through a carpal tunnel, and the recurrent branch often gets injured. This can really be a problem. Just try picking up a pencil without the use of your thumb.” He pauses, and his face lights up. “When students see this median nerve with their own eyes, they are astounded. They had no idea how complex this tiny part of their bodies could be. Neither did I, until I began to study anatomy.”

David Geffner is a freelance writer in Los Angeles. * Photograph by David Miezal

 





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