Nerve Surgeons' Assessment of the Role of Eduard Pernkopf's Atlas of Topographic and Applied Human Anatomy in Surgical Practice.

(Reprinted with permission from NEUROSURGERY, Volume 84, Number 2, February 2019).

Nerve Surgeons' Assessment of the Role of Eduard Pernkopf's Atlas of Topographic and Applied Human Anatomy in Surgical Practice.

BACKGROUND: Pernkopf's atlas of Anatomy contains anatomical plates with detailed images of the peripheral nerves. Its use is controversial due to the author's association with the "Third Reich" and the potential depiction of victims of the Holocaust. The ethical implications of using this atlas for informing surgical planning have not been assessed. OBJECTIVE: To (1) assess the role of Pernkopf's atlas in nerve surgeons' current practice and (2) determine whether a proposal for its ethical handling may provide possible guidance for use in surgery and surgical education. METHODS: Members of American Society for Peripheral Nerve and PASSIO Education (video-based learning platform) were surveyed and 182 responses collected. The survey introduced the historical origin of Pernkopf's atlas, and respondents were asked whether they would use the atlas under specific conditions to serve as a recommendation for its ethical handling. An anatomical plate comparison between Netter's and Pernkopf's atlases was performed to compare anatomical accuracy and surgical utility. RESULTS: Fifty-nine percent of respondents were aware of Pernkopf's atlas, with 13% currently using it. Aware of the historical facts, 69% were comfortable using the atlas, 15% uncomfortable, and 17% undecided. Additional information on conditions for an ethical approach to the use of the atlas led 76% of those "uncomfortable" and "undecided" to becoming "comfortable" with use. CONCLUSION: While the use of Pernkopf's atlas remains controversial, a proposal detailing conditions for an ethical approach in its use provides new guidance in surgical planning and education.

Medical Students' Assessment of Eduard Pernkopf's Atlas: Topographical Anatomy of Man.

INTRODUCTION: To date, there has been no study examining the perceptions of first-year medical students regarding Eduard Pernkopf's atlas, particularly during their study of gross anatomy and prior to coursework in medical ethics. We present a discussion of Pernkopf's Atlas: Topographical Anatomy of Man from the perspective of U.S. medical students, and sought to determine whether medical students view Pernkopf's Topographical Anatomy of Man as a resource of greater accuracy, detail, and potential educational utility as compared to Netter's Atlas of Human Anatomy. METHODS: The entire first-year class at Drexel University College of Medicine (265 students) was surveyed at approximately the midpoint of their gross anatomy course and 192 responses were collected (72% response rate). RESULTS: Of these, 176 (95%) were unaware of the existence of Pernkopf's atlas. Another 71% of students found the Pernkopf atlas more likely complete and accurate, whereas 76% thought the Netter atlas more useful for learning (p<.001). When presented with a hypothetical scenario in which the subjects used in creating Pernkopf's atlas were donated, or unclaimed, but with knowledge that Pernkopf was an active member of the Nazi party, 133 students (72%) retained their original position (p=.001). About 94% desired discussion of Pernkopf within a medical school bioethics course. The relationship between level of self-reported knowledge and whether or not students would advocate removal of the atlas was statistically significant (p=.013). CONCLUSION: Discussing ethical violations in medical history, especially the Pernkopf atlas, must attain a secure place in medical school curricula, and more specifically, within a bioethics course.

The Plastic Surgeon as Employee: A Pilot Survey of the California Society of Plastic Surgeons.

INTRODUCTION: Plastic surgeons endure years of training yet remain poorly equipped to negotiate first employment contracts. Our aims were to evaluate typical plastic surgeon employment contracts and assess contract comprehensiveness. We sought elements that should be included to better preserve varied interests. METHODS: A brief, anonymous, e-mailed survey was sent to California Society of Plastic Surgeons members and responses collected over 2 months. We collected information such as years in practice, geographic area, types of practices and number of surgeons within them, and legal standing of partnerships. We asked whether respondents sought legal assistance and specific elements were elaborated. We asked how content they were with their contracts while allowing commentary. RESULTS: Our survey generated 113 responses. 50.0% of respondents reported being in practice for at least 20 years; 2.68% had been in practice for up to 5 years. 62.5% reported being in private practice and 27.7% reported being in academia. In-state geographic distribution of respondents accounted for 85.6%, whereas 14.4% reported practicing out-of-state.Practice size was diverse, with 41.4% of respondents having worked in a group practice of 3 or more, 27.9% in partnership, and 23.4% in solo practice. For partnerships, 29.9% had made formal legal arrangements, whereas 20.6% had made informal arrangements. 74.5% of respondents did not seek legal assistance.Malpractice coverage varied from 51.6% with claims-made, to 21.7% with tail, to 33.0% with no coverage at all. 63.9% reported having no group disability policy. 26.4% reported annual income of less than US $100,000; 49.1% reported US $101,000 to US $200,000; 17.9% reported US $201,000 to US $300,000; 6.60% reported greater than US $300,000. Using a 5-point scale, 7.69% of respondents reported being "extremely dissatisfied" with their first employment contracts (score of 1), whereas 24.0% were "perfectly happy" (5).Eighty-two respondents offered advice. Common themes included seeking legal counsel; considering eventual solo practice; planning long-term; seeking mentorship; and cautioning against third party interests. CONCLUSIONS: New plastic surgeons will find themselves employed by institutions. Seeking attorneys familiar with the profession is advisable. Lack of awareness regarding malpractice options and disability coverage are 2 areas of concern. We reveal critical contract elements that surgeons should negotiate to ensure smooth transition to practice.