OPERATIVE SURGERY AND TOPOGRAPHIC ANATOMY: A CRISIS OF TEACHING, THE NATURE OF A DISCIPLINE, AND THE HORIZON OF WHAT LIES AHEAD

INTRODUCTION. The teaching of operative surgery and topographic anatomy is undergoing a systemic crisis driven not by a shortage of educational materials but by a loss of conceptual clarity regarding the very nature of the discipline – its subject matter, its method, and its place within medical education.

AIM: to define the discipline as a unified epistemological tradition originating with Pirogov; to analyse the historical causes of the dissolution of the original synthesis between topographic anatomy and operative surgery in Russian medical schools; and to substantiate the principles underlying a contemporary curriculum appropriate to both the classical content of the subject and the technological horizon of surgery in the coming decades.

MATERIALS AND METHODS. Historico-epistemological analysis of the discipline's formation; comparative analysis of three international models of teaching (French, German, and Hispanic-Argentine); conceptual analysis of the relationship between descriptive anatomy, topographic anatomy, and operative surgery as distinct types of medical knowledge; development of a structured curriculum for medical specialty 31.05.01 (General Medicine), year 4.

RESULTS AND DISCUSSION.The discipline is defined as a system of anatomical justification for the surgical method of treatment. Three historical vectors of synthesis degradation are identified: administrative separation of the subject's components, displacement to earlier years of study, and the disappearance of the clinical anatomist as the distinctive professional subject of teaching. The centrality – rather than peripherality – of variant anatomy in curriculum design is substantiated. It is shown that robotic and navigational surgery does not reduce but intensifies the demands placed on anatomical reasoning. An eight-module curriculum (324 hours) is developed, implementing the principle of the inseparability of topographic anatomy and operative intervention.

CONCLUSION. The crisis in teaching this discipline is epistemological, not methodological. Its resolution requires the restoration of the language of reasoning – from anatomical fact to surgical inference – as the primary language of both teaching and educational texts.

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