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The new frontier of studying human anatomy: Introducing evidence‐based anatomy

While many medical disciplines have recognized the need for evidence-based data, clinical anatomy remains largely based on observations from single epidemiological-type studies that are rarely standardized reporting (Tomaszewski et al., 2017). Most reviews in clinical anatomy are narrative in nature: the bulk of anatomical literature consequently lacks the statistical power that would permit extrapolation to whole populations. We propose that evidence-based research principles and techniques should be applied to clinical anatomy (Standring, 2012; Henry et al., 2016). Evidence-Based Anatomy (EBA) relies on two complimentary components. First, EBA aims to enhance the quality of original anatomical research by standardizing and improving reporting in clinical anatomy studies (Tomaszewski et al., 2017). To this end, an international team of world-renowned anatomists, anatomical journal editors, and editors of anatomical texts and atlases, organized by the International Evidence-Based Anatomy Working Group (iEBA-WG), created the Anatomical Quality Assurance (AQUA) Checklist, to provide standardized reporting guidelines for original anatomical studies. The AQUA checklist enables reporting of methodology and results that is both reproducible and unambiguous (Tomaszewski et al., 2017). These guidelines will help to increase the internal validity of anatomical studies and enhance consistency in reporting of quantitative and qualitative data. The AQUA Checklist was designed to be applicable to all forms of anatomical research, including cadaveric, imaging, and intraoperative studies. Second, EBA employs systematic reviews (SR) and metaanalyses (MA) to provide high level assessment of primary research. It aims to synthesize more accurate, evidencebased data in order to improve clinical practice and enhance understanding of the human form (Standring, 2012; Henry et al., 2016). The AQUA Tool was designed by the iEBA-WG and its international collaborators to assess risk of bias in studies included in anatomical SRs/Mas (Henry et al., 2017b). It aims to evaluate the quality and reliability of anatomical studies on which our understanding of a particular human structure is based. Through EBA, data obtained from thousands of subjects can be analyzed and associations between anatomy and variables such as age, race, sex, side, laterality, or pathology can be evaluated. Moreover, inferences about prevalence and variation can be drawn that would not be deducible from single studies with small sample sizes (Henry et al., 2017a). It is hoped that novel insights gained from such analyses will translate into improved preoperative planning, safer procedures, reduction in the incidence of iatrogenic injuries, and more accurate interpretation of imaging examinations. Data from EBA should be incorporated into anatomical education curricula at both undergraduate and postgraduate level.