Why we puthands on abody in thesecond week

The usual sequence is to teach a region thoroughly and then, once the student knows the anatomy, to teach them to feel it. It is a reasonable-sounding order. We do the opposite, and we have done since 2007.

What goes wrong with the usual order

A student who has spent six weeks learning the anatomy of the lumbar spine arrives at the treatment table already knowing what is there. That sounds like an advantage. It is not.

They palpate, and what they report is the diagram. They find the transverse process where the book put it. They describe a texture they were told to expect. The knowledge has arrived before the sensation and it colours everything after it.

The problem is not that they are lying. They genuinely feel it, in the same way that everyone genuinely sees the face in the electrical socket.

What we do instead

In the second week of year one, before the lumbar course has properly started, students palpate with their eyes closed and describe what they find in ordinary language. Not names — descriptions. Harder here than there. A ridge running this way. Something that moves when I press and something that does not.

They are bad at it, and it is uncomfortable, and that is the point. They are building a vocabulary for sensation that is not borrowed from a diagram.

The anatomy arrives two or three weeks later and lands on top of something. Students say a version of the same thing every year: so that was what I was feeling.

The cost

It is slower for the first term and it makes the first assessment look worse. Students who came from a science baccalauréat find it particularly frustrating, because their usual strategy — learn the material, reproduce it — does not work on a question that has no right answer written down anywhere.

By the middle of year two the difference is not visible in the marks. It shows up in year three, in the clinic, when a patient presents with something that does not match any diagram and the student has to describe what their hands are actually finding.

That is the whole argument. It is not about learning styles. It is about not teaching people to hallucinate confirmation.