Resident and faculty experiences of an integrated anatomy curriculum in general and orthopedic surgery: a qualitative study of specialty alignment and psychological safety

Clinical anatomy is widely regarded as a precondition of safe operative practice, yet formal instruction usually ends in the preclinical years, leaving a prolonged interval before residents assume operative responsibility. An integrated clinical anatomy curriculum shared by General Surgery and Orthopedic Surgery residents was implemented over one academic year at a single university-affiliated teaching hospital in Tehran, Iran. This qualitative study explored how residents and faculty experienced that curriculum and the learning environment in which it was delivered. A qualitative descriptive design within an interpretivist paradigm was used. Twenty individual semi-structured interviews were conducted with 8 residents (4 General Surgery, 4 Orthopedic Surgery, one per postgraduate year PGY1–PGY4) and 12 faculty members (4 orthopedic surgeons, 4 general surgeons, 4 clinical anatomists) during the eight weeks following completion of the first full curriculum cycle and its end-of-course OSCE. Interviews were conducted in Persian, audio-recorded and transcribed verbatim; only reported quotations were translated into English with independent back-translation. Transcripts were analyzed using codebook thematic analysis with a hybrid inductive–deductive orientation. Dataset adequacy was appraised using information power rather than saturation. Reporting follows COREQ (Additional file 1); the interview guides and the final coding framework are provided as Additional files 2 and 3. Six themes were developed. Participants across groups described anatomy as a perceived precondition of operative safety and reported an estimated five- to seven-year interval since preclinical teaching. General surgery residents perceived the shared content as weighted toward orthopedics; orthopedic residents did not raise a reciprocal concern, and the demand for deeper limb and joint coverage came from orthopedic faculty rather than from orthopedic residents. Residents described post-call fatigue, unprotected academic half-days and inter-hospital commuting as constraints on participation, whereas faculty described the same conditions as delivery problems and emphasised the absence of any national reference curriculum. Cadaveric prosection, case-based Integrated Clinical Morning Report (ICMR) sessions and surgeon–anatomist co-teaching were the most positively described components. Assessment comments concerned the perceived clarity, timing and authenticity of the OSCE rather than its measured validity. Residents and faculty described hierarchy and embarrassment as inhibiting elementary anatomy questions, with small-group and case-based settings perceived as comparatively safer. Participants perceived the integrated curriculum as relevant and, with reservations, acceptable. Their accounts indicate that perceived value was conditional on specialty alignment, protected educational time, transparent assessment standards, and a climate in which knowledge gaps can be voiced. This study reports perceptions and experiences; it did not measure anatomical knowledge, curriculum effectiveness, assessment validity, or patient-safety outcomes, and its conclusions should be read accordingly.