Cadaver Dissection Is Obsolete in Medical Training! A Misinterpreted Notion

Medical students' initial experiences of the dissection room and interaction with body donors: A qualitative study of professional identity formation, educational benefits, and the experience of Pasifika students

The first experience of medical students in the dissecting room (DR) likely influences professional identity formation (PIF). Sparse data exist exploring how exposure to the DR and body donors without undertaking dissection influences PIF, or how culture may influence this experience. This qualitative study explored students' first, non-dissection DR experience to determine how this contributes to PIF, including the impact of culture through a Pasifika-student lens. It also explored student perspectives on what learning opportunities are unique to this experience. Medical students with no prior DR experience were recruited and then interviewed after initial engagement with the DR and body donors. Questions included participant experiences, cultural perspectives, and how the DR differed from other teaching experiences. Interviews were recorded, transcribed, and analyzed thematically. Twenty students were interviewed (mean age 22 years, 12 females; 8 Pasifika) resulting in 520 min of audio recording (mean 26 min). Four primary themes were identified: professional identity formation, educational elements, death and spirituality, and cultural perspectives. Three subthemes including student experiences, behaviors, and environment were developed within each theme. Findings indicate development of PIF likely occurs from a single engagement with body donors without undertaking dissection, including recognition of professional role. Culture can play an important role for students, with several Pasifika students viewing the DR as a "cultural purgatory". Unique learning experiences are identified, such as cultural awareness around behaviors with the dead. The experience is an educational "threshold concept" where students likely undergo substantial developments in PIF, and educational initiatives to support students are outlined.

A comparison of 1- versus 3-month regional anatomy exposure on learning outcomes of undergraduate medical students

Regional anatomy teaching forms a cornerstone of undergraduate medical education. Owing to an increase in teaching and learning content throughout the medical curriculum in recent years, contact hours and overall course durations in anatomy are under review worldwide. This study aimed to assess whether shortening the course content duration impacts learning gain and the ability to identify anatomical structures correctly. Undergraduate medical students of the Johannes Kepler University Linz (JKU; n = 310) and at the Medical University of Graz (MUG; n = 156) participating in regional anatomy courses were included. Whole body regional anatomy courses, including hands-on dissection and accompanying lectures, were delivered over one or three months. Course content and examination mode were kept consistent, while the duration of knowledge delivery was one or three months, respectively. Objective structured practical examinations (OSPE) were then carried out on prosections for the neck, thorax, and abdomen. 3-month course exposure resulted in significantly higher OSPE scores for the neck (49 vs. 37%), thorax (65 vs. 54%), and abdomen (65 vs. 45%), respectively. Further evaluation of the utility of different embalming types yielded higher 3-month scores in the neck and thorax regions with Thiel-embalmed tissues and thorax and abdomen regions in ethanol-glycerin-embalmed tissues. Course exposure over a more extended period, like three months, appears to be highly beneficial.

A method for assessing student ability to apply anatomical knowledge within a traditional anatomy laboratory examination

Fidelity between teaching activities and assessment methods is an important goal of knowledge and performance evaluations in medical education. Ideally, assessment methods provide evidence of learning that reflects the types of knowledge described in the learning objectives of the course. The most reliable assessments involve the same or similar tasks as those used during the instructional components of the course. Our preclinical human anatomy course includes, in addition to traditional lecture and cadaver-based laboratory learning activities, a series of applied human anatomy learning activities intended to emphasize human anatomy as it is encountered in living human individuals. The learning activities involve psychomotor behaviors including inspection, palpation, and auscultation, techniques used in the physical examination, as well as other activities designed to emphasize anatomical structures and tissues as they may be found in patient populations. We describe here our method for measuring student success in learning human anatomy in this manner, highlighting the direct linkage between the learning activities and the assessment tasks. We describe our performance scoring method and how we include this data in the calculation of an anatomy examination grade. As an indicator of our success with this approach, we include performance scores for the applied anatomy questions included on the laboratory component of our unit examinations for two successive academic years. We conclude with summary comments from students regarding the applied anatomy learning activities and assessment approach and offer suggestions for addressing specific challenges associated with the use of these types of assessment methods.

Historical trends and current experiences of anatomical body donation in two Zimbabwean medical schools

BACKGROUND

Body donation is integral to anatomy education, but procurement can be ethically fraught. While voluntary donation is preferred, the use of unclaimed bodies, although considered unethical, is a primary means for body procurement in some countries. This mixed methods study examined historical trends and anatomy technical staff perspectives on body donation in two Zimbabwean medical schools.

METHODOLOGY AND MAIN FINDINGS

In Phase 1, 194 cadaver paper records from January 1984 to January 2021 were reviewed. Unclaimed bodies accounted for 67% while 33% (all white Zimbabweans) were voluntarily donated. Most cadavers were black Africans (62.4%) followed by white Zimbabweans (34.0%). Race was not indicated in seven (3.6%) records. In Phase 2, semi-structured interviews were conducted with seven technicians responsible for sourcing cadavers at the two institutions. Data were thematically analysed resulting in the development of eight themes, arranged into three domains. Cadaver procurement themes related to (1) cadaver source, (2) adherence to procurement guidelines, (3) screening for suitability, and (4) cultural and religious beliefs. Cadaver embalmment focused on (5) embalming practices, and (6) hospital mortuary-based embalming. Finally, (7) disposal processes and (8) resource constraints were found to influence cadaver disposal practices.

CONCLUSIONS

Contrary to best practice, there is continued reliance on the use of unclaimed bodies to support anatomy education in the two Zimbabwean medical schools. Improving the ethical sourcing of bodies requires increased efforts to educate all Zimbabweans, especially the black majority, about the role and importance of voluntary body donation in medical education. Additionally, well-structured, and well-resourced body donation programs could enhance ethical procurement.

Leading the transition to ethical human body sourcing in Africa: The South African experience

BACKGROUND

The use of human bodies for anatomy education and research forms an integral part of the training of health professionals around the world. However, the ethical acquisition of human remains for this purpose has been a challenge in many countries, particularly for those on the African continent. South African institutions have however, been able to progressively transition to a more ethical approach to human body acquisition. The aim of the current study was to investigate the provenance of human bodies and the number used in South African health sciences institutions during the period 2017-2021.

METHODS

an online self-administered anonymised questionnaire was circulated to all health sciences institutions in South Africa. Questions were focused on establishing the provenance and the associated number of bodies and body donor programmes.

RESULTS

responses were received from thirteen of the fourteen South African institutions. All thirteen institutions use human bodies for teaching and research, with the majority of the institutions being reliant on bequests (77%) and family donations (62%), and less on unclaimed remains (46%). Most institutions have established body donor programmes. Four institutions were negatively affected by the effects of the pandemic. Memorial services, which continued during the pandemic, were conducted by eight of the thirteen institutions.

CONCLUSION

South Africa is leading the transition to the ethical acquisition of human remains on the African continent. It is hoped that South African institutions will soon transform to the exclusive sourcing of bodies through willed donation and provide guidance and support for the other countries on the continent.

A Brief Review of Anatomy Education in Korea, Encompassing Its Past, Present, and Future Direction

Anatomy is a foundational subject in medicine and serves as its language. Hippocrates highlighted its importance, while Herophilus pioneered human dissection, earning him the title of the founder of anatomy. Vesalius later established modern anatomy, which has since evolved historically. In Korea, formal anatomy education for medical training began with the introduction of Western medicine during the late Joseon Dynasty. Before and after the Japanese occupation, anatomy education was conducted in the German style, and after liberation, it was maintained and developed by a small number of domestic anatomists. Medicine in Korea has grown alongside the country's rapid economic and social development. Today, 40 medical colleges produce world-class doctors to provide the best medical care service in the country. However, the societal demand for more doctors is growing in order to proactively address to challenges such as public healthcare issues, essential healthcare provision, regional medical service disparities, and an aging population. This study examines the history, current state, and challenges of anatomy education in Korea, emphasizing the availability of medical educators, support staff, and cadavers for gross anatomy instruction. While variations exist between Seoul and provincial medical colleges, each manages to deliver adequate education under challenging conditions. However, the rapid increase in medical student enrollment threatens to strain existing anatomy education resources, potentially compromising educational quality. To address these concerns, we propose strategies for training qualified gross anatomy educators, ensuring a sustainable cadaver supply, and enhancing infrastructure.

Donor memorialization practices at religious institutions in the United States

Many institutions worldwide honor the gift of human body donors through memorial services, ceremonies, and various other means, such as guided reflection or art activities. Memorial services can vary when it comes to the name, who is involved in the planning, and who may attend. Within the United States, the role of religion in the planning and delivery of these ceremonies at religious institutions has yet to be actively explored. This study aimed to collect information about human body donor memorialization practices at religious institutions in the United States to help guide further suggestions for enhancing inclusivity in these practices. This study utilized a voluntary survey that was distributed to anatomy educators and human body donor programs to complete if they were from a religious institution that utilized human body donors. Based on the data collected in this study (n = 39), most religious institutions have some form of donor memorialization practices, which may or may not include a formal memorial service. In these practices described by survey participants, religion was commonly represented using an interfaith approach, in which campus ministry often assisted in planning and facilitating the memorialization. Those with masses/services refer to them by different names, and most occur in a religious-specific place on campus. In conclusion, among survey participants at religious institutions that utilize and memorialize human body donors, most take an inclusive interfaith approach to their memorialization practices, as this can be more representative of the body donors and students who learn from them.

Investigating the status of whole-body donation across the United States of America

Dissection of human body donors is a valuable part of anatomical education, research, and clinical training. In the United States, deceased human bodies are predominantly sourced through whole-body donation programs (BDPs) housed by academic institutions. Due to the lack of information regarding BDPs, the aim of this study was to gather information from US BDPs through a survey to better understand the donation process and standard operating procedures of these programs. In 2021, a Qualtrics survey was distributed to 125 BDPs and yielded responses from 72 program leaders. Collectively, these programs received more than 26,000 whole-body donations annually. Findings show that 70% typically receive enough donations to fit the needs of their institutions, 17% receive a surplus of donations, and 13% receive too few donations. Sixty-eight percent of programs permit next of kin body donation regularly or in times of need, and 44% allow next of kin to make changes to a donor's donation form after death. On average, over 85% of the registered donor population is composed of white individuals, and only 6 institutions have methods in place to promote diversity among their donor population. Overall, there is considerable variability in the operation of BDPs across the United States. These findings can be used to make recommendations about donor enrollment and program operations to ultimately improve the donation process. Future research needs to investigate the opinions and preferences of body donors along with their next of kin on the body donation process and associated policies.

The combined effects of an anatomy program integrating drawing and gamification on basic psychological needs satisfaction among sport sciences students: Results of a natural experiment

According to self-determination theory, the need for competence, autonomy, and relatedness has been associated with intrinsic motivation. Fulfilling basic psychological needs can lead to better learning, academic performance, and well-being. In this study, an anatomy program integrated gamification and drawing methods to explore their influence on basic psychological needs satisfaction and potential learning implications. Basic psychological needs outcomes of sport sciences students were compared to test the effects of the Observe-Reflect-Draw-Edit-Repeat (ORDER) method and gamification (experimental condition) versus a non-ORDER and non-gamified program (control condition). These two different 30-h (7-week) anatomy education programs were implemented at two Spanish public universities with 116 first-year sport sciences students. Pre and post-treatment measurements were collected using the Basic Psychological Needs Satisfaction Scale. Statistical analyses included independent samples t-tests, ANCOVAs, and factorial repeated measures ANOVAs 2 × 2 (time × treatment). The gamified ORDER program achieved higher satisfaction scores in basic psychological needs compared to the control group (t = 2.98, p = 0.004, d = 0.54). Additionally, an interaction effect between time and treatment was observed (p = 0.042,η p 2  = 0.038). Treatment and interaction effects were observed for 'autonomy' (p = 0.003,η p 2  = 0.074) and 'competence' satisfaction (p = 0.048,η p 2  = 0.035). A time effect was found for 'relatedness' in the control group, but no significant treatment or interaction effects were identified. The causes of these effects are debated in the study, as well as the limitations. These findings support the notion that students' basic psychological needs are better satisfied in anatomy education with the implementation of this multimethod educational intervention based on ORDER and gamification.

Stereotactic anatomy of the third ventricle

PURPOSE

Endoscopic third ventriculostomy (ETV) is a surgical procedure that can lead to complications and requires detailed preoperative planning. This study aimed to provide a more accurate understanding of the anatomy of the third ventricle and the location of important structures to improve the safety and success of ETV.

METHODS

We measured the stereotactic coordinates of six points of interest relative to a predefined stereotactic reference point in 23 cadaver brain hemi-sections, 200 normal brain magnetic resonance imaging (MRI) scans, and 24 hydrocephalic brain MRI scans. The measurements were statistically analyzed, and comparisons were made.

RESULTS

We found some statistically significant differences between genders in MRIs from healthy subjects. We also found statistically significant differences between MRIs from healthy subjects and both cadaver brains and MRIs with hydrocephalus, though their magnitude is very small and not clinically relevant. Some stereotactic points were more posteriorly and inferiorly located in cadaver brains, particularly the infundibular recess and the basilar artery. It was found that all stereotactic points studied were more posteriorly located in brains with hydrocephalus.

CONCLUSION

The study describes periventricular structures in cadaver brains and MRI scans from healthy and hydrocephalic subjects, which can guide neurosurgeons in planning surgical approaches to the third ventricle. Overall, the study contributes to understanding ETV and provides insights for improving its safety and efficacy. The findings also support that practicing on cadaveric brains can still provide valuable information and is valid for study and training of neurosurgeons unfamiliar with the ETV technique.

Challenges to sourcing human bodies for teaching and research in Africa: Are the challenges insurmountable?

The teaching and learning of human anatomy by dissection has existed for thousands of years. Over the centuries, evolving ethical considerations for the sourcing of human bodies for dissection have resulted in a transition from the use of unconsented individuals to that of body donors and the institution of body donation programmes around the world. However, major challenges on the African continent have resulted in the continued use of unconsented or unclaimed bodies and the ethical dilemma for African anatomy departments regarding their use. Some of the key difficulties in sourcing donor bodies which exist on the African continent emanate from religious, cultural, societal trust and other confounding factors. This manuscript explores the challenges and suggests ways in which some of these constraints may be overcome.

Cadaver Dissection Experience for First-Time Dissectors: a Hypothetical Three-Pronged Approach for Student Preparation

This systematic review synthesized evidence for the development of a preparatory process for first-time dissectors, geared toward improving cadaver dissection (CD) experiences. Eleven studies focused on pre-CD intervention were selected from a literature search in PubMed, the Education Resources Information Centre (ERIC), Google Scholar, PsycNET, and the Cochrane Library. A three-pronged preparatory process was formulated for first-time dissectors based on the evidence from the review. The process includes (1) background assessment; (2) pre-CD education; and (3) gradual exposure and desensitization. The preparatory process shows some hypothetical potential for decreasing negative CD-related experiences, but it still needs validation before implementation.

Advances in Pediatric Surgery Simulation-Based Training

Pediatric surgery is the diagnostic, operative, and postoperative surgical care of children with congenital and acquired anomalies and diseases. The early history of the specialty followed the classic "see one, do one, teach one" philosophy of training but has since evolved to modern methods including simulation-based training (SBT). Current trainees in pediatric surgery face numerous challenges, such as the decreasing incidence of congenital disease and reduced work hours. SBT consists of several modalities that together assist in the acquisition of technical skills and improve performance in the operating room. SBT has evolved to incorporate simulator models and video gaming technology, in parallel with the development of simulation in other surgical and non-surgical pediatric fields. SBT has advanced to a level of sophistication that means that it can improve the skills of not only pediatric surgery trainees but also practicing attending surgeons. In this review, we will discuss the history of pediatric surgery, simulation in pediatric surgery training, and the potential direction of pediatric surgical simulation training in the future.

A Know-Brainer: The Power of Cadaver-Based Instruction to Teach Clinical Neuroanatomy

PURPOSE

Learning experiences that incorporate cadaver prosection or dissection of the brain have shown to enhance the acquisition and retention of neuroanatomy and improve standardized examination scores when included within medical curriculum. However, the role of cadaver-based instruction within allied health fields, and particularly in the field of communication sciences and disorders (CSD), remains limited and less understood.

METHOD

The effectiveness of a cadaver-based lab compared to lecture to teach neuroanatomy within an undergraduate/postbaccalaureate clinical neuroscience course for CSD majors was explored within a crossover design. Fifty-four participants were stratified by class rank between two initial training sessions: lab-first versus lecture-first. Neuroanatomical knowledge was tested via labeling tasks at baseline, after the first allocated training, and at 1-week follow-up after crossover training had been completed.

RESULTS

Both cohorts demonstrated significant gains in neuroanatomical knowledge following training, yet after the initial training session, students that received cadaver-based instruction produced a significantly greater number (p < .001) and more accurate (p < .001) anatomical labels than students that received lecture. After completion of the crossover design, students receiving cadaver-based instruction prior to lecture continued to demonstrate superior labeling accuracy at follow-up testing (p = .022).

CONCLUSIONS

Cadaver-based instruction was more effective in improving students' ability to identify neuroanatomy compared to lecture for CSD students. Interestingly, cadaver-based demonstrations were also most effective in bolstering students' retention of structural knowledge when conducted before, instead of after, a lecture. Clinical training programs, specifically student learning outcomes, benefit from cadaver-based instruction that provides both three-dimensional orientation and a deep appreciation of the human elements of clinical anatomy. Furthermore, both the acquisition and retention of anatomical concepts may be enhanced through strategic instructional design, particularly in regard to the order of lecture and lab experiences.

Time-lapse dissection videos: traditional practice in a new, digital format

This research introduces an innovative series of time-lapse dissection videos that enable accelerated observation of the dissection process. Cadaveric dissection has consistently been described in the literature as a reliable method for enhancing student understanding and visualisation, however as a process it is expensive and extremely time-consuming, hence it is often inaccessible to learners. When active dissection is unavailable, prosections can be used to teach anatomy, however a considerable amount of spatial and structural information is lost during the dissection process. These time-lapse videos demonstrate dissection quickly and accurately and allow an irreversible process to be rewound and rewatched with flexibility. Results suggest that time-lapse offers a comprehensive and engaging view of the dissection process that students appreciate being able to observe within a concise timeframe. Written annotation, audio narration and colourful highlighting were essential inclusions following student feedback. These videos can provide instruction before dissection classes or can expose the dissection process to learners without access to cadaveric specimens. However, certain invaluable elements of practical dissection are rooted within constructivism and cannot be replicated by video. Time-lapse dissection videos should therefore be used to supplement and not replace active dissection.

Commentary: Is There a Lack of Insight on the Anatomy Teaching Adaptations Made by "Cadaver-Free" Medical Schools in Response to the COVID-19 Pandemic?

The COVID-19 pandemic negatively impacted anatomy education as it ceased face-to-face anatomy teaching sessions and laboratory practicals. In the past 2 years, a growing body of literature has been dedicated to the adaptations made in the teaching of anatomy predominantly by medical schools who employ cadaveric dissection and prosection-based practicals to teach anatomy. Despite this, there is dearth of evidence in terms of the challenges that medical schools who do not use cadaveric dissection or prosected specimens to teach anatomy faced as well as the adaptations they made in response to the pandemic.

Graduating from Laboratory to Operating Rooms-the Way Forward for Future Surgeons!

Background

Changing healthcare and social scenarios are reducing the learning opportunities of surgical postgraduates in our country. Majority of surgical training centers in the developed world use laboratory training as an integral part of their curricula. However, in India, most of surgical residents are still trained by traditional apprenticeship model.

Aims

To describe the role of laboratory training in improving the competency of surgical postgraduates.

Settings and Design

Laboratory dissection was used as an educational intervention for postgraduates in tertiary care teaching hospital.

Methods and Material

Thirty-five (35) trainees from various surgical subspecialties performed cadaveric dissection led by senior faculty members. The perceived knowledge and operative confidence of trainees were assessed before and three weeks after the course using a five-point Likert scale. A structured questionnaire was administered to explore the experience of training. Results were tabulated in percentage and proportion. Wilcoxon signed-rank test was applied to find any difference between pre and post perception of knowledge and operative competence of participants.

Results

Thirty four (34/35; 96%) were males; 65.7% (23/35) trainees demonstrated improvement in knowledge level after dissection (p < 0.0001) and 74.3% (26/35) in operative confidence (p < 0.0001). Majority believe that cadaveric dissection helps to improve knowledge of procedural anatomy (33/35; 94.3%) and enhances technical skill (25/35; 71.4%). Thirty participants (86%) rated cadaveric dissection as the best tool for surgical training of postgraduates better than operative manuals, surgical videos, and virtual simulators.

Conclusions

Laboratory training including cadaveric dissection is feasible, relevant, effective, and acceptable to postgraduate surgical trainees with few disadvantages, which can be taken care of. Trainees felt it should be made part of curriculum.

The Attitude of Medical Students Toward Voluntary Body Donation: A Single Institute Survey and Narrative Review of Global Trends

INTRODUCTION

Voluntary body donation (VBD) programs form the backbone of cadaveric teaching and learning in medical schools. It benefits the medical fraternity the most. Yet, there is a dearth of VBD practice among medical students. We aimed to understand the knowledge and attitude of first-year medical students in a tertiary institute with a systematic review of willingness toward VBD among undergraduate students worldwide.

METHODS

 The first-year medical undergraduates were given a 12-item questionnaire to assess their knowledge and attitude toward VBD. Statistical tests were applied to analyze the difference between the variables. We systematically searched Google Scholar, PubMed, and SCOPUS databases until October 15, 2022. Data concerning knowledge, awareness, and attitude toward VBD among undergraduates of medical backgrounds were extracted and analyzed qualitatively.

RESULTS

A total of 82.5% of students returned the completed responses. A significant association was seen between their attitudes toward whole body donation by strangers (p=0.043) and family members (p=0.035). The religion of the participants significantly affected their opinions on VBD and their willingness to pledge themselves (p=0.034). For the review, 20 studies were selected to be analyzed qualitatively. These studies included 4232 undergraduate students globally who were assessed for knowledge, awareness, and attitude toward VBD. Around 50% of the studies were published in India. The first study included was published in 2008. Seven studies were exclusively conducted on medical undergraduates, while the rest consisted of a mixed cohort. The attitude and knowledge of medical undergraduates on VBD were assessed via questionnaires containing both open-ended and closed-ended questions.

CONCLUSION

Based on observations from our survey and review, we concluded that while undergraduate students have a highly positive attitude toward VBD, their rate of pledging is low. The most prominent barrier to this attitude is their experience with cadavers in the dissection hall. Hence, we recommend a revisit of cadaver handling practices and the establishment of appropriate protocols for safe and deferential cadaver handling.

The Application of 3D Anatomy for Teaching Veterinary Clinical Neurology

Neuroanatomy is always a challenging topic for veterinary students. It is widely accepted that understanding the anatomy of the central nervous system (CNS) is essential to explain many of the pathological processes that affect the brain. Although its study has varied over time to achieve this goal, in human and veterinary medicine it is difficult to find a teaching method that associates normal anatomy with pathological alterations of the brain. For the first time, we have created an educational tool that combines neuroanatomy and neuropathology, using different magnetic resonance (MR) images as a basis and EspINA software as analyzer, to obtain segmented structures and 3D reconstructions of the dog brain. We demonstrate that this combination is an optimal tool to help anatomists to understand the encephalon, and additionally to help clinicians to recognize illness including a multitude of neurological problems. In addition, we have tried to see whether photogrammetry, which is a common technique in other sciences, for example geology, could be useful to teach veterinary neuroanatomy. Although we still need further investigations, we have been able to generate 3D reconstructions of the whole brain, with very promising results to date.

Fewer medical students are open to body donation after dissecting human cadavers

INTRODUCTION

Cadaver dissection has long been hailed as a vital component of medical education. Although most physicians acknowledge positive impacts of cadaver dissection on their learning, they are less likely to will their bodies for anatomical dissection than the general public. This study aims to determine whether the proportion of medical students open to willed body donation changes after completing cadaver dissection.

METHODS

We conducted a longitudinal study surveying 323 medical students across three cohorts before and after anatomical dissection of human cadavers. Through the survey, students indicated whether they would will their body for anatomical dissection. Additionally, students responded to items regarding the rationale underlying their decision, demographics and perceived effects of anatomical dissection on medical education.

RESULTS

The proportion of students who expressed openness to willed body donation decreased by 25% after cadaver dissection. Of the 171 students who initially stated they would will their body, 61 (35%) changed their response after completing cadaver dissection. Those who cited religion as a motivating factor were less likely to show openness to body donation, whereas those who cited ethical factors were more likely.

CONCLUSIONS

This study documents a substantial decrease in the proportion of students open to willed body donation after completion of cadaver dissection. Despite this, students almost universally report educational benefits of cadaver dissection. This raises interesting questions regarding the emotional impact of cadaver dissection and the ethical implications of willed body donation.

Determinants of Learning Anatomy in an Immersive Virtual Reality Environment - A Scoping Review

Given the decline of cadavers as anatomy teaching tools, immersive virtual reality (VR) technology has gained popularity as a potential alternative. To better understand how to maximize the educational potential of VR, this scoping review aimed to identify potential determinants of learning anatomy in an immersive VR environment. A literature search yielded 4523 studies, 25 of which were included after screening. Six common factors were derived from secondary outcomes in these papers: cognitive load, cybersickness, student perceptions, stereopsis, spatial understanding, and interactivity. Further objective research investigating the impact of these factors on anatomy examination performance is required.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s40670-022-01701-y.

Increased use of cadaver specimens as a method for improving medical student satisfaction with clinical ear anatomy teaching at St George's, University of London: a pilot study

BACKGROUND

Delivering sufficient otology education for undergraduates is known to be difficult, with limited teaching time being a contributing factor. Increasing student access to dissections of the ear could serve to increase satisfaction with teaching at St George's, University of London, UK.

OBJECTIVE

To evaluate student satisfaction with clinical ear anatomy teaching and investigate whether it can be improved using dissected specimens.

METHOD

Participants completed an online survey and knowledge examinations, both before and after attending a new tutorial, with answers from before and after the session being compared.

RESULTS

Pre-teaching satisfaction scores concerning teaching were low, at an average of 2.45 (out of 7), with a mean examination result of 6.53 (out of 10). Post-teaching average satisfaction increased by 3.20 points to 5.65 (out of 7) (p < 0.01) and examination scores increased by 1.53 points to 8.07 (out of 10) (p < 0.01).

CONCLUSION

Students are supportive of increased access to cadaver dissections of the ear, and facilitating this can improve satisfaction with otology teaching.

Design for assessment of dissection in anatomy laboratory based on group identification of structures and peer evaluation

Dissection is a unique multisensory educational experience and is essential to learning the anatomical construction of the human and animal bodies. This study aims to introduce a specialized design for the assessment of dissection and to discuss the assessment's attributes. The design was a product of the "assessment drives learning" concept and was developed to motivate students to dissect. Students were awarded "dissection points" based on prior group dissection and identification of structures. Students' perception of the design was examined, and content analysis was performed. The assessment consisted of two parts: the first assigning each student group structures to "pin" on their previously dissected cadavers; the second was a group peer evaluation. The most critical factor for the assessment's success was careful selection of structures assigned to students to pin. The assessment was fit for the purpose, valid, reliable, and had a significant educational impact. Eighty-three percent of students (n = 116) recommended maintaining the assessment design, as they felt it promoted a deep approach to learning as well as teamwork while reducing stress to a minimum. A strong correlation (Spearman's rho = 0.46, P < 0.0001) was present between the high rating of the design and the number of structures learned, as well as, high rating and lower stress level (Spearman's rho = 0.40, P < 0.0001). There was no apparent influence of grades on student perception of the effectiveness of the assessment. This specific design of evaluation could be used as part of anatomy education in veterinary and medical schools.

An initial preparation for human cadaveric dissection ameliorates the associated mental distress in students

It is universally recognized that cadaveric dissection is an essential part of anatomy training. However, it has been reported to induce mental distress in some students and impair their intrinsic motivation (IM) to study. One of the postulated reasons for this behavior is the lack of adequate information and preparation of students for cadaveric dissection. Therefore, it is hypothesized that providing relevant information prior to cadaveric dissection will ameliorate the mental distress, enhance the IM of students, and improve their academic performance. A cohort of occupational therapy students enrolled in an anatomy course were psychologically prepared for cadaveric dissection. Students were provided with a curated list of YouTube videos and peer-reviewed journal articles related to cadaveric dissection prior to the commencement of the anatomy course. All students were also required to attend an oral presentation immediately before commencing dissection. The control group included students who had not been provided with any resources in preparation for cadaveric dissection. Compared to the control group, students who had been prepared demonstrated better quality of cadaveric dissection, improved academic performance, reported less mental distress and greater IM. Moreover, students reported the oral presentation to be most relevant and journal articles to be least useful in their preparation. Therefore, this is an effective approach in the amelioration of mental distress and improvement of performance in anatomy students. Consequently, this study represents a paradigm shift in the pedagogy of anatomy, and could represent a vital element in the evolution of a revitalized anatomy curriculum.

The question of dissection in medical training: Not just "if," but "when"? A student perspective

While debate about the use of-and alternatives to-human cadaveric dissection in medical training is robust, little attention has been paid to questions about timing. This study explores the perspectives of medical students and recent graduates with regard to two key questions: when in the degree program do students prefer dissection opportunities and what are the students getting out of participating in dissection? Self-report survey data from students in preclinical years (n = 105), clinical years (n = 57), and graduates (n = 13) were analyzed. Most (89%) preferred dissection during the preclinical years, with no effect by training year (χ²  = 1.98, p = 0.16), previous anatomy (χ²  = 3.64, p = 0.31), or dissection (χ²  = 3.84, p = 0.26) experience. Three key findings emerged. First, the majority of students prefer to dissect in the preclinical years because they view dissection as important for developing foundation knowledge and delivering an opportunity for consolidation prior to transitioning to primarily clinical studies. In addition, students recognize that it is a time-consuming activity requiring specialized facilities. Second, three main understandings of the purpose of dissection were reported: depth of learning, learning experience, and real-world equivalence. Third, these student perspectives of the purpose of dissection are associated with timing preferences for dissection opportunities. The results identify the preclinical phase as the optimal time to strategically integrate dissection into medical training in order to maximize the benefits of this unique learning opportunity for students and minimize its impact upon curricular time.

One year of anatomy teaching and learning in the outbreak: Has the Covid-19 pandemic marked the end of a century-old practice? A systematic review

At the end of 2019, the Covid-19 pandemic spread caused restrictions in business and social spheres. Higher education was also severely affected: universities and medical schools moved online to distance learning and laboratory facilities closed. Questions arise about the long-term effects of this pandemic on anatomical education. In this systematic review, the authors investigated whether or not anatomical educators were able to deliver anatomical knowledge during this pandemic. They also discuss the challenges that anatomical education has faced over the last year. The search strategy was conducted between July 2020 and July 2021. Two hundred and one records were identified, and a total of 79 studies were finally included. How best to deliver anatomy to students remains a moot point. In the last years, the advent of new technologies has raised the question of the possible overcoming of dissection as the main instrument in anatomical education. The Covid-19 pandemic further sharpened the debate. Remote learning enhanced the use of technologies other than cadaveric dissection to teach anatomy. Moreover, from the analyzed records it appears that both from students' perspective as well as teachers' there is a clear tear between those who endorse dissection and those who believe it could be easily overcome or at least integrated by virtual reality and online learning. The authors strongly believe that the best anatomy teaching practice requires the careful adaptation of resources and methods. Nevertheless, they support cadaveric dissection and hope that it will not be replaced entirely as a result of this pandemic.

The Importance of Optional Practical Anatomy Courses for Undergraduate Speech Therapy Students

An in-depth understanding of the anatomy discipline is essential for the work of healthcare professionals. In recent decades, the content and time of teaching anatomy have decreased in all health science degrees. The aim of this study was to look for alternatives for compensating the reduction of the teaching of anatomy by supplementing students with a practical training course and to know evaluations of the course given by students enrolled in the degree in Speech Therapy and its impact on their academic results. All students (100%) positively evaluated having acquired skills and attitudes for their future professional life. The majority of the students (95.8%) believed that their knowledge was acceptable; 97.2% of the students thought they would have the possibility to apply their acquired anatomical knowledge as professionals; 98.5% were satisfied with the voluntary course; and finally, the percentage of students that passed the "Anatomophysiology of language and voice organs" course increased from previous academic years. Optional (theoretical/practical) undergraduate courses can be used in parallel to overcome the devaluation of anatomical studies in new curricula. The optional undergraduate anatomy course in the Speech Therapy program has been positively evaluated because it stimulated students' motivation and appealed to their interest in anatomy. Students considered that these courses would help them in their training and they could put what they had learned into practice in their future professions. However, very little evidence for the impact of optional practical courses exists, yet it could be an efficient method to increase anatomical knowledge.

Teaching Musculoskeletal Module using dissection videos: feedback from medical students

BACKGROUND AND AIMS

Over the last two decades many medical schools have been exploring alternatives to hands-on cadaver dissection in teaching anatomy. This study aimed at reporting medical students' feedback on using dissection videos in teaching anatomy of the musculoskeletal system.

METHODS

Dissection videos were used to teach the anatomy of the musculoskeletal system for third year medical students. At the end of the module, feedbacks from medical students were reported using a questionnaire designed for this purpose. Statistically valid responses were considered for 284 students.

RESULTS

Around 60% of the students enjoyed learning anatomy by watching dissection videos but the majority - mostly non-Jordanian - thought that the duration of the videos should be shorter. 83% (236/284)of the students enjoyed the presence of an instructor to guide them through the video and 85% (241/284) wanted to discuss the content with the instructor after watching. Most of the students liked to have access to the videos at any time in an open lab policy. Only 23% (66/284) of the students - mostly Jordanian - were willing to completely replace cadaveric prosections with dissection videos. Most of the students found that dissection videos helped them to understand anatomy lectures in a better way and in memorizing anatomical details. A significantly higher percentage of Jordanian students preferred watching dissection videos at home and preferred dissection videos to replace traditional anatomy lab sessions.

CONCLUSIONS

In the light of our present findings, using dissection videos as a teaching method of anatomy was well received by students. However, it seemed that the students wanted dissection videos to be integrated with using cadaveric prosections rather than replacing them.

The Past, Present, and Future: A Discussion of Cadaver Use in Medical and Veterinary Education

Cadaver usage in medical training, although controversial, has persisted over centuries. In veterinary education various methods have been proposed to either improve cadaver preservation, reduce cadaver use, or to replace cadavers entirely, but to date few have gained popularity. This manuscript seeks to: (i) describe the history of cadavers in medical and veterinary education; (ii) compare available cadaveric preservation methods; (iii) reflect on applications of cadaver use in the educational setting; (iv) discuss alternatives to traditional cadaver use; and (v) consider the perceptions of the stakeholders who use them.

Is Digital Animation Superior to Text Resources for Facial Transplantation Education? A Randomized Controlled Trial

BACKGROUND

Facial transplantation is a complex surgical procedure that requires education of medical professionals, patients, and the general public. The objective of this randomized controlled trial was to compare the educational efficacy of facial transplantation digital animation versus text resources for teaching medical students a complex surgical procedure and its applicable anatomical and surgical principles.

METHODS

Medical student volunteers were recruited and prospectively randomized to an animation or a text group. Students completed preintervention and postintervention assessments of confidence and knowledge of head and neck anatomy and facial transplantation. Student Evaluations of Educational Quality survey assessed student satisfaction with both tools following study crossover. Knowledge assessment was developed using National Board of Medical Examiners guidelines and content validated by four experts. The Cohen d statistic was used to measure the effect size of each intervention.

RESULTS

Thirty-six students were assigned randomly to the animation group (n = 19) or the text (n = 17) group. Postintervention analysis demonstrated significantly higher performance scores in the animation group compared to the text group (p = 0.029). The animation group had a larger effect size (Cohen d = 1.96 versus 1.27). Only students in the animation group reported significantly improved confidence in head and neck anatomy after the intervention (p = 0.002). Both groups demonstrated significantly increased postintervention confidence in knowledge of facial transplantation (p < 0.001). Satisfaction scores revealed that students significantly favored the animation resource (p < 0.001).

CONCLUSIONS

Animation can be an effective tool for facial transplantation education and results in improved student knowledge, confidence, and satisfaction compared to text resources. Facial transplantation can also be used as an educational framework for teaching medical students anatomical and surgical principles.

Facilitating Student Understanding through Incorporating Digital Images and 3D-Printed Models in a Human Anatomy Course

Combining classical educational methods with interactive three-dimensional (3D) visualization technology has great power to support and provide students with a unique opportunity to use them in the study process, training, and/or simulation of different medical procedures in terms of a Human Anatomy course. In 2016, Rīga Stradiņš University (RSU) offered students the 3D Virtual Dissection Table “Anatomage” with possibilities of virtual dissection and digital images at the Department of Morphology. The first 3D models were printed in 2018 and a new printing course was integrated into the Human Anatomy curriculum. This study was focused on the interaction of students with digital images, 3D models, and their combinations. The incorporation and use of digital technologies offered students great tools for their creativity, increased the level of knowledge and skills, and gave them a possibility to study human body structures and to develop relationships between basic and clinical studies.

Digital Feast and Physical Famine: The Altered Ecosystem of Anatomy Education due to the Covid-19 Pandemic

This article explores the effects of the coronavirus disease 2019 (Covid-19) pandemic on the evolution of both physical and digital cadavers within the unique ecosystem of the anatomy laboratory. A physical cadaver is a traditional and established learning tool in anatomy education, whereas a digital cadaver is a relatively recent phenomenon. The Covid-19 pandemic presented a major disturbance and disruption to all levels and types of education, including anatomy education. This article constructs a conceptual metaphor between a typical anatomy laboratory and an ecosystem, and considers the affordances, constraints, and changing roles of physical and digital cadavers within anatomy education through an ecological lens. Adaptation of physical and digital cadavers during the disturbance is analyzed, and the resiliency of digital cadaver technology is recognized. The evolving role of the digital cadaver is considered in terms of increasing accessibility and inclusivity within the anatomy laboratory ecosystem of the future.

Multiple-Choice versus Open-Ended Questions in Advanced Clinical Neuroanatomy: Using a National Neuroanatomy Assessment to Investigate Variability in Performance Using Different Question Types

Methods of assessment in anatomy vary across medical schools in the United Kingdom (UK) and beyond; common methods include written, spotter, and oral assessment. However, there is limited research evaluating these methods in regards to student performance and perception. The National Undergraduate Neuroanatomy Competition (NUNC) is held annually for medical students throughout the UK. Prior to 2017, the competition asked open-ended questions (OEQ) in the anatomy spotter examination, and in subsequent years also asked single best answer (SBA) questions. The aim of this study is to assess medical students' performance on, and perception of, SBA and OEQ methods of assessment in a spotter style anatomy examination. Student examination performance was compared between OEQ (2013-2016) and SBA (2017-2020) for overall score and each neuroanatomical subtopic. Additionally, a questionnaire explored students' perceptions of SBAs. A total of 631 students attended the NUNC in the studied period. The average mark was significantly higher in SBAs compared to OEQs (60.6% vs. 43.1%, P < 0.0001)-this was true for all neuroanatomical subtopics except the cerebellum. Students felt that they performed better on SBA than OEQs, and diencephalon was felt to be the most difficult neuroanatomical subtopic (n = 38, 34.8%). Students perceived SBA questions to be easier than OEQs and performed significantly better on them in a neuroanatomical spotter examination. Further work is needed to ascertain whether this result is replicable throughout anatomy education.

The Cadaver Conundrum: Sourcing and Anatomical Embalming of Human Dead Bodies by Medical Schools during and after COVID-19 Pandemic: Review and Recommendations

COVID-19 pandemic has posed a new challenge for medical schools across the world regarding the acceptance of donated and unclaimed dead bodies for academic purpose. Uncertainty of the COVID-19 status among the donated bodies poses a health risk for embalming personnel and medical students who handle the embalmed cadavers. There is a paucity of literature delineating the criteria for accepting or rejecting the bodies during COVID-19 pandemic. Similarly, there is no recommended standard operating procedure for anatomical embalming during COVID-19. We propose certain criteria for accepting and rejecting the human dead bodies for anatomical embalming. And we propose some technical modifications to the conventional procedure of formalin-based anatomical embalming. A guarded approach and diligent screening of donated bodies is the way forward during the COVID-19 pandemic.

Clay-Based Modeling in the Anatomist's Toolkit: A Systematic Review

Anatomical education has suffered from reduced teaching time and poor availability of staff and resources over the past thirty years. Clay-based modeling (CBM) is an alternative technique for teaching anatomy that can improve student knowledge and experience. This systematic review aimed to summarize and appraise the quality of the literature describing the uses, advantages, and limitations of CBM compared to alternative methods of teaching human gross anatomy to students or qualified healthcare professionals. A systematic search of Embase, MEDLINE, Scopus, and Web of Science databases was conducted, and the Medical Education Research Quality Instrument (MERSQI) was used to assess study quality. Out of the 829 studies identified, 12 papers met the inclusion criteria and were eligible for this review. The studies were of high quality, with a mean MERSQI score of 11.50/18. Clay-based modeling can be used to teach all gross anatomical regions, and 11 studies demonstrated a significant improvement in short-term knowledge gain in students who used CBM in comparison to other methods of learning anatomy. Eight studies that included subjective assessment showed that CBM is rated highly. However, some studies showed that students viewed CBM as juvenile and experienced difficulty making the models. Additionally, there is no evidence to suggest that CBM improves long-term knowledge. Clay-based modeling is an effective learning method for human gross anatomy and should be incorporated into the anatomists' toolkit. In the future, more randomized controlled studies with transparent study designs investigating the long-term impact of CBM are needed.

A Surgical View of Anatomy: Perspectives from Students and Instructors

As curricular emphasis on anatomy in undergraduate medical education continues to evolve, new approaches to anatomical education are urgently needed to prepare medical students for residency. A surgical anatomy class was designed for third- and fourth-year medical students to explore important anatomical relationships by performing realistic surgical procedures on anatomical donors. Under the guidance of both surgeons and anatomists, students in this month-long elective course explored key anatomical relationships through performing surgical approaches, with the secondary benefit of practicing basic surgical techniques. Procedures, such as left nephrectomy, first rib resection for thoracic outlet syndrome, and carotid endarterectomy, were adapted from those used clinically by multiple surgical subspecialties. This viewpoint commentary highlights perspectives from students and instructors that suggest the value of a surgical approach to anatomical education for medical students preparing for procedure-oriented residencies, with the goals of: (1) describing the elective at the authors' institution, (2) promoting similar efforts across different institutions, and (3) encouraging future qualitative and quantitative studies of similar pedagogic efforts.

The place of cadaveric dissection in post-COVID-19 anatomy education

From time immemorial, cadaveric dissection has been commonly employed as a method of practical teaching and learning for anatomical education globally. Conventionally, cadaveric dissection has been embraced and widely accepted as the best fit for comprehensive and gross teaching in anatomy education, thus placing an undue rise in cadavers' demands. The emergence of the new coronavirus disease 2019 (COVID-19) has posed significant effects on medical education with substantial impacts on anatomy education, as seen in the shift from classroom to virtual learning. An essential area of anatomy education and training requiring immediate consideration is the position of cadaveric dissection in a post-COVID-19 era, which entails the safety of cadavers from possible SARS-CoV-2 infection before their use. This article explores the place of cadaveric dissection in post-COVID-19 anatomy education.

Post-COVID-19 pandemic: Standard operating procedures for gross anatomy laboratory in the new standard

The culture of cadaver dissection remains the most commonly used method of practical teaching and learning of human anatomy. Anatomist and medical professionals considered cadaver dissection as the gold standard for teaching and learning anatomy in detail. The increase seen in the establishment of new medical training institutions globally has consequently led to a proportionate increase in the sourcing for cadavers. Moreover, the surge in mortality rates following the recent coronavirus disease 2019 (COVID-19) pandemic with no cure or approved vaccine has been a source of concern for academia, especially on the safety in the usage of cadavers for dissection. Notwithstanding, several countries continue to depend on unclaimed bodies as the primary source for cadavers, regardless of the cause of death. Besides, body donation is also usually reported to be strained during disease outbreaks thereby putting countries that depend solely on it in a dilemma. This study highlighted the recommended standard operating procedures (SOPs) to be imbibed in gross anatomy dissection halls during and post-COVID-19 pandemic.

Producing three-dimensional printed models of the hepatobiliary system from computed tomography imaging data

INTRODUCTION

Macroscopic anatomy has traditionally been taught using cadaveric material, lectures and a variety of additional resources including online modules and anatomical models. Traditional plastic models are effective educational tools yet they have significant drawbacks such as a lack of anatomical detail, a lack of texturisation and cost. Three-dimensional printed models stand to solve these problems and widen access to high-quality anatomical teaching. This paper outlines the use of three-dimensional multiplanar imaging (computed tomography) in the development of an accurate model of the hepatobiliary system.

MATERIALS AND METHODS

Computed tomography scans were used to construct a virtual three-dimensional model of the hepatobiliary system. This was printed locally as a full-size colour model. We give a complete account of the process and software used.

DISCUSSION

This study is among the first of a series in which we will document the newly formed Oxford Library of Anatomy. This series will provide the methodology for the production of three-dimensional models from computed tomography and magnetic resonance imaging scans, and the library will provide a complete collection of the most complex anatomical areas. We hope that these models will form an important adjunct in teaching anatomy to medical students and surgical trainees.

Is exam performance in anatomy influenced by teaching with prosected cadavers? An evidence-based study

INTRODUCTION

Little empirical evidence substantiates the need to use cadavers to teach anatomy effectively. We investigated the effect of attendance at anatomy laboratories and cadaver use on .anatomy exam performance over a 12-year period (2006-2007 to 2018-2019) before and after a curricular change (2013-2014).

MATERIALS AND METHODS

Anatomy exam performance data were collected from undergraduate files at Memorial University of Newfoundland, Canada, for 782 medical students over a 12-year period. Three groups emerged: (i) 6 years of the old curriculum using prosected specimens, N = 376; (ii) 3 years of the new curriculum using prosected specimens, N = 239; (iii) 3 years of the new curriculum using no prosected specimens, N = 240. For the 2018-2019 academic year, laboratory attendance was recorded, N = 80.

RESULTS

The unplanned discontinuation of prosected specimens did not markedly impact anatomy instruction. Student performance under the new and old curricula (p = .0018) and with and without cadavers (p = .0117) is slightly, but significantly, different. Student performance is not associated with the number of missed laboratories (Spearman ρ = 0.145, p = .2).

DISCUSSION

Although use of cadavers and prosected specimens continues in anatomy-wet laboratories, today's tech-savvy students want information at their fingertips 24/7. The three factors examined in this study suggest a surprisingly consistent performance on anatomy examinations despite changing conditions. Perhaps medical schools should offer as many quality resources as budgets allow, inform students of their availability and let students decide which learning methods work best for them individually, thus facilitating self-directed learning.

CONCLUSION

Consistent exam performance can be achieved using a variety of teaching and learning methods.

Comparison of Hands-On Versus Online Learning in Teaching Ultrasound Skills for Achilles Tendon Rupture: A Pilot Study

Introduction

In the emergency department, the diagnosis of an Achilles tendon rupture (ATR) is reportedly missed in greater than 20% of cases. A limited number of studies evaluate the use of cadaver models as a potential ultrasound teaching and training modality. We hypothesize that emergency medicine residents can effectively utilize point-of-care ultrasound (POCUS) on cadaver models and a focused teaching intervention to assess their ability to detect ATRs.

Methods

A prospective study of 23 EM residents was performed. All participants in the study were divided into two learner groups: (a) independent and (b) hands-on. The independent learner group received a 30-minute online didactic lecture demonstrating how to diagnose ATRs. The hands-on learner group received direct instruction on cadaver lower leg models with a ruptured and normal Achilles tendon (AT). Both groups then participated in identifying either normal or ruptured ATs on six cadaver lower leg models.

Results

The sensitivity and specificity were 89% and 82% in the independent learner group 96% and 100% in the hands-on learner group, respectively. The overall sensitivity and specificity were 91% and 88%, respectively. There was a trend toward successful identification with increased years of residency training.

Conclusions

In this study, lower leg and ankle cadaver models were found to be as effective as an independent learner model for potential POCUS teaching and training modality in both novice and more advanced trainees.

Approaches used for teaching anatomy and physiology in the university pre-professional program at King Saud bin Abdulaziz University for Health Sciences

Many medical schools offer pre-professional programs to undergraduate students. The main purpose of the university pre-professional program (UPPP) is to equip students with the necessary knowledge and skills required to successfully cope with the academic demands of further education provided by professional colleges. The aim of this commentary article is to describe the role of UPPP at King Saud bin Abdulaziz University for Health Sciences (KSAU-HS) in preparing students to continue studies at the College of Medicine (COM) and other health-related colleges. The anatomy and physiology course is presented as a representative model. An outline of the UPPP in the context of the curriculum, teaching strategies, learning facilities, and assessment is presented. The pre-professional program at KSAU-HS prepares school graduates to become self-learners and enable them to learn effectively in the clinical context in a problem-based learning curriculum at COM.