Vertical distribution of formaldehyde concentration and simulated temperature and wind velocity from computational fluid dynamics in a gross anatomy laboratory

Cadavers for gross anatomy laboratories are typically embalmed in formaldehyde. Thus, medical students and instructors are exposed to formaldehyde vapors emitted from cadavers during dissection. In an attempt to improve the dissection environment, we examined indoor formaldehyde concentrations in a gross anatomy laboratory. Air samples were taken from 20, 110, 160, and 230 cm above the floor between dissection beds to represent areas near the floor, in the breathing zone of sitting students, in the breathing zone of standing students, and near the ceiling, respectively. Formaldehyde vapors were thoroughly diffused from the floor to the ceiling, suggesting that medical students are exposed to similar concentrations of formaldehyde based on distance from the floor. Computational fluid dynamics showed that cadavers are warmed by overhead fluorescent lights and the body heat of anatomy students, and indicated that the diffusion of formaldehyde vapors is increased by lighting and the body temperature of students. Computational fluid dynamics showed that gentle convection from anatomy students and cadavers carry formaldehyde vapors upward; downward flow near admission ports diffuse formaldehyde vapors from the ceiling to the floor in the anatomy laboratory.     

Formaldehyde concentrations in the breathing zone of medical students during gross anatomy laboratory in Toho University

Cadavers for gross anatomy laboratories are conventionally embalmed by formaldehyde (FA) solution in most medical schools. Thus, medical students and instructors are exposed to FA vapors emitted from cadavers during dissection. As a basic survey for the improvement of the dissection environment, we examined FA concentration in the gross anatomy laboratory during the 2006 academic year at the Faculty of Medicine of Toho University. Air samples were taken from 20 cm above a cadaver as breathing zone, and above a desk between cadavers as indoor FA concentration. FA concentrations in the breathing zone were ranged from 0.24 to 3.04 (mean 1.71) ppm during systematic anatomy, and from 0.72 to 1.60 (mean 1.16) ppm during neuroanatomy, and indoor FA concentration ranged from 048 to 1.11 (mean 0.76) ppm and from 0.21 to 0.23 (mean 0.22) ppm, respectively. These results showed that medical students and instructors are exposed to higher concentrations of FA than allowed by the guidelines of the Japan Ministry of Health, Labor and Welfare, and suggested the need to reduce FA levels in the gross anatomy laboratory.     

Attempt to reduce the formaldehyde concentration by blowing cooled fresh air down in to the breathing zone of medical students from an admission port on the ceiling during gross anatomy class

Cadavers in gross anatomy laboratories at most medical schools are conventionally embalmed in formaldehyde solution, which is carcinogenic to humans. Medical students and instructors are thus exposed to formaldehyde vapors emitted from cadavers during dissection. To reduce high formaldehyde concentrations in the breathing zone above cadavers being examined by anatomy medical students provisionally, dissection beds were located under existing admission ports on the ceiling to supply cooled fresh air from the admission port blowing downward on to the cadaver. In all cases, compared to normal condition, the downward flow of cooled fresh air from an admission port reduced formaldehyde concentrations by 0.09-0.98 ppm and reduced to 12.6-65.4% in the air above a cadaver in the breathing zone of students. The formaldehyde concentrations above cadavers under admission ports were not more than the formaldehyde concentrations between beds representing the indoor formaldehyde concentrations. Although the application of an existing admission port on the ceiling in this study did not remove formaldehyde, the downflow of cooled fresh air using this system reduced the formaldehyde concentration in the air above cadavers being attended by anatomy students during dissections. These results suggest the need for reducing formaldehyde levels in gross anatomy laboratories using fundamental countermeasures in order to satisfy the guidelines of 0.08 ppm established by the World Health Organization and the Japan Ministry of Health, Labor and Welfare.     

Human gross anatomy: A crucial time to encourage respect and compassion in students

We suggest four ways in which human gross anatomy instructors can reinforce respect and compassion in students. First, encourage respectful language in the laboratory. The term “donor” should be used instead of “cadaver” or “corpse” in referring to the donated body because this promotes appreciation for the students' first “patient.” Second, provide the students with the actual name, age, history, and likely cause of death of the donor so that they more fully appreciate the donor as having once been a living human being. Third, prompt students to explore feelings and discuss topics stimulated by the intense experience of human dissection. Suggested topics include the students' feelings about dissecting a human being, the difficulty in deciding to donate one's body, the central importance of anatomy to a medical practitioner's role, and the historical development of the study of anatomy. Fourth, hold a memorial ceremony, in which both students and faculty participate, as a positive closure to an emotionally and intellectually intense course. Additionally, a ceremony reinforces salutary values in students, enhances social bonding among students, and encourages their appreciation of various cultural and religious beliefs. These methods introduce a new dimension of experience for anatomy students. We have developed these methods in response to what we view as a negative trend in the medical profession in which health care becomes technical and patients become objects. It is our role as faculty to reinforce respectful and compassionate attitudes in medical students from the very beginning. © 1995 WiIey-Liss, Inc.     

The quest for the deciphering stone—“How do I study for this course?”: Suggestions on how to approach medical gross anatomy

Faculty are frequently asked, “How do I study for this course?” Many have formulated responses, but often there is little sharing of this wisdom among faculty, and students may receive different and often conflicting suggestions from each faculty member they encounter. Although most students believe their study problems are unique, we have found students encounter typical pitfalls as they “learn how to learn” gross anatomy. This paper will describe a six-step Suggested Learning Plan for a dissection course in gross anatomy and its rationale, as well as other pertinent advice our students have found beneficial in making the transition from failing or “just getting by” to doing well and feeling confident about gross anatomy.     

Formaldehyde exposure levels and exposure control measures during an anatomy dissecting course

The evaporation of formaldehyde from cadavers can produce high exposures among students and instructors. A possible causal role for formaldehyde has been considered likely for tumor of the nasopharynx and the nasal cavities in human beings. Due to this reason, Japan Ministry of Education, Culture, Sports, Science and Technology (MEXT) has set a guideline, which includes--decrease in gaseous formaldehyde in gross anatomy dissection laboratories and a guide to medical students about the toxicity of formaldehyde and protective method to avoid damages to skin, mucous, membrane, etc, in 2002. To understand what effective plans should be regarding the awareness of students about this notification, this study measured the gaseous formaldehyde concentrations in the anatomy dissection room and also analyzed the formaldehyde-related symptoms, and frequency of using protective measures. The study was conducted over a period of 3 months during the anatomy dissection exercise. We found that immediately after removing the cadavers' plastic covering, formaldehyde concentrations in the dissection room increased sharply. The concentration reached a peak point of 0.62 ppm after 10 minutes of starting of the class. This was much above the recommended level of 0.5 ppm set by Japan Society for Occupational Health. After 30 minutes of achieving the peak the formaldehyde level started decreasing gradually to a level of 0.11 ppm. Formaldehyde-related symptoms were observed in 59% of students. They had experienced symptoms of irritation of eyes, nose, throat, airways, skin, and headache during the course. Ocular discomfort was found significantly higher in the contact lenses users compared to the spectacle users or the normal eye sight group. Although, the guidelines about toxicity of formaldehyde and its protective measures to prevent damages to skin, mucous membrane etc. were informed to every student, only 52% of the students used both the mask containing activated carbon and the rubber gloves in every practical class without fail. Environmental Health Criteria 89 of International Program of Chemical Safety states, "It must be regarded that formaldehyde fluid is not absorbed directly into tissues through the skin". So the students may be allowed in some cases to touch the cadaver, treated by formaldehyde content fixative, by bare hands to understand the feel of certain organs and tissues. These results support that the rules of health supervision including necessity to use of protective measures, monitoring of indoor air formaldehyde etc. should be adhered by students and instructors in anatomy dissection room during the practical class.     

Effects of an alternate dissection schedule on gross anatomy laboratory practical performance

The current medical curricula reform that is taking place in many medical schools throughout the world has resulted in less time for gross anatomy laboratory instruction. In response, anatomists are using a variety of approaches (e.g., peer teaching, prosections, plastinated anatomical models, etc.) to adapt to these changes. To accommodate recent curricular reform at the University of Health Sciences College of Osteopathic Medicine, an alternating dissection schedule was implemented. The purpose of this study is to examine the effects of the alternating schedule on gross anatomy laboratory practical performance. Using a Mann-Whitney Rank Sum test, back and upper limb (back-upper limb), and lower extremity laboratory practical performance for students who dissected in every laboratory (EL group; n = 227) is compared to students who dissected in every other laboratory (EOL group; n = 254). For the back-upper limb part of the anatomy laboratory practical, the mean percentage scores for the EL and EOL groups were 74.5% and 68.1%, respectively (P < 0.001). The mean percentage scores for the EL and EOL groups on the lower limb portion of the anatomy lab practical were 75.9% and 75.6%, respectively (P = 0.994). These data suggest that the use of an alternating dissection schedule had an equivocal effect on the students' gross anatomy laboratory practical performance for these two sections. The reasons for these conflicting results may have been related to regional complexity or volume of information, and the sequence in which the regions were taught.     

Clinical anatomy of the subserous layer: An amalgamation of gross and clinical anatomy

The 1998 edition of Terminologia Anatomica introduced some currently used clinical anatomical terms for the pelvic connective tissue or subserous layer. These innovations persuaded the present author to consider a format in which the clinical anatomical terms could be reconciled with those of gross anatomy and incorporated into a single anatomical glossary without contradiction or ambiguity. Specific studies on the subserous layer were undertaken on 79 Japanese women who had undergone surgery for uterine cervical cancer, and on 26 female cadavers that were dissected, 17 being formalin‐fixed and 9 fresh. The results were as follows: (a) the subserous layer could be segmentalized by surgical dissection in the perpendicular, horizontal and sagittal planes; (b) the segmentalized subserous layer corresponded to 12 cubes, or ligaments, of minimal dimension that enabled the pelvic organs to be extirpated; (c) each ligament had a three‐dimensional (3D) structure comprising craniocaudal, mediolateral, and dorsoventral directions vis‐á‐vis the pelvic axis; (d) these 3D‐structured ligaments were encoded morphologically in order of decreasing length; and (e) using these codes, all the surgical procedures for 19th century to present‐day radical hysterectomy could be expressed symbolically. The establishment of clinical anatomical terms, represented symbolically through coding as demonstrated in this article, could provide common ground for amalgamating clinical anatomy with gross anatomy. Consequently, terms in clinical anatomy and gross anatomy could be reconciled and compiled into a single anatomical glossary. Clin. Anat. 29:508–515, 2016. © 2015 Wiley Periodicals, Inc.     

On behalf of tradition: An analysis of medical student and physician beliefs on how anatomy should be taught

Human anatomy, one of the basic medical sciences, is a time‐honored discipline. As such, it is taught using traditional methods, cadaveric dissection chief among them. Medical imaging has recently gained popularity as a teaching method in anatomy courses. In light of a general tendency to reduce course hours, this has resulted in a decrease of dissection time and intense debates between traditional and modern approaches to anatomy teaching. In an attempt to explore trends in the attitudes of medical professionals toward the various methods of anatomy teaching, medical imaging in particular, the authors constructed a questionnaire and conducted a nationwide survey among medical students (in all stages at medical school), residents, and specialists in all fields of medicine. The survey results demonstrated indisputable appreciation of traditional methods of anatomy teaching, particularly cadaveric dissection, and showed that specialists believe significantly more strongly than clinical or preclinical students that anatomy and medical imaging should be taught separately. Strong correlations among the components of the traditional approach to anatomy instruction were also found. In light of the results, it was recommended that imaging should be incorporated into anatomy courses with caution, and, as far as possible, not at the expense of dissection time. It was advised that medical imaging has to be taught as a separate course, parallel to a traditional anatomy course. This will allow anatomical principles to be appreciated, which in turn will serve the students when they study radiology. “And we proceed in the following order: in front walks Nikolai with the slides or atlases, I come after him, and after me, his head humbly lowered, strides the cart horse; or else, if necessary, a cadaver is carried in first, after the cadaver walks Nikolai, and so on. At my appearance, the students rise, then sit down, and the murmur of the sea suddenly grows still. Calm ensues.” —From “A Boring Story: From the Notebook of an Old Man” by Anton Chekhov. Clin. Anat. 28:980–984, 2015. © 2015 Wiley Periodicals, Inc.     

Improved dissection efficiency in the human gross anatomy laboratory by the integration of computers and modern technology

The need to increase the efficiency of dissection in the gross anatomy laboratory has been the driving force behind the technologic changes we have recently implemented. With the introduction of an integrated systems-based medical curriculum and a reduction in laboratory teaching hours, anatomy faculty at the University of North Texas Health Science Center (UNTHSC) developed a computer-based dissection manual to adjust to these curricular changes and time constraints. At each cadaver workstation, Apple iMac computers were added and a new dissection manual, running in a browser-based format, was installed. Within the text of the manual, anatomical structures required for dissection were linked to digital images from prosected materials; in addition, for each body system, the dissection manual included images from cross sections, radiographs, CT scans, and histology. Although we have placed a high priority on computerization of the anatomy laboratory, we remain strong advocates of the importance of cadaver dissection. It is our belief that the utilization of computers for dissection is a natural evolution of technology and fosters creative teaching strategies adapted for anatomy laboratories in the 21st century. Our strategy has significantly enhanced the independence and proficiency of our students, the efficiency of their dissection time, and the quality of laboratory instruction by the faculty.     

New views of male pelvic anatomy: role of computer-generated 3D images

There is considerable controversy concerning the role of cadaveric dissection in teaching gross anatomy and the potential of using 3D computer-generated images to substitute for actual laboratory dissections. There are currently few high-quality 3D virtual models of anatomy available to evaluate the utility of computer-generated images. Existing 3D models are frequently of structures that are easily examined in three dimensions by removal from the cadaver, i.e., the heart, skull, and brain. We have focused on developing a 3D model of the pelvis, a region that is conceptually difficult and relatively inaccessible for student dissection. We feel students will benefit tremendously from 3D views of the pelvic anatomy. We generated 3D models of the male pelvic anatomy from hand-segmented color Visible Human Male cryosection data, reconstructed and visualized by Columbia University's in-house 3D Vesalius trade mark Visualizer.(1) These 3D models depict the anatomy of the region in a realistic true-to-life color and texture. They can be used to create 3D anatomical scenes, with arbitrary complexity, where the component anatomical structures are displayed in correct 3D anatomical relationships. Moreover, a sequence of 3D scenes can be defined to simulate actual dissection. Structures can be added in a layered sequence from the bony framework to build from the "inside-out" or disassembled much like a true laboratory dissection from the "outside-in." These 3D reconstructed anatomical models can provide views of the structures from new perspectives and have the potential to improve understanding of the anatomical relationships of the pelvic region (http://www.cellbiology.lsuhsc.edu/People/Faculty/Venuti_Figures/movie_index.html).     

Undergraduate coursework in anatomy as a predictor of performance: comparison between students taking a medical gross anatomy course of average length and a course shortened by curriculum reform

The performance of students taking medical gross anatomy at the University of California at Davis during a 4-year period (1999-2002) was correlated with prior undergraduate anatomy coursework. Significant correlations were observed between class rank in medical anatomy and taking any undergraduate anatomy as well as the total number of undergraduate anatomy units (P<0.01). Taking human gross anatomy and an anatomy laboratory course were significantly correlated with medical anatomy class rank (P<0.01) as were grades in human anatomy, comparative vertebrate anatomy and anatomy laboratory courses (P<0.05). The medical anatomy course offered in 1999-2000 was 172 hr long, and the course offered in 2001-2002 was 135 hr long, with most of the difference made by decreasing lecture time while sparing the dissection laboratory. The reduction in course length was the consequence of a curriculum-wide cap in weekly contact hours. In the 172-hr medical anatomy course there were significant correlations between the students who took undergraduate anatomy and both class rank and the score on the final examination (P<0.01). These correlations did not exist for the 135-hr course. This may be explained by previous anatomy experiences helping students learn from lecture more than from dissection laboratory, as well as the extra study time available to students in the reformed medical curriculum. Pre-medical students and health science advisors need to consider that the benefits of taking anatomy as an undergraduate may be dependent on the configuration of a medical school's curriculum.     

Effects of four supplemental instruction programs on students' learning of gross anatomy

Many researchers have reported that supplemental instruction programs improve medical students' performance in various basic sciences. This study was conducted to evaluate the summative effects of four supplemental instruction programs (i.e., second-year medical student teaching assistant program; directed study program; weekly instructor laboratory reviews; and a web-based anatomy program) on medical students' gross anatomy laboratory practical performance. First-year medical students from the graduating class of 2006 (n = 223) received the four supplemental instruction programs (Experimental Group). The Control Group consisted of first-year medical students from the graduating class of 2005 (n = 254) who did not receive the four supplemental learning methods. Mann-Whitney rank sum tests were used to compare the two groups' median percentages for the back-upper limb (B-UL) and the lower limb (LL) parts of a gross anatomy laboratory practical. The Experimental Group's median percentages for both the B-UL (77.78%) and LL (83.33%) were significantly greater than that of the Control Group (B-UL = 69.00%; LL = 81.00%; P < 0.05). Results from a post-hoc student survey showed that more students both rated and ranked the weekly instructor laboratory reviews as extremely useful and most beneficial, respectively. A greater number of students rated and ranked the web-based anatomy program as not useful and least beneficial, respectively. The results from this study suggest that the four supplemental instruction programs improved students' learning of gross anatomy as measured by laboratory practical performance. In addition, students most valued the additional time in the gross anatomy laboratory with the instructors.     

Comparisons between the attitudes of medical and dental students toward the clinical importance of gross anatomy and physiology

Marked changes are occurring within both the medical and dental curricula and new ways of teaching the basic sciences have been devised and traditional methods (e.g., dissection for gross anatomy and of bench‐based animal preparations for physiology) are increasingly no longer the norm. Although there is much anecdotal evidence that students are not in favor of such changes, there is little evidence for this based on quantitative analyses of students' attitudes. Using Thurstone and Chave attitude analyses, we assessed the attitudes of first year medical and dental students at Cardiff University toward gross anatomy and physiology in terms of their perceived clinical importance. In addition, we investigated the appropriateness (“fitness for purpose”) of teaching methodologies used for anatomy and physiology. The hypotheses tested recognized the possibility that medical and dental students differed in their opinions, but that they had a preference to being taught gross anatomy through the use of dissection and had no preference for physiology teaching. It was found that both medical and dental students displayed positive attitudes toward the clinical relevance of gross anatomy and that they preferred to be taught by means of dissection. Although both medical and dental students displayed positives attitudes toward the clinical relevance of physiology, this was greater for the medical students. Both medical and dental students showed a preference for being taught physiology through didactic teaching in small groups but the medical students also appreciated being taught by means of practicals. Overall, this study highlights the expectations that students have for the basic science foundation teaching within their professional training and signals a preference for being taught experientially/practically. Differences were discerned between medical and dental students that might reflect the direct association between systems physiology and pathophysiology and the application of this knowledge within the medical field in comparison to the dental field, which is heavily skill‐based. Clin. Anat. 27:976–987, 2014. © 2014 Wiley Periodicals, Inc.     

Back to basics.

The present study sought to establish findings and share views concerning the teaching of gross anatomy. The conclusions were drawn from feedback taken in 1995 from Year 1 (M1) through Year 5 (M5) (final year) medical students at the National University of Singapore. The survey was taken from two groups of students that had gone through two different curricula. The first group of M4 and M5 students studied under an old curriculum that taught anatomy over a period of three semesters. The second group of M1 through M3 students studied under a new curriculum of two semesters' duration. Altogether, 546 (M1: 147; M2: 120; M3: 78; M4: 107; M5: 97) completed questionnaires were analyzed. Throughout the years of study, the majority of students found dissection helpful (55.2-72. 7%) or very helpful (18.9-40.7%) in their understanding of gross anatomy. A minority of students (0-25.3%) found it not helpful. Taking all of the five years of students together, this would mean that 60.7% of the students found dissection helpful and 28% of them found it very helpful in their understanding of gross anatomy. Of the M3 students who had both dissection and demonstrations on prosected specimens, the majority of them found dissection helpful (55.2%) or very helpful (33.3%); they also found demonstrations on prosected specimens helpful (64.6%), or very helpful (27.8%). When asked whether dissection should be replaced completely by demonstrations on prosected specimens, 86.7% gave a resounding no. With regard to gross anatomy coverage, 11.7% of M4 and M5 students found it inadequate, 67.5% adequate, and 20.8% excessive. Only 1% of these students found that the gross anatomy they had learned was of no clinical relevance; 22.3% found it of little clinical relevance; and an overwhelming majority (76.7%) found it mostly clinically relevant. Most were grateful that they had been taught the basics of gross anatomy. These findings are discussed with an emphasis on the time needed and deep level approach required to gain conceptual understanding of anatomical organization.     

Formaldehvde and Dhenol exposure during an anatom; dissecdon course: a Dossible source of IgE-mediated sensitizkion?

The sensitizing potency of formaldehyde and phenol exposure during 4 weeks of an anatomy dissection course was assessed in 45 medical students. Specific IgE against formaldehyde by RAST and by ELISA and specific IgE against phenol by ELISA were assessed before and after the course. At the start of the course. symptoms, type I allergy, respiratory diseases, and smoking habits were noted. At the end of the course, only symptoms experienced during the dissection lessons were assessed. Indoor formaldehyde levels were measured continuously. The mean indoor formaldehyde level was 0.124±0.05 ppm, with a minimum of 0.059 ppm and a maximum of 0.219 ppm. Specific IgE against formaldehyde or phenol was found in none of the subjects at the beginning of the course, and no student showed specific IgE against formaldehyde or phenol after the course. Assessment of primarily irritant symptoms during the lessons revealed itch and paraesthesia of hands in 33/45 students (P<0.00005), headache in 15/45 students, burning eyes in 13/45 students (P<0.02), dizziness in 8/45 students (P<0.008), sneezing in 4/45 students, epistaxis in 2/45 students, and shortness of breath in 1/45 students. According to our data, l-month exposure to formaldehyde and phenol during an anatomy dissection course does not induce specific IgE against formaldehyde or phenol.     

Anatomy of the thorax and shoulder girdle displayed by magnetic resonance imaging

In 1971, radiographic anatomy of the human body was added to the gross anatomy course at UCLA. Radiographic contrast studies and plain anatomical displays were formulated into teaching packages for all organ systems. Residents presented each package to first-year medical students in the dissection laboratory to augment the teaching of anatomy. In November 1984, magnetic resonance imaging was instituted in the radiology department. Imaging the chest produced coronal and axial planes which displayed the muscles and soft tissues of the thorax. In 1986, the authors presented their study of MR anatomy of the chest and shoulder girdle to the American Association of Anatomists. The purpose of this presentation is to demonstrate the anatomy of the thorax and shoulder girdle as displayed by magnetic resonance, correlated with regional anatomy, with emphasis on soft tissue structures.     

Near‐peer driven dissection selective: A primer to the medical school anatomy course

In the anatomy laboratory, skill remains a critical component to unlocking the true value of learning from cadaveric dissection. However, there is little if any room for provision of instruction in proper dissection technique. We describe how near‐peer instructors designed a supplemental learning activity to enhance the dissection experience for first‐year medical students. This study aimed to evaluate the efficacy of this curriculum in improving participants' understanding of dissection technique and its impact on perceived challenges associated with the anatomy course. Curriculum was designed under faculty guidance and included didactic sessions, low‐fidelity models, dissection, student presentations, and clinical correlations. Participants' (n = 13) knowledge of basic dissection techniques and concepts were assessed before the selective, and both participants' and nonparticipants' (n = 39) knowledge was assessed at the end of week one and week seven of the anatomy course. Scores were compared using repeated measures ANOVA followed by post hoc t‐tests. Thirteen deidentified reflective essays were reviewed by four independent reviewers for themes that aligned with learning objectives. Participants in the selective course scored higher on assessment of dissection techniques and concepts one week after the selective compared to both nonparticipants and their own baseline scores before the selective. Analysis of student reflections resulted in four themes: confidence with dissection skill, sharing resources and transfer of knowledge, learning environment, and psychological impact of perceived challenges of the anatomy course. Near‐peer driven supplemental exercises are effective in facilitating dissection skills. This dissection primer increases student confidence and alleviates apprehension associated with anatomy courses. Clin. Anat. 28:985–993, 2015. © 2015 Wiley Periodicals, Inc.     

Rotation of dissecting groups among different cadavers provides students of anatomy with increased opportunity to observe human variations

One way to increase medical students' awareness of anatomical variability is the dissection of different cadavers throughout laboratory coursework. This report covers such a procedure successfully instituted in a human gross anatomy course. © 1995 WiIey-Liss, Inc.