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.     

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.     

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.     

Interpretation of multi-detector computed tomography images before dissection may allow detection of vascular anomalies: a postmortem study of anomalous origin of the right subclavian artery and the right vertebral artery

The Graduate School of Medicine at Chiba University is planning to introduce computed tomography (CT) images of donated cadavers to the gross anatomy laboratory. Here we describe an anomaly of the right subclavian artery that was detected by interpretation of CT images prior to dissection. The anomaly was verified to be the right subclavian artery, as the last branch of the aortic arch, by subsequent dissection of the cadaver. We also identified an anomalous origin of the right vertebral artery by dissection. This anomaly was also visible on CT images, although it had not been recognized in the first interpretation of the CT images. Our results suggest that branching anomalies of arteries with a diameter of >1?cm are detectable on CT images even without the injection of contrast medium. We also discuss the utility of interpreting CT images prior to dissection as a means by which medical students can gain a better understanding of human body during the gross anatomy laboratory.     

Integrating gross pathology into teaching of undergraduate medical science students using human cadavers

Human cadavers offer a great opportunity for histopathology students for the learning and teaching of tissue pathology. In this study, we aimed to implement an integrated learning approach by using cadavers to enhance students' knowledge and to develop their skills in gross tissue identification, handling and dissection techniques. A total of 35 students enrolled in the undergraduate medical science program participated in this study. A 3‐hour laboratory session was conducted that included an active exploration of cadaveric specimens to identify normal and pathological tissues as well as tissue dissection. The majority of the students strongly agreed that the integration of normal and morbid anatomy improved their understanding of tissue pathology. All the students either agreed or strongly agreed that this laboratory session was useful to improve their tissue dissection and instrument handling skills. Furthermore, students from both cohorts rated the session as very relevant to their learning and recommended that this approach be added to the existing histopathology curriculum. To conclude, an integrated cadaver‐based practical session can be used effectively to enhance the learning experience of histopathology science students, as well as improving their manual skills of tissue treatment, instrument handling and dissection.     

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.     

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.     

Teaching anatomy with surgeons' tools: use of the laparoscope in clinical anatomy.

The purpose of this study was to establish the feasibility of laparoscopy in embalmed cadavers to teach abdominal gross anatomy. One cadaver was selected based on body habitus and absence of previous abdominal operations. A standard trocar was used to enter the abdomen at the umbilicus. Two trocars were placed in the left upper quadrant. Pneumoperitoneum was achieved with continuous CO(2) pressure. Liver retraction was achieved percutaneously, exposing the porta hepatis and the gallbladder. The dissection was done with four first-year medical students using standard laparoscopic equipment. Following this, the demonstration was projected over multiple monitors so that all students could participate. Laparoscopic dissection in an embalmed cadaver is feasible and an excellent educational tool for both the medical student and the dissector. The dissector has the opportunity to manipulate laparoscopic tools in a human model closely paralleling operative experience, and the students have an opportunity to learn abdominal anatomy from a clinical perspective. Laparoscopic examination and dissection of fresh cadavers has been used for training surgeons on new procedures such as colon resection, antireflux procedures, and cholecystectomy. There is no report of this same technology used in embalmed cadavers to teach basic anatomy. This approach allows first-year medical students to learn the anatomy while exposing them to the technology currently used in surgical practice, and it affords surgical residents and students additional opportunities to practice laparoscopic skills.     

Formaldehyde exposure and its effects during pregnancy: Recommendations for laboratory attendance based on available data

Formalin is commonly used in fixation of cadaveric specimens. Exposure to formaldehyde, a component of formalin and a known carcinogen, during gross anatomy laboratory dissection is a continuing concern for pregnant students and instructors. Since there is little literature on this specific topic, the current review was compiled in the hope of offering recommendations to pregnant students and instructors who are engaged in human anatomical dissection where formalin is used. Relevant articles were obtained through searches of PubMed and Google Scholar for the terms “formaldehyde,” “pregnant,” “formalin,” and “exposure.” A literature search was conducted for chemical information and articles about exposure as issued by government regulatory agencies and chemical companies that produce formaldehyde. This led to the compilation of 29 articles each of which included references to previous, relevant, human research. The reviewed literature contains data strongly suggesting that pregnancy can be affected by formaldehyde exposure. Therefore, on the basis our analysis, female students who might be pregnant should avoid formaldehyde exposure, including that in a gross anatomy laboratory. Instructors should find other means of ensuring anatomical competence for these students. Clin. Anat. 28:972–979, 2015. © 2015 Wiley Periodicals, Inc.     

The study techniques of Asian, American, and European medical students during gross anatomy and neuroanatomy courses in Poland

Background  

Past research in medical education has addressed the study of gross anatomy, including the most effective learning techniques, comparing the use of cadavers, dissection, anatomy atlases, and multimedia tools. The aim of this study was to demonstrate similarities and differences among American, Asian, and European medical students (MS) regarding different study methods and to see how these methods affected their clinical skills.     

An improved low-formaldehyde embalming fluid to preserve cadavers for anatomy teaching

The desired properties required for successful embalming of cadavers for gross anatomy teaching include: (1) good long-term structural preservation of organs and tissues with minimal shrinkage or distortion; (2) prevention of over-hardening, while maintaining flexibility and suppleness of internal organs; (3) prevention of desiccation; (4) prevention of fungal or bacterial growth and spread within a specific cadaver and to other cadavers in the dissection room; (5) reduction of potential biohazards (spread of infection to dissection personnel and students); (6) reduction of environmental chemical hazards (especially from formaldehyde and phenol) in order to comply with increasingly severe health and safety regulations and a new awareness of possible dangers of these chemicals in the workplace; and (7) retention of colour of tissues and organs while minimising oxidation effects that result in 'browning'.     

Time‐saving and fail‐safe dissection method for vestibulocochlear organs in gross anatomy classes

Because the vestibulocochlear organs are tiny and complex, and are covered by the petrous part of the temporal bone, they are very difficult for medical students to dissect and visualize during gross anatomy classes. Here, we report a time‐saving and fail‐safe procedure we have devised, using a hand‐held hobby router. Nine en bloc temporal bone samples from donated human cadavers were used as trial materials for devising an appropriate procedure for dissecting the vestibulocochlear organs. A hand‐held hobby router was used to cut through the temporal bone. After trials, the most time‐saving and fail‐safe method was selected. The performance of the selected method was assessed by a survey of 242 sides of 121 cadavers during gross anatomy classes for vestibulocochlear dissection. The assessment was based on the observation ratio. The best procedure appeared to be removal of the external acoustic meatus roof and tympanic cavity roof together with removal of the internal acoustic meatus roof. The whole procedure was completed within two dissection classes, each lasting 4.5 hr. The ratio of surveillance for the chorda tympani and three semicircular canals by students was significantly improved during 2013 through 2016. In our dissection class, “removal of the external acoustic meatus roof and tympanic cavity roof together with removal of the internal acoustic meatus roof” was the best procedure for students in the limited time available. Clin. Anat. 30:703–710, 2017. © 2017Wiley Periodicals, Inc.     

Integration of clinical problems in teaching gross anatomy: living anatomy, X-ray anatomy, patient presentations, and films depicting clinical problems

In addition to lectures and the dissection course, four supplements are described to stimulate first-year medical students to learn gross anatomy. All topics are coordinated with the dissection course. The additional options are living anatomy, X-ray anatomy by a roentgenologist, presentation of patients by clinicians, and films on clinical problems. This integrated curriculum of basic and applied anatomy generates a high level of student interest in gross anatomy.     

A unique, innovative, and clinically oriented approach to anatomy education.

The establishment of The Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, whose first class entered in 2004, provided a unique opportunity to design an anatomy program that, from all indications, is effective, time efficient, and clinically relevant in the context of a nonlecture, problem-based, organ-systems-oriented curriculum. Through consultation with surgery colleagues, the case-directed anatomy program was developed. This approach, meeting one day a week for 1 hour 50 minutes for 30 weeks, uses clinical cases to introduce anatomical information that is reinforced using prosected cadavers and imaging. The format of the approach involves three steps: (1) students preview a clinical case with clinical questions and learning objectives, (2) students acquire basic knowledge using textbooks and self-directed learning modules, and (3) students reinforce their basic knowledge in weekly case-directed anatomy sessions, which involve an interactive discussion of the clinical case followed by a laboratory. In the laboratory, students rotate around stations viewing prosected cadavers and imaging. Learning anatomy does not stop after the first year, because the program is longitudinal. During the second year, students review anatomy in each organ-system course using the first-year format. Also, second-year students can assist the fellows or residents prepare the prosections for first-year students and for their review of anatomy in the second year. This provides students with a dissection experience. During third-year clinical rotations, anatomy knowledge is reinforced, and several surgery anatomy electives are available during the final year. In this way, anatomy is learned and reinforced throughout the medical school curriculum.     

Overcoming the tension between scientific and religious views in teaching anatomical dissection: the Israeli experience

More than three thousand years of Jewish historical and scholarly writings have addressed the problematic relationship between anatomical dissection for the purpose of medical education and Judaism, which values the wholeness and sanctity of the human body. The Department of Anatomy at Tel Aviv University's Sackler Faculty of Medicine has sought to bridge the gap between science and Jewish religious-cultural values. The Department requires students to conduct laboratory dissections on cadavers in an ethical and respectful manner. Student emotions are also addressed by the Department as students are encouraged to share their apprehensions and concerns about participating in dissections in discussion groups. At the same time, the high academic standards of the medical school are strictly upheld, ensuring that each student has a thorough knowledge of human anatomy. Teaching anatomy in Israeli medical school involves reconciling two conflicting approaches to dissection: (1) The scientific-medical approach, which views the human body as inert material and anatomical dissection as a means of studying anatomy and gaining medical knowledge. (2) A Jewish religious point of view, which perceives anatomical dissection as a threat to the sanctity of a human body and leads to the defilement of those participating in the dissection. In this article, the views of major Jewish scholars regarding dissection are presented and discussed in relation to their implementation in the dissection theater. These views are examined in an anthropological light based on observations in the dissection room and interviews with students and faculty members. The findings reflect the emotions and concerns of Israeli medical students at the Sackler Faculty of Medicine in particular as well as those of the Israeli-Jewish population as a whole. In the dissection theater, medical students must gain a comprehensive understanding of human anatomy while dealing with their own personal ethical, cultural, and religious views on death and dying. Confronting these issues enhances both personal growth as individuals and professional behavior as future physicians.     

Gross anatomy: An outdated subject or an essential part of a modern medical curriculum? Results of a questionnaire circulated to final-year medical students

Final-year undergraduate medical students were given a questionnaire on the gross anatomy curriculum they had experienced in their first year at medical school 5 years earlier. They were asked to evaluate the relevance of the dissection course, lectures and seminars in gross anatomy for clinical courses, clerkships, and everyday practical work on the ward. About two-thirds of the students found the time spent on 10 different regions in anatomy to be adequate, and a considerable number of students would have liked even more details. The vast majority expressed a wish to repeat topographical anatomy during their clinical teaching. Furthermore, ～75% of the students showed interest in short, specialized dissection courses during the clinical curriculum. Medical students just before graduation ranked gross anatomy with the dissection course and integrated clinical topics as a keystone for their clinical courses. The results of such surveys should be taken into consideration when discussing modification to teaching gross anatomy or arguing about a balanced dissection course. © 1993 Wiley-Liss, Inc.     

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.     

Integrating gross anatomy into a clinical oncology curriculum: the oncoanatomy course at Duke University School of Medicine.

The amount of time devoted to teaching gross anatomy to medical students is declining. This topic remains critically important for some medical students, especially those seeking training in anatomy-laden specialties. The authors describe a course currently offered in the department of radiation oncology in the Duke University School of Medicine, developed in 2005, that expands anatomy education into the medical school clinical years.The aim of the course is to help reinforce anatomy knowledge in the clinical context of radiation oncology priorities and concerns, as well as to provide direct visualization and palpation of human cadavers, thus enabling the understanding of complex three-dimensional and anatomic principles. The audience for this course consists of medical students rotating through and the residents and clinical faculty in the department of radiation oncology. Anatomists and radiation oncology residents together present monthly didactic lectures, clinical case presentations, and cadaver-based demonstrations about the relationships between a tumor's anatomic location and its symptoms, patterns of spread, and treatment considerations.Anonymous surveys were distributed to course participants to assess the three components of the course. Survey results indicate that the participants found the anatomy lectures, clinical case presentations, and dissection presentations all to be interesting, relevant, and of high quality. This course is therefore favored by students, residents, and faculty as a way to supplement gross anatomy education during training for a specialty in which anatomy knowledge is essential.     

Attitudes of medical and dental students to dissection

Guy's, King's, and St. Thomas's School of Medicine encourages students to learn anatomy from human dissection. Today, there is a worldwide move of anatomy-based teaching away from dissection to prosection. This study investigates how attitudes toward dissection vary with gender and ethnicity. We assessed students' reactions and concerns regarding the dissecting room, any coping strategies they use to combat them, and analyzed effective methods of teaching anatomy to medical and dental students. Three questionnaires were distributed amongst 474 first-year medical and dental students before dissection and 1 week and 12 weeks after exposure to the dissecting room. Over the 3 months we found significant changes in the concerns of students about dissection. There were also significant differences (P < 0.05) between medical and dental students, males and females, and students of differing ethnic backgrounds, which persisted over 12 weeks. Both medical and dental students found tutorials and textbooks of most value in learning anatomy. Dental students found prosection more useful than medical students (P < 0.001) though neither group demonstrated a significant preference for prosection over dissection. Of concern, 7% reported recurring images of cadavers and 2% insomnia after commencing dissection. Interest in the subject matter and discussion were the commonest methods used to combat stress. This study contributes to the ongoing debate about the value of the dissecting room in the medical school curriculum.     

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.