The dissection course – necessary and indispensable for teaching anatomy to medical students

Anatomy is a major basic subject in medicine and related biomedical sciences. A central tool most universities use for teaching anatomy is the “dissection course”, in which medical students learn the basic constructional principles of the human body by dissecting a cadaver. In recent years, the relevance and value of the dissection laboratory have been under discussion at different universities due to high costs and problems of shortness in time in some medical curricula. Indeed, during the last 10 years, several universities in the US and the UK have abandoned dissection and have moved from a cadaver-oriented to a cadaverless anatomy. This development results in a fundamental discussion on the role of the “dissection course” in the medical curriculum, ultimately raising the question as to whether we should continue teaching anatomy by dissection. This article presents nine arguments for the dissection course as a central tool for teaching macroscopic anatomy and is an attestment to the continuation of the use of cadaver material in anatomical laboratories within the auspices of scholastic and university order for the benefit of future physicians with due respect and honour guaranteed for every donor.     

Web‐delivery of anatomy video clips using a CD‐ROM

Until recently, anatomists had no doubt that the teaching of anatomy had to include cadaver dissection. However, due to a changing academic environment as well as challenged financial institutional resources, computer‐assisted instruction was introduced into medical curriculum in an attempt to reduce the cost and the time committed to cadaver dissection. Computer‐assisted instruction included locally created or commercially available anatomy software, Internet sites, and databases of digital images of cadaveric structures such as the Virtual Human Project. However, until now, bandwidth limitations have not allowed effective visualization in real‐time over the Internet of recorded videos or 3D animations reconstructed from a database. We describe how to successfully link and display large video clips stored on a CD‐ROM in support of lectures saved in HTML format on the Internet. This process, described in its totality, allows students to access audiovisual files on a CD‐ROM through the Internet, from any location, with either Macintosh or Windows computers, using the Netscape browser. This process allowed us to circumvent one of the most significant limitations of the computer‐assisted instruction on the Internet by delivering full audio and visual information on demand, as it would happen in a traditional classroom. Anat Rec (New Anat) 261:78–82, 2000. © 2000 Wiley‐Liss, Inc.     

Fluoroscopic angiography in the gross anatomy dissection laboratory: visualizing the aortic arch and its branches in a cadaver

We present fluoroscopic images of the aortic arch and its branches obtained in a first year medical gross anatomy teaching laboratory after an aberrant right subclavian artery was discovered during dissection. The aortic arch and its branches in the cadaver were filled with contrast medium in molten agar. After the agar solidified, a portable fluoroscope was used to obtain radiographic images. These post-mortem images were then compared with computed tomography images obtained while the individual was living. The embryology, prevalence, and clinical findings of this arterial variation are reviewed, and the importance of recognizing the presence of an aberrant right subclavian artery before performing various procedures is discussed. This exercise gave students the unique opportunity to compare the three-dimensional anatomy seen in the dissection laboratory with the two-dimensional presentation of that same anatomy in the radiographic images that they will see in clinical practice.     

Use of Web-based materials to enhance anatomy instruction in the health sciences

Teaching anatomy by dissection is under considerable pressure to evolve and/or even be eliminated, and curricular hours in the dissection laboratory are decreasing. As a possible means of easing this pressure, an online interactive anatomy program has been created to enhance the dissection experience, observational learning, and three-dimensional comprehension of human anatomy. An assessment was made of the utility of the program in preparing students for dissection laboratories and for examinations. The efficacy of the application was evaluated by first-year students and faculty with pre- and post-use surveys in anatomy courses at three medical schools. It was found that students felt better prepared if they utilized the Web site prior to their dissection laboratory, and faculty reported spending less time explaining basic concepts or techniques. It is concluded that a comprehensive online program significantly enhances the quality and efficiency of instruction in human anatomy in the dissection laboratory and could prove to be a useful tool at other institutions.     

Web-delivery of anatomy video clips using a CD-ROM

Until recently, anatomists had no doubt that the teaching of anatomy had to include cadaver dissection. However, due to a changing academic environment as well as challenged financial institutional resources, computer-assisted instruction was introduced into medical curriculum in an attempt to reduce the cost and the time committed to cadaver dissection. Computer-assisted instruction included locally created or commercially available anatomy software, Internet sites, and databases of digital images of cadaveric structures such as the Virtual Human Project. However, until now, bandwidth limitations have not allowed effective visualization in real-time over the Internet of recorded videos or 3D animations reconstructed from a database. We describe how to successfully link and display large video clips stored on a CD-ROM in support of lectures saved in HTML format on the Internet. This process, described in its totality, allows students to access audiovisual files on a CD-ROM through the Internet, from any location, with either Macintosh or Windows computers, using the Netscape browser. This process allowed us to circumvent one of the most significant limitations of the computer-assisted instruction on the Internet by delivering full audio and visual information on demand, as it would happen in a traditional classroom.     

Viewpoint: exploring the human interior: the roles of cadaver dissection and radiologic imaging in teaching anatomy.

For a variety of reasons, new radiological imaging techniques are supplanting traditional cadaver dissection in the teaching of human anatomy. The authors briefly review the historical forces behind this transition, and then explore the advantages and drawbacks of each approach. Cadaver dissection offers an active, hands-on exploration of human structure, provides deep insights into the meaning of human embodiment and mortality, and represents a profound rite of passage into the medical profession. Radiological imaging permits in vivo visualization, offers physiologic as well as anatomic insights, and represents the context in which contemporary practicing physicians most frequently encounter their patients' otherwise hidden internal anatomy. Despite its important strengths, radiology cannot simply substitute for cadaver dissection, and the best models for teaching gross anatomy will incorporate both cadaver dissection and radiological imaging.     

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.     

Two years' experience of assessment of anatomy teachers and courses by preclinical and clinical students

Students at the Royal College of Surgeons in Ireland completed a questionnaire at the end of the anatomy course assessing teachers and teaching in the department of anatomy. Individual teachers were rated on a five-point scale for their performance as lecturers, demonstrators, and examiners. Anatomy teaching was considered in its various subdivisions: regional anatomy, the dissection room course (gross laboratory), radiological anatomy, embryology, neuroanatomy, and histology, and each was scored on a similar five-point scale for relevance and interest. Constructive criticism of both staff (faculty) and course was invited. The results of this survey have been used to counsel staff to good effect, and to improve course structure and content. Resultant changes were made in the teaching of histology, neuroanatomy, and embryology, and the restructuring of surface anatomy tutorials. Numerical scores for teachers provide indices of teaching abilities for comparative purposes and for professional advancement. A similar questionnaire given to clinical students 1 year after completion of the anatomy course is shown to have been of little value. © 1993 Wiley-Liss, Inc.     

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).     

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.     

The new face of gross anatomy

The nature of anatomy education has changed substantially over the past decade due to both a new generation of students who learn differently from those of past years and the enormity of advances in anatomical imaging and viewing. At Mount Sinai School of Medicine, our anatomy courses have been designed to meld classic dissection with the tools physicians and surgeons will use tomorrow. We introduce students to the newest technologies available for viewing the body, such as minimally invasive approaches, ultrasonography, three-dimensional visualizations, multi-axial computerized image reconstructions, multi-planar magnetic resonance imaging, and plastinated prosections. Students are given a hands-on, team-building experience operating laparoscopes in the laboratory. A great strength of our program is the important and active participation by faculty from 15 different basic and clinical departments, including several chairs and voluntary faculty. This interdisciplinary approach brings to our students direct, one-on-one encounters or presentations by our finest physicians and surgeons and our core anatomy faculty. In addition, the presence of many teaching assistants drawn from upper classmen and advanced graduate students adds an additional, vibrant dimension. Our anatomy programs for medical/graduate students and postgraduates are structured around three simple principles: (1) it is a privilege to teach, (2) we enlist only passionate teachers, and (3) it is our role to instill appreciation and respect for human form.     

Self-guided clinical cases for medical students based on postmortem CT scans of cadavers

In the summer of 2009, we began full body computed tomography (CT) scanning of the pre-embalmed cadavers in the University of Michigan Medical School (UMMS) dissection lab. We theorized that implementing web-based, self-guided clinical cases based on postmortem CT (PMCT) scans would result in increased student appreciation for the clinical relevance of anatomy, increased knowledge of cross-sectional anatomy, and increased ability to identify common pathologies on CT scans. The PMCT scan of each cadaver was produced as a DICOM dataset, and then converted into a Quicktime movie file using Osirix software. Clinical cases were researched and written by the authors, and consist of at least one Quicktime movie of a PMCT scan surrounded by a novel navigation interface. To assess the value of these clinical cases we surveyed medical students at UMMS who are currently using the clinical cases in their coursework. Students felt the clinical cases increased the clinical relevance of anatomy (mean response 7.77/10), increased their confidence finding anatomical structures on CT (7.00/10), and increased their confidence recognizing common pathologies on CT (6.17/10). Students also felt these clinical cases helped them synthesize material from numerous courses into an overall picture of a given disease process (7.01/10). These results support the conclusion that our clinical cases help to show students why the anatomy they are learning is foundational to their other coursework. We would recommend the use of similar clinical cases to any medical school utilizing cadaver dissection as a primary teaching method in anatomy education.     

Reciprocal peer teaching: students teaching students in the gross anatomy laboratory

Three common instructional strategies used to teach gross anatomy are lecture, discovery or inquiry-based learning, and cooperative learning. One form of cooperative learning, called reciprocal peer teaching (RPT), illustrates circumstances where students alternate roles as teacher and student. By assuming the responsibility of teaching their peers, students not only improve their understanding of course content, but also develop communication skills, teamwork, leadership, confidence and respect for peers that are vital to developing professionalism early in their medical careers. Traditionally in our Anatomy department, students dissect the entire body using a standard dissection manual. More non-traditionally, however, we have increased cooperative learning in the dissection laboratory by involving students in a series of supplementary RPT activities. During these exercises, 10% of the class practiced their demonstration with course instructors until the students felt prepared to demonstrate the exercise to their classmates. We designed one peer demonstration emphasizing three to six teaching objectives for most of the 40 dissection units. This resulted in a compendium of peer demonstrations for implementation throughout the course. The multitude of diverse exercises permitted each student many opportunities to teach their peers. A debriefing questionnaire was administered at the end of the course demonstrating that 100% of students agreed the RPT experience increased their understanding of the topics they taught and 97% agreed it increased their retention of information they taught to their peers. In addition, 92% agreed that RPT improved their communication skills, which can be applied beyond anatomy to their careers as future physicians.     

Imaging microscopy of the middle and inner ear: Part II: MR microscopy

Anatomic definition of the membranous labyrinth in the clinical setting remains limited despite significant technological advances in magnetic resonance imaging (MRI). Recent developments in ultra-high resolution imaging for use in the research laboratory on small animals and pathologic specimens have given rise to the field of imaging microscopy. We have delineated for the first time the labyrinthine structures in a human temporal bone cadaver specimen using these novel techniques. This approach to the study of the middle and inner ear avoids tissue destruction inherent in histological preparations using standard light microscopy techniques. Part I of this series focused on bony middle and inner ear anatomy with MicrCT. In Part II, we present high-resolution MicroMR images to highlight the utility of this technique in teaching radiologists and otolaryngologists clinically relevant anatomy focusing on the membranous labyrinth. This anatomy can be further enhanced using 3D volume-rendered images. It is hoped that familiarity with these ex vivo anatomic techniques will encourage further developments in the field of high-resolution clinical imaging for patients with temporal bone pathologies.     

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.     

Provision of anatomical teaching in a new British medical school: getting the right mix

In response to a government report, which recommended a substantial increase in the number of medical students in the United Kingdom by 2005, several new medical schools have been set up throughout the country. One such school, the Brighton and Sussex Medical School (BSMS), recently opened its doors to new students. BSMS offers a 5-year medical curriculum that uses an integrated systems-based approach to cultivate academic knowledge and clinical experience. Anatomy is one of the core elements of the program and, as such, features strongly within the modular curriculum. The challenge for the anatomy faculty has been to decide how best to integrate anatomy into the new curriculum and what teaching modalities should be used. A multidisciplinary approach has been taken using both traditional and contemporary teaching methods. Unlike most of the other new medical schools, BSMS uses cadaveric dissection as the cornerstone of its teaching, as the faculty believes that dissection still provides the most powerful technique for demonstrating anatomy as well as enhancing communication and teamwork skills. The dissection experience is handled using an understanding and professional way. However, to ensure that our students do not become detached from the process of patient-focused care, emphasis in the dissecting room environment is also placed on respect and compassion. To enhance conceptual understanding of structure and function and provide further clinical relevance, we are using imaging technology to demonstrate living anatomy. Unique to the BSMS curriculum is the teaching of the anatomy in the later years of the program. During specialist rotations, students will return to the dissecting room to study the anatomy relevant to that area. Such vertical integration ensures that core anatomical knowledge is gained at the most appropriate level relative to a student's clinical experience.     

Approach to the educational opportunities provided by variant anatomy, illustrated by discussion of a duplicated inferior vena cava

Variant anatomy recognized during routine cadaveric dissection in the first year of medical school offers great learning potential by allowing students to gain enhanced understanding of an array of important subjects. It provides a framework for reviewing common morphology and embryogenesis of the structure in question, and through the help of appropriate faculty, yields insight into the potential medical, radiologic, and surgical implications. The frequency of clinically important anatomic variation is high enough to allow the gross anatomy laboratory to serve as an excellent teaching platform in this regard. Through anatomy, the student is introduced to the concept of patient individuality, and to the individualization of medical and surgical therapies. Recently, one of the variations encountered in our lab was a duplicated inferior vena cava. We describe our approach to such findings through a systematic discussion of the anatomy and embryology, as well as the radiologic and clinical correlates.     

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.