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.     

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.     

Using ATP‐driven bioluminescence assay to monitor microbial safety in a contemporary human cadaver laboratory

Introduction: The objective of this study was to utilize a cost‐effective method for assessing the levels of bacterial, yeast, and mold activity during a human dissection laboratory course. Nowadays, compliance with safety regulations is policed by institutions at higher standards than ever before. Fear of acquiring an unknown infection is one of the top concerns of professional healthcare students, and it provokes anti‐laboratory anxiety. Human cadavers are not routinely tested for bacteria and viruses prior to embalming. Human anatomy dissecting rooms that house embalmed cadavers are normally cleaned after the dissected cadavers have been removed. There is no evidence that investigators have ever assessed bacterial and fungal activities using adenosine triphosphate (ATP)‐driven bioluminescence assays. Methods: A literature search was conducted on texts, journals, and websites regarding bacterial, yeast, and mold activities in an active cadaver laboratory. Midway into a clinical anatomy course, ATP bioluminescence assays were used to swab various sites within the dissection room, including entrance and exiting door handles, water taps, cadaver tables, counter tops, imaging material, X‐ray box switches, and the cadaver surfaces. Results: The results demonstrated very low activities on cadaver tables, washing up areas, and exiting door handles. There was low activity on counter tops and X‐ray boxes. There was medium activity on the entrance door handles. Conclusion: These findings suggest an inexpensive and accurate method for monitoring safety compliance and microbial activity. Students can feel confident and safe in the environment in which they work. Clin. Anat. 28:164–167, 2015. © 2014 Wiley Periodicals, Inc.     

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.     

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 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.     

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.     

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.     

The study of anatomy in England from 1700 to the early 20th century

The study of anatomy in England during the 18th and 19th century has become infamous for bodysnatching from graveyards to provide a sufficient supply of cadavers. However, recent discoveries have improved our understanding of how and why anatomy was studied during the enlightenment, and allow us to see the context in which dissection of the human body took place. Excavations of infirmary burial grounds and medical school cemeteries, study of hospital archives, and analysis of the content of surviving anatomical collections in medical museums enables us to re-evaluate the field from a fresh perspective. The pathway from a death in poverty, sale of the corpse to body dealer, dissection by anatomist or medical student, and either the disposal and burial of the remains or preservation of teaching specimens that survive today in medical museums is a complex and fascinating one.     

Computer-based sessions in radiological anatomy: one year’s experience in clinical anatomy

In the last curricular review (1995/96) radiological anatomy was introduced as an innovation in the program of the course of clinical anatomy of the Medical School. Since computer-based media are known to facilitate the understanding of the human body, computer technology was selected in the academic year of 1997/98 as an elective educational tool to teach radiological anatomy. CD-ROMs were introduced as additional instructional resources in 1997/98. This technology aimed to provide educational support to the program, namely, to the sessions of radiological anatomy in each section of the course head, neck, thorax, abdomen, pelvis and perineum. A questionnaire was designed to evaluate the opinion of the students enrolled in this course, focusing on the teaching sessions of radiological anatomy. Of 152 students, 135 (88.8%) returned the questionnaire. To describe the relationship between the value of this technology and several aspects of its organisation and adequacy, the Spearman rank correlation coefficient was used canonical correlation was used for the various practical sessions. The comments of students were very positive emphasising the quality of the media, organisation of the course, immediate feedback, degree of interactivity and simplicity of use they suggested a larger facility for the computers and acquisition of more programs and hardware. The positive evaluation of the use of the CD-ROMs in clinical anatomy allows us to foresee the formal integration of these instructional tools in the whole course, and not to restrict its use to specific units within the course.     

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.     

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.     

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.     

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.     

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.     

From formalin to thiel embalming: What changes? One anatomy department's experiences

In 2009, the Centre for Anatomy and Human Identification started Thiel embalming on a small scale to assess (i) the suitability for our current teaching in which long‐lasting dissection courses are key, (ii) the potential for new collaborations and activities, and (iii) the practical implications of changing our embalming method from formalin to Thiel. Twenty six Thiel‐embalmed cadavers have been used for dissection by staff and students on a taught MSc course, as a model for clinical and surgical training, and increasingly as a model for evaluation of new medical devices and procedures. Our experiences with dissection were mostly positive especially for teaching the musculoskeletal system. Internal organs handle differently from formalin‐fixed organs and dissection manuals need to be adjusted to reflect this. Durability of the cadavers was not an issue, though changes are seen over time due to gradual fluid loss. We have started new collaborations related to postgraduate anatomy teaching and advanced training in surgical and clinical skills. In general, feedback is very positive and demand for cadavers outstrips our current limited supply. Thiel‐embalmed cadavers were found to provide a unique opportunity for evaluation of medical products especially in areas where no suitable alternative model is available, and without the complications associated with clinical testing. This has resulted in new collaborations and research projects. As a result Thiel‐embalmed cadavers are used for longer and for more activities than formalin cadavers: this requires changes in our procedures and staff roles. Clin. Anat. 26:564–571, 2013. © 2013 Wiley Periodicals, Inc.     

Pathological analysis of cadavers for educational dissection by using postmortem imaging

This study was performed primarily to clarify whether pathological analysis of cadavers for anatomical dissection is possible using postmortem imaging (PMI), and whether this is worthwhile. A total of 33 cadavers that underwent systematic anatomical dissection at our medical school also underwent PMI. Fixative solution was injected into the corpus 3–4 days after death. PMI was then performed using an 8‐slice multi‐detector CT scanner 3 months before dissection. Before dissection, a conference was held to discuss the findings of the PMI. First, two radiologists read the postmortem images without any medical information and deduced the immediate cause of death. Then, the anatomy instructor revealed the medical information available. Based on this information, the radiologist, anatomy instructor, and pathologists suggested candidate sampling sites for pathological examination. On the last day of the dissection period, the pathologists resected the sample tissues and processed them for pathological examination. In 12 of 33 cases, the presumed causes of death could be determined based on PMI alone, and revision of the cause of death described in the death certificate was considered in five (15.2%) cases, based on PMI and pathological analysis. This article presents a novel method of pathological analysis of cadavers for anatomical dissection using PMI without disturbing the anatomy education of medical students.     

The use of small group case-based exercises in human gross anatomy: A method for introducing active learning in a traditional course format

As part of the curricular change at the University of Rochester School of Medicine and Dentistry, we focused on active learning and greater integration of basic and clinical sciences. With these objectives in mind, this report describes the use of small-group, case-based exercises in our gross anatomy course and provides one example of integrating such activities into a traditional course. In addition to formal lectures and laboratory dissection, students meet approximately every fourth class period in small groups to discuss a clinical case which focuses on the relevant anatomy taught at that time. Two first-year students lead each small group; one fourth-year student facilitator also attends to provide clinical correlations, answer questions, and reinforce the anatomy. Formative feedback suggests students enthusiastically endorse the self-directed active learning; they feel these exercises offer both a valuable approach to learning and an opportunity to practice presentation and leadership skills. First-year students enjoy the interaction with fourth-year facilitators and the fourth-year students appreciate the opportunity to review basic science material. Our data suggest that students learn to “think” about the anatomy, and we hope learn to use their understanding and knowledge base in a practical fashion. Moreover, these case-based exercises can fit nicely into a variety of curricular formats, especially where problem-based tutorials may not be feasible or desirable. © 1994 Wiley-Liss, Inc.