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.     

Human anatomy: A foundation for education about death and dying in medicine

In most medical schools, little curricular time is devoted to the art of medicine, and this is particularly evident with respect to death education. We make a case for including education on death and dying in medical schools, specifically its early introduction in the anatomy course. Studies indicate that whereas dissection of cadavers is an exciting discovery for most students, for many it is traumatic and if not addressed, students may use depersonalization and denial as their approach to suffering. The dissecting experiences in two different medical schools are described. The University of Massachusetts program developed in a traditional curriculum and explores humanistic issues with lectures and group discussions. Parallels are drawn between dissection and patient care, and coping styles are discussed openly. In the problem-based curriculum at Dalhousie Medical School, death and grief are discussed in the first week of medical school, and students are given information about the body donor program and support systems for students. This program is part of a longitudinal curriculum on death and dying. In both schools, students tour the dissecting rooms before the course begins and organize memorial events for body donors at the end of the academic year. These examples illustrate how death education can begin early in the medical curriculum and contribute to the development of practitioners who are sensitive to broader issues of human mortality. Clin. Anat. 10:118–122, 1997 © 1997 Wiley-Liss, Inc.     

Attitudes to anatomy dissection in an Irish medical school

Many studies around the world have looked at the stresses placed on medical students by cadaveric dissection. Although these studies have linked the use of cadavers in medical teaching to stress, some investigations have suggested an association with severe psychological stress and even post‐traumatic stress disorder. This study assessed the attitudes of medical and biomedical sciences students in an Irish medical school towards cadaveric dissection by recording, through a questionnaire, their perceptions and experience before initial exposure to dissection and subsequently examining their attitudes after the first dissection and after 9 weeks. Student attitudes towards the dissecting room remained consistently positive for the duration of the study with only a minority of respondents reporting negative symptoms. Pre‐existing attitudes to the idea of dissection were unaffected by exposure and subsequent continuous experience of dissection. The majority of students in this study did not find the dissecting room experience stressful, and considered time spent in the dissecting room valuable. However, the proportion of students with negative experiences in the dissecting room was higher than has been reported in previous studies. Many respondents felt they could be better prepared for the dissecting room experience, indicating an increasing requirement for effective preparatory programmes. Clin. Anat. 22:386–391, 2009. © 2009 Wiley‐Liss, Inc.     

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.     

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.     

Status of gross anatomy in the U.S. and Canada: Dilemma for the 21st century

As a component of a recent academic review, the Department of Anatomy and Neurosciences faculty at the University of Texas Medical Branch in Galveston, Texas, developed a questionnaire designed to compare the curricula, direction, and challenges of their department with the approximately 140 anatomy departments in the U. S. and Canada. The response was overwhelming in that over 80% of the schools returned a completed questionnaire. One of the areas of interest revealed by this survey was a growing concern over significant changes in both medical school curricula and the future of anatomy departments. Most departments still used traditional lectures to present course material and the majority of the scheduled contact hours were in the dissection laboratory; however, other teaching formats, such as case studies and small group discussions, accounted for significantly more of the teaching effort. Nearly 20% of the schools were making major modifications in their teaching methods. The general trend was to include more integrated, problem-based learning and computer-assisted teaching while reducing overall content, didactic lectures, and rote memorization. The role and need for traditionally trained gross anatomists in medical education appeared to be diminishing as curricular reform moved toward more student-directed, faculty-facilitated programs. Concurrently, the recruitment and career development of gross anatomy faculty appeared to be influenced more by funding status than by academic training or teaching experience, as most departmental chairman were willing to hire non-anatomists and “train” them to assume an often reduced teaching load in gross anatomy courses. In addition, fewer graduate students were being trained in classical gross anatomy, a trend that better suited the emerging student-directed medical school curricula. The reduction in classically trained anatomists also appeared to reflect the widespread practice whereby anatomy faculty were rewarded far more for research than for teaching. Although the continued inclusion of gross anatomy in medical education appeared to be assured, its traditional mode of presentation and academic prominence will likely change by the turn of the century. © 1994 Wiley-Liss, Inc.     

Human dissection and attitudes of preclinical students to death and bereavement

Two questionnaires were used to gather information about preclinical education concerning death and bereavement. One was mailed to Heads of Anatomy Departments of 26 UK medical schools. The other was distributed to 220 first- and 210 second-year preclinical students in Cambridge. Among curricular organizers (77% response rate), the motivation for giving such education was primarily to improve knowledge about dissection, and only secondarily and infrequently to prepare students for clinical practice or to address their attitudes or feelings. In contrast, the primary concern of students (response rate 54%) was preparation for encounters with death in clinical practice (61–85%), lesser concerns being to address their own fears and feelings (30–40%) or knowledge about the dissecting room, cadavers, etc. (23–37%). Students were also asked about their reactions to dissection in order to determine whether the dissecting room might provide an opportunity for teaching about death. Most (66%) admitted experiencing moderate to extreme apprehension in advance of dissection. Apprehension was associated, on starting dissection, with very strong reactions, which in some cases interfered with learning. Some (27%) dealt with this by depersonalization. The only previous experiences that showed a significant association with the occurrence during dissection of interfering and/or non-task-related thoughts and feelings were (i) for both men and women the occurrence and quality of handling of death experience(s) at school, and (ii) for a group of male students the experience of the death of more than one close non-family friend. A strategy for effective use of the dissecting room in studies on death is outlined. © 1994 Wiley-Liss, Inc.     

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.     

Problem-based learning with gross anatomy specimens: One year trial

A problem-based learning experience was implemented at the University of Florida College of Medicine during the Fall, 1989 gross anatomy course for first year medical and dental students. A problem for deliberation was selected by students at one dissecting table (two medical and two dental) that related to the cadaver they were dissecting. Each member of the group picked a single topic and researched that subject either through use of the library or personal contacts with basic science or clinical faculty. Specific times within the course were established for the problem-based sessions. Each student gave a 5 to 10 minute oral presentation to a faculty member and one or two other groups of students. The overall rating for the sessions by the students was positive (72.5% ranked them either outstanding or above average). Eighty-two percent of the students felt that these sessions were a useful method of providing clinical correlations with gross anatomy and 81.6% stated they thought the program should be continued next year. Conversely, approximately 20% of the students responded that they could have been doing something more productive with their time and several felt it was unfair that their sessions were scheduled just prior to an examination. Overall, the opinion of the faculty was that the sessions were a positive experience, encouraged cooperation between medical and dental students, and generated additional interest in the dissecting experience.     

Ethicists and clinicans: the case for collaboration in the teaching of medical ethics

It has become part of conventional wisdom that medical students experience a clear separation between the explicit ethics curriculum of the lecture room and the implicit curriculum of the clinic. This paper outlines and critiques some important assumptions made about the teaching of ethics in medical schools. It identifies the need for close collaboration between clinical and non-medical ethics teachers to advance the teaching of ethics in medical training.     

Changing anatomy education and introduction of self assessment of teacher performance in Japan.

The current curriculum reform is directed toward improvement of students' ability of clinical practice in primary care, and a substantial system of bedside learning is being extensively explored. Introduction of clinical clerkship necessarily forces qualitative changes in the teaching of basic medical sciences. A large number of Japanese medical schools is now attempting to establish a new educational system that makes it possible to change from "didactic education" by lectures and laboratory studies to "self learning education" by means of tutorials and other systems. In this context, Japanese anatomists are urgently requested to develop new and effective clinically oriented educational systems in teaching gross anatomy as a shift from the traditional teaching as a science of morphology. Evaluation of faculty staff's teaching achievement is about to start in many medical schools. Research activities can be evaluated quantitatively. In contrast, measurement of educational activities of faculty staff is very difficult, and all medical schools are devoted to construct effective and liable systems. Anatomy faculty is obliged to devote more time than that of other disciplines in education-related activities such as cadaver collection and associated business. How to evaluate adequately these invisible activities is an issue to be solved before the introduction of a self assessment system. Successful solutions to these issues are critical for production of future anatomists.     

The relationships between learning outcomes and methods of teaching anatomy as perceived by medical students

The best method to teach anatomy continues to be widely debated. Many UK medical schools have recently changed their course structure with the use of cadaveric dissection declining. A recent study by Patel and Moxham ([ 2008] Clin. Anat. 21:182-189) found that professional anatomists viewed dissection to be the most suitable method to fulfil anatomical learning outcomes. The opinion of 580 second year medical students across two UK medical schools was surveyed. A methodology similar to that employed by Patel and Moxham ([ 2008] Clin. Anat. 21:182-189) aimed to explore which teaching methods students considered best to fulfil a prescribed set of anatomical learning outcomes. A total of 302 responses were returned (52%). Difference in students' opinion with regard to the teaching methods was statistically significant (P < 0.0001). A statistically significant agreement was found between the opinions of students from Imperial and Nottingham, and between the anatomists and the students, regarding the effectiveness of all teaching methods at meeting learning outcomes. Dissection was overall most "fit for purpose" in meeting learning outcomes, but no single teaching modality met all aspects of the curriculum. Dissection should remain a leading teaching modality in modern medical school anatomy courses. In addition to its role in the teaching of anatomy, it enables learning in a social context and holds broader learning opportunities to help future doctors best fulfill Good Medical Practice guidelines (General Medical Council, 2006). This, however, should be in the context of a multi-modal approach to the teaching of anatomy.     

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 use of plastinated prosections for teaching anatomy--the view of medical students on the value of this learning resource

Over the past decade, the role of anatomical teaching in the undergraduate medical curriculum has changed considerably. At some medical schools, active dissection of cadaveric specimens is gradually being replaced by prosection-based methods and other resources such as e-learning. Warwick Medical School has recently obtained a large collection of plastinated prosections, which replace wet cadaveric specimens in undergraduate anatomy teaching. The aim of this study was to examine students' views on the use of plastinated prosections for their anatomical learning. A mixed method approach was employed using a questionnaire and focus group for data collection. The questionnaire was completed by 125 first-year medical students (response rate 68%). The majority of students (94%) rated plastinated prosections as a valuable resource for their anatomical learning. Various features of the specimens were highlighted, such as the detailed view of relevant anatomy, appreciation of relations between structures, and visualization of anatomy in real life. However, learning on plastinated prosections was perceived to be compromised because of limitations in terms of tactile and emotional experience. We conclude that plastinated prosections are an adequate resource for the early stages of undergraduate training, but that the learning experience may be further enhanced by providing opportunity for the study of wet cadaveric material.     

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.     

Problem based teaching and learning as a bridge from basic anatomy to clinical clerkships

This article describes a Clinical Anatomy course designed to bridge basic anatomy with clinical clerkships. It is given in the second year, after the traditional dissecting anatomy course. Students revisit anatomy during small group discussions of clinical cases. An example of a case is described together with a summary of a typical group process stimulated by the case. The group process enables students to develop clinical thinking and problem solving skills fundamental to clinical practice. They learn to search for medical knowledge resources, and to work in teams. The tutor evaluates the students’ progress based on their knowledge building, problem solving and development of their interpersonal skills. Problem based learning in this interdisciplinary anatomy course allows students and faculty both horizontal and vertical integration within the curriculum.     

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.     

The importance of anatomy in health professions education and the shortage of qualified educators.

The current shortage of faculty qualified to teach anatomy in U.S. medical schools is reversible. Sufficient numbers of individuals are in the pipeline to provide a future cadre of well-trained faculty members educating students in gross anatomy. The challenge is to realign departmental, institutional, and federal training grant priorities and resources, creating incentives for graduate students, postdoctoral fellows, and faculty members to stay the course and become the teachers needed to educate the next generation of health professionals. These strategies include (but are not limited to) team-teaching gross anatomy, thereby distributing the time commitments of a laboratory-based course more widely within a department; funds made available from the administration of medical schools to allow postdoctoral fellows to participate in teaching and providing compensation for the research activities; using "mission-based budgeting" to specifically compensate for faculty teaching time; and, finally, re-instituting federally funded training grants that solved this same teaching crisis in the not-too-distant past.     

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.     

Do we need dissection in an integrated problem-based learning medical course? Perceptions of first- and second-year students

BACKGROUND: The introduction of a problem-based learning (PBL) curriculum at the School of Medicine of the University of Melbourne has necessitated a reduction in the number of lectures and limited the use of dissection in teaching anatomy. In the new curriculum, students learn the anatomy of different body systems using PBL tutorials, practical classes, pre-dissected specimens, computer-aided learning multimedia and a few dissection classes. The aims of this study are: (1) to assess the views of first- and second-year medical students on the importance of dissection in learning about the anatomy, (2) to assess if students' views have been affected by demographic variables such as gender, academic background and being a local or an international student, and (3) to assess which educational tools helped them most in learning the anatomy and whether dissection sessions have helped them in better understanding anatomy. METHODS: First- and second-year students enrolled in the medical course participated in this study. Students were asked to fill out a 5-point Likert scale questionnaire. Data was analysed using Mann-Whitney's U test, Wilcoxon's signed-ranks or the calculation of the Chi-square value. RESULTS: The response rates were 89% for both first- and second-year students. Compared to second-year students, first-year students perceived dissection to be important for deep understanding of anatomy (P < 0.001), making learning interesting (P < 0.001) and introducing them to emergency procedures (P < 0.001). Further, they preferred dissection over any other approach (P < 0.001). First-year students ranked dissection (44%), textbooks (23%), computer-aided learning (CAL), multimedia (10%), self-directed learning (6%) and lectures (5%) as the most valuable resources for learning anatomy, whereas second-year students found textbooks (38%), dissection (18%), pre-dissected specimens (11%), self-directed learning (9%), lectures (7%) and CAL programs (7%) as most useful. Neither of the groups showed a significant preference for pre-dissected specimens, CAL multimedia or lectures over dissection. CONCLUSIONS: Both first- and second-year students, regardless of their gender, academic background, or citizenship felt that the time devoted to dissection classes were not adequate. Students agreed that dissection deepened their understanding of anatomical structures, provided them with a three-dimensional perspective of structures and helped them recall what they learnt. Although their perception about the importance of dissection changed as they progressed in the course, good anatomy textbooks were perceived as an excellent resource for learning anatomy. Interestingly, innovations used in teaching anatomy, such as interactive multimedia resources, have not replaced students' perceptions about the importance of dissection.