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Dissections in the 21st century - antiquated or useful for learning anatomy?

Contents

Introduction

“Those who have dissected or inspected many [bodies] have at least learnt to doubt; while others who are ignorant of anatomy and do not take the trouble to attend it are in no doubt at all.” - Giovanni Battista Morgagni, the father of anatomical pathology

Cadaveric dissection was the main teaching and learning method for understanding the intricate, yet fascinating, subject of anatomy. It overcame great challenges, ever since its introduction in the 3rd century BC. Historical anatomy heavyweights like Hippocrates, Galen, Andreas Vesalius, and Leonardo da Vinci had an incredible contribution to the overall subject, making it the current joy (or nightmare) of health science students.

DaVinci's Dissections

Historically, it was considered a rite of passage for budding doctors and each and every single one of them was meant to get through it - no exceptions. However, things have changed in the current century with the rapid advance of technology, science, and learning methods. As a result, a heated debate around the usefulness of dissections has commenced recently. Some schools have completely abandoned this teaching method, while others still view it as being the best. This article will discuss this debate and will try to answer the most pressing question of every anatomy department - ‘are cadaveric dissections antiquated or useful for learning anatomy?’

The last ‘man’ standing

One can argue that anything standing the test of time is somewhat special and worthwhile. For the world of anatomy, cadaveric dissections have certainly accomplished this. It started in the Greek school of medicine in Alexandria in the 3rd century BC. The practice was utterly stomped out during the Middle Ages, but it returned with a vengeance in Bolognia, Italy, during the 14th century. Its popularity kept increasing and even shortages of bodies didn’t stop it. In fact, the law was bent to suit dissecting, making it easier to obtain specimens and continue this practice. It survived the church, world wars, negative public perception, and numerous other onslaughts, finally reaching the present day. It is the ‘last man standing’.

However, a lot of medical schools throughout the world have either reduced or completely eliminated this method of teaching in the 21st century. Nowadays, anatomy is taught via methods that would have gobsmacked the anatomy heavyweights, such as prosections (dissections performed by an experienced anatomist and later used for teaching), 3D models, imagistics, virtual tables (Anatomage), and virtual reality. In addition, many schools have dramatically reduced the number of anatomy hours or use a problem-based learning curriculum in which anatomy is learned on the go. Is this is a good thing or a bad thing? Actually, the answer is not black or white, but rather an ugly grey with many factors playing a part.

Heart Model

Are dissections antiquated?

Firstly, consider the skeptical side - cadaveric dissections are useless and completely replaceable. Here are some aspects associated with this practice, according to experts and reports:

  • Very strong emotions - These cover a spectrum from extreme anxieties and emotional disturbances, all the way to desensitization, detachment and indifference towards death and dying.
  • Little clinical relevance - Cadavers have a completely unrealistic color, smell and texture. They also lack mobility.
  • Health and safety dangers - A potential exposure exists for students towards chemicals, incorrectly preserved human materials and pathologies like AIDS, hepatitis, and tuberculosis.
  • Practical limitations - It is increasingly difficult and costly to obtain, transport, maintain, and dispose cadavers.
  • Time consuming - It takes a long time to properly teach anatomy via dissections.

Cadaveric dissection (head of caudate nucleus) - cross-sectional view

Experts on this side of the argument firmly believe that technology can fully replace cadavers, due to their following advantages:

  • Continuously evolve - Imaging and diagnostics equipment are become increasingly more automated, portable, easier to use, more widespread and consequently cheaper.
  • Reflect the professional requirements - In their daily practice, health practitioners are exposed to such technologies rather than stiff and smelly corpses.
  • Flexible - They can handle different anatomical views much more easily and more rapidly. The anatomy of any pathological situation can simply be loaded on a computer and shown to an entire class of students, something that is very limited by using cadavers.
  • Longevity - Technology usually requires a once-off investment and can last for many generations, reducing the difficulties of handling corpses.

Essentially, supporters of this view believe that anatomy teaching should simply reflect the 21st century, rather than use an antique method from the 3rd century BC.

Are dissections useful?

Now consider the supportive side - cadaveric dissections are extremely important and totally irreplaceable for anatomy learning. This point of view is more abstract compared to its contender and it requires you to adopt a slightly more philosophical nature. Perhaps the lack of concrete and obvious benefits allowed the intrusion of technology lead teaching in the field of anatomy. Here are the advantages of cadaveric dissections:

  • Help students evolve - Psychologically, scientifically, and socially.
  • Develop empathy - Otherwise known as “compassionate detachment”, it is a crucial mindset required by every medical practitioner.
  • Confirm reality of structures
  • Teach responsibility - Students learn this by using the same corpse for the entire duration of their anatomical course.
  • Provides clear teaching - Dissections simplify anatomy learning and teaches the pure science of the human body, stripping away the distracting complexities.
  • Illustrate morbidity and mortality - They bring the student to the closest and most comprehensive encounter with human mortality, simultaneously teaching them defense mechanisms to deal with stress and dying.
  • Tactile feedback - Inputs received by touching a cadaver are indispensable for correctly appreciating tissue dimensions, densities, and strength. In other words, students appreciate the full spectrum of human variance. Also, the simple act of touching and manipulating the body gives student a totally unique perspective that aids learning.
  • Expose anatomical variations

Basically, the supporters of this point of view believe that dissections survived for so long for a reason and follow the philosophy that ‘if it ain’t broke, don’t fix it’.

The debate

The debate about dissections as a teaching and learning method is not really cut and dried. It’s similar to being cut by a hacksaw rather than a scalpel - the result is an ugly and jagged laceration which is lacking well defined edges. Therefore, it is up to you to really decide which side are you on.

Emotional impact

The first point you should take into account are emotions. There is no doubt that being exposed to an embalmed corpse, which is literally torn apart week by week, can evoke strong reactions in any individual. The feelings really hit home when you have to actually cut the body. Therefore, it is understandable that some students become extremely anxious and terrified. Some force themselves to great extents to cope with the situation and they end up on the opposite side, experiencing desensitization and lack of emotions.

Emotional Impact

The flip side is that learning to cope teaches future practitioners how to handle stress, unpleasant situations, and develop empathy. They understand and appreciate morbidity (disability/poor health) and mortality (death). In other words, they evolve socially, psychologically, and emotionally. The question YOU need to ask yourself is this - “What is more important? Feeling comfortable or learning how to control your emotions, preparing you for the emotional rollercoaster that is medicine?”

Relevance and costs

The second point often debated about is the balance between clinical relevance and overall costs. Let’s be honest, meeting and treating patients in your daily practice is a totally different ball game than your anatomy dissection room. Living human beings don’t have the smell, color, texture, and mobility of cadavers. Therefore, for all the high costs of procuring and maintaining dead bodies for learning purposes, their relevance might not be worthwhile.

Brain MRI

In addition, almost all health practitioners are exposed to technology rather than corpses in clinics, so they should be exposed to sophisticated diagnostics in order to become familiar with them. However, it is more to this than meets the eye. Isn’t anatomy a pure science that every health professional should be knowledgeable in? In your anatomy course, you are simply trying to learn the structure of the human body. Cadaveric dissections do simply that and they have accomplished it well for centuries.

A lot of medical schools are trying to teach everything in one go, so they throw at you a lot of teaching methods simultaneously - anatomy, diagnostics, imagistics, etc. Is this not confusing to you, especially in first year of medical school, when anatomy is usually taught? One common cause is lack of time, but is eliminating dissections the most effective answer? Once again, it is up to YOU to reflect on this: “What would benefit you more? Simply learning and mastering anatomy without all the distracting technology or doing a bit of everything and mastering nothing?” There is also the point that future professional are becoming obsessively focused on clinical aspects and lack the knowledge of the basic sciences...

Tactile feedback

A third point in the debate are the benefits, or lack off, obtained through tactile feedback from dissecting a cadaver. On one side, experts say that touching anatomical structures is quite useless since not everyone becomes a surgeon. In addition, performing your job requires you to mentally conceptualize rather than ‘feel’ the anatomy.

Tactile feedback

All of this is true, but humanity in general and learning in the 21st century have a common denominator - “what’s the point of studying/doing this if I won’t use it?”. You are becoming a health practitioner, a position synonymous with knowledge, respect, compassion, and honour. Although not directly applicable, knowing how to differentiate blood vessels from nerves by palpation, or the pressure required to cut layers of fascia are just expected of you. As humans, we have lost the joy of gathering knowledge for the sake of being more knowledgeable. Basically, we believe that if it’s of no use, let’s not bother with it. In addition, touching and manipulating a cadaver gives you a unique perspective that facilitates learning. This last point is more abstract - “Do you want to feel proud that you are representing your profession as best as you can or you want to simply learn the useful things?” This is only for YOU to answer.

The answer? Integration

As you can see, there are many subjective factors which need to be taken into account when discussing cadaveric dissections. The ones illustrated in this article are only scratching the surface. You and your friend might have totally conflicting answers to the above questions. Perhaps the best course of action to take for the moment is to integrate cadavers and technology. They both bring tremendous benefits to students and totally eliminating dissections might deprive budding practitioners of crucial personal growth. Therefore, keep your scalpel, gloves, lab coat and cap and use them in your anatomy practicals. It’s not the end for them yet!

Highlights

The Debate

  • There are many subjective factors which need to be taken into account when discussing the usefulness of cadaveric dissections. In the end the general consensus is not black or white, but a rather grey and personal one.
  • Some claim that cadavers can invoke very strong emotions, have little clinical relevance, have practical limitations and are time consuming. Therefore, they can be easily replaced with more sophisticated technology that reflects the 21st century.
  • Dissection enthusiasts believe that working on cadavers allows students to develop psychologically, develop empathy, become more responsible, understand anatomical variations and learn via tactile feedback.

The Decision

The aspects that you need to balance and questions you need to answer are the following:

  • What is more important? Feeling comfortable or learning how to control your emotions, preparing you for the emotional rollercoaster that is medicine?
  • What would benefit you more? Simply learning and mastering anatomy without all the distracting technology, or doing a bit of everything and mastering nothing?
  • Do you want to feel proud that you are representing your profession as best as you can, or you want to simply learn the useful things?
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Show references

References:

  • Pawlina, W. and N. Lachman: Dissection in learning and teaching gross anatomy: rebuttal to McLachlan. Anat Rec B New Anat, 2004. 281(1): p. 9-11.
  • Elizondo-Omana, R.E., S. Guzman-Lopez, and L. Garcia-Rodriguez Mde: Dissection as a teaching tool: past, present, and future. Anat Rec B New Anat, 2005. 285(1): p. 11-5.
  • McLachlan, J.C. and D. Patten: Anatomy teaching: ghosts of the past, present and future. Med Educ, 2006. 40(3): p. 243-53.
  • Ghosh, S.K: Human cadaveric dissection: a historical account from ancient Greece to the modern era. Anat Cell Biol, 2015. 48(3): p. 153-69.
  • Aziz, M.A., et al: The human cadaver in the age of biomedical informatics. Anat Rec, 2002. 269(1): p. 20-32.
  • Custer T, Michael K (2015): The Utilization of the Anatomage Virtual Dissection Table in the Education of Imaging Science Students. J Tomogr Simul 1: 102. doi:10.4172/jts.1000102  

Article, Review and Layout:

  • Adrian Rad
  • Franchesca Druggan

Illustrators:

© Unless stated otherwise, all content, including illustrations are exclusive property of Kenhub GmbH, and are protected by German and international copyright laws. All rights reserved.

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