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 Table of Contents  
EDITORIAL
Year : 2022  |  Volume : 11  |  Issue : 3  |  Page : 123-125

Future of cadaveric dissection in anatomical science education


1 Assistant Professor, Department of Anatomy, All India Institute of Medical Sciences, Bathinda, Punjab, India
2 Assistant Professor, Department of Anatomy, JSS Medical College, JSSAHER, Mysore, Karnataka, India
3 Professor (Additional), Department of Anatomy, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India

Date of Submission05-Jul-2022
Date of Decision15-Jul-2022
Date of Acceptance25-Jul-2022
Date of Web Publication12-Aug-2022

Correspondence Address:
Kumar Satish Ravi
Department of Anatomy, All India Institute of Medical Sciences, Rishikesh, Uttarakhand
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/NJCA.NJCA_126_22

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How to cite this article:
Patra A, Pushpa N B, Ravi KS. Future of cadaveric dissection in anatomical science education. Natl J Clin Anat 2022;11:123-5

How to cite this URL:
Patra A, Pushpa N B, Ravi KS. Future of cadaveric dissection in anatomical science education. Natl J Clin Anat [serial online] 2022 [cited 2022 Oct 6];11:123-5. Available from: http://www.njca.info/text.asp?2022/11/3/123/353719



Shreds of evidence of human cadaveric dissection date back to the 3rd century BC.[1] Herophilus and Erassistratus from Greece, were the first to conduct systematic dissection of human cadaver. 2nd century witnessed Galen, a Greek physician, and the Latin versions of his texts became the standard for teaching anatomy in the Western world. However, the social, religious, and ethical taboos prevented scholars from conducting dissection, and barber surgeons were dissecting the instructions of anatomists. Andreas Vesalius, the father of Anatomy, asserted that doing dissection by himself is the best way to learn anatomy. In that way, he spearheaded a paradigm shift from learning anatomy through a series of illustrations to accepting cadaveric dissection as the crucial tool and challenged various notions of Galen in his book-De humani corporis fabrica.[2],[3]

Since then, human cadaveric dissection has remained the primary channel of teaching anatomy to medical students.[4] However, in recent years, teaching anatomy by dissection is becoming challenging for various reasons, the most essential being cadaver shortage. Anatomy teachers across the world started using different modern technology like virtual cadavers or simulators to make the anatomy teaching–learning more exciting and to overcome the cadaver scarcity.[5] Before COVID 19, the rampant usage of advanced technology in anatomy teaching was just an “option”. However, the COVID pandemic has led to a paradigm shift; what was an “option” earlier is now an “obligation.”[6] At present, although most medical schools have reopened, body donation is still at an all-time low, making the situation “back to square one.

As far as the global scenario is concerned, most countries of Africa, North America, and Asia use cadaveric dissection as the primary modality of teaching gross anatomy. However, in European countries, cadaveric dissection is optional and not overwhelmingly used.[7],[8] In India, the majority of the institute religiously follow cadaveric dissection, and slowly, there is changing trend to utilize other modalities in place of cadaveric dissection to teach anatomy[9] such as virtual dissection table, synthetic cadavers, high-fidelity simulation, three-dimensional (3D) anatomy education program, 3D-printing technology, and so on [Figure 1].
Figure 1: Cadaveric dissection and other modalities of teaching

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Virtual dissection table simulation technology is utilized in virtual dissection table to offer realistic visualization of the 3D anatomical details of the virtual cadaver. Unlike real corpses, the students can “do-undo-redo” the dissection repeatedly on this virtual dissection table. Apart from virtual dissection, this software can also cater to the need for virtual 3D atlas and virtual simulators of different structures.[10]


  Synthetic Cadavers Top


SynDavers are head-to-toe replicas of the human body consisting of skin with fat, ligaments, tendons, muscles, bones, etc., Their main content is water (85%); they provide a life-like experience of dissecting human cadavers. Although expensive, one of the most significant advantages is it can be used for repeated dissection. Still, the major drawbacks are students will not be able to remove the organs as they do on real cadavers. Another disadvantage is their careful storage to prevent the growth of bacteria and fungi.[11]


  Three-Dimensional Printing Top


3D-printing technologies are another newer modality for making a 3D model of dissected specimens. 3D printing is a stirring application for creating models of organ or particular structure. One can develop models that students can explore to interact and learn. It can decrease the time spent planning and designing models.[12]


  Immersion/Haptic Technology Top


Virtual reality and augmented reality technologies can create a unique scenario where learners get benefit from simulations generated by computers. The human-computer interface help in developing a virtual environment and students will experience the 3D architecture of the structure. This technology offers the varied experience of immersion, interactivity, and fidelity compared to others.[13]


  Anatomy Studio Top


Is a collaborative mixed reality dissection table approach in which a user can investigate a whole anatomical details of the body and perform manual 3D reconstructions virtually. Anatomy studio consists of a drafting table, while users are provided with head-mounted see-through displays and tablets with styli. With hand gestures and mobile touchscreens, the operator can decode cryosection or 2D contour to 3D reconstructed model.[14]


  Three-Dimensional Stereoscopy Top


Here, the depth of illusion is augmented using a stereoscope or binocular vision recent stereoscopes aid viewers in appreciating the 3D depth of 2D images. Stereoscopic 3D instructional videos can be accessed with smartphones hence can be well utilized to understand the 3D complexity of the anatomical structures. Studies have shown better test scores with stereoscopic 3D teaching for neuroanatomy.[15]

However, recent literature suggests that cadaveric dissection remains the most persuasive means of delivering fundamental anatomical knowledge to medical students to develop clinical acumen for efficient clinical practice.[9] Holding the scalpel and giving an incision on the human body for the first time provides a thrilling experience for every medical student, so decreased use of cadavers or virtual dissectors can negatively influence the learner and ultimately lead to poor performance. Medical students are of the opinion that cadavers impart a real-time 3D perspective about human body complexities, which interactive multimedia can never substitute.[16] Hence, virtual modalities can only supplement the traditional pedagogy of human cadaveric dissection, but to think that 1 day it will substitute the latter is fictitious and deleterious for the entire medical fraternity.

However, there appears a need to enhance or give different dimensions to traditional teaching concerning the requirement of current surgical practice, a few of which include.


  Cadaveric Workshop Top


Cadaveric workshops using soft embalming have been used widely in western countries. They play a significant role where patient safety and prior experience cannot be controlled; hence, the main aim of the cadaveric workshop is to train future surgeons/residents before they operate on patients. This will overcome the limitations of limited exposure to patients and reduce untoward effects while performing on the patients.[17]


  Laparoscopic Surgeries Top


Although human anatomy remains the same, advanced technical operations demand simultaneous advancement in surgical management. In laparoscopic surgery, initial entry is often performed blindly, which may sometimes lead to vascular/organ damage. Hence, a laparoscopic surgeon's operative quality and technical competency begin with the optimal anatomical insight of the operative area and port/trocar placement. A significant challenge for an operating surgeon is visualizing the region by the small aperture of the anatomy through the small aperture in contrast to laparotomy, where the broad area is exposed, and visualization is better during initial entry.[18] Hence, there should be an adaptation to teach the internal anatomy, which will aid in better visualization in laparoscopic surgeries.


  Endoscopic Technology Top


In this procedure, endoscopy is used to visualize the internal anatomy of the hollow organ/cavity of the body. Unlike many other medical imaging techniques, endoscopes are inserted directly into the organ.[19] Hence, there should be an option/exposure by which medical students can visualize the internal anatomy in a narrow view in addition to traditional dissection.

Decreased teaching h and admittance to cadaveric dissection or prosection-based training in anatomical sciences education have prompted many specialist doctors revealing lacking anatomical knowledge of junior doctors. This pattern represents a critical gamble. Cadaveric-based instructing has for some time been its center and is perceived by medical students, instructors, and clinicians similarly as the most gainful approach to learning anatomical sciences. Cadaveric-based showing stays a foundation of most anatomical sciences curricula; notwithstanding, there has been a new pattern away from cadaveric dissection or prosection instructing and toward various models and technology-based anatomical learning devices. In a study conducted by Sheikh et al. in 2016, most of the surgeons, regardless of vocation stage accept that cadaveric-based anatomical sciences education is the best strategy for teaching and training anatomical sciences and that it ought to be improved in the medical teaching. Radiological imaging to be coordinated more into undergrad teaching and training. Thus, a sensitive equilibrium should be struck between fitting instructing approaches that guarantee medical students are good for practicing medicine.[20]

The National Medical Commission of India may start working on preparing the guidelines or requirements to commence super specialty courses in anatomical sciences such as DM/MCh in neuroanatomy, developmental anatomy, structural anatomy, radiological anatomy, and surgical anatomy.



 
  References Top

1.
Serageldin I. Ancient Alexandria and the dawn of medical science. Glob Cardiol Sci Pract 2013;2013:395-404.  Back to cited text no. 1
    
2.
Yammine K. The current status of anatomy knowledge: Where are we now? Where do we need to go and how do we get there? Teach Learn Med 2014;26:184-8.  Back to cited text no. 2
    
3.
Nwachukwu C, Lachman N, Pawlina W. Evaluating dissection in the gross anatomy course: Correlation between quality of laboratory dissection and students outcomes. Anat Sci Educ 2015;8:45-52.  Back to cited text no. 3
    
4.
Magee R. Art macabre: Resurrectionists and anatomists. ANZ J Surg 2001;71:377-80.  Back to cited text no. 4
    
5.
Pushpa NB, Ravi KS. Does the corpse teach the living? – Anatomy in the era of COVID-19. Natl J Clin Anat 2020;9:79-81.  Back to cited text no. 5
  [Full text]  
6.
Patra A, Asghar A, Chaudhary P, Ravi KS. Integration of innovative educational technologies in anatomy teaching: New normal in anatomy education. Surg Radiol Anat 2022;44:25-32.  Back to cited text no. 6
    
7.
Memon I. Cadaver dissection is obsolete in medical training! A misinterpreted notion. Med Princ Pract 2018;27:201-10.  Back to cited text no. 7
    
8.
Ali A, kHAN ZN, Konczalik W, Coughlin P, S EI Syed. The perceptionof anatomy teaching among UK medical students. RCS Bull 2015;97:397-400.  Back to cited text no. 8
    
9.
Ravi KS. Dead body management in times of covid-19 and its potential impact on the availability of cadavers for medical education in India. Anat Sci Educ 2020;13:316-7.  Back to cited text no. 9
    
10.
García MJ, Dankloff MC, Aguado HS. Possibilities for the use of anatomage (the Anatomical Real Body-Size Table) for teaching and learning anatomy with the students. Biomed J Sci Tech Res 2018;4:94.  Back to cited text no. 10
    
11.
Richardson NS, Zwambag D, McFall K, Andrews DM, Gregory DE. Exploring the utility and student perceptions of synthetic cadavers in an undergraduate human anatomy course. Anat Sci Educ 2021;14:605-14.  Back to cited text no. 11
    
12.
Sharma A, Kumar A. Evolving trends in anatomy – A global perspective. Indian J Clin Anat Physiol 2021;8:159-61.  Back to cited text no. 12
    
13.
Kapoor S, Arora P, Kapoor V, Jayachandran M, Tiwari M. Haptics – Touchfeedback technology widening the horizon of medicine. J Clin Diagn Res 2014;8:294-9.  Back to cited text no. 13
    
14.
Zorzal ER, Sousa M, Mendes D, Anjos RK, Medeiros D, Paulo SF, et al. Anatomy studio: A tool for virtual dissection through augmented 3D reconstruction. Comput Graph 2019;85:74-84.  Back to cited text no. 14
    
15.
Bernard F, Richard P, Kahn A, Fournier HD. Does 3D stereoscopy support anatomical education? Surg Radiol Anat 2020;42:843-52.  Back to cited text no. 15
    
16.
Basavanna PN, Ravishankar MV, Arora D. Anatomy lives in the dissection hall: Post-COVID-19 perception of students. Anat Sci Educ 2022;15:83-5.  Back to cited text no. 16
    
17.
Gilbody J, Prasthofer AW, Ho K, Costa ML. The use and effectiveness of cadaveric workshops in higher surgical training: A systematic review. Ann R Coll Surg Engl 2011;93:347-52.  Back to cited text no. 17
    
18.
Alkatout I, Mettler L, Maass N, Noé GK, Elessawy M. Abdominal anatomy in the context of port placement and trocars. J Turk Ger Gynecol Assoc 2015;16:241-51.  Back to cited text no. 18
    
19.
Nguyen VX, Le Nguyen VT, Nguyen CC. Appropriate use of endoscopy in the diagnosis and treatment of gastrointestinal diseases: Up-to-date indications for primary care providers. Int J Gen Med 2010;3:345-57.  Back to cited text no. 19
    
20.
Sheikh AH, Barry DS, Gutierrez H, Cryan JF, O'Keeffe GW. Cadaveric anatomy in the future of medical education: What is the surgeons view? Anat Sci Educ 2016;9:203-8.  Back to cited text no. 20
    


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