Current and potential use of fresh frozen cadaver in surgical training and anatomical education

As surgical procedures continue to be more complex, the need for more effective training in anatomy has increased. The study of anatomy plays a significant role in the understanding of the human body as well as in basic and advanced clinical training. Among the different cadaver models, fresh frozen cadavers (FFCs) are known for their realistic tissue quality. The purpose of this article was to review and summarize the preparation procedures for and reported cases involving FFCs. PubMed, Scopus, Medline, and Web of Science were searched for relevant studies. The preparation procedures were divided into five steps: washing, irrigation, freezing, defrosting, and arterial infusion. Not all steps were reported to be mandatory, but omitting one or more could result in a loss of quality. FFCs were reported to be used for various purposes: undergraduate education, general surgery training, vascular surgery training, minimal access surgery (laparoscopic surgery) training, and microsurgery training. In all categories, expert opinions and statistical analyses indicated successful outcomes. The reasons for high satisfaction with FFCs included realistic texture, capability of reenacting actual operations, and accuracy of anatomical locations. The results also revealed the importance and advantages of the dissection courses in surgical training. Since the direct comparison between cadaver models is insufficient, future studies regarding this topic are deemed necessary. In addition, it would be advantageous to develop methods to improve FFC quality, or ideas to optimize this model for certain purposes.     

Dynamic three-dimensional virtual environment to improve learning of anatomical structures

Increasing number of medical students and limited availability of cadavers have led to a reduction in anatomy teaching through human cadaveric dissection. These changes triggered the emergence of innovative teaching and learning strategies in order to maximize students learning of anatomy. An alternative approach to traditional dissection was presented in an effort to improve content delivery and student satisfaction. The objective of this study is to acquire three-dimensional (3D) anatomical data using structured-light surface scanning to create a dynamic four-dimensional (4D) dissection tool of four regions: neck, male inguinal and femoral areas, female perineum, and brachial plexus. At each dissection step, identified anatomical structures were scanned using a 3D surface scanner (Artec Spider™). Resulting 3D color meshes were overlaid to create a 4D (3D+time) environment. An educational interface was created for neck dissection. Its implementation in the visualization platform allowed 4D virtual dissection by navigating from surface to deep layers and vice versa. A group of 28 second-year medical students and 17 first-year surgery residents completed a satisfaction survey. A majority of medical students (96.4%) and 100% of surgery residents said that they would recommend this tool to their colleagues. According to surgery residents, the main elements of this virtual tool were the realistic high-quality of 3D acquisitions and possibility to focus on each anatomical structure. As for medical students, major elements were the interactivity and entertainment aspect, precision, and accuracy of anatomical structures. This approach proves that innovative solutions to anatomy education can be found to help to maintain critical content and student satisfaction in anatomy curriculum.     

The wider importance of cadavers: Educational and research diversity from a body bequest program

The debate surrounding the use of cadavers in teaching anatomy has focused almost exclusively on the pedagogic role of cadaver dissection in medical education. The aim of this study was to explore the wider aspects of a body bequest program for teaching and research into gross anatomy in a University setting. A retrospective audit was undertaken on body donation and the use of cadaver specimens for teaching and research at our institution between 1876 and 2009. The body bequest program, first established in 1943, now receives more than 40 donations per year. In addition to the medical course, nine other University degrees and courses currently use cadaver specimens for gross anatomy; four of these are research degrees and the remainder undergraduate degrees and courses. The use of cadaver specimens by non‐University groups has also increased, particularly during the past decade, such that there are now 16 different groups using cadaver specimens for instructional courses; most of these are professional medical courses. The use of cadavers for both research and teaching may encourage a more evidence‐based approach to clinical anatomy. This unique audit, spanning more than a century of anatomy education within a single University Medical School, highlights the utility of a robust body bequest program and the wide range of students and health professionals who interact with this precious resource. Anat Sci Educ 2:234–237, 2009 © 2009 American Association of Anatomists.     

Evolution of the anatomical theatre in Padova

The anatomical theatre played a pivotal role in the evolution of medical education, allowing students to directly observe and participate in the process of dissection. Due to the increase of training programs in clinical anatomy, the Institute of Human Anatomy at the University of Padova has renovated its dissecting room. The main guidelines in planning a new anatomical theatre included: (1), the placement of the teacher and students on the same level in a horizontal anatomical theatre where it is possible to see (theatre) and to perform (dissecting room); (2), in the past, dissection activities were concentrated at the center of the theatre, while in the new anatomical theatre, such activities have been moved to the periphery through projection on surrounding screens—thus, students occupy the center of the theatre between the demonstration table, where the dissection can be seen in real time, and the wall screens, where particular aspects are magnified; (3), three groups of tables are placed with one in front with two lateral flanking tables in regards to the demonstration table, in a semicircular arrangement, and not attached to the floor, which makes the room multifunctional for surgical education, medical students and physician's continued professional development courses; (4), a learning station to introduce the students to the subject of the laboratory; (5), cooperation between anatomists and architects in order to combine the practical needs of a dissection laboratory with new technologies; (6), involvement of the students, representing the clients' needs; and (7), creation of a dissecting room of wide measurements with large windows, since a well‐illuminated space could reduce the potentially negative psychological impact of the dissection laboratory on student morale. Anat Sci Educ 7: 487–493. © 2014 American Association of Anatomists.     

Human Anatomy: Let the students tell us how to teach

Anatomy teaching methods have evolved as the medical undergraduate curriculum has modernized. Traditional teaching methods of dissection, prosection, tutorials and lectures are now supplemented by anatomical models and e‐learning. Despite these changes, the preferences of medical students and anatomy faculty towards both traditional and contemporary teaching methods and tools are largely unknown. This study quantified medical student and anatomy faculty opinion on various aspects of anatomical teaching at the Department of Anatomy, University of Bristol, UK. A questionnaire was used to explore the perceived effectiveness of different anatomical teaching methods and tools among anatomy faculty (AF) and medical students in year one (Y1) and year two (Y2). A total of 370 preclinical medical students entered the study (76% response rate). Responses were quantified and intergroup comparisons were made. All students and AF were strongly in favor of access to cadaveric specimens and supported traditional methods of small‐group teaching with medically qualified demonstrators. Other teaching methods, including e‐learning, anatomical models and surgical videos, were considered useful educational tools. In several areas there was disharmony between the opinions of AF and medical students. This study emphasizes the importance of collecting student preferences to optimize teaching methods used in the undergraduate anatomy curriculum. Anat Sci Educ 7: 262–272. © 2013 American Association of Anatomists.     

Assessing the impact of the Graduate Certificate in Anatomical Sciences Instruction: A post‐degree survey

There are few graduate programs available for pursuing a doctorate in anatomy where students gain specific training in gross anatomy dissection and the responsibilities of a medical educator. In light of this fact, the University of Kentucky created a Graduate Certificate in Anatomical Sciences Instruction in 2006. This 12‐credit hour curriculum includes detailed training in gross anatomy and/or neuroscience courses, practicum experiences, a seminar class in pedagogical literature, and a course in educational strategies for the anatomical sciences. The award of certificate completion affirms that the candidate has demonstrated faculty‐supervised proficiency in anatomy dissection, instruction in anatomy topics, and teaching strategies for anatomy. Seventeen graduate students have earned the certificate since its inception; nine students accepted teaching positions in anatomy following their graduate training and currently nine certificate graduates have assistant (six) or associate (three) professor positions in academia. In 2016, an anonymous survey including Likert‐style and open‐ended questions was emailed to all certificate graduates. Graduates favorably responded (each question averaged 4.4 or greater out of 5) that the certificate increased their awareness of teaching‐faculty responsibilities, adequately prepared them for teaching‐related duties, and positively contributed toward their first employment. Graduates indicated that the lecturing and dissection experience, awareness of faculty responsibilities, and job preparation (e.g., teaching philosophy development) were the most helpful aspects of the certificate. These results indicate that the Graduate Certificate in Anatomical Sciences Instruction is viewed by its graduates and their employers as a valuable teaching credential that can be attained alongside a basic science degree. Anat Sci Educ 11: 516–524. © 2018 American Association of Anatomists.     

The translucent cadaver: An evaluation of the use of full body digital x-ray images and drawings in surface anatomy education

It has been noted by staff at the Faculty of Health Sciences, Stellenbosch University that medical students neglect the study of surface anatomy during dissection. This study reports on the novel use of Lodox® Statscan® images in anatomical education, particularly the teaching of surface anatomy. Full body digital X‐ray images (Lodox Statscan) of each cadaver (n = 40) were provided to second year medical students. During dissection students were asked to visualize landmarks, organs, and structures on the digital X‐ray and their cadaver, as well as palpate these landmarks and structures on themselves, their colleagues, and the cadaver. To stimulate student engagement with surface anatomy, dissection groups were required to draw both the normal and actual position of organs on a laminated image provided. The accuracy of the drawings was subsequently assessed and students were further assessed by means of practical identification tests. In addition, students were asked to complete an anonymous questionnaire. A response rate of 79% was obtained for the student questionnaire. From the questionnaire it was gathered that students found the digital X‐ray images beneficial for viewing most systems' organs, except for the pelvic organs. Although it appears that students still struggle with the study of surface anatomy, most students believed that the digital X‐rays were beneficial to their studies and supported their continued use in the future. Anat Sci Educ. © 2012 American Association of Anatomists.     

The effect of simulation-based education before a cadaver dissection course

Although the methods for medical education continue to evolve due to the development of medicines, the cadaver dissection course still plays a fundamental role. The cadaver dissection course allows students to learn to handle instruments correctly while actively exploring three-dimensional anatomy. However, dissection comes with the risk of accidental injury. In recent years, the number of classes offered for the cadaver dissection course has decreased while the amount of knowledge required in clinical medicine has increased. Simulation-based education (SBE) has been proven to be an effective educational method that enhances the development of practical skills by integrating learners' knowledge and skills. This study aimed to investigate the effect of SBE as a preparatory education course when taken prior to a medical student's enrollment in the cadaver dissection course. In the present study, an SBE assuming practical cadaver dissection course was performed in the Clinical Simulation Center. The frequency of injury rates per 1000 h of cadaver dissection course was significantly less in 2017 and 2018 compared to that in 2016. Two years after the implementation of the SBE, average student self-efficacy scores and written examination scores significantly increased, whereas self-contentment scores were relatively unchanged. The results showed that the implementation of SBE decreased the incidence of injuries and improved students' overall self-efficacy scores and increased acquisition of knowledge evident on written examination score. Therefore, SBE as a preparatory education course may effectively promote the combined development of dissection skills and anatomical knowledge in the subsequent fundamental cadaver dissection course.     

Sharps Injuries during Dissection: A Five-Year Retrospective Study in the Context of Safety

The supplementation of lecture-based anatomy teaching with laboratory sessions, involving dissection or anatomical specimens, is commonly used. Hands-on dissection allows students to handle instruments correctly while actively exploring three-dimensional anatomy. However, dissection carries a potential risk of sharps and splash injuries. The aim of this study was to quantify the frequency rate of such cases per 1,000 student-hours of dissection and identify potential factors than might influence safety in anatomy laboratories. Data were retrospectively collected from September 2013 to June 2018 at the University of St Andrews, Scotland, UK. Overall, 35 sharps injuries were recorded in undergraduate medical students, with a frequency rate of 0.384 and no splash cases. A statistically significant, moderate negative association between year of study and frequency rate (rho₍₂₅₎ = −0.663; P < 0.001) was noted. A statistically significant difference in the frequency rate between different semester modules (χ²₍₄₎ = 13.577, P = 0.009) was observed with the difference being between Year 1 Semester 2 and Year 3 Semester 1 (P = 0.004). The decreasing trend with advancing year of study might be linked to increasing dissecting experience or the surface area of the region dissected. The following factors might have contributed to increased safety influencing frequency rates: single-handed blade removal systems; mandatory personal protective equipment; and having only one student dissecting at a given time. The authors propose that safety familiarization alongside standardized training and safety measures, as part of an evidence-based culture shift, will instill safety conscious behaviors and reduce injuries in anatomy laboratories.     

A Novel Approach to Gross Dissection of the Human Pelvis and Perineum

Progressive curricular changes in medical education over the past two decades have resulted in the diaspora of gross anatomy content into integrated curricula while significantly reducing total contact hours. Despite the development of a wide range of alternative teaching modalities, gross dissection remains a critical component of medical education. The challenge posed to modern anatomists is how to maximize and integrate the time spent dissecting under the current curricular changes. In this study, an alternative approach to the dissection of the pelvis and perineum is presented in an effort to improve content delivery and student satisfaction. The approach involves removal of the perineum en bloc from the cadaver followed by excision of the pubic symphysis, removal and examination of the bladder and associated structures, examination and bisection of the midline pelvic organs in situ, and midsagittal hemisection of the pelvis for identification of the neurovasculature. Results indicate that this novel dissecting approach increases the number of structures identified by 46% ± 14% over current dissecting methods. Survey results indicate that students were better able to integrate lecture and laboratory concepts, understand the concepts, and successfully identify more structures using the new approach (P < 0.05). The concept of anatomic efficiency is introduced and proposed as a standard quantitative measure of gross dissection proficiency across programs and institutions. These findings provide evidence that innovative solutions to anatomy education can be found that help to maintain critical content and student satisfaction in a modern medical curriculum.     

Dissecting the dissectors: Knowledge,attitude, and practice of body bequests by Nigerian anatomists

Anatomy education in most African countries is limited by an insufficient number of cadavers for students to undertake dissection. This already significant shortage is exacerbated by an increasing number of medical schools and students. Virtual dissections are impractical in alleviating such a shortfall in African anatomy education, and further cadaver supply is challenged by unethical and dubious sources. This study was designed to assess the knowledge, attitudes, and practice of whole body and organ donation by Nigerian anatomists with the aim of finding solutions to the problems associated with the availability of cadavers in Nigerian medical schools. Out of 46 anatomists that participated in the survey, only 23.9% would consider donating their whole bodies and 60.9% their organs. More than 95% of respondents did not believe that body bequests could become the sole source of cadavers for anatomic dissection in Nigeria. Age and gender were not statistically significant in the choice of being a body or organ donor. The unacceptability to one's family members regarding body donation was the major reason for respondents' unwillingness to make a whole body donation. None of the 14 medical schools sampled in this study have yet instituted a body registration and donation program. The anatomists showed a high level of knowledge and awareness of body bequest programs, which were not reflected by their attitudes and practice. The authors recommend proactive measures aimed at improving the perception and attitudes of Nigerian anatomists. Anat Sci Educ. © 2012 American Association of Anatomists.     

反思“教育制度移植”——基于哲学的解释学视角

从一个教育制度体系移植或借用的教育制度不会具有该制度在原初教育制度体系中的任何意义。意义(意味着语词的观念内含)从来就不会转移,因为它总是涉及一种特殊的符号———文化情境。原初的教育制度一旦跨越了边界,就必然会经历某种变化,影响其作为制度的资质,而纯粹的命题性陈述与其意义之间的分离阻止了教育制度本身的迁移。     

Coupled physical and digital cadaver dissection followed by a visual test protocol provides insights into the nature of anatomical knowledge and its evaluation

This research effort compared and contrasted two conceptually different methods for the exploration of human anatomy in the first‐year dissection laboratory by accomplished students: “physical” dissection using an embalmed cadaver and “digital” dissection using three‐dimensional volume modeling of whole‐body CT and MRI image sets acquired using the same cadaver. The goal was to understand the relative contributions each method makes toward student acquisition of intuitive sense of practical anatomical knowledge gained during “hands‐on” structural exploration tasks. The main instruments for measuring anatomical knowledge under this conceptual model were questions generated using a classification system designed to assess both visual presentation manner and the corresponding response information required. Students were randomly divided into groups based on exploration method (physical or digital dissection) and then anatomical region. The physical dissectors proceeded with their direct methods, whereas the digital dissectors generated and manipulated indirect 3D digital models. After 6 weeks, corresponding student anatomical assignment teams compared their results using photography and animated digital visualizations. Finally, to see whether each method provided unique advantages, a visual test protocol of new visualizations based on the classification schema was administered. Results indicated that all students, regardless of gender, dissection method, and anatomical region dissected performed significantly better on questions presented as rotating models requiring spatial ordering or viewpoint determination responses in contrast to requests for specific lexical feature identifications. Additional results provided evidence of trends showing significant differences in gender and dissection method scores. These trends will be explored with further trials with larger populations. Anat Sci Ed 1:27–40, 2008. © 2007 American Association of Anatomists.     

National survey on anatomical sciences in medical education

The drivers for curricular change in medical education such as the addition of innovative approaches to teaching, inclusion of technology and adoption of different assessment methods are gaining momentum. In an effort to understand how these changes are impacting and being implemented in gross anatomy, microscopic anatomy, neuroanatomy/neuroscience, and embryology courses, surveys were sent out to course directors/discipline leaders at allopathic Medical Schools in the United States during the 2016‐2017 academic year. Participants in the study were asked to comment on course hours, student experiences in the classroom and laboratory, amount of faculty participation, the use of peers as teachers in both the classroom and laboratory, methods used for student assessment and identification of best practices. Compared to data published from a similar survey in 2014, a number of changes were identified: (1) classroom hours in gross anatomy increased by 24% and by 29% in neuroanatomy/neuroscience; (2) laboratory hours in gross anatomy decreased by 16%, by 33% in microscopic anatomy, and by 38% in neuroanatomy/neuroscience; (3) use of virtual microscopy in microscopic anatomy teaching increased by 129%; and (4) the number of respondents reporting their discipline as part of a partially or fully integrated curriculum increased by greater than 100% for all four disciplines. Anat Sci Educ 11: 7–14. © 2017 American Association of Anatomists.     

The diverse utility of wet prosections and plastinated specimens in teaching gross anatomy in New Zealand

Anatomical education has traditionally used cadaveric material to study the human body, with both wet prosections and plastinated (PP) material commonly utilized. However, the frequency of use of these different preparation modes in a tertiary institution has not been previously examined. An audit of PP use in the Department of Anatomy and Structural Biology at the University of Otago was performed for 2009, assessing the number of courses, variety, and number of PP used throughout 2009. Results indicate the unique and diverse nature of PP utilization and are discussed with reference to their relative strengths and weaknesses. Such information is useful to those wishing to initiate or maintain programs that involve the teaching of human anatomy with cadaveric material.     

The translucent cadaver: A follow‐up study to gauge the efficacy of implementing changes suggested by students

In a study conducted in 2011, the use of full body digital X‐ray images (Lodox^® Statscan^®) and drawings were described for surface anatomy education during which suggestions were made by students on how to improve the method. Educational innovations should continuously be adjusted and improved to provide the best possible scenario for student learning. This study, therefore, reports on the efficacy of implementing some of these suggestions. Suggestions incorporated into the follow‐up study included: (1) The inclusion of eight strategically placed labeled digital X‐ray images to the dissection halls, (2) The placement of both labeled and unlabeled digital X‐ray images online, (3) The inclusion of informal oral questions on surface anatomy during dissection, (4) The requirement of students to submit individual drawings in addition to group drawings into their portfolios, and (5) Integrating information on how to recognize anatomical structures on X‐rays into gross anatomy lectures given prior to dissection. Students were requested to complete an anonymous questionnaire. The results of the drawings, tests and questionnaires were compared to the results from the 2011 cohort. During 2012, an increased usage of the digital X‐rays and an increase in practical test marks in three out of the four modules (statistically significant only in the cardiovascular module) were reported. More students from the 2012 cohort believed the images enhanced their experience of learning surface anatomy and that its use should be continued in future. The suggested changes, therefore, had a positive effect on surface anatomy education. Anat Sci Educ 6: 433–439. © 2013 American Association of Anatomists.     

A shortage of cadavers: The predicament of regional anatomy education in mainland China

Both in mainland China and around the world, regional anatomy stands as one of the most important basic science courses in medical school curricula. As such, dissection of human cadavers and use of prosected specimens remains the most essential teaching method in anatomy education. However, medical educators have raised increasing concerns about an ongoing shortage of cadavers for medical use in mainland China, a problem which may seriously limit the future development of human anatomy education. Based on a survey on cadaver usage in anatomy education in mainland China, this study found that the cadaver resources of most given medical schools in mainland China are associated with their geographic location, academic ranking, and local support for body donation policies. Effective measures to alleviate this shortage of cadavers may include future efforts to promote national‐level body donation legislation, broader acceptance of body donation among Chinese citizens, and an efficient and humane protocol for body donation. Anat Sci Educ 11: 397–402. © 2018 American Association of Anatomists.     

Dual‐extrusion 3D printing of anatomical models for education

Two material 3D printing is becoming increasingly popular, inexpensive and accessible. In this paper, freely available printable files and dual extrusion fused deposition modelling were combined to create a number of functional anatomical models. To represent muscle and bone FilaFlex^3D flexible filament and polylactic acid (PLA) filament were extruded respectively via a single 0.4 mm nozzle using a Big Builder printer. For each filament, cubes (5 mm³) were printed and analyzed for X, Y, and Z accuracy. The PLA printed cubes resulted in errors averaging just 1.2% across all directions but for FilaFlex^3D printed cubes the errors were statistically significantly greater (average of 3.2%). As an exemplar, a focus was placed on the muscles, bones and cartilage of upper airway and neck. The resulting single prints combined flexible and hard structures. A single print model of the vocal cords was constructed which permitted movement of the arytenoids on the cricoid cartilage and served to illustrate the action of intrinsic laryngeal muscles. As University libraries become increasingly engaged in offering inexpensive 3D printing services it may soon become common place for both student and educator to access websites, download free models or 3D body parts and only pay the costs of print consumables. Novel models can be manufactured as dissectible, functional multi‐layered units and offer rich possibilities for sectional and/or reduced anatomy. This approach can liberate the anatomist from constraints of inflexible hard models or plastinated specimens and engage in the design of class specific models of the future. Anat Sci Educ 11: 65–72. © 2017 American Association of Anatomists.     

Altruism in death: Attitudes to body and organ donation in Australian students

Health education, research, and training rely on the altruistic act of body donation for the supply of cadavers. Organ transplantation and research rely on donated organs. Supply of both is limited, with further restrictions in Australia due to requirements for a next-of-kin agreement to donation, irrespective of the deceased's pre-death consent. Research suggests health workers are less likely to support the donation of their own bodies and/or organs, despite recognizing the public good of donation, and that exposure to gross anatomy teaching may negatively affect support for donation. Attitudes to body and organ donation were examined in Australian students studying anatomy. Support for self-body donation (26.5%) was much lower than support for self-organ donation (82.5%). Ten percent of participants would not support the election of a family member or member of the public to donate their body, and just over 4% would not support the election of a family member to donate their organs, with one-to-two percent not supporting this election by a member of the public. Exposure to gross anatomy teaching was associated with an increased likelihood of consideration of issues about body and organ donation, whether for self, family, or the public, and registration as an organ donor. Exposure decreased participants' willingness to donate their own body, with those who practiced a religion least likely to support body donation. Gross anatomy courses provide an opportunity to inform future healthcare workers about altruistic donation, albeit with a recognition that religious or cultural beliefs may affect willingness to donate.     

Anatomy education in Namibia: balancing facility design and curriculum development

The anatomy curriculum at Namibia's first, and currently only, medical school is clinically oriented, outcome-based, and includes all of the components of modern anatomical sciences i.e., histology, embryology, neuroanatomy, gross, and clinical anatomy. The design of the facilities and the equipment incorporated into these facilities were directed toward simplification of work flow and ease of use by faculty, staff, and students. From the onset, the integration of state of the art technology was pursued to facilitate teaching and promote a student-centered pedagogical approach to dissections. The program, as realized, is comprised of three 16-week semesters with seven hours of contact time per week, namely three hours of lectures and four hours of dissection laboratory and microscopy time. Set outcomes were established, each revolving around clinical cases with integrated medical imaging. The design of the facility itself was not constrained by a legacy structure, allowing the School of Medicine, in collaboration with architects and contractors, to design the building from scratch. A design was implemented that allows for the sequential processing of cadaveric material in a unidirectional flow from reception, to preparation, embalming, storage, dissection, and maceration. Importantly, the odor of formaldehyde typically associated with anatomy facilities was eliminated outside of the dissection areas and minimized within via a high-performance ventilation system. By holistically incorporating an integrated curriculum, facility design, and teaching at an early stage, the authors believe they have created a system that might serve as a model for new anatomy programs.