Introducing gross pathology to undergraduate medical students in the dissecting room

Pathology and anatomy are both sciences that contribute to the foundations of a successful medical career. In the past decade, medical education has undergone profound changes with the development of a core curriculum combined with student selected components. There has been a shift from discipline‐based teaching towards problem‐based learning. Both anatomy and pathology are perceived to have suffered from this educational shift. The challenge is to introduce methods of learning for these subjects into an integrated student‐centered curriculum. The purpose of this study was to determine the prevalence of pathology in 12 donor cadavers in the dissecting room of the Bute Medical School, University of St Andrews. All of the cadavers had multiple pathologies (between three to four conditions) ranging from common to rare disorders. A number of prostheses and surgical interventions were also noted. This small study confirms that cadaveric dissection provides an excellent opportunity for the integration of anatomy, pathology, and clinical medicine into the early clinical training of undergraduate medical students. The identification of disease in a cadaver provides an excellent introduction to the gross features of a disease process, but does not substitute for the detailed study of a process later in the curriculum. Anat Sci Educ 3: 97–100, 2010. © 2010 American Association of Anatomists.     

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.     

Creating a Human Gross Anatomy Laboratory: The Experience at a Primarily Undergraduate Institution

This paper details the creation of a human gross anatomy laboratory from a defunct chemistry laboratory at West Liberty University, a small primarily undergraduate institution in West Virginia. The article highlights important considerations with regard to the development of a human gross anatomy laboratory including access to human gifts; assessment of the space for size, security, and privacy; assessment of the utilities; acquisition of a dissection table; ventilation; aesthetics in functional design; expenses; and sustainability. The report also identifies favorable conditions and potential pitfalls regarding the creation of a human gross anatomy laboratory. This paper demonstrates that a human gross anatomy laboratory can be created quickly and at little expense.     

Cadaveric Dissection in Relation to Problem-Based Learning Case Sequencing: A Report of Medical Student Musculoskeletal Examination Performances and Self-Confidence

Mercer University School of Medicine utilizes a problem-based learning (PBL) curriculum for educating medical students in the basic clinical sciences. In 2014, an adjustment was piloted that enabled PBL cases to align with their corresponding cadaver dissection that reviewed the content of anatomy contained in the PBL cases. Faculty had the option of giving PBL cases in sequence with the cadaveric dissection schedule (sequential group) or maintaining PBL cases out of sequence with dissections (traditional group). During this adjustment, students’ academic performances were compared. Students’ perception of their own preparedness for cadaveric dissection, their perceived utility of the cadaver dissections, and free-response comments were solicited via an online survey. There were no statistically significant differences when comparing student mean examination score values between the sequential and traditional groups on both multidisciplinary examinations (79.39 ± 7.63 vs. 79.88 ± 7.31, P = 0.738) and gross anatomy questions alone (78.15 ± 10.31 vs. 79.98 ± 9.31, P = 0.314). A statistically significant difference was found between the sequential group's and traditional group's (63% vs. 29%; P = 0.005) self-perceived preparedness for cadaveric dissections in the 2017 class. Analysis of free-response comments found that students in the traditional group believed their performance in PBL group, participation in PBL group and examination performance was adversely affected when compared to students with the sequential schedule. This study provides evidence that cadaveric dissections scheduled in sequence with PBL cases can lead to increased student self-confidence with learning anatomy but may not lead to improved examination scores.     

A dissecting competition for medical students

After repeated requests from medical students for more cadaver dissection opportunities, a voluntary dissecting "competition" was initiated for the third year medical students in 2006. This has been held annually on five occasions since, offering up to 30 dissection stations and accommodating an average of 53 students (range 40-66) per year, representing about 20-25% of the total class. Material is standardized to distal upper or lower limb specimens, each of which is dissected by one or two students during a single weekend day. Participants are required to complete their dissection in about six hours and present an appropriately labeled display together with a 300 word abstract, emphasizing clinical relevance. Dissections are judged on presentation, accuracy of identification and labeling, and relevance to the clinical abstract, taking into account the technical difficulty of the particular dissection. Judging from successive annual uptake of places and informal feedback, this is not only a popular event allowing students to focus creatively on producing a clinically relevant dissection in a relaxed learning environment but also of educational value. An unexpected outcome has been the production of many specimens suitable as prosections for future classes. A dissecting competition may be a useful method of stimulating learning for medical students interested in undertaking further dissection but it requires appropriate staff commitment and a supply of suitable cadaver specimens.     

Fear of Death and Examination Performance in a Medical Gross Anatomy Course with Cadaveric Dissection

Cadaveric dissection offers an important opportunity for students to develop their ideas about death and dying. However, it remains largely unknown how this experience impacts medical students' fear of death. The current study aimed to address this gap by describing how fear of death changed during a medical gross anatomy dissection course and how fear of death was associated with examination performance. Fear of death was surveyed at the beginning of the course and at each of the four block examinations using three of the eight subscales from the Multidimensional Fear of Death Scale: Fear of the Dead, Fear of Being Destroyed, and Fear for the Body After Death. One hundred forty-three of 165 medical students (86.7%) completed the initial survey. Repeated measures ANOVA showed no significant changes in Fear of the Dead (F (4, 108) = 1.45, P = 0.222) or Fear for the Body After Death (F (4, 108) = 1.83, P = 0.129). There was a significant increase in students' Fear of Being Destroyed (F (4, 108) = 6.86, P < 0.0005) after beginning dissection. This increase was primarily related to students' decreased willingness to donate their body. Concerning performance, there was one significant correlation between Fear for the Body After Death and the laboratory examination score at examination 1. Students with higher fears may be able to structure their experience in a way that does not negatively impact their performance, but educators should still seek ways to support these students and encourage body donation.     

Application of flipped classroom pedagogy to the human gross anatomy laboratory: Student preferences and learning outcomes

To improve student preparedness for anatomy laboratory dissection, the dental gross anatomy laboratory was transformed using flipped classroom pedagogy. Instead of spending class time explaining the procedures and anatomical structures for each laboratory, students were provided online materials to prepare for laboratory on their own. Eliminating in‐class preparation provided the opportunity to end each period with integrative group activities that connected laboratory and lecture material and explored clinical correlations. Materials provided for prelaboratory preparation included: custom‐made, three‐dimensional (3D) anatomy videos, abbreviated dissection instructions, key atlas figures, and dissection videos. Data from three years of the course (n = 241 students) allowed for analysis of students' preferences for these materials and detailed tracking of usage of 3D anatomy videos. Students reported spending an average of 27:22 (±17:56) minutes preparing for laboratory, similar to the 30 minutes previously allocated for in‐class dissection preparation. The 3D anatomy videos and key atlas figures were rated the most helpful resources. Scores on laboratory examinations were compared for the three years before the curriculum change (2011–2013; n = 242) and three years after (2014–2016; n = 241). There was no change in average grades on the first and second laboratory examinations. However, on the final semi‐cumulative laboratory examination, scores were significantly higher in the post‐flip classes (P = 0.04). These results demonstrate an effective model for applying flipped classroom pedagogy to the gross anatomy laboratory and illustrate a meaningful role for 3D anatomy visualizations in a dissection‐based course. Anat Sci Educ 11: 385–396. © 2017 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.     

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.     

Student laboratory presentations as a learning tool in anatomy education

Previous studies have shown that anatomy students who complete oral laboratory presentations believe they understand the material better and retain it longer than they otherwise would if they only took examinations on the material; however, we have found no studies that empirically test such outcomes. The purpose of this study was to assess the effectiveness of oral presentations through comparisons with other methods of assessment, most notably, examination performance. Specifically, we tested whether students (n = 256) performed better on examination questions on topics covered by their oral presentations than on other topics. Each student completed two graded, 12‐minute laboratory presentations on two different assigned topics during the course and took three examinations, each of which covered a third of the course material. Examination questions were characterized by type (memorization, pathway, analytical, spatial). A two‐way repeated measures analysis of variance revealed that students performed better on topics covered by their presentations than on topics not covered by their presentations (P < 0.005), regardless of presentation grade (P > 0.05) and question type (P > 0.05). These results demonstrate empirically that oral presentations are an effective learning tool. Anat Sci Educ 2: 260–264, 2009. © 2009 American Association of Anatomists.     

The Use of Anatomical Dissection Videos in Medical Education

Dissection videos are commonly utilized in gross anatomy courses; however, the actual usage of such videos, as well as the academic impact of student use of these videos, is largely unknown. Understanding how dissection videos impact learning is important in making curricular decisions. In this study, 22 dissection videos were created to review structures identified in laboratory sessions throughout the Organ Systems 1 (OS1), 2 (OS2), and 3 (OS3) courses. Dissection videos were provided to 201 first-year medical students, and viewing data were recorded. Demographic data for age and gender identity were also collected from students. Overall, there was a significant decrease in total views (P = 0.001), the number of students who pressed play (P < 0.001), and the number of students who viewed ≥ 90% of the total length of videos (P < 0.001) from OS1 to OS3. The total adjusted time spent viewing videos was not significantly different between individual OS courses. There were some instances where significant differences existed in examination performance between those who did and did not view videos, and by time spent viewing videos. There were no significant differences in time spent viewing videos by gender. Together these data suggest that students may utilize dissection videos more at the beginning of a dissection course, although they remain an important resource throughout the year for a subset of students.     

Prosection or Dissection: Which is Best for Teaching the Anatomy of the Hand and Foot?

Due to the current trend of decreasing contact hours and less emphasis being given to the basic science courses in the pre-clinical years of medical education, it is essential that new approaches to teaching gross anatomy are investigated to ensure medical students are being adequately exposed to anatomical content. This study retrospectively analyzed practical examination data from four medical gross anatomy classes (N = 569) to ascertain which pedagogical approach, student participation in the dissection process, or interaction with prosected specimens is best for teaching the anatomy of the hand and foot. Data analysis involved the use of propensity score matching, a nonparametric preprocessing statistical approach which ensures accurate representation of the true treatment effect by balancing cohorts prior to statistical analysis. Statistical analysis indicated that those students who were exposed to the anatomy of the hand through interactions with prosected specimens performed 5.6% better (P = 0.012) while for the foot, students who interacted with prosections performed 13.0% better (P < 0.001). Although limited, data from this study suggest that utilizing prosections of the hand and foot seems to be a more advantageous pedagogical approach for teaching these regions than requiring students to dissect them.     

Medical students' attitudes toward the anatomy dissection room in relation to personality

Assessment of the personalities of medical students could enable medical educators to formulate strategies for the best development of academic and clinical competencies. In this article, we focus on the experience of students in the anatomy dissecting room. While there have been many attempts to evaluate the emotional responses of medical students to human cadaveric dissection, there has been no investigation into how different personality traits affect the responses. The main hypothesis tested was that there is a relationship between personality traits and attitudes toward the dissection room. For the present study, a group of French medical students (n = 403; mean age 21.3 ± 1.6; 65.3% female) completed a "Big Five" personality inventory and a questionnaire to assess their attitudes in regard to human dissection. The findings are consistent with our hypothesis, in that we found a relationship between reporting anxiety and four of the "Big Five" dimensions (all except openness). The rated level of anxiety was positively correlated with negative affectivity, more strongly at the beginning than at the end of the course. There were significant gender differences in attitudes toward dissection. The findings are discussed in relation to the possibility of preparing students for the dissecting room experience and also in relation to the students' understanding of mortality issues.     

The dissection room experience: A factor in the choice of organ and whole body donation—A Nigerian survey

The psychosocial impact of human dissection on the lives of medical and health science students has been noted. To assess the impact of the dissection room experience on one's willingness to become a whole body and organ donor, the attitudes of 1,350 students and professionals from the medical, health, and non‐health related disciplines to body and organ donation were studied. The participants were broken into categories according to degree of exposure to human dissection. Participants who were never exposed to the dissection experience showed more willingness to donate their bodies than those who were exposed. With the exception of the physiotherapy department, the students and professionals from the health science departments who were exposed to the dissection room but never engaged in dissection showed the most unwillingness to donate their bodies (P < 0.001). An unwillingness to donate oneself was noted as one of the negative impacts associated with exposure to the dissection room. Willingness to donate an organ correlated positively with the level of exposure to the dissection room (P < 0.001). Most of the reasons for unwillingness were traceable to negative perceptions of the dissection room as a result of poor and disrespectful management of the human cadavers. Anat Sci Educ. 7: 56–63. © 2013 American Association of Anatomists.     

Gross anatomy videos: Student satisfaction,usage, and effect on student performance in a condensed curriculum

Anatomy educators are being tasked with delivering the same quantity and quality of material in the face of fewer classroom and laboratory hours. As a result they have turned to computer‐aided instruction (CAI) to supplement and augment curriculum delivery. Research on the satisfaction and use of anatomy videos, a form of CAI, on examination performance continues to grow. The purpose of this study was to describe the usage and effect on examination scores of a series of locally produced anatomy videos after an 11% curriculum reduction. First‐year medical students (n = 40) were given access to the videos and the prior year's students (n = 40) were used as historical controls. There was no significant difference in demographics between the two groups. The survey response rate was 85% (n = 34) in the experimental group. The students found the videos to be highly satisfying (median = 5 on a five‐point Likert scale, interquartile range = 1) and used them on average 1.55 times/week (SD ± 0.77). Availability of the videos did have a statistically significant effect (4% improvement) on the final laboratory examination (p = 0.039). This suggests that the videos were a well‐received form of CAI that may be useful in bridging the gap created by a reduction in gross anatomy course contact hours. Anat Sci Educ 7: 273–279. © 2013 American Association of Anatomists.     

The use of specially designed tasks to enhance student interest in the cadaver dissection laboratory

Cadaver dissection is a key component of anatomy education. Unfortunately, students sometimes regard the process of dissection as uninteresting or stressful. To make laboratory time more interesting and to encourage discussion and collaborative learning among medical students, specially designed tasks were assigned to students throughout dissection. Student response and the effects of the tasks on examination scores were analyzed. The subjects of this study were 154 medical students who attended the dissection laboratory in 2009. Four tasks were given to teams of seven to eight students over the course of 2 weeks of lower limb dissection. The tasks were designed such that the answers could not be obtained by referencing books or searching the Internet, but rather through careful observation of the cadavers and discussion among team members. Questionnaires were administered. The majority of students agreed that the tasks were interesting (68.0%), encouraged team discussion (76.8%), and facilitated their understanding of anatomy (72.8%). However, they did not prefer that additional tasks be assigned during the other laboratory sessions. When examination scores of those who responded positively were compared with those who responded neutrally or negatively, no statistically significant differences could be found. In conclusion, the specially designed tasks assigned to students in the cadaver dissection laboratory encouraged team discussion and collaborative learning, and thereby generated interest in laboratory work. However, knowledge acquisition was not improved.     

Medical students' reactions to anatomic dissection and the phenomenon of cadaver naming

The teaching of gross anatomy has, for centuries, relied on the dissection of human cadavers, and this formative experience is known to evoke strong emotional responses. The authors hypothesized that the phenomenon of cadaver naming is a coping mechanism used by medical students and that it correlates with other attitudes about dissection and body donation. The authors developed a 33‐question electronic survey to which 1,156 medical students at 12 medical schools in the United States voluntarily responded (November 2011–March 2012). They also surveyed course directors from each institution regarding their curricula and their observations of students' coping mechanisms. The majority of students (574, 67.8%) named their cadaver. Students most commonly cited the cadaver's age as the reason they chose a particular name for the cadaver. A minority of the students who did not name the cadaver reported finding the practice of naming disrespectful. Almost all students indicated that they would have liked to know more about their donor, particularly his or her medical history. Finally, students who knew the birth name of the donor used it less frequently than predicted. The authors found that the practice of naming cadavers is extremely prevalent among medical students and that inventive naming serves as a beneficial coping mechanism. The authors suggest that developing a method of providing students with more information about their cadaver while protecting the anonymity of the donor and family would be useful. Anat Sci Educ 7: 169–180. © 2013 American Association of Anatomists.     

Reflective Writing on the Cadaveric Dissection Experience: An Effective Tool to Assess the Impact of Dissection on Learning of Anatomy,Humanism, Empathy,Well-Being,and Professional Identity Formation in Medical Students

Growing evidence supports the use of reflective writing activities centered around the human cadaveric dissection experience to support and assess elements of medical student wellness. Dissection may promote personal and professional development, increase resilience, and foster a sense of connection and community. This study employed a qualitative analysis of a reflective writing exercise to explore the question: “What is the impact of the cadaveric dissection anatomy experience on the personal and professional development of medical students?” This cross-sectional study was conducted at the conclusion of the first-year anatomy module. A total of 117 United States allopathic medical students were given a questionnaire designed to elicit the students' experiences and introspection. The exercise included four reflective questions that were provided to 20 groups of six students. Grounded theory analysis was used to explore themes that arose in students' responses. Participants exhibited several common reactions to cadaveric dissection. After analyzing all responses, 266 unique open codes were identified for all four questions. These open codes were sorted into ten distinct axial codes, which are broader categorical themes of open codes. The aims of our study were to identify themes that emerged as students reflected on the impact of their dissection experience using reflective writing as a tool to capture these themes and to gather information to inform pedagogical methodologies. The researchers observed that the educational effects of dissection captured in the reflective writing resembled those found in other areas of medical education that emphasize professional identity formation and important humanistic qualities.