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.     

Explorable three‐dimensional digital model of the female pelvis,pelvic contents,and perineum for anatomical education

The anatomy of the pelvis is complex, multilayered, and its three‐dimensional organization is conceptually difficult for students to grasp. The aim of this project was to create an explorable and projectable stereoscopic, three‐dimensional (3D) model of the female pelvis and pelvic contents for anatomical education. The model was created using cryosection images obtained from the Visible Human Project, in conjunction with a general‐purpose three‐dimensional segmentation and surface‐rendering program. Anatomical areas of interest were identified and labeled on consecutive images. Each 2D slice was reassembled, forming a three‐dimensional model. The model includes the pelvic girdle, organs of the pelvic cavity, surrounding musculature, the perineum, neurovascular structures, and the peritoneum. Each structure can be controlled separately (e.g. added, subtracted, made transparent) to reveal organization and/or relationships between structures. The model can be manipulated and/or projected stereoscopically to visualize structures and relationships from different angles with excellent spatial perception. Because of its ease of use and versatility, we expect this model may provide a powerful teaching tool for learning in the classroom or in the laboratory. Anat Sci Educ. © 2010 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.     

Attitudes to cadaveric organ donation in Irish preclinical medical students

There is a worldwide shortage of organs for transplantation. It has been shown that the attitude of healthcare professionals can improve the rates of organ donation, and that educational programs aimed at improving both attitudes and knowledge base of professionals can have positive outcomes. Although there has been research carried out on this topic, there has been none in Ireland. Anatomy dissection can be a stressor to medical students-we investigate the attitudes of Irish students to organ donation and how they change with exposure to anatomy dissection. A questionnaire was administered to first year students in the School of Medicine in University College Dublin, Ireland, three times over a nine-week period at the commencement of classes in an academic year. The attitudes of the students were positive throughout regarding organ donation by a stranger, a family member, or themselves. There was, however, a significant decrease in support for the donation of a family member's organs in a minority of students. Irish students' attitudes to postmortem organ donation are positive and are not changed by exposure to the dissecting room. There is support for the donation of organs, and willingness among students to donate their own organs and support donation by family members.     

中药保留灌肠治疗盆腔炎的疗效观察及护理

目的:评价中药保留灌肠对盆腔炎患者的疗效。方法:将100例盆腔炎患者,随机分为治疗组和对照组各50例,对照组患者给予常规抗感染治疗,治疗组患者给予辨证用药中药灌肠给药疗,分析其两组的疗效并作对比分析。结果:治疗组患者的治疗有效率优于对照组患者的治疗有效率,前者的总有效率优于后者(P0.01),结论:中药保留灌肠给药对盆腔炎患者的治疗效果优于常规抗感染治疗。     

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.     

A human dissection training program at Indiana University School of Medicine‐Northwest

As human cadavers are widely used in basic sciences, medical education, and other training and research venues, there is a real need for experts trained in anatomy and dissection. This article describes a program that gives individuals interested in clinical and basic sciences practical experience working with cadavers. Participants are selected through an open application process and attend sessions focused on anatomical terminology, gross anatomy and radiography, and some of the educational applications of human cadavers. Dissection skills are honed during an intensive, two‐day cadaver dissection and orthopedic workshop. Participants communicate the knowledge they gain through table‐side discussions, reflect upon the experience during a memorial service, and submit written program evaluations. Additionally, the dissection and preparation of cadaveric materials accomplished in this course are used in the medical school gross anatomy course during the next academic year. From 2004 through 2008, the annual number of applicants increased from 40 to 167, and the number of participants increased from 25 to 43 per year. Program participants have represented diverse ethnic, educational, and professional backgrounds. Feedback from participants has been remarkably positive, including comments on the large amount of learning that takes place during the sessions, the positive impact the program has had on career choice, and the desire for program expansion. This program, which could be replicated at other institutions, teaches anatomy, prepares cadaveric prosections for teaching and training others, and encourages participants to pursue careers in anatomical and biomedical sciences. Anat Sci Educ 3: 77–82, 2010. © 2010 American Association of Anatomists.     

The anatomy of anatomy: A review for its modernization

Anatomy has historically been a cornerstone in medical education regardless of nation or specialty. Until recently, dissection and didactic lectures were its sole pedagogy. Teaching methodology has been revolutionized with more reliance on models, imaging, simulation, and the Internet to further consolidate and enhance the learning experience. Moreover, modern medical curricula are giving less importance to anatomy education and to the acknowledged value of dissection. Universities have even abandoned dissection completely in favor of user‐friendly multimedia, alternative teaching approaches, and newly defined priorities in clinical practice. Anatomy curriculum is undergoing international reformation but the current framework lacks uniformity among institutions. Optimal learning content can be categorized into the following modalities: (1) dissection/prosection, (2) interactive multimedia, (3) procedural anatomy, (4) surface and clinical anatomy, and (5) imaging. The importance of multimodal teaching, with examples suggested in this article, has been widely recognized and assessed. Nevertheless, there are still ongoing limitations in anatomy teaching. Substantial problems consist of diminished allotted dissection time and the number of qualified anatomy instructors, which will eventually deteriorate the quality of education. Alternative resources and strategies are discussed in an attempt to tackle these genuine concerns. The challenges are to reinstate more effective teaching and learning tools while maintaining the beneficial values of orthodox dissection. The UK has a reputable medical education but its quality could be improved by observing international frameworks. The heavy penalty of not concentrating on sufficient anatomy education will inevitably lead to incompetent anatomists and healthcare professionals, leaving patients to face dire repercussions. Anat Sci Educ 3: 83–93, 2010. © 2010 American Association of Anatomists.     

Importance of adequate gross anatomy education: the impact of a structured pelvic anatomy course during gynecology fellowship

Medical education underwent standardization at the turn of the 20th century and remained fairly consistent until recently. Incorporation of a patient-centered or case-based curriculum is believed to reinforce basic science concepts. One negative aspect is a reduction in hours spent with cadaveric dissection in the gross anatomy laboratory. For those entering a surgical career, limited anatomical exposure leaves knowledge deficits that must be corrected during further education during residency training. The benefit of providing formal anatomy education to residents and surgical fellows is described in the literature, specifically noting improvement in written test scores and surgical application.     

Pulling my gut out—Simple tools for engaging students in gross anatomy lectures

A lecture is not necessarily a monologue, promoting only passive learning. If appropriate techniques are used, a lecture can stimulate active learning too. One such method is demonstration, which can engage learners' attention and increase the interaction between the lecturer and the learners. This article describes two simple and useful tools for demonstration during gross anatomy lectures. One is an apron for demonstrating midgut rotation and the other is a simple “human” model for demonstrating the relationship between the uterus and the peritoneum. Anat Sci Educ. © 2010 American Association of Anatomists.     

Anatomical knowledge retention in third‐year medical students prior to obstetrics and gynecology and surgery rotations

Surgical anatomy is taught early in medical school training. The literature shows that many physicians, especially surgical specialists, think that anatomical knowledge of medical students is inadequate and nesting of anatomical sciences later in the clinical curriculum may be necessary. Quantitative data concerning this perception of an anatomical knowledge deficit are lacking, as are specifics as to what content should be reinforced. This study identifies baseline areas of strength and weakness in the surgical anatomy knowledge of medical students entering surgical rotations. Third‐year medical students completed a 20–25‐question test at the beginning of the General Surgery and Obstetrics and Gynecology rotations. Knowledge of inguinal anatomy (45.3%), orientation in abdominal cavity (38.8%), colon (27.7%), and esophageal varices (12.8%) was poor. The numbers in parentheses are the percentage of questions answered correctly per topic. In comparing those scores to matched test items from this cohort as first‐year students in the anatomy course, the drop in retention overall was very significant (P = 0.009) from 86.9 to 51.5%. Students also scored lower in questions relating to pelvic organs (46.7%), urogenital development (54.0%), pulmonary development (17.8%), and pregnancy (17.8%). These data showed that indeed, knowledge of surgical anatomy is poor for medical students entering surgical clerkships. These data collected will be utilized to create interactive learning modules, aimed at improving clinically relevant anatomical knowledge retention. These modules, which will be available to students during their inpatient surgical rotations, connect basic anatomy principles to clinical cases, with the ultimate goal of closing the anatomical knowledge gap. Anat Sci Educ 7: 461–468. © 2014 American Association of Anatomists.     

Participation in Dissection Affects Student Performance on Gross Anatomy Practical and Written Examinations: Results of a Four-Year Comparative Study

The role of human dissection in modern medical curricula has been a topic of intense debate. In part, this is because dissection can be time-consuming and curricular hours are being monitored more carefully. This has led some to question the efficacy and importance of dissection as a teaching method. While this topic has received considerable attention in the literature, the question of how dissection impacts learning has been difficult to evaluate in a real-world, high-stakes setting since participation in dissection is often one of many variables. In this study, this challenge was overcome due to a change in the curriculum of a Special Master Program (SMP) that permitted a comparison between two years of students that learned anatomy using prosection only and two years of students that participated in dissection laboratories. Since each class of SMP students took courses in the medical school, and the medical school anatomy curriculum was constant, medical student performance served as a control throughout the study period. Results demonstrate that SMP students who learned through prosection had lower performance on anatomy practical and written examinations compared to medical students. When the SMP program changed and students started participating in dissection, there were measurable improvements in both practical and written examinations. These findings provide evidence of dissection’s role in learning and applying anatomy knowledge both within and outside the gross anatomy laboratory.     

Talking about death: Implementing peer discussion as a coping mechanism to overcome fears about dissection,death, and dying

Many studies have reported on the perceptions of medical students toward dissection. It is important to understand the feelings and symptoms experienced during dissection so that they can be adequately handled. Prior to dissection, first year students are given lectures on aspects of dissection, death and dying, and death rituals in various cultures. Two separate questionnaires, one given during the first week of dissection and another given one month into the program were then completed anonymously by dissection groups. The questions were designed to be open‐ended, thereby encouraging group discussion amongst students. The questionnaires were used to determine the perception of students to dissection and to discover if these perceptions change during the dissection program. The first questionnaire revealed that students do experience fears and anxiety prior to and at the beginning of dissection; however, most of these fears dissipated by the time of the second questionnaire. One month into dissection students cited talking to peers as their main coping mechanism and fewer students mentioned emotional detachment from their cadaver as a coping mechanism, as was the case in the first questionnaire. Dissection was perceived as a positive experience by our student cohort and most students cited the main advantage of dissection as the ability to visualize organs in three dimensions. The comprehensive answers received from the students indicated that thorough discussion of feelings amongst peers occurred, introducing students to an important coping mechanism at an early stage of their learning. Anat Sci Educ. © 2013 American Association of Anatomists.     

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.     

Physician Associate Students' Experience of Anatomy Dissection

The role of physician assistant/associate (PA) has expanded from its inception in the United States over 50 years ago, to European countries including Ireland. While there is an increasing body of evidence exploring the role and training of PAs in clinical settings, there is a scarcity of research exploring PA students' perspectives in relation to their experience of anatomy dissection, or how these experiences may contribute to the development of their core professional identity. Students in the first two cohorts of PA Program at the Royal College of Surgeons in Ireland program were invited to interviews which solicited them to reflect and report on their own experiences of anatomical dissection during their course. Participants' responses were analyzed using a thematic inductive approach; common themes and patterns were organized into a hierarchical structure, which generated the final framework of themes. Ten participants took part in the study; only one had previous personal experience of dissection, while two further participants had some familiarity with prosected specimens. The first theme concerned the participants' expectation of anatomical dissection, with sub-themes of preconceptions, smell, and emotions. The second theme involves discussion of coping strategies that the participants used, including talking, viewing the cadaver as their first patient, and naming (or not naming) the cadaver. The third theme includes how the participants' talked about respect and compassion in the dissection room, development of team working skills, and awareness of bereavement and organ donation. A number of recommendations were also made for the experience and orientation of future students in such a program.     

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.     

Does an Audiovisual Dissection Manual Improve Medical Students' Learning in the Gross Anatomy Dissection Course?

The gross anatomy dissection course is considered to be one of the most important subjects in medical school. Advancing technology facilitates the production of e-learning material that can improve the learning of topographic anatomy during the course. The purpose of this study was to examine a locally produced audiovisual dissection manual's effects on performance in dissection, formal knowledge gained, motivation, emotions, learning behavior, and learning efficiency of the medical students. The results, combined with the total effort put into the production of the manual, should support decisions on further implementation of this kind of audiovisual e-learning resource into the university's curriculum. First-year medical students (n = 279) were randomly divided into three groups for two weeks within the regular dissection course hours during the dissection of the anterior and posterior triangles of the neck. Two groups received an audiovisual dissection manual (n = 96) or an improved written manual (n = 94) as an intervention, the control group (n = 89) received the standard dissection manual. After dissection, each student filled out tests and surveys and their dissections were evaluated. The audiovisual dissection manual did not have any significant positive effects on the examined parameters. The effects of the audiovisual dissection manual on the medical students' learning experience, as observed in this study, did not support further curriculum implementation of this kind of e-learning resource. This study can serve as an orientation for further evaluation and design of e-learning resources for the gross anatomy dissection course.     

The gross anatomy course: An analysis of its importance

The gross anatomy dissection course is a cost‐intensive piece of undergraduate medical education that students and professionals alike describe as very important within the overall medical curriculum. We sought to understand more explicitly students' valuation of gross anatomy as an “important” course and so developed a quantitative longitudinal questionnaire. Medical students (n = 124) enrolled in the winter term 2006/2007 gross anatomy course at the Ulm University Faculty of Medicine were surveyed anonymously prior to, in the middle of, and at the end of the dissection course. Subgroups of students expressing rising or falling opinions of course value were identified and correlated with student opinions about the course's ability to convey professional competencies. Five‐point Likert scales were used for each survey item, which included such standardized instruments as the NeoFFI, BSI, and FBM. The study confirmed that medical students believe dissection to be valuable. Students indicated that participation in the course facilitated acquisition of anatomy knowledge as well as skills related to teamwork, coping with stress, and, to a lesser extent, time management. Students also noted that they developed less empathy than expected beforehand. Significant subgroup differences were observed relative to the competencies of teamwork, stress coping strategies, and empathy, as well as in students' stress levels associated with having to take a dissection course. Our study builds on previous work that has shown dissection courses help students develop professional competencies. The increase in professionalism might be a reason for the generally high value students place on the gross anatomy dissection course, Anat Sci Educ 3:3–11, 2010. © 2010 American Association of Anatomists.     

A modified dissection method to preserve neck structures

The neck is not only one of the more challenging anatomical regions to dissect but also has important application to clinical conditions, diseases, and procedures. In this study, we describe two simple modifications for dissection of the neck that (1) aid in the identification and preservation of the cutaneous branches of the cervical plexus and the accessory nerve, and (2) provide wide exposure of the root of the neck. The cutaneous branches of the cervical plexus can be identified with relative ease at the nerve point of the neck, where they are largest. To accomplish this, the skin and platysma are reflected beginning from the anterior border of trapezius and proceeding anteriorly to the midline of the neck, rather than the conventional approach of reflecting the skin from the anterior midline. The accessory nerve is identified by its relationship to the nerve point and its course to the trapezius muscle. To achieve wide exposure of the root of the neck and its contents, the acromioclavicular and sternoclavicular joints are disarticulated, and then the clavicle removed completely, rather than the more common approach of removing only the middle section of the clavicle. These modified procedures can be readily performed by first‐year medical students and integrate well with methods described in widely used anatomy dissection manuals. Anat Sci Educ 2:186–192, 2009. © 2009 American Association of Anatomists.