Medicine From The Trenches

Experiences from undergradute, graduate school, medical school, residency and beyond.

New Gross Anatomy

Many medical schools have gone from cadaver dissection to prosection to digital dissection in their Gross Anatomy labs. Certainly concerns of inhalation of formalin are removed with digital delivery but hands-on dissection of the human body is quite sacred and tremendously educational for a physician. I also understand that digital dissection is far cheaper than having cadavers for teaching purposes.

With digital dissection, many lose the ability to see the variations possible. When I was in Gross Anatomy Laboratory, it was wonderful when another group shared an anatomic variation or a great dissection with the rest of the class. We could see and touch it. It was the touch with the appreciation for anatomy in three dimensions that was a wonder. That three-dimensional anatomy and seeing structures within context probably crystallized my love and appreciation for the variations I see in surgery on a daily basis.

All human bodies are a wonder to observe, examine and treat. On any given day, each patient with their capacity to heal, is a marvel that can’t be made by man. My study of medicine after study of biochemistry, deepened my appreciation for all that the human body is capable of performing without exception. Dissection and observation with hours of hands-on work only served to deepen that appreciation.

We might argue that digital learning is powerful because the medical student can be in the anatomy lab at any time. Digital anatomy platforms like Anatomatage can move through the body layer by layer but just as something is lost with a text message instead of a phone call, looking but not touching the structures is a loss.

The best use of digital dissection is as an adjunct to dissection of the cadaver. During those hours in the Gross Anatomy lab so many years ago, I carried my Netter Atlas, my Grant Dissector (filled with notes) and my list of structures that I needed to find so that I could see and feel them in all of their dimension.  The experience was profound; deepened my appreciation for those physicians who had spent hours doing the same thing in the quest to learn medicine.

Today, education experts and designers look at teaching and delivery of curriculum as a profit-making entity. Many of these experts have never studied my discipline, practiced medicine/surgery or even taught in a classroom. My duties as a professor are to be leader and coach for my students. I give them the benefit of what my anatomy professors, surgery professors and mentors in medicine passed on to me. Education experts tend to discount experience, one of the essentials of medical practice, and attempt to replace with newer (read cheaper) substitutes.

Yes, digital delivery of curriculum is a great adjunct but it doesn’t replace hands-on experience especially in the Gross Anatomy Lab. Prosections are great but the process of discovery is lost when one does not find structures for oneself. Vivid memories of the dissection of the venous supply of the face remain in my memory today though I seldom perform surgery on the face.

I would hope that those who didn’t get a chance to perform cadaver dissection at least spend some time in the Pathology lab assisting/observing autopsies. The marvel of the human form will not be lost upon you taking the time to do this. Even today, unless you are near a forensic lab, you don’t see too many post-mortem exams taking place. If you have an opportunity to observe one, take advantage and watch. Every structure, normal or abnormal is miraculous.

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23 September, 2017 - Posted by | academics, medical school |

5 Comments »

  1. I agree completely with your thoughts on the inappropriateness of “experts” who are not physicians having a strong influence on curriculum, but I’m going to be a voice of dissent about the importance of anatomy. I spent hours and hours of my life in a dark basement that reeked of formaldehyde, carefully dissecting out structures that would rip in my hands if I was the slightest bit too aggressive or hasty, and I hated pretty much every minute of it. And as an internist, most of the knowledge I gained from that was 1) useless to me and 2) forgotten as soon as I wrote the exam.

    Medical education struggles from too much to learn in too short a time, and I think digital dissections could be a huge advantage in terms of letting students learn the same concepts in less time. Perhaps medical schools could have two anatomy streams – digital dissections for students who know they’re going a non-surgical route and real dissections for students with a surgical interest? My medical school offered an extended rotation (2 or 4 weeks, I think) during clerkship for students with an interest in surgery, so I think there can be ways of getting in-depth, cadaver-based anatomy teaching to the students who will benefit from it.

    Comment by Solitary Diner | 24 September, 2017 | Reply

  2. I couldn’t agree with you more! I am so grateful to have gotten the exposure to cadavers in our Anatomy lab. Words cannot express my amazement and appreciation of the human body. Anatomy labs have complemented my learning in so many ways and have solidified concepts in my mind in a way that nothing else could. To top it off, we had a beautiful commemoration ceremony to honour our “silent teachers” and meet their families. Thank you for your post!

    Comment by Potential Doctor | 23 September, 2017 | Reply

  3. It grieves me that so many students are missing out on the dissection experience. Not only was it educational, it was transformative.

    Comment by Victo Dolore | 23 September, 2017 | Reply

    • The push for cheaper, faster delivery of curriculum coupled with our “educational design experts” who have never studied or taught our disciple plus the enchantment with technology drives this. I have new residents who do not understand three-dimensional anatomy because of lack of exposure. In a surgeon, this can be problematic and increases the need for one-on-one instruction by faculty surgeons.

      Comment by drnjbmd | 23 September, 2017 | Reply

      • There is much about medical education that is lacking across the board. Many new physicians that I interact with are sorely lacking. I do not believe the new educational models are turning out stronger physicians.

        Comment by Victo Dolore | 23 September, 2017


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