|Year : 2019 | Volume
| Issue : 4 | Page : 365-369
Cadaveric dissection and changing perceptions in learning anatomy
Manah Changmai1, Kastury Gohain2
1 Department of Anatomy, International Medical School, Management and Science University, Shah Alam, Selangor, Malaysia
2 Department of Statistics, Faculty of Business and Professional Studies, Management and Science University, Shah Alam, Selangor, Malaysia
|Date of Submission||04-Jul-2018|
|Date of Decision||28-Oct-2019|
|Date of Acceptance||20-Nov-2019|
|Date of Web Publication||16-Jul-2020|
Dr. Manah Changmai
Brunsfield Riverview Apartment, 0403, Jalan Yoga 13/42, Section 13, Shah alam 40100, Selangor
Source of Support: None, Conflict of Interest: None
Background: An insight of human anatomy is achieved by imparting knowledge through different models and cadavers. Students experience the reality of the human body through dissection. The present study is conducted to know the perception and importance of cadaveric dissection among students in learning anatomy. Methodology: A total of 115 students participated in this study. A closed-structured questionnaire was used to collect the data from the 1st year Bachelor of Medicine and Bachelor of Surgery students in the International Medical School, Management and Science University, Shah Alam, Malaysia. A descriptive analysis was performed to determine the mean, frequency, and variance. The percentages of the calculated variable were measured by ANOVA, and the significance level is compared with Fisher's test. The analysis of the collected data was performed using SPSS version 23 with a statistical significance of P < 0.05. Results: The results indicated no gender difference in opinions concerning dissection between majority of students. However, there is a belief among students that demonstrations of specimen are equally important as performing dissection. Conclusion: The breakthrough in technology in teaching–learning methodology in medicine diversified the student's perception in learning anatomy. The final result demonstrated conflicting opinion between students agreeing dissection as the only catalyst to learn anatomy.
Keywords: Anatomy, cadavers, dissection, knowledge, student's perception
|How to cite this article:|
Changmai M, Gohain K. Cadaveric dissection and changing perceptions in learning anatomy. J Datta Meghe Inst Med Sci Univ 2019;14:365-9
| Introduction|| |
The knowledge of anatomy is very essential for medical students practicing medicine. The perception of human anatomy is achieved by imparting knowledge through different models and cadavers. The dissection is one of the important methods in learning anatomy. For centuries, dissection was the main teaching model in learning anatomy. Students experience the reality of the human body through dissection. It gives them an opportunity to understand the surface anatomy of various structures, realizing the texture of the tissues and organs, and to verify that the variation of normal is very frequent. The dissection also serves to help the student to face agony and death in the future. Cadaveric dissection provides student the concept of anatomy from many aspects. There are studies which reflect dissection to be time-consuming and unhealthy. However, there is diversity on the views and approaches among the students. There are reports showing students having physical and emotional effects after exposure to cadaveric dissection. Cadaveric dissection stimulates the motivation to learn anatomy. However, there are differences in opinion between genders reflecting comprehensive command in anatomy between them. The diversification between genders on cadaveric dissection is obvious to acquire knowledge in anatomy. The enlightenment of learning anatomy differs in accordance with the cultural atmosphere of a medical student.,, There is a gender impact on cultural approach in learning anatomy indicated by past studies., Today, the number of cadavers for dissection in medical schools has decreased. Different methods such as anatomical models or natural specimen from autopsies or amputated limbs were used to teach anatomy. However, still, the students and the clinicians prefer dissection to identify the structure and to practice surgery. The present study was conducted to illuminate the student experience and perception on cadaveric dissection. It has reflected notable differences between genders in learning approach to get command in anatomy.
| Methodology|| |
The population groups for the study are students of Bachelor of Medicine and Bachelor of Surgery in Malaysia. A total of 115 students contributed in the study. The aim of the study is to find the student experience and perception on cadaveric dissection. A closed-ended questionnaire was used to collect data from 1st year preclinical medical students of the International Medical School, Management and Science University. The questionnaires were distributed to students before their professional I examination. All the students were explained about the purpose of the study.
In the present study, mean, frequency, and variance were determined by a descriptive analysis. The percentages of the variables calculated were measured by ANOVA, and significance level is compared with Fisher's test. The calculated data should have a statistical significance of P < 0.05. The statistical analysis of the collected data was performed using IBM, Statistical Package for the Social Sciences (SPSS) 22.214.171.124 software.
Ethical clearance was obtained from the Institutional Ethical Committee of Management and Science University, Shah Alam, Selangor, Malaysia on 11th March 2018. With ethical clearance no MASU/Eth/2018-19/4
| Results|| |
The present study evaluated the 1st-year medical students (n = 115) on experience and perception on the dissection of cadavers. In between them, 29 were male (25.2%) and 86 were female (77.4%). The students are from the International Medical School under Management and Science University in Shah Alam, Malaysia. On an average, most of the students are in between the age of 22–25 years (98%). The analyses confirmed that majority of the students are the Malay (66%), followed by the Indians (25%). The Chinese are the least numbered (3.5%).
Many students are apprehensive in the dissection hall in the beginning of their session. The results showed that equal percentage of male (23%) and female (23%) students never had a pleasant feeling during practical session in dissection hall. However, the remaining 77% of both genders are astonished and amazed on seeing a cadaver. However, there are no significant differences in opinion between the two groups (P > 0.967). The students are always in anxiety and stress when it comes to entering the dissection hall. However, for them, the extensive causes of stress are overload of study, examination, and time constraints. For that very few students participate in cadaveric dissection during the practical. In this study, 19.2% of male students and 38.2% revealed that they are stressful in the practical which is reflected in the result. The findings of test highlighted no significant variance among genders in this statement (P > 0.073). The recurrent flashbacks of dissection hall are very common among students after their practical in dissection hall. It is seen that more female students (33%) confessed that they do have a flashback after the practical compared to only 23% in male students. There is no significant contrast between groups revealed by the test (P > 0.308). Many students want to avoid practical in dissection hall because of the aroma of formalin. The smell of formalin in cadaver while performing dissection is exceptionally agonizing. More than half of the male students (57.6%) and 47.1% of female students supported this fact as shown by the finding. However, there was no significance between students on this statement (P > 0.350). The command of osteology is necessary while performing cadaveric dissection. This gives a student a better understanding of the dissected part. This is reflected from the results showing majority of the male (73%) and female (89%) students agreeing in this reality. However, the test result shows that outstanding difference revealing anatomy of the dissected part is better understood without bone also (P < 0.04). The outcome of the analysis reported that almost equal percentage of both the genders (male 19%; female 20%) feels scared and nervous while handling the cadaver during practical. There is no remarkable significant difference between students as reported by test results (P > 0.9). The accumulated data also confirmed that majority of students (male 84.6%; female 94%) supported the fact of being a critical thinker with the concept and command on anatomy by dissection study. The test results showed no differences in opinion on this statement (P = 0.105). The dissection is ethically accepted by a high percentage of female students (95.5%), whereas 84% of male students agreed to it. The result concludes no significant variance among students (P > 0.06). The findings also demonstrated that 92.3% of male and 87.6% of female students believe in respecting the cadaver while performing dissection. The analysis of the test revealed no breach in opinion in this context (P > 0.868).
Sometimes, it is arduous to apprehend the concept of anatomy in the practical. Regarding this, both the genders (male 88.5%; female 87.6%) equally feel that they can improve the concept by dissection in the company of a distinguished instructor. In this regard, no significant difference is seen between students (P > 0.911). Most of the female students (97.7%) compared to males (88.4%) consider dissection to be an important part in medical degree for anatomy knowledge. However, there are notable differences between genders accepting dissection in medical degree for comprehension of anatomy knowledge (P < 0.04). The results showed that favorable percentage of male students (88.4%) have an emotional impact when they see a dead body in the dissection hall compared to only 74% of female students confessing the truth. The conclusion from the test revealed no differences among genders (P > 0.1). However, both the genders (male 58%; female 64%) also revealed that an interaction with anatomy staff in the dissection hall decreases their emotional impact. However, the test indicates no remarkable differences in opinion (P > 0.560). Majority of the students (male 85%; female 97%) accept that dissection provides better results than demonstration in learning anatomy. However, there are valid differences in the findings of the test showing that demonstration of the specimen is also valuable than dissection (P < 0.02). A higher percentage of female students (84%) think that enlightenment of gross anatomy can only achieve by cadaveric specimen through dissection. However, only 77% of male students stand along with them. It cannot be replaced by plastic model, three-dimensional (3D) images, and computer-assisted training, whereas the report of the test concludes no differences in opinion (P > 0.389).
| Discussion|| |
On getting admitted to a medical course, the newly joined students were very excited in entering into a dissection hall for learning anatomy. Their idiosyncrasies toward dissection and exposure to cadavers increase. After confronting the cadavers for the first time, their perception toward dissection gets customized. The present study was conducted among year I medical students of the International Medical School, Management and Science University, Malaysia. The results have demonstrated differences in opinion regarding dissection between the students. Today, dissimilarity in views between genders is confronted in medical schools due to different approaches adopted to learn anatomy. The percentage of female students in this study is 77% compared to only 23% of male students.
The results [Table 1] and [Figure 1] in this study reflect that majority of the male and female students have a pleasant feeling during the practical in the dissection. A high percentage of female students confessed that they are stressful and also have recurrent flashback after practical in the dissection hall. A study also reported a connection between gender and dissection hall practical with cadavers. The information of gross anatomy obtained during cadaveric dissection is indispensable for clinical practice. There are illustrations of female students undergoing more stress and anxiety during practical involving cadaveric dissection., An average percentage of male and female students skips practical in the dissection due to the smell of formalin. They reported it to be extremely agonizing. A similar finding in a study showed 45% of students ignoring dissection for the foul smell of formaldehyde. The results illustrated a high percentage of females (94%) accepting the importance of knowledge of bone during cadaveric dissection. However, the test results conclude valid differences of opinion among groups in this context. There is a suggestion that new techniques and innovative approaches focusing clinical anatomy enhance comprehension in anatomy., In the present study, almost similar percentage (male 88.5%; female 87.6%) commented that cadaveric dissection boosts notion in anatomy. A similar percentage of students (male 19%; female 20%) are anxious while handling the cadaver during practical. It is also seen that majority of the students (male 84.6%; female 94.3%) predominantly supported the fact of being a critical thinker with the concept and command on anatomy by dissection study (P > 0.105). There is a belief that skills in cadaveric dissection enhance the knowledge of anatomy in students and assemble them for undergraduate courses and future medical practice. The dissection is ethically accepted by a high percentage of female students (95.5%), whereas 84% of male students agreed to it (P > 0.06). The handling of human cadavers for illustration of anatomy instruction is encircled by a plenty of ethical controversies., Cadaveric dissection is a long-standing tool in anatomy teaching under medical. The findings also demonstrated that 92.3% of male and 87.6% of female students believe in respecting the cadaver while performing dissection (P > 0.868). There are comments that main ethical concern for anatomy dissection is respect to human life. Both the genders (male 88.5%; female 87.6%) equally feel that they can improve the concept by dissection in the company of a distinguished instructor (P > 0.911). The studies showed that teaching faculties are the role models who show the direction, thereby helping the students by laying a foundation stone to their clinical training. A higher percentage of female students (97.7%) consider dissection to be an important tool in medical degree for anatomy knowledge. However, the outcome of the test result showed that this as insignificant as dissection is not always the way to understand anatomy. There are evidence that blended e-learning if combine with verbal, visual, and auditory stimulation improves long-term retention of information on anatomy knowledge.
|Table 1: A comparison of positive responses between genders toward dissection to learn anatomy|
Click here to view
A favorable percentage of female students (98%) believe that a good concept of anatomy can only be achieved by cadaveric dissection. There are reports that cadaveric dissection is the main tool in learning anatomy for many years. It is the prime driver to obtain skills for surgical career for medical students. The practical in the dissection hall provides a wide range of prospect in illumination of anatomy., About 88.4% of male students confessed to have an emotional impact when they see a dead body in the dissection hall compared to only 74% of female students accepting the truth. The students also (male 58%; female 64%) believed that an interaction with anatomy staff in the dissection hall decreases their emotional impact. The dissection is the preferred way for learning anatomy. It is the most important motivating tool to achieve command in anatomy.
The female students are more focused in dissection (male 85%; female 97%) to apprehend command in anatomy rather than only concentrating on demonstration of cadaveric specimen. However, the test results showed that demonstration of cadaveric specimen is also significant than dissection (P < 0.02). The other innovative methods of learning should combine with dissection to understand anatomy. Hence, for example, comprehension in radiological anatomy can be enhancing if the dissection is combined with 3D scanning of the cadaver. Both the genders (84% female; male 77%) believe that good understanding of gross anatomy can only be achieved by cadaveric specimen. It cannot be replaced by plastic model, 3D images, and computer-assisted training (P > 0.38). There are reports revealing contradictory finding in different studies showing only a small percentage of female students (36%) accepting dissection that cannot be replaced by plastic models, 3D images, and computer-based program. The identification and concept on anatomical structure is achieved better by cadaveric specimen rather than plastic and plastinated models. The overall accumulated result exhibits variance and changing perception between students in enlightenment of knowledge in anatomy rather than accepting dissection to be the motivating tool.
| Conclusion|| |
Today, with the advent of new innovative technology in learning anatomy, the role of cadaveric dissection for medical teaching has become an argument. The results of this study proposed a shift in student's perception on dissection agreeing on other additional methods of teaching in learning anatomy. Many universities use 3D models and plastinated specimen to teach anatomy. Along with the current practice of team-based learning and case studies, an element of gamification should be incorporated for persuading knowledge in anatomy., The student's perplexity and stress should be communicated during the practical. An emotional approach of an anatomy lecturer can encourage someone who is dependable to become independent. In future, it will stimulate them to develop a good doctor–patient relationship. The findings of the study reflected the role of cadaveric dissection in medical teaching to become a doctor. It has reported different dissection room experiences faced by the students. Their experiences will definitely measure the formation of relations with their patients in clinical years that will have direct melancholy in the general population.
The authors appreciate and convey gratitude to all the participants involved in this study.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Meester LD. Learning anatomy for use beyond the classroom: A guide for medical students. McMaster Univer Med J 2011;8:45-8.
Richardson R. Death, Dissection and the Destitute. London: Penguin; 2013.
Antonio B. The importance of anatomy and dissection in the human corpse. Open Acc Res Anatomy 2017;1:OARA.000506.
Winkelmann A. Anatomical dissection as a teaching method in medical school: A review of the evidence. Med Educ 2007;41:15-22.
Lufler RS, Zumwalt AC, Romney CA, Hoagland TM. Incorporating radiology into medical gross anatomy: Does the use of cadaver CT scans improve students' academic performance in anatomy? Anat Sci Educ 2010;3:56-63.
Bharadwaja A, Aman M. Cadaveric dissection – Its importance and students response: A questionnaire study. Int J Sci Stud 2017;5:252-5.
Plaisant O, Stephens S, Apaydin N, Courtois R, Lignier B, Loukas M, et al
. Medical students' attitudes towards science and gross anatomy, and the relationship to personality. J Anat 2014;224:261-9.9.
Mitchell BS, Xu Q, Jin L, Patten D, Gouldsborough I. A cross-cultural comparison of anatomy learning: Learning styles and strategies. Anat Sci Educ 2009;2:49-60.
Mustafa AG, Allouh MZ, Mustafa IG, Hoja IM. Anatomy learning styles and strategies among Jordanian and Malaysian medical students: The impact of culture on learning anatomy. Surg Radiol Anat 2013;35:435-41.
Zurada A, Gielecki JS, Osman N, Tubbs RS, Loukas M, Zurada-Zielińska A, et al
. The study techniques of Asian, American, and European medical students during gross anatomy and neuroanatomy courses in Poland. Surg Radiol Anat 2011;33:161-9.
Kerby J, Shukur ZN, Shalhoub J. The relationships between learning outcomes and methods of teaching anatomy as perceived by medical students. Clin Anat 2011;24:489-97.
Sándor I, Birkás E, Győrffy Z. The effects of dissection-room experiences and related coping strategies among Hungarian medical students. BMC Med Educ 2015;15:73.
Bleakley A. Gender matters in medical education. Med Educ 2013;47:59-70.
Atlasi MA, Moravveji A, Nikzad H, Mehrabadi V, Naderian H. Learning styles and strategies preferences of Iranian medical students in gross anatomy courses and their correlations with gender. Anat Cell Biol 2017;50:255-60.
Prakash, Prabhu LV, Rai R, D'Costa S, Jiji PJ, Singh G. Cadavers as teachers in medical education: Knowledge is the ultimate gift of body donors. Singapore Med J 2007;48:186-9.
Granger NA, Calleson D. The impact of alternating dissection on student performance in a medical anatomy course: Are dissection videos an effective substitute for actual dissection? Clin Anat 2007;20:315-21.
Naz S, Nazir G, Iram S, Mohammad M, Umair, Qari IH, et al
. Perceptions of cadaveric dissection in anatomy teaching. J Ayub Med Coll Abbottabad 2011;23:145-8.
Older J. Anatomy: A must for teaching the next generation. Surgeon 2004;2:79-90.
Rowland S, Ahmed K, Davies DC, Ashrafian H, Patel V, Darzi A, et al
. Assessment of anatomical knowledge for clinical practice: Perceptions of clinicians and students. Surg Radiol Anat 2011;33:263-9.
Pais D, Casal D, Mascarenhas-Lemos L, Barata P, Moxham BJ, Goyri-O'Neill J. Outcomes and satisfaction of two optional cadaveric dissection courses: A 3-year prospective study. Anat Sci Educ 2017;10:127-36.
Thidar AM, Myint TT, Naing DK, Mustapha ZA. Preferred modalities for learning anatomy: Medical students' opinion. Borneo J Med Sci 2016;10:1-13.
Nuzhat A, Salem RO, Al Hamdan N, Ashour N. Gender differences in learning styles and academic performance of medical students in Saudi Arabia. Med Teach 2013;35 Suppl 1:S78-82.
Pawlina W, Hammer RR, Strauss JD, Heath SG, Zhao KD, Sahota S, et al
. The hand that gives the rose. Mayo Clin Proc 2011;86:139-44.
Persaud TV. Early History of Human Anatomy: From Antiquity to the Beginning of the Modern Era. Springfield, IL: Thomas; 1984.
Shaikh ST. Cadaver dissection in anatomy: The ethical aspect. Anat Physiol S 2015;5:7.
Bertman SL, Marks Jr SC. The dissection experience as a laboratory for self-discovery about death and dying: Another side of clinical anatomy. Clinical Anatomy: The Official Journal of the American Association of Clinical Anatomists and the British Association of Clinical Anatomists. 1989;2:103-13.
Ngana OM, Tang TL, Chan AK, Chen DM, Tang MK. Blended learning in anatomy teaching for non-medical students: An innovative approach to the health professions education. Health Professions Educ 2018;4:149-58.
Estai M, Bunt S. Best teaching practices in anatomy education: A critical review. Ann Anat 2016;208:151-7.
Rajeh NA, Badroun LE, Alqarni AK, Alzhrani BA, Alallah BS, Almghrabi SA, et al
. Cadaver dissection: A positive experience among Saudi female medical students. J Taibah Univ Med Sci 2017;12:268-72.
Azer SA, Eizenberg N. Do we need dissection in an integrated problem-based learning medical course? Perceptions of first- and second-year students. Surg Radiol Anat 2007;29:173-80.
Ghosh SK. Cadaveric dissection as an educational tool for anatomical sciences in the 21st
century. Anat Sci Educ 2017;10:286-99.
Murakami T, Tajika Y, Ueno H, Awata S, Hirasawa S, Sugimoto M, et al
. An integrated teaching method of gross anatomy and computed tomography radiology. Anat Sci Educ 2014;7:438-49.
Sugand K, Abrahams P, Khurana A. The anatomy of anatomy: A review for its modernization. Anat Sci Educ 2010;3:83-93.
Allen RE, Copeland J, Franks AS, Karimi R, McCollum M, Riese DJ 2nd
, et al
. Team-based learning in US colleges and schools of pharmacy. Am J Pharm Educ 2013;77:115.
Aburahma MH, Mohamed HM. Educational games as a teaching tool in pharmacy curriculum. Am J Pharm Educ 2015;79:59.