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

Commentary: Is There a Lack of Insight on the Anatomy Teaching Adaptations Made by "Cadaver-Free" Medical Schools in Response to the COVID-19 Pandemic?

The COVID-19 pandemic negatively impacted anatomy education as it ceased face-to-face anatomy teaching sessions and laboratory practicals. In the past 2 years, a growing body of literature has been dedicated to the adaptations made in the teaching of anatomy predominantly by medical schools who employ cadaveric dissection and prosection-based practicals to teach anatomy. Despite this, there is dearth of evidence in terms of the challenges that medical schools who do not use cadaveric dissection or prosected specimens to teach anatomy faced as well as the adaptations they made in response to the pandemic.

The effects of enhanced formaldehyde clearance in a gross anatomy laboratory by floor plan redesign and dissection table adjustment

Formaldehyde has carcinogenic properties. It is associated with nasopharyngeal cancer and causes irritation of the eyes, nose, throat, and respiratory system. Formaldehyde exposure is a significant health concern for those participating in the gross anatomy laboratory, but no learning method can substitute cadaver dissection. We performed a formaldehyde level study in 2018, which found that most of the breathing zone (S-level) and environment (R-level) formaldehyde levels during laboratory sessions at the Faculty of Medicine Siriraj Hospital exceeded international ceiling standards. In the academic year 2019, we adapted the engineering rationale of the NIOSH hierarchy of controls to facilitate formaldehyde clearance by opening the dissection table covers and increasing the area per dissection table, then measured formaldehyde ceiling levels by formaldehyde detector tube with a gas-piston hand pump during (1) body wall, (2) upper limb, (3) head-neck, (4) thorax, (5) spinal cord removal, (6) lower limb, (7) abdomen, and (8) organs of special senses dissection sessions and comparing the results with the 2018 study. The perineum region data were excluded from analyses due to the laboratory closure in 2019 from the COVID-19 outbreak. There were statistically significant differences between the 2018 and 2019 S-levels (p < 0.001) and R-levels (p < 0.001). The mean S-level decreased by 64.18% from 1.34 ± 0.71 to 0.48 ± 0.26 ppm, and the mean R-level decreased by 70.18% from 0.57 ± 0.27 to 0.17 ± 0.09 ppm. The highest formaldehyde level in 2019 was the S-level in the body wall region (1.04 ± 0.3 ppm), followed by the S-level in the abdomen region (0.56 ± 0.08 ppm) and the spinal cord removal region (0.51 ± 0.29 ppm). All 2019 formaldehyde levels passed the OSHA 15-min STEL standard (2 ppm). The R-level in the special sense region (0.06 ± 0.02 ppm) passed the NIOSH 15-min ceiling limit (0.1 ppm). Three levels for 2019 were very close: the R-level in the head-neck region (0.11 ± 0.08 ppm), the abdomen region (0.11 ± 0.08), the body wall region (0.14 ± 0.12 ppm), and the S-level in the special sense region (0.12 ± 0.04 ppm). In summary, extensive analysis and removal of factors impeding formaldehyde clearance can improve the general ventilation system and achieve the OSHA 15-min STEL standard.

Human body donation and surgical training: a narrative review with global perspectives

Utilization of human material in surgical simulation training has been well-established as an effective teaching method. Despite the value of donor-based surgical simulation training, its application may be hampered by difficulties regarding access to donated bodies. Therefore, the aim of this review is to assess body donation and body acquisition practices with regard to surgical simulation training programs around the world. The results of this review highlight discrepancies regarding body donation practices and surgical simulation programs among continents and countries. The utilization of donor bodies in surgical simulation appears to mirror body donation practices. In countries that rely mostly or exclusively upon unclaimed bodies or executed criminals, there are scant reports of donor-based surgical simulation programs. In countries where willed-body donation is the principal source of human material, there tend to be many surgical simulation programs that incorporate human material as part of surgical training. This review suggests that, in anatomical and surgical education, the utilization of active willed-body donation programs, as opposed to the utilization of unclaimed human bodies, positively corresponds with the development of beneficial donor-based surgical simulation programs. Likewise, donor-based surgical simulation training programs may have an influence on the perpetualization of willed-body donations.

Creating an inexpensive yet effective downdraft table for a gross anatomy laboratory: Proof-of-concept

The expense of creating exhaust ventilation in a gross anatomy laboratory can be an impediment to gross anatomical education, especially in locations with little availability of funds (e.g., developing countries). Thus, the need for inexpensive yet effective exhaust ventilation is important for gross anatomical education. This study details the creation of a downdraft ventilation table that cost less than 200 USD to build, was built with commonly available materials (i.e., lumber, tarps, rebar, corrugated steel, staples, and screws), was built by one person with little difficulty in a matter of hours, was relatively light weight (75.2kg fully-assembled), and was easy to transport. Further, the table was structurally sound and handled a load of at least 331kg without damage. The table was affixed to a simple local exhaust ventilation system that cost ∼300 USD and generated an exhaust flow of 3099m³/h from the table. The table was capable of removing all airborne formaldehyde (0.00ppm) despite a pool of 100% formalin placed 20.3cm above the table. Furthermore, the height of the table could easily be adapted for handicapped accessibility and for individuals who are shorter or taller than average. The downdraft system also has applications beyond the gross anatomy laboratory (e.g., exhaust ventilation for embalming, manufacturing, and clinical/surgical aerosol-generating procedures). This report represents a proof-of-concept: a downdraft table that costs less than 200 USD can be built easily and paired effectively with an inexpensive local exhaust ventilation system at a total expense of approximately 500 USD. This report marks an improvement in gross anatomy laboratory safety and accessibility.

The Challenges of Teaching Anatomy and Physiology Laboratory Online in the Time of COVID-19

In early spring 2020, New York's K-12 schools, colleges, and universities went into lockdown in response to the COVID-19 pandemic, and faculty began converting face-to-face classes into distance learning classes. Teachers and college faculty learned to use new technology to continue instruction for the remainder of the academic year. Learning curves were steep for some, as using technology proved to be overwhelming. Students who registered for in-person classes had to learn in an online environment. Pre-Health Science majors who rely heavily on practical, hands-on courses to gain the necessary skills required for their career participated in virtual anatomy and physiology laboratories. Clearly, face-to-face courses are not always possible; therefore, it is imperative to know the best practices of online teaching and learning.

Local exhaust ventilation systems for the gross anatomy laboratory

The inability to exhaust airborne formaldehyde and other volatile organic compounds from a gross anatomy laboratory is an impediment to gross anatomical education. Despite the importance of removing harmful airborne chemicals, there is scant information regarding how to build effective local exhaust ventilation systems. In this study, various exhaust systems were built and assessed for exhaust flow, airborne formaldehyde removal, and noise production with the aim of identifying inexpensive and simple exhaust systems that can create a healthy and quiet exhaust flow from a downdraft dissection table. The results of the study include details regarding 11 local exhaust ventilation systems, including an exhaust system that produces an exhaust flow of 777cfm, allows no detectable airborne formaldehyde (0ppm) despite a 1000mL pool of formalin (composed of 37% formaldehyde) positioned directly beneath a formaldehyde-meter, and operates at a very low noise level (maximum of 69.2dBA with coexisting baseline room noise of 38.6dBA). Furthermore, the aforementioned local exhaust ventilation system costs less than $400 (USD) to build and can be assembled in a matter of minutes with minimal know-how. The local ventilation systems assessed in this study were capable of down-drafting air away from the breathing zone; therefore, the utilization of such local ventilation systems may have the additional benefit of decreasing the person-to-person transmission of aerosolized pathogens. This information marks an improvement in laboratory health and safety measures, facilitates the creation of gross anatomy laboratories, and improves access to gross anatomical education.