In defence of human anatomy--a commentary

Anatomy: An Opportunity for South African Health Science Students to Discuss Their Emotional Responses to Human Remains in the Laboratory

Human dissection remains a cornerstone of the anatomy learning experience. However, the emotional response of students to the use of human remains for learning is influenced by a number of factors and is not always positive. Therefore, this study explored the students’ emotional response to and factors affecting their perceptions of the use of human remains for learning anatomy in a South African context. Four hundred and eighty of the 1538 health sciences students enrolled in human anatomy courses at the University of the Witwatersrand, South Africa during 2016 and 2017, completed a voluntary survey. The survey included closed and open-ended questions on students’ emotional responses, coping mechanisms and the factors that affected their perceptions of the use of human remains and dissection. Overall, the students had a positive emotional response. Their perceptions of dissection were affected in positive and negative ways by their religious and cultural beliefs. Feelings of gratitude and respect toward the cadaver were informed by belief systems. However, anxiety was caused by the delay of accepted sociocultural burial practices. Peer discussions were the preferred coping method, which may provide an approach for students to discuss how their beliefs influence their dissection experience.

Digital and Social Media in Anatomy Education

The use of images in various forms (drawing, photography, digital applications) has always been intrinsically associated with anatomy; however, the way in which anatomy educators and students create, access, view and interact with images has changed dramatically over the last 20 years. The method that anatomy educators use to engage with students and the wider public and how students engage with each other and faculty has also changed since the turn of the century, largely due to the emergence of social media. These two facets, the move towards digital images and the use of social media, are now intricately interlinked because social media enable anatomy educators to share digital learning resources easily and instantly to a global audience. This new trend of using social media to share digital images has created some ethical dilemmas that anatomy educators are researching and seeking guidance on to ensure that they are representing the potential conflicting needs and/or requirements of different stakeholders, including donors, donor families, students, the public, regulators and anatomy educators themselves. Meeting the various needs of stakeholders is complex; however, this chapter suggests an ethical approach for how digital images and social media can continue to be part of anatomy education.

A Good Death - Can the Concept Be Applied to Anatomy?

The importance of patient-centered decisions is embedded throughout clinical practice. The principle that the patient is at the center of all decisions has helped form the contemporary approach to death and dying. The concept of a "good death" will naturally mean different things to different individuals, but is based on the foundation of being pain free, comfortable, and able to make informed decisions. Potential donors are faced with many personal, ethical, and often spiritual considerations when they come to think about their wishes after death. One consideration is that of a "good death." This article explores how the concept of a "good death" may be applied to anatomy. Where first-person consent is in place, the motivating factors frequently include the wish for others to learn from the donation, and this notion may form part of the "good death" for the donor. Such motivations may impact positively on how students feel about dissecting and may provide comfort, assuaging feelings of discomfort, and allowing students to focus on anatomical learning. For donors where second-person consent is in place, the concept of a "good death" must depend on whether the individual wanted to donate their body in the first instance. The notion of a "bad death" may also be considered with body donation where no consent for donation is in place. This article proposes that there is ultimately a place for the concept that a "good death" may involve an individual donating their body to medical education.

Anatomy: spotlight on Africa

Anatomy departments across Africa were surveyed regarding the type of curriculum and method of delivery of their medical courses. While the response rate was low, African anatomy departments appear to be in line with the rest of the world in that many have introduced problem based learning, have hours that are within the range of western medical schools and appear to be well resourced. Human body dissection is a constant and strong aspect of the majority of the courses surveyed. The staff to student ratio appears to be relatively high in Africa, but in many of the responding African institutions, there appears to be little difficulty in attracting suitable faculty (including those who are medically qualified) to teach anatomy. Retaining this faculty, in some cases, may be difficult because of a global demand for anatomy educators.

Clinical neuroanatomy module 5 years’ experience at the School of Medicine of Padova

Macroscopic anatomy of the brain is scheduled during the last meeting of the Short Course of Dissection, an optional course for second-year medical students at the School of Medicine of Padova, following the official 44 h of lectures of Neuroanatomy. The aim of the present study was to ascertain the value of brain dissection in retention of neuroanatomical knowledge by medical students. An anatomical questionnaire was given to second-year students in the years 2002-2006, aiming at evaluating their initial neuroanatomical background. Administered twice, at the beginning and end of the last meeting of the optional course, the questionnaire consisted of three diagrams, showing the base, the convexity of the brain, and an axial section of the cerebrum. For each diagram, ten anatomical structures were selected, according to their clinical importance. Students then followed a worksheet for external examination of the brain and cutting. The teacher presented three examples of pathologies causing elevated intracranial pressure, and indicated their locations on the relative cerebral structures. At the end of the meeting, the same questionnaire was given again. To evaluate long-term retention of information, it was also given to third-year students. The questionnaire revealed improved knowledge of neuroanatomy in a mean of 57% of students, especially as regards the axial section (72%), with respect to that of the brain base (43%) and convexity (40%). After 1 year, long-term assessment of information retention showed that 65% of the group which had followed the dissection course correctly answered with respect to the control group (40%), and even better (87.5%) as regards anatomical details presented in their clinical aspects. The main guidelines in planning the clinical neuroanatomy module were: (1) selection of anatomical landmarks of importance from the clinical viewpoint; (2) identification of pathologies which involve the above anatomical landmarks; (3) relationships between morphology and pathology enhancing anatomo-clinical importance.

Going back to dissection in a medical curriculum: the paradigm of Necker-Enfants Malades

In 1999, we first reported on various methods of teaching anatomy subsequent to visits to a variety of medical schools in the United States and Europe. We compared the number of contact hours for lectures, dissection classes and tutorials and provided different models for the teaching of anatomy. With respect to the nine French medical schools surveyed, it is clear that the French model is characterized by being lecture-orientated (time in lectures > time in tutorials > time spent on dissection). For the American model (also in the UK and some other parts of Europe), the training is often characterized by being dissection-based (time spent on dissection > time in lectures > time in tutorials; 10 medical schools surveyed). Exceptionally, in one Australian school, time in tutorials exceeds time in lectures (dissection = 0). The differences between the French and American models relate to teaching aims-where dissection predominates, the aims are not just the learning of anatomical facts but include practical skill acquisition and experiential learning. In 2001, to help us change the methods of teaching of anatomy in our medical school at CHU Necker-Enfants Malades (Paris V, France), we asked other French medical schools (and some foreign schools) to suggest ways of organizing anatomy training within certain time constraints. In this paper, we present the answers received. The responses received were of two kinds: (1) those providing a description of the anatomy teaching in their own medical school; (2) those providing a system for organizing the teaching if we, in Paris, have 120 hours in total to teach gross anatomy (except neuroanatomy). In the latter case, a considerable variety of different, and innovative, alternative schemes were suggested that are described in this article.

The human cadaver in the age of biomedical informatics

Major national and international critiques of the medical curriculum in the 1980s noted the following significant flaws: (1) over-reliance on learning by rote memory, (2) insufficient exercise in analysis and synthesis/conceptualization, and (3) failure to connect the basic and clinical aspects of training. It was argued that the invention of computers and related imaging techniques called to question the traditional instruction based on the faculty-centered didactic lecture. In the ensuing reform, which adopted case-based, small group, problem-based learning, time allotted to anatomical instruction was severely truncated. Many programs replaced dissection with prosections and computer-based learning. We argue that cadaver dissection is still necessary for (1) establishing the primacy of the patient, (2) apprehension of the multidimensional body, (3) touch-mediated perception of the cadaver/patient, (4) anatomical variability, (5) learning the basic language of medicine, (6) competence in diagnostic imaging, (7) cadaver/patient-centered computer-assisted learning, (8) peer group learning, (9) training for the medical specialties. Cadaver-based anatomical education is a prerequisite of optimal training for the use of biomedical informatics. When connected to dissection, medical informatics can expedite and enhance preparation for a patient-based medical profession. Actual dissection is equally necessary for acquisition of scientific skills and for a communicative, moral, ethical, and humanistic approach to patient care. Anat Rec (New Anat) 269:20-32, 2002.

The role of three-dimensional information in health care and medical education: the implications for anatomy and dissection

The purposes of medical education can be summarized as learning how to take an effective history, perform a physical examination, and perform diagnostic and therapeutic procedures with minimal risk and maximal benefit to patients. Because patients are three-dimensional (3-D) objects, health care and medical education involve learning and applying 3-D information. The foundation begins in anatomy where students form and confirm or reform their own 3-D ideas and images of the development and structure of the human body at all levels of organization. Students go on to understand the interdependence of structure and function in health and disease. The basic questions for those teaching anatomy are "How do we learn and use 3-D information?" and "How is it taught most effectively?" These are not easy questions for teachers and are rarely asked by those who currently defend or reframe curricula. Unfortunately, there is little information on how we learn 3-D information and no evidence-based literature on the relative long-term vocational effectiveness of methods for teaching it. It is clear that we learn in several distinct modalities and that our students represent a spectrum of learning styles. To support the 3-D learning essential to both medical education and health care, anatomical societies need to provide answers to the following questions: Do the opportunities of dissection (visual, tactile, time, discovery, group process, mentoring) contribute to short- and long-term learning of 3-D information? If so, how? Does dissection offer significant advantages over other methods for learning, confirming, and using 3-D information in anatomy? Answers to these questions will provide a rational basis for decisions about curricular changes in anatomy courses (if, where, and when dissection should occur). This, in turn, will link these changes to society's ultimate purposes for medical education and health care rather than to the fiscal concerns of the businesses of health care and medical education, which is the current practice.

What is anatomy? Implications for anatomy as a discipline and for Clinical Anatomy as a journal

Anatomy as a discipline is explored against a background of the growth of scientific knowledge and developments within modern universities. The structural overtones of anatomic approaches provide intellectual cohesion for the approaches of complementary disciplines. When anatomy departments function in a transdisciplinary manner, they encompass a range of areas from molecular biology to functional anatomy and biological anthropology. Suggestions are made for a journal, such as Clinical Anatomy, to provide stimulus for the further development of anatomy as a coherent discipline.