Is Cadaver Dissection Still Necessary in Surgical Education?

Introduction

Cadaver dissection has been the traditional method for teaching and learning anatomy in medical education since the 3rd century. By the 18th century, cadaver-based teaching had become a core component of medical education.¹ However, the COVID-19 pandemic, technological advancements providing alternative models for learning anatomy, as well as progressively increasing basic, social, and clinical scientific knowledge vying for space in medical education curriculum raise an important question: What are the advantages and disadvantages of using cadavers to teach anatomy in modern medical education?

Disadvantages

In the 1980s, medical school curricular reforms led to a reduction in didactic and laboratory-based methods focused on problem-based learning and clinical reasoning pedagogy.¹ Anatomy education was greatly reduced for several reasons. Cadaver acquisition and preservation were (and remain) expensive, and prolonged exposures to standard aliphatic preservation agents can lead to health risks.² Furthermore, traditional cadaveric dissection requires an extensive amount of time and skill acquisition to finish, competing against the growing foundation of medical knowledge that must also be learned. In addition, Liaison Committee on Medical Education (LCME) guidelines recommended limiting the number of hours of scheduled synchronous coursework. This provided additional challenges for course directors and forced curriculum committees to make hard choices. As a result, anatomy education became significantly truncated, and in many programs, cadaver-based laboratory methods were reduced to prosection-based exploration or eliminated altogether.¹ Finally, cadaver-based teaching was very difficult to continue during the COVID-19 pandemic due to the need to limit synchronous in-person sessions to small groups.^3-5

Advantages

Despite the disadvantages described above, medical students, residents, and educators have collectively shown favorable attitudes to learning anatomy and surgical skills by cadaver dissection compared to alternative modalities alone.^{2, 7-9} In one study, two classes of medical students’ anatomy education were compared before and after the start of the pandemic. The pre-COVID class attended regular cadaver anatomy laboratory sessions that included elements of dissection and expressed higher confidence in their knowledge, technical skills, and clinical skills compared to the class of medical students who attended a virtual anatomy lab.⁷ Both groups demonstrated favorable attitudes towards having cadaver dissection as part of their curriculum and the second group notably demonstrated a higher rate of disengagement during their virtual anatomy learning experience. This may be due, at least in part, to challenges with developing spatial knowledge and a lack of hands-on experience with virtual labs alone.

Implementing cadaveric dissection curricula in surgical residencies has also shown improved trainee confidence, anatomical knowledge, and surgical skills by both trainees and faculty, leading to greater autonomy in the operating room.^8,9 These findings indicate that cadaver dissection remains a valuable component of anatomical and surgical education.

A Way Forward?

Other than the traditional cadaver dissection labs, there are currently numerous alternative and more affordable modalities for anatomy education. These include traditional textbooks/atlases, 3D models, digital media, social media, interactive software and simulators, augmented or video reality,^1-4 and, even, body painting.10 However, with so many options, it may feel overwhelming and challenging to gauge which modality is best for a given program’s pedagogical goals.

Each of these modalities are comparable to each other and cadaver-based dissection. A meta-analysis by Wilson and colleagues (2018) demonstrated that there were no significant differences in student’s test scores when traditional cadaver dissection was the primary learning method compared to alternative approaches such as 3D models, prosection, digital media, or hybrid approaches.⁵ Another study suggests that prior anatomical knowledge had a stronger influence on short-term retention of information than the type of learning modality utilized.⁶ Therefore, a multimodal approach that includes cadaver dissection may be most cost effective for institutions and efficacious for learners.^2,5 This approach should include cadaver labs that are also supplemented with textbooks, multimedia learning modules, and video-based training.^8,9,11 Adopting a vertical integration model where anatomy modules are revisited at different points in the medical school curricula (during the pre-clinical and clinical years) as well as regular postgraduate integration (for example, invasive procedure laboratory sessions) provides repetitive exposure to level-appropriate anatomy education and may also help to reinforce learning.

Summary

In conclusion, while whole cadaver dissection may never return as the primary modality for surgical education, cadaver dissection remains an essential component of surgical education for learners at all levels. The future of surgical anatomy education lies with vertical and longitudinal integration that aligns anatomical concepts with clinical content as the learners’ experience and context expand. A multimodal approach with a stepwise progression of selective and procedure-based anatomical dissection will likely prove more beneficial both pedagogically and economically. Additional work will include the use of fresh cadaver dissection or more life-like cadaver preservation techniques for teaching multi-step invasive surgical procedures such as placing chest tubes, performing cricothyrotomies, taking biopsies, or performing larger operative procedures. Surgical educators must continue to strongly advocate for anatomy education and champion innovative methods to integrate anatomy education well beyond the pre-clinical medical school years.