A Cut Above- A reduction in the number of cadavers and instructors actually improves the teaching of medical gross anatomy

By Michael Dauzvardis

Time: midnight
September, 2011
Place: gross anatomy lab
Music playing softly in the background: Your Body is a Wonderland, by John Mayer

“I’ve been at it for 4 hours and still can’t find the greater occipital nerve!” barks Joe, a first year medical student meticulously dissecting the posterior neck region on his cadaver— which he has nick-named Marvin.

Emily, one of Joe’s four dissection partners, quips “Perhaps that’s what killed Marvin—the congenital lack of a left greater occipital nerve!” 

“Hilarious, “Joe retorts “Remind me to laugh.”

At that instant, Joe, in a moment of frustration, slips and forcibly plunges his scalpel into the neck musculature– striking bone.

Emily cautiously points, smiles, and adds “Oh—I didn’t know the greater occipital nerve was hollow.”

Joe, with his overzealous dissection technique, had managed to cut through both the greater occipital nerve and occipital artery.

“You’ll make a fine psychiatrist” taunts Emily.

Joe sets down his scalpel, rips off his gloves, and sulks out of the lab…

This type of scenario has been repeated hundreds of times in medical school anatomy labs across the country.  A medical student will spend an inordinate amount of time locating one anatomical structure, only to realize that he has not learned the names or function of the other twenty that he needs to master by the next day’s exam.  In addition, a skilled dissector may expose several delicate structures only to have a less dexterous lab partner come in and destroy ten hours of work.

This widely employed model, in which every student dissects on one of as many as 40 cadavers, has been undergoing a metamorphosis at many medical schools. In this old dissection based model, the class is divided into groups of 4 students with each group assigned to their own cadaver. The anatomy course may be as long as a year with nearly 20 faculty participating.  One or more faculty are assigned to each cadaver group of 4 students. Why is this historical approach changing? At least four reasons are important:

  1. Classically trained anatomists are a dying breed and are not being replaced. Here, at Loyola our faculty participating in anatomy has dropped from twelve to four.
  2. In many areas of the country cadaver donations are down making availability scarce.
  3. Other courses such as pathology, physiology, immunology, introduction to clinical medicine and genetics have expanded at anatomy’s expense and limiting available time for dissection.
  4. The real estate dedicated to pure gross anatomy lab space has declined at many medical schools.

How are we addressing these challenges?  We have compressed our gross course into ten weeks and reduced our cadaver count to six. The faculty dissect (prosect) all cadavers but 2.  Our class of 156 students is divided into 12 groups of 13 students each. Each of our 4 faculty is assigned to 1 prosected cadaver. Each faculty member then spends 40 minutes with each of 3 groups of 13 students (have you dusted off your slide rule yet?) In this manner, all 156 students (12 groups of 13) have spent 40 minutes with 1 faculty member and his assigned cadaver. Each successive day, each group of 13 rotates to a new faculty member and cadaver. Using this model. A faculty member can point to and discuss some 20 pre-dissected structures to 13 students in 40 minutes—and in In 2 hours—39 students. In this manner the entire class has been exposed to the 20 structures in the 2 hour lab slot.  The same 20 structures would have taken a group of 4 students 8+ hours to find on their own using the old model. Two undissected cadavers are also provided for the antisocial future surgeons that want to dissect on their own—but typically by the third week of class no one continues to show interest.

In addition, the use of modern technology has really helped to grease the anatomical wheel when using this new approach. Sixty inch monitors and digital cameras have been installed at each cadaver station to insure clear viewing by all students. Plastinated specimens are provided and all lab practicals are based on high quality digital images. All lectures and labs are video-taped.

To summarize, this model has worked well, students love it, and board scores have held or improved.

“Joe, would you like to show the other 11 students the key structures in the neck?” asks the anatomy instructor as he adjusts the overhead camera so it displays the neck of the prosected cadaver on the large monitor.

“Why certainly” Joe eagerly answers “Here is the splenius capitis muscle, the rectus capitis muscle, the spinous process of C2, the occipital artery,  and— the elusive greater occipital nerve……”

Emily nods approvingly and adds “You know he was in my undergrad biology class at Notre Dame.”

dauzvardis-b
Michael Dauzvardis, PhD
, is Assistant Professor of Medical Education at the Loyola University Chicago Stritch School of Medicine. He holds a doctorate in anatomy and has been recognized by the Stritch students with numerous teaching awards.

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