To see or to view: A dilemma in anatomy teaching

In science fiction writer Isaac Asimov’s book, The Naked Sun, the few thousand inhabitants living on an Earth-sized planet never “see” each other. Living alone on huge territories cultivated by millions of robots they detest and abhor physical closeness to other humans. Their only comfortable way of socializing is by “viewing” each other using holograms and other visual techniques. This science fiction scenario came to my mind as I was reading about a current trend in medical schools to give up on cadaver dissecting (seeing) and use various electronic and related viewing techniques (viewing) to teach anatomy. 

Looking back in ancient history, generations upon generations of medical professionals only “viewed” or merely touched the human body. Then some 500 years ago Andreas Vesalius and other anatomists introduced dissecting, “seeing” and touching the insides of human bodies. The early anatomists’ work led to one of the greatest leaps in Western medical science and practices. 

In 1951, in my first year of medical school, I spent a lot of time in the dissecting room. I had to hold onto myself for a few moments when I first removed the face covering of the body assigned to my group of four fellow students. I also found dissection of the formaldehyde-saturated cadaver very frustrating. Even with the illustrated pages of the dissection manual next to the cadaver we often had trouble finding blood vessels, ureters, even some of the smaller organs. All the same, we felt extremely privileged to have such intimate contact with a dead human being who at some time in his or her life must have felt happiness, sadness, humor, and pain. Significantly, I also felt from that point that I was really on my way to become a doctor. 

For many years there have been illustrated anatomy texts, classroom instructions with diagrams, and various dissection manuals with minute anatomical details to help students learn the complexities of human anatomy. In the last few years a number of other ingenious methods have been developed, some using computerized digital illustrations, which permit three-dimensional viewing of various parts of the body. Without question, some of these teaching tools, including the ones using thousands of thin slices of a human body, are quite exceptional in their concepts and also may be cheaper in the long run than obtaining and maintaining cadavers. However, they are only viewing tools, distancing the student from what is real. I think that exploring and identifying the inside of the human body by dissection provides teaching moments that stimulate the students’ admiration and curiosity about the structure and functions of a living person. In addition, early hands-on anatomy experience in the curriculum may well be a fundamental but perhaps unrecognized feature of medical education. Students’ dissection experience may be essential to understanding the reality and seriousness of walking the strenuous path to become doctors and it may also help create the bond between and among physicians and medical scientists that is so essential to the complex practice of medicine.
—George Szasz, CM, MD

Suggested reading
McLachlan JC, Bligh J, Bradley P, Searle J. Teaching anatomy without cadavers. Med Educ 2004;38:418-424.

Papa V, Vaccarezza M. Teaching anatomy in the XXI century: New aspects and pitfalls. The Scientific World Journal Volume 2013, Article ID: 310348.

Saltarelli AJ, Roseth CJ, Saltarelli WA. Human cadavers vs multimedia simulation: A study of student learning in anatomy. Anat Sci Educ 2014;7:331-339.

This post has not been peer reviewed by the BCMJ Editorial Board.

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