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. © 2002 Wiley‐Liss, Inc.

[1]  G R LEYMASTER,et al.  Medical Education in the United States and Canada , 1910, Nature.

[2]  E. Pellegrino.  Philosophy of Medicine: problematic and potential. , 1976, The Journal of medicine and philosophy.

[3]  W. Cottam,et al.  Adequacy of medical school gross anatomy education as perceived by certain postgraduate residency programs and anatomy course directors , 1999, Clinical anatomy.

[4]  I Whitmore,et al.  Terminologia Anatomica: New terminology for the new anatomist , 1999, The Anatomical record.

[5]  E. J. Evans,et al.  The dissecting room: Reactions of first year medical students , 1992 .

[6]  A R Feinstein,et al.  What kind of basic science for clinical medicine? , 1970, The New England journal of medicine.

[7]  V. Spitzer,et al.  The visible human dataset: The anatomical platform for human simulation , 1998, The Anatomical record.

[8]  D. Bryant.  The doctor and death. , 1986, Journal of the National Medical Association.

[9]  G. L. Engel.  Enduring attributes of medicine relevant for the education of the physician. , 1973, Annals of internal medicine.

[10]  F. N. L. Poynter,et al.  The Story of My Life , 1885, Atlanta Medical and Surgical Journal (1884).

[11]  A medical school curriculum for the 1980s. , 1983, The New England journal of medicine.

[12]  P. Amadio.  Reaffirming the importance of dissection , 1996, Clinical anatomy.

[13]  C. Rosse,et al.  The potential of computerized representations of anatomy in the training of health care providers , 1995, Academic medicine : journal of the Association of American Medical Colleges.

[14]  I. C. Roddie,et al.  THE EDINBURGH DECLARATION , 1988, The Lancet.

[15]  S. Bloch.  Instruction on death and dying for the medical student , 1976, Medical education.

[16]  P. Braunstein,et al.  AUGMENTED SPLENIC UPTAKE OF RADIOCOLLOID IN PATIENTS WITH MALIGNANT MELANOMA , 1974 .

[17]  R. Lockhart.  THE ART OF LEARNING ANATOMY. , 1927 .

[18]  L. Bassett,et al.  Anatomy instruction by radiologists. , 1985, Investigative radiology.

[19]  G. L. Engel.  Care and feeding of the medical student. The foundation for professional competence. , 1971, JAMA.

[20]  G L Nieder,et al.  Using QuickTime virtual reality objects in computer‐assisted instruction of gross anatomy: Yorick—the VR Skull , 2000, Clinical anatomy.

[21]  M. Lüdinghausen.  The goal of dissection in clinically oriented teaching , 1992 .

[22]  H. Lippert,et al.  Integration of clinical problems in teaching gross anatomy: Living anatomy, X‐ray anatomy, patient presentations, and films depicting clinical problems , 1986, The Anatomical record.

[23]  H. Ellis.  Teaching in the dissecting room , 2001, Clinical anatomy.

[24]  A H Crisp,et al.  The relevance of anatomy and morbid anatomy for medical practice and hence for postgraduate and continuing medical education of doctors. , 1989, Postgraduate medical journal.

[25]  Christopher Lane.  Thoughts for the Times on War and Death , 2019 .

[26]  D. Cahill,et al.  Standards in health care and medical education , 2000, Clinical anatomy.

[27]  W E Erkonen,et al.  Gross anatomy instruction with diagnostic images. , 1990, Investigative radiology.

[28]  R. Drake,et al.  Anatomy education in a changing medical curriculum , 1998, Kaibogaku zasshi. Journal of anatomy.

[29]  D. W. Foster.  To be a physician. , 2000, The Mount Sinai journal of medicine, New York.

[30]  N. Gustavson.  The effect of human dissection on first-year students and implications for the doctor-patient relationship. , 1988, Journal of medical education.

[31]  G. Cerri,et al.  The value of teaching sectional anatomy to improve CT scan interpretation , 2001, Clinical anatomy.

[32]  D. Bowsher.  What should be taught in anatomy? , 1976, Medical education.

[33]  G R Norman,et al.  Do virtual computer models hinder anatomy learning? , 1999, Academic medicine : journal of the Association of American Medical Colleges.

[34]  M Utting,et al.  What future for dissection in courses of human topographical anatomy in universities in the UK? , 1995, Clinical anatomy.

[35]  G. L. Engel.  The need for a new medical model: a challenge for biomedicine , 1977 .

[36]  J. Warren,et al.  A crisis in medical education. Thoughts on listening to a conference on medical education for the 21st century. , 1985, JAMA.

[37]  D. Metcalfe.  The Edinburgh Declaration. , 1989, Family practice.

[38]  D. A. Moosman.  A surgeon's view: the decline and perhaps the fall of gross anatomy instruction. , 1980, American journal of surgery.

[39]  S. Bertman,et al.  Experiences with learning about death and dying in the undergraduate anatomy curriculum. , 1980, Journal of medical education.

[40]  C. Rosse.  Terminologia Anatomica: Considered from the perspective of next‐generation knowledge sources , 2001, Clinical anatomy (New York, N.Y. Print).

[41]  Cornelius Rosse,et al.  Computer‐generated three‐dimensional reconstruction of the mediastinm correlated with sectional and radiological anatomy , 1992 .

[42]  D. C. Tosteson,et al.  New pathways in general medical education. , 1990, The New England journal of medicine.

[43]  S. Blecher.  Anatomy — The patient's or the book's? , 1978 .

[44]  O. Beahrs.  Gross anatomy in medicine , 1991 .

[45]  J. Horder.  THE CARE OF THE PATIENT. , 1963, Medical world.

[46]  I. Mcmanus,et al.  How will medical education change? , 1991, The Lancet.

[47]  S. Marks,et al.  The role of three‐dimensional information in health care and medical education: The implications for anatomy and dissection , 2000, Clinical anatomy.

[48]  D. Reiser.  Struggling to stay human in medicine: one student's reflections on becoming a doctor. , 1973, The New physician.

[49]  A. Rossier.  Letter to the Editor , 1986, Paraplegia.

[50]  C. E. Sedgwick,et al.  Surgical Anatomy , 1849, Major problems in clinical surgery.

[51]  M G Levine,et al.  Implementing and integrating computer‐based activities into a problem‐based gross anatomy curriculum , 1999, Clinical anatomy.

[52]  T. Nishimura.  [Magnetic resonance imaging of the cardiovascular system]. , 1986, Kokyu to junkan. Respiration & circulation.

[53]  M. Paalman,et al.  Why teach anatomy? Anatomists respond , 2000, The Anatomical record.

[54]  S. Marks,et al.  Teaching and learning anatomy in medicine , 1988 .

[55]  A. Shalev,et al.  Medical students' stress reactions to dissections. , 1985, The Israel journal of psychiatry and related sciences.

[56]  R. Drake,et al.  Gross anatomy of the head and neck and neuroscience in an integrated first‐year medical school curriculum , 2000, The Anatomical record.

[57]  R Wolkomir.  Charting the terrain of touch. , 2000, Smithsonian.

[58]  P. Willan,et al.  Concepts of variation and normality in morphology: Important issues at risk of neglect in modern undergraduate medical courses , 1999, Clinical anatomy.

[59]  W. Hendee,et al.  Magnetic Resonance Imaging of the Central Nervous System , 1988 .

[60]  S. Bertman,et al.  Humanities in medical education: rationale and resources for the dissection laboratory , 1985, Medical education.

[61]  K. Parry.  The curriculum for the year 2000 , 1989 .

[62]  D. Miller,et al.  Magnetic resonance imaging of the central nervous system. , 1989, The New Zealand medical journal.

[63]  R. Pabst.  Medical education and reform initiatives in Germany , 1995, Academic medicine : journal of the Association of American Medical Colleges.

[64]  M. Mcluhan,et al.  The Medium is the Massage : An Inventory of Effects , 1967 .

[65]  S C Marks,et al.  Information technology, medical education, and anatomy for the twenty‐first century , 1996, Clinical anatomy.

[66]  W. R. Kennedy,et al.  Magnetic Resonance Imaging of the Cardiovascular System: Present State of the Art and Future Potential , 1988 .

[67]  J. Lister.  Doctors – The Biography of Medicine. , 1989 .

[68]  J. Sutin,et al.  Evaluation of a gross anatomy program without dissection. , 1978, Journal of medical education.

[69]  Michael von Lüdinghausen Prof..  The goal of dissection in clinically oriented teaching , 1992 .

[70]  S. Bertman,et al.  Human anatomy: A foundation for education about death and dying in medicine , 1997, Clinical anatomy.

[71]  Mittler Pj,et al.  MEDICAL MANPOWER IN NEW ZEALAND. , 1964 .

[72]  Geerat J. Vermeij.  Privileged Hands: A Scientific Life , 1996 .

[73]  W E Erkonen,et al.  Effectiveness of teaching radiologic image interpretation in gross anatomy. A long-term follow-up. , 1992, Investigative radiology.

[74]  C. McGuire,et al.  The curriculum for the year 2000 † , 1989, Medical education.

[75]  D G Jones,et al.  Reassessing the importance of dissection: A critique and elaboration , 1997, Clinical anatomy.

[76]  Lindsey,et al.  Catching up. , 1999, The Harvard mental health letter.

[77]  Lawrence H. Mathers,et al.  Post‐traumatic stress among medical students in the anatomy dissection laboratory , 1990 .

[78]  M J Fitzgerald,et al.  Undergraduate medical anatomy teaching. , 1992, Journal of anatomy.

[79]  J. P. Schaeffer,et al.  Morris' human anatomy : a complete systematic treatise , 1943 .

[80]  S. Dubovsky,et al.  Evaluating medical school graduates of a reduced course program: a preliminary report. , 1984, Journal of medical education.

[81]  C. Pietrangeli.  The Sistine Chapel: A Glorious Restoration , 1994 .

[82]  J. Claverie,et al.  What If There Are Only 30,000 Human Genes? , 2001, Science.

[83]  M. Aziz,et al.  The Dead Can Still Teach the Living: The Status of Cadaver-Based Anatomy in the Age of Electronic Media , 2015 .

[84]  C. Hulsebosch,et al.  Status of gross anatomy in the U.S. and Canada: Dilemma for the 21st century , 1994 .

[85]  J. Penney.  Reactions of medical students to dissection. , 1985, Journal of medical education.

[86]  C. E. Skinner,et al.  Are the two heads of the human lateral pterygoid separate muscles? A perspective based on their nerve supply. , 1998, Journal of Orofacial Pain.

[87]  J. Skandalakis,et al.  Editorial: Surgical anatomy. , 1974, Surgery.

[88]  Roy Porter,et al.  The greatest benefit to mankind : a medical history of humanity , 1998 .

[89]  J. Coulehan,et al.  The first patient: Reflections and stories about the anatomy cadaver , 1995 .

[90]  R. Gorlin,et al.  Physicians' reactions to patients. A key to teaching humanistic medicine. , 1983, The New England journal of medicine.

[91]  N. A. Moore.  To dissect or not to dissect? , 1998, The Anatomical record.

[92]  W. Monkhouse,et al.  Tomorrow's doctors: Today's mistakes? , 1999, Clinical anatomy.

[93]  L. Romrell,et al.  Moving a graveyard: how one school prepared the way for continuous curriculum renewal , 1998, Academic medicine : journal of the Association of American Medical Colleges.

[94]  D. Sinclair.  THE TWO ANATOMIES , 1964, The Lancet.

[95]  E. Pellegrino.  Educating the humanist physician. An ancient ideal reconsidered. , 1974, JAMA.

[96]  Victor M. Spitzer,et al.  Atlas of the Visible Human Male: Reverse Engineering of the Human Body , 1997 .

[97]  P. Maguire.  Barriers to psychological care of the dying. , 1985, British medical journal.

[98]  L. W. Eichna.  A medical-school curriculum for the 1980s. , 1983, The New England journal of medicine.

[99]  T Bacro,et al.  Web‐delivery of anatomy video clips using a CD‐ROM , 2000, The Anatomical record.

[100]  R. Pabst,et al.  Emotional reactions of medical students to dissecting human bodies: A conceptual approach and its evaluation , 2000, The Anatomical record.