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ARTICLE

Assessment of Role of Dissection in Anatomy Teaching from the Perspective of Undergraduate Students: A Qualitative Study
Latika Arora*1 and BR Sharma2

1. Department of Anatomy 2. Department of Forensic Medicine Santosh Medical College and Hospital, Ghaziabad, India.

*Corresponding author: L. Arora Email: latika_arora@rediffmail.com Published: 30 March 2011 Ibnosina J Med BS 2011,3(2):59-65 Received: 06 October 2010 Accepted: 03 December 2010 This article is available from: http://www.ijmbs.org This is an Open Access article distributed under the terms of the Creative Commons Attribution 3.0 License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract Teaching of Anatomy and the use of dissection in undergraduate teaching is witnessing a major change in medical colleges of India. Undergraduate medical students in India go through an extensive Anatomy teaching by dissection. There has been much debate about use of dissection or prossected part Anatomy teaching and both sides of argument are significant. Many issues have been debated about variety of responses of undergraduate medical students to human cadaver, problems faced by students who are taught by dissection or by prossected part teaching and relative costs and educational merits of using cadaver with alternative methods. The present study is an attempt to express our views in this ongoing debate based on the views of undergraduate students gathered by their participation in this questionnaire based study. It was noted that both MBBS and BDS students found dissection as a tool that helps them in better understanding of Anatomy and provides to visualize different organs of human body
Ibnosina Journal of Medicine and Biomedical Sciences (2011)

and their relationship. Introduction The provision of learning gross Anatomy in medical schools provides an emotional as well as intellectual approach to medical education. The amount of Anatomy teaching required in undergraduate curriculum and the best way to impart this knowledge are issues that are frequently debated by medical community. Throughout history, dissection of human cadavers for medical education has experienced various cycles of legalization and proscription in different countries. Early systematic human dissection were carried by Greek physicians Herophilus of Chalcedon and Erasistratus of Chios in the early part of third century BC (1). Due to decline in the number of cadavers available for donation (2), establishment of new medical schools without dissection facilities and financial strain faced in procuring cadaver lead to the argument of teaching gross Anatomy without

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dissection (3,4). Many medical schools have moved to prossection based tutorials as prime teaching method. Computer media, CD ROM, has also been implemented in many courses. Administrators in medical schools are concerned with time management and cost control in Anatomy educational programs. Science controlling medical care is growing vastly and more time should be devoted to ethics, professionalism and humanism. Due to such challenges Anatomy courses and body donation programmes are long, labour intensive and costly. Though the use of prosected specimens and computer learning packages are beneficial to student teaching, many anatomists believe that practice of dissection is invaluable tool for teaching Anatomy (5). Anatomical dissection is systematic exploration of preserved human cadaver by sequential division of tissue layers and liberation of certain structures by removal of regional fat and connective tissue with the aim of supporting the learning of gross Anatomy by visual and tactile experience. Learning on human cadavers is complex learning experience and is not easy to quantify and evaluate objectively. Such aspect pertain to question of professionalisation, social skill and attitude towards death (6). There have been pro (7,8) and con (9,10) arguements on whether medical students should dissect the whole body or learn from predissected bodies. The present study is an assessment of the response of the undergraduate to dissection and Anatomy teaching in an attempt to formulate effective aids of Anatomy teaching to medical and dental students. Material and Methods Setting Santosh Medical College (SMC) is a well established college in Ghaziabad region of UP since 1995. SMC has adopted 3 learning models which yield insight into teaching practice novice\ expert behaviours, cognitive development and learning styles, along with ways in which instructors can draw on these models in course planning and classroom teaching. These models have been overviewed by Horri CV (11). We are primarily concerned to deliver high quality clinical care and physicians should acquire proper Anatomy knowledge about body structure and function. Appropriate use of factual information from Anatomy in professional practice should be attempted by physicians. At SMC all new medical and dental students receive a lecture about dissection and a tour of dissecting room. Students dissect under the supervision of Anatomy teachers
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and are encouraged to study relevant surface Anatomy. Anatomy teaching also includes lectures and tutorials provided by Anatomy teachers with the help of prossection based teaching and examination of museum specimens. A CD-ROM based learning program for Anatomy has also been installed on computer network at Anatomy department of SMC, to which students have a free access. Study Protocol Anonymous questionnaires modelled after the one used by Lempp KH12 were given to first year medical and dental students of year 2008-2009 at SMC at different stages. The first occasion at which questionnaire was given to students was before they started their routine lecture and practical classes in Anatomy. Forty five medical and 34 dental students out of a group of 70 each responded. Second time, the questionnaire was given after they had attended 6 weeks of theory and practical classes and third time the questionnaire was given after 12 weeks of scheduled classes and practical. Forty five medical 34 dental, and 42 medical and 34 dental students respectively responded to the questionnaire. Students given the questionnaire were in the age group of 17 to 19 years. 46% of them were male and 54% females. The questionnaire evaluated the concerns and feelings of students on handling Anatomy specimens and cadavers. Concerns were divided into interest, excitement, curiosity, fear, anxiety, disgust, nausea, smell, sight, touch of cadaver and risk of infection. The subsequent surveys evaluated how these concerns progressed over a period of 12 weeks. On the last occasion, students were asked which teaching method they preferred using ordinal scale from 1-5. Throughout questionnaire other questions were asked from students on their social life and hobbies to get better and unbiased response. Results The trend in scoring over 3 surveys is presented in table 1. The emotional response showed that percentage of students showing interest and excitement in handling Anatomy specimens and cadavers increased over the following weeks while curiosity declined after 6 and 12 weeks. The percentage of students showing negative emotional response fear, anxiety, nausea and disgust declined steadily over the following weeks. On analyzing the response to practical concerns, the strength of students showing aversion to smell decreased while for concern regarding touch of specimen and risk of infection showed slight increase. Aversion regarding to

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Table 1. Comparison between the responses of students in 3 surveys Response of students Emotional response Interest Excitement Curiosity Fear Anxiety Disgust Nausea Prior to dissection (%) 37.16 19.02 23.66 5.55 6.22 4.16 4.11

6 weeks after dissection (%) 39.18 23.45 19.58 4.16 5.55 3.87 3.95

12 weeks after dissection (%) 40.60 30.45 14.04 3.85 4.95 3.12 2.85

Practical response Smell Sight

38.34 20.28 18.76 22.59

37.15 18.50 22.11 5.05

35.28 20.67 23.03 4.08

Touch of specimen Risk of infection

Table 2. Comparison between response of male and female students during 3 surveys Response of students Emotional response Interest Prior to dissection (%) 6 weeks after dissection (%) 12 weeks after dissection ( %)

Excitement Curiosity Fear Anxiety Disgust Nausea Practical response Smell Sight Touch of specimen Risk of infection

37.81 19.8 22.2 5.4 5.3 4.7

Male

female 37.16 21.75 6.8 7.2 20.6

39.31 24.25 19.50 4.2 4.8

Male

female 39.10 19.02 3.9 4.2 24.11

42.55 27.77 14.05 3.8 4.6 3.8

Male

Female 41.33 26.75 13.05 3.05 4.02 2.75 3.4

4.16

3.98 4.34 37.66 13.33 16.87 22.05

3.52 4.12 37.61 5.33 17.05 22.83

3.23 4.16 36.51 4.98 17.82 22.57

2.98

38.09 14.28 16.66 21.75

35.71 3.42 19.85 23.98

34.92 3.08 20.02 23.75

Ibnosina Journal of Medicine and Biomedical Sciences (2011)

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Table 3. Comparison between response of MBBS and BDS students during 3 surveys. Prior to dissection Response of 6 weeks after dissection 12 weeks after dissection ( %) students (%) ( %) Emotional response MBBS BDS MBBS BDS MBBS BDS Interest Excitement Curiosity Fear Anxiety Disgust Nausea Practical response Smell 36.48 23.12 22.71 4.16 5.02 4.02 3.07 39.87 11.30 17.85 23.14 37.18 22.93 22.17 3.95 4.95 3.85 2.94 38.85 10.85 17.05 22.89 39.10 27.52 17.58 3.72 4.01 3.75 2.98 37.23 4.78 18.11 23.98 38.81 27.47 17.02 3.12 3.95 3.98 2.75 36.15 4.33 17.98 23.45 41.95 30.05 14.32 3.11 3.98 3.17 2.15 35.85 3.95 19.11 24.05 42.02 31.52 13.98 2.98 3.58 2.98 2.02 34.71 3.87 19.85 24.84

Sight Touch of specimen Risk of infection

Figure 1. Resonse of MBBS and BDS students to different teaching methods sight of specimen decreased significantly. On comparing difference between response of male and female students interest, excitement, curiosity was exhibited by equal number of male and female students but more number of female students showed fear and anxiety
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which declined over the following weeks . The response for practical concerns was almost similar between male and female students (Table 2). Comparison between medical and dental students was not much significant for emotional as well as practical concerns

Ibnosina J Med BS Appendix . The text of the Questionnaire Why did you decide to study medicine? At what age did you decide to study medicine? Has medical training met your expectation so far? If yes why? If no why? What do you enjoy most in your training and why? What do you enjoy least in your training and why? How did medical school teaching differ from your experience when you went to school? How did teaching of Anatomy from prossected specimens affect you at the very beginning of your training? What emotional reaction did you experience during handling of Anatomy specimens? Interest Anxiety Excitement Disgust Curiosity Nausea Fear (students were asked to tick one of the options) What practical concerns did you experience during handling of Anatomy specimens? Smell Sight Touch of specimen Risk of infection Are your parents medical professionals? If yes how they help you in your work? Do you think women are better suited to certain kinds of medical specialities than men? (Which?\ Why?) Do you feel respected as medical students in the classroom? In your opinion what is the likely scenario for the future in medicine

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(Table3). For the means of teaching, Medical students gave highest score to dissection followed by demonstration, prossected part teaching, computer teaching and lecture respectively. Dentists also gave highest score to dissection as means of Anatomy teaching followed closely by demonstration, prossected part teaching, lecture and computer teaching. Dissection was given highest score by both MBBS and BDS students. Dentists found lecture teaching better over computer, while MBBS students gave higher score to computer teaching over lectures (figure 1). Discussion Our study was conducted in one medical school on a small sample with simple counting methods which enabled us to
Ibnosina Journal of Medicine and Biomedical Sciences (2011)

focus on detailed description and their meanings. Thus our findings may not be widely generalisable, but is valuable in generating important educational issues. The potential of a dissected body to give better understanding of Anatomy to medical and dental students is remarkable. Previous studies have assessed reactions of undergraduate students to dissection (13,14). Some studies stated that better preparation of students was necessary for dissection (15). Most medical students are able to adapt to dissecting room, but few students were reported to have high of stress after dissection (13,16) for which counselling and compulsory formal course on death and dying was desired by students. Some institutions have implemented ancillary programmes on death and dying to meet stress experienced by students (17,18). In our study we looked at attitudes of

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students to dissection and were encouraged to find that percentage of students showing interest and excitement for dissection increased over the successive weeks and negative symptoms fear and anxiety declined. Positive response to dissection has also been reported in other studies (19). Aversion of smell for dissection room decreased. The number of students showing touch of specimen and risk of infection showed mild increase which has also been reported by other authors (20). To reduce aversion to touch of specimen and risk of infection, students were constantly advised to wear gloves. For smell, frequent measurement of formaldehyde conc was checked in dissection room and it was never found to go beyond permissible limits. More over, our dissection room is well ventilated with windows and local exhaust fans. The significant decline in sight was because of constant counselling and encouragement to students by Anatomy teachers for human specimens. For gender differences more females reported fear and anxiety but for other concerns there was not significant difference. But Snelling et al (21) reported that along with emotional concerns physical concerns were also much higher in females. Comparison between medical and dental students showed no difference in response to dissection which was supported by other authors (21). There is lot of debate about teaching Anatomy by dissection or prossection (22). According to our study both medical and dentists scored dissection as the preferred choice over teaching Anatomy from prossected part. Nnodim et al (23) studied the performance of students who were taught by dissection and those who were taught from prossected part specimen and found that scores gained by both goups were almost similar . According to another study (21) undergraduate students gave equal scores to dissection and prossected part teaching. Leager VL (22) found that students taught from prossected specimens and those taught by dissection scored equal grades but difference was found in comprehensive test where dissectors scored higher grade. Thus dissection may aid in retaining knowledge. In SMC gross Anatomy is taught by dissection and demonstration on prossected part specimens which helps the students to better understand predissected bodies. Students see whole dissection and not just named structures on the dissected body or as given in atlases. Every student does some dissection in every region of the body; therefore understanding of Anatomy is carried over to regions which they do not dissect. Thus we consider dissection forms important part in training of undergraduate students .The other means of teaching are effective and have been rated
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highly by students, but anatomical dissection for teaching of Anatomy is too valuable to ignore. References 1. von Staden H. The discovery of the body: human dissection and its cultural contexts in ancient Greece. Yale J Biol Med 1992;65:223-41. 2. Ajita R, Singh Y I. Body donation and its relevance in Anatomy learning A Review. Journal of Anatomical Society of India 2007;56:44-7. 3. Dinsmore CE, Daugherty S, Zeitz HJ. Teaching and learning gross Anatomy: dissection, prossection, or both of the above? Clin Anat 1999;12:110-14. 4. McLachlan JC, Bligh J, Bradley P, Searle J. Teaching Anatomy without cadavers. Med Educc 2004;38:418-24. 5. Aziz MA, McKenzie JC, Wilson JS, Cowie RJ, Ayeni SA, Dunn BK. The human cadaver in the age of biomedical informatics. Anat Re 2002;269:2032. 6. Lock DG. Biomedicine Examined. Dordrecht: Kluwer Academic Publishers 1988. P. 125-54. 7. Ellis H. Teaching in the dissecting room. Clin Anat 2001;14:149-51. 8. Cahill DR, Leonard RJ, Weiglen AH, von Ludinghausen M. Viewpoint: unrecognized values of dissection considered. Surg Radiol Anat 2002;24:137-9. 9. Ferm VH, Lyons JH Jr. Experience with a shortened curriculum in gross Anatomy. J Med Educ 1971;46:673-6. 10. Nnodim JO, Learning human Anatomy; by dissection or from prossection. Med Educ 1990;24:389-95. 11. Horii CV. Teaching insights from adult learning theory. J Vet Med Educ Fall 2007;34:369-76. 12. Lempp HK Perceptions of dissection by students in one medical school: beyond learning about Anatomy. A qualitative study. Medical Education 2005;39:318-25. 13. Ninodim JO. Preclinical student reactions to dissection, death and dying. Clin Anat 1996;9(3):175-82. 14. Leong SK. Back to basics. Clin Anat 1999;12:42226. 15. Horne DJ, Tiller JW, Eizenberg N, Tashveska M, Biddle N. Reactions of first year medical students to their initial encounter with a cadaver in the dissecting room. Acad Med 1990;65:645-6. 16. Evans EJ, Fitzgibbon GH. The dissecting room: reactions of first year medical students. Clin Anat 1992;5:311-20. 17. Bertman SL, Marks SC Jr. The dissection experience as a laboratory for self discovery about

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