Dead Body of Knowledge
Dead Body of Knowledge
The recent article by Christine Montross published March 26, 2009 deals with a timely and important subject and deserves further discussion. The subjects that are of primary interest to me are as follows: what is the best way to transfer information into the head of a student of anatomy; is it important to have a student ‘take a blade to a dead man’s skin’ in order to have an appreciation of the wonders of the human body, to learn to heal, or to improve one’s bedside manner.
I have several questions concerning the claims made by Dr. Montross. Many of the courses in medical school are not necessarily taught in the best way but in the way they have always been taught. For example, have there been studies to prove that the traditional cadaver dissection is superior to manipulating a pro-section or a dissected plastinated body? Have there been studies demonstrating that learning anatomy using state-of-the-art medical imaging is inferior to dissections? Is it not as beneficial to hold the heart of a pro-sected or plastinated heart? What is the evidence that allows a scientist to conclude that ‘we learn to heal the living by first dismantling the dead’? Is it not equally awe-inspiring to manipulate and have access to inaccessible computerized anatomical information? How can it be concluded that working on a cadaver reinforces fundamental lessons that are carried to the bedside?
In my view, while cadaver dissection is an important part of a student’s medical or dental school experience, there are limitations inherent in the method. Over the last few years I have discussed the topic with my colleagues as well as a number of medical students and have heard their contrasting opinions. Often the student experience is limited to only one cadaver and not several cadavers with a range of ethnicities, ages or pathologies, something that a digital anatomical library can easily support. The tissue colors are not realistic and students admits they often don’t not recognize and don’t understand what they are dissecting and they can’t distinguish arteries, veins and nerves from one another other. The time that they have with the cadaver is brief and the dissections are limited to the lesson plan or the future medical board questions. When the course is over access to the cadaver lab is limited or impossible.
Medical imaging cannot be defined as a black, white and gray CT scan or a nuanced M.R.I. Instead it covers a vast spectrum of images, ranging from Stanford’s spectacular Bassett serial dissection series to an enhanced false-colored 7T MRI to a very high-resolution, high-contract Seiman’s C-arm scanner. The amount of information that can be gleaned from the digital data sets is far superior to what can be revealed by any cadaver. A library of images can hold an infinite variety of body sizes, ages, medical conditions, pathologies and anomalies. The images can be segmented so that anatomical structures can be identified independently or in many combinations and since the images are 3-dimensonal, they can be viewed from any orientation. By annotating the structures, an unlimited amount of information can also be attached. The student can thereby learn the location, the vocabulary, the function, the blood supply, the innervation, the importance, the surgical access and significance, etc. and the information is accessible 24/7 from anywhere in the world. It is also possible to perform surgical simulations on the computer from the library of anatomical variations. It is unnecessary for the student to revisit the anatomy lab for a refresher in anticipation of a need for the information.
I expect that anatomical dissections will continue to be supported in the majority of medical schools in the future. The role of technology and medical imaging will inevitably increase. New digital tools like the ones we are developing at Stanford have been shown to greatly enhance the learning experience. Only by well designed, validated studies will we have the answer to the issues introduced by Dr. Montross.
W. Paul Brown, DDS,FICD,FACD
Consulting Associate Professor
Stanford University, Division of Anatomy
269 Campus Drive
CCSR Bldg , 0135
Stanford, CA 94305-5140
This is in response to Dr. Montross’ argument that it is necessary to take a blade to a dead man’s skin’ to learn an appreciation of the wonders of the human body and improve one’s bedside manner. No research demonstrates that learning anatomy using state-of-the-art medical imaging programs is inferior to the information gained through the brief dissection of the one cadaver allotted to each medical student.
The role of technology and medical imaging programs will inevitably increase in anatomy courses. New digital tools, like the ones we are developing at Stanford, have been shown to greatly enhance the learning experience. We now have the ability to visualize and interact with anatomical information that was previously inaccessible. Teaching anatomy cannot be couched in an ‘either or’ framework, instead, technology and cadavers should enhance each other. Only well designed, validated studies will provide answers to the issues introduced by Dr. Montross.