Should cadaver lab be phased out?

[Stagg737]

Several medical schools are now moving away from having students experience cadaver labs and moving towards using 3D software to teach the lab portion of anatomy in med school. There are always some students who hate cadaver lab and some who love it, but is it really a necessary part of medical education? I was curious how actual surgeons and surgery residents felt about cadaver lab. Is it a necessary part of learning to become a physician, or an antiquated practice that it's time to move past?

Additionally, as surgeons do you all feel like it was helpful to have dissected a cadaver before operating on a living person? Do you believe that using 3D software to learn anatomy would be better than physically dissecting a cadaver?

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[cubsrule4e]

Several medical schools are now moving away from having students experience cadaver labs and moving towards using 3D software to teach the lab portion of anatomy in med school. There are always some students who hate cadaver lab and some who love it, but is it really a necessary part of medical education? I was curious how actual surgeons and surgery residents felt about cadaver lab. Is it a necessary part of learning to become a physician, or an antiquated practice that it's time to move past?

Additionally, as surgeons do you all feel like it was helpful to have dissected a cadaver before operating on a living person? Do you believe that using 3D software to learn anatomy would be better than physically dissecting a cadaver?

I honestly dont see how you can say its anywhere close to the same experience. You cant open up a 3D anatomy program and see and feel what a cirrhotic liver looks like, or a kidney with renal calculi, etc, etc. Sure it may seem outdated because of all this new technology, but that, nor "not liking it" nor the smell or formaldehyde shouldnt be an adequate reason to ditch it. Maybe I'm biased since I did love anatomy and I did become a surgeon. Opening up an eyeball in anatomy lab and seeing the intraocular lens inside of it that was carefully placed there by a doctor performing microsurgery, it kinds of puts you in that moment and sears it into your memory.

There was a running joke about one of our old anatomy professors when I was in med school who had been around for some 40 plus years... we all figured after he died he would donate his body for medical research in a cadaver lab, but when the students opened him up, all of his muscles, veins, arteries, ligaments, etc would already be precisely tagged and labeled appropriately

 

[TraumaLlamaMD]

I didn’t like cadaver lab at all as a student. The smell, the dead colorless structures, the overall macabre atmosphere really didn’t appeal to me... It wasn’t until I was in the OR experiencing moving, living structures that I realized I loved surgery. That said, if I could have retaken anatomy lab as a surgical intern or so, I think I would have gotten a lot more out of it. 3D models are nothing close. I think as long as there are people willing to give their bodies to teach our students, we have a lot to gain from accepting that gift.

 

[HighPriest]

It’s needed. I do agree that it’s nothing like living tissue. You can learn Netter anatomy from a text. You don’t even need a 3D software package, to be honest. But no text or software is going to demonstrate the variability of an actual body. It’ll never have the detail, even if it is tarnished by preservatives. Plus, I think cadaver labs give you a strong sense of respect for where you’re going. These are people who sacrificed their bodies for your education. If you didn’t feel a degree of humility in anatomy lab, you might be a bit of a sociopath.

Plus, as mentioned above, it’s like a macabre treasure hunt.

We had a table of all girls dissection an elderly gentleman’s body. I remember the day they accidentally found the bulb for his inflatable penile pump.

You never expect a zombie plague, but you even less expect it to start with an erection.

 

[AsianPersuasion]

It's obviously not the same as a living tissue and I hated my anatomy lab. Truthfully, I didn't really care for it as much as other students, I sorta peaked above everyone and just tried to get whatever experience I can get. But third year really opened my eyes on surgery and I truly wished I can get a sense of the body plane and different approaches etc. But I'm sure that will all come with residency this year. I vote that we shouldn't get rid of gross anatomy.

 

[Wordead]

It's just another way for schools to cut down on costs without reducing tuition. computer software will never be as good

 

[kemper6036]

cannot be replicated. i felt it was a huge part of the transition from student to doctor.

 

[cubsrule4e]

Several medical schools are now moving away from having students experience cadaver labs and moving towards using 3D software to teach the lab portion of anatomy in med school. There are always some students who hate cadaver lab and some who love it, but is it really a necessary part of medical education? I was curious how actual surgeons and surgery residents felt about cadaver lab. Is it a necessary part of learning to become a physician, or an antiquated practice that it's time to move past?

Additionally, as surgeons do you all feel like it was helpful to have dissected a cadaver before operating on a living person? Do you believe that using 3D software to learn anatomy would be better than physically dissecting a cadaver?

Wow, I just found the thread you mentioned that inspired your creation of this topic and all i can say is: millennial entitlement. People just think theyre above the tried and true ways of learning and developing into a physician, and some dont even want to interact with people anymore. They just want to sit in their room alone and somehow become an expert in a field that requires the utmost knowledge of human anatomy, function, and social interaction. Its really becoming a$$-backwards.

 

[siliso]

IMO autopsies give a better view of anatomy (and of the reality of death and bodies) than preserved cadavers or surgery. But there aren’t enough of them and you can’t dissect down all the muscles and nerves. No, I don’t think a computer sim can substitute for any of the above. We’re dealing with earthy fleshy humans, hands on, in this profession, not in the end abstractions for board scores.

 

[droliver]

I personally think it’s a dated, expensive, and very inefficient way to learn anatomy at this point.

 

[Winged Scapula]

It's just another way for schools to cut down on costs without reducing tuition. computer software will never be as good

Yes let’s not pretend it’s anything but an attempt to cut costs as schools increase their tuition to ridiculous rates.

 

[deleted941485]

Yeah I mean who knows in the future. Having to work on actual patients to be adequately trained in a specialty could be considered anachronistic in 10 years. Just complete a few thousand computer sims each day and that’ll cover it. No more residency.

 

[VincentAdultman]

and all i can say is: millennial entitlement.

Millennials are KILLING cadaver lab.

Now that I’ve taken a moment to mock tired cliches, I think it’s necessary to see anatomy firsthand just like you should have to hunt for proximal tubules on microscope slide. Software is never going to replicate that.

That being said I didn’t really think a gross anatomy class as a first year prepares you in any way for residency 3-5 years later.

 

[HighPriest]

It doesn't prepare you for residency any more than most classes. But it does prepare you more than some. I certainly reflect back on anatomy more than I do biochem. Ask me to recite the Kreb cycle. I think it helps with spatial orientation and variation more than any 3D program I've ever seen.

I think things like 3D training programs and critical care/trauma dummies are a solution looking for a problem. That's not to say that they don't have inherent value. But, like a lot of research, the driving research behind them is basically someone who says "I think 3D programs are really cool, now what can I apply them to?" One obvious answer is human anatomy, and so you're going to direct your research to show a benefit there. But showing that it is feasible or that there is some value doesn't mean that it has the capacity to replace tried and true methods. We know what the end result of residency and anatomy courses are because we've been doing it for years. A handful of studies demonstrating that kids can pass a test after a 3D anatomy course doesn't mean you'll have the same results. So I think we put the cart ahead of the horse by assuming that anatomy lab is outdated. Again, same with trauma/critical care dummies. We had a ton of them in the Army, and we had a huge lab in med school (which at the time was not the norm). I get it. They're useful. But at least at that time the school and the Army were acting like these things could replace actual patient contact in every way.....they cannot....

 

[HighPriest]

I heard talk at one point about having anatomy lab optioned as a cadaver lab vs 3D lab with the idea that students could self select. That would allow for fewer students/cadaver and it would allow for further testing in the future. Although I imagine it would be biased, as I think a lot of pre-surgeons would take the gross lab and most of the rest would do the computer simulation. Frankly, I always thought the biggest weakness of anatomy across the board (at least at my medical school) was a lack of radiographic anatomy, which is really more pertinent for most people. That seems to explain why most of the referrals I get come from providers who NEVER PERSONALLY LOOK AT THE FILMS THEY ORDER......

It's something that annoys me.

 

[VA Hopeful Dr]

I heard talk at one point about having anatomy lab optioned as a cadaver lab vs 3D lab with the idea that students could self select. That would allow for fewer students/cadaver and it would allow for further testing in the future. Although I imagine it would be biased, as I think a lot of pre-surgeons would take the gross lab and most of the rest would do the computer simulation. Frankly, I always thought the biggest weakness of anatomy across the board (at least at my medical school) was a lack of radiographic anatomy, which is really more pertinent for most people. That seems to explain why most of the referrals I get come from providers who NEVER PERSONALLY LOOK AT THE FILMS THEY ORDER......

It's something that annoys me.

If you'll permit me a slight derailment, what kind of problems are you seeing on this front?

I work under the usually correct assumption that the radiologists are going to be better at reading almost everything better than I am (exception sometimes being plain films where I know exactly where to look for the problem). For ENT what films and what diseases are you seeing that you think us PCP types might pick up on?

I mean this honestly, I am fairly self-conscious about sending crappy referrals and anything I can do to cut down on that would be helpful.

 

[HighPriest]

If you'll permit me a slight derailment, what kind of problems are you seeing on this front?

I work under the usually correct assumption that the radiologists are going to be better at reading almost everything better than I am (exception sometimes being plain films where I know exactly where to look for the problem). For ENT what films and what diseases are you seeing that you think us PCP types might pick up on?

I mean this honestly, I am fairly self-conscious about sending crappy referrals and anything I can do to cut down on that would be helpful.

I see things missed not infrequently. If the radiologist isn't entirely sure what it is you're having them look at, they may focus on an incidental finding and miss the actual problem. Had a referral from the ER last month where the guy came in with anterior neck pain and they did a CT, Neck and the radiologist said his submandibular gland was swollen. End of story. Sialoadenitis. But the scan clearly showed a thyroglossal duct cyst in the area where the patient was symptomatic. It wasn't huge, but it was pretty obvious, and if I knew where the patient was pointing when he was asked where it hurt, it would have been more obvious.

I see patients referred for problems that CT scans effectively rule out (like sinusitis). "Patient with chronic sinusitis. Treated with four courses of antibiotics. Got a CT after the second course which was basically normal, but still got two more courses of antibiotics." I can't tell you how many times I see patients referred from an urgent care center with a diagnosis of sinusitis, told that they have sinusitis, only symptom is occipital headache, and they have a sinus CT performed at the urgent care center which is totally normal.
Also, take "mastoiditis" for example. Radiographic mastoiditis is just fluid of any kind whatsoever in the mastoid. I feel like even a primary care doc could look at a scan and say "well, I suppose that a single, subcentimeter, opacified aircell is probably not an issue. But as soon as some guys see "mastoiditis" on a report, they just refer. I see asymptomatic patients all of the time for "mastoiditis," because they had an MRI performed for totally unrelated issues and the radiologist called it mastoiditis. That's why the radiologist generally follows up with "please correlate clinically," because nothing beats seeing a scan and seeing the patient together. Isolated, non-obstructive maxillary sinus mucoceles are the same thing. Tons of consults for those, and the treatment is nothing at all 100% of the time. But the radiologist says "mucocele vs polyp." I honestly don't think you need to be a specialist to decide that a 1cm perfectly round cystic structure in the floor of an asymptomatic maxillary sinus with no signs of erosion probably doesn't need to see a specialist. They're not even uncommon. Just the opposite, they're extremely common.

Now, some radiologists are good enough to specify exactly what they're seeing, but not all are. Unfortunately, the only way that you know who is who is to look at the scans yourself. Otherwise, it's all face value.

Also, I feel like I'm better at reviewing head and neck (not brain or spine) scans than most radiologists. Not all. There are some head and neck radiologists who are absolutely amazing. But frankly, I bet that I look at more CT, Necks than most general radiologists on average. But I also understand that that isn't the same if you're looking at scans of everything from bellies to brains.


So, all of that being said: I don't at all expect a PCP to be able to read a CT, Neck like I can. or a sinus, temporal bone, whatever. I don't expect that their reviewing the scan will eliminate inappropriate consults. But like everything, the more you do something, the better you get at it (except dying, for some reason, you're just good at that off the bat). So regularly reviewing films can help determine what's normal, what's disease, and what's radiographically abnormal but really not a real issue that needs referral. And they have something to add to the scan: they've seen the patient. Sometimes it'll still be a gray area and patients will get referred even though they don't need additional treatment.

We have a certain ethical responsibility, I feel, to try to keep healthcare costs under control and I do think that just looking at the images and tests that you order could make a not-insignificant difference

 

[Raney Schauer]

Sectra sucks. It's great in theory, but the execution from an HMI standpoint is a dog's ballsack.

 

[HighPriest]

If you'll permit me a slight derailment, what kind of problems are you seeing on this front?

I work under the usually correct assumption that the radiologists are going to be better at reading almost everything better than I am (exception sometimes being plain films where I know exactly where to look for the problem). For ENT what films and what diseases are you seeing that you think us PCP types might pick up on?

I mean this honestly, I am fairly self-conscious about sending crappy referrals and anything I can do to cut down on that would be helpful.

This coincidentally came in today. Patient with unilateral hearing loss, imbalance, aural fullness. Was told 3 years ago that someone thought she had a benign tumor behind her ear on the right. PCP ordered an MRI which was read as normal. She was told there wasn’t a tumor. (See images) that is not abnormal MRI of the IACs. You don’t even have to know that much about the problem, just roughly where the ears are and that asymmetric enhancement is bad.

Radiologist amended his report, and didn’t even give me credit. Where’s the honor?

 

[Jolie South]

This coincidentally came in today. Patient with unilateral hearing loss, imbalance, aural fullness. Was told 3 years ago that someone thought she had a benign tumor behind her ear on the right. PCP ordered an MRI which was read as normal. She was told there wasn’t a tumor. (See images) that is not abnormal MRI of the IACs. You don’t even have to know that much about the problem, just roughly where the ears are and that asymmetric enhancement is bad.

Radiologist amended his report, and didn’t even give me credit. Where’s the honor?

I diagnosed Eagle Syndrome in a patient where CTA was read as normal. Patient had ptosis and "buzzing in her ear." Ipsilateral carotid essentially impinged upon 100% by styloid. They thought she had a stroke because of the ptosis even though there was flow distal. *eyeroll* Didn't bother to call ENT either.

 

[Medstart108]

Several medical schools are now moving away from having students experience cadaver labs and moving towards using 3D software to teach the lab portion of anatomy in med school. There are always some students who hate cadaver lab and some who love it, but is it really a necessary part of medical education? I was curious how actual surgeons and surgery residents felt about cadaver lab. Is it a necessary part of learning to become a physician, or an antiquated practice that it's time to move past?

Additionally, as surgeons do you all feel like it was helpful to have dissected a cadaver before operating on a living person? Do you believe that using 3D software to learn anatomy would be better than physically dissecting a cadaver?

I love dissection, it was actually the first sign that I might be interested in surgery. Not everyone liked it, in fact most did not, but I find it is sort of a right of passage and it is still useful to most. If we are going to learn about nutrition, breast feeding and the like in medical school we sure have time for dissection.