The Dead Can Still Teach the Living: The Status of Cadaver-Based Anatomy in the Age of Electronic Media

THE DEAD CAN STILL TEACH THE LIVING: THE STATUS OF CADAVER-BASED ANATOMY IN THE AGE OF ELECTRONIC MEDIA M. ASHRAF AZIZ and JAMES C. McKENZIE* I sing the body electric. —Walt Whitman Introduction Recent trends in education for the medical, dental, and allied health professions have promoted a réévaluation of teaching tools and techniques in the basic sciences curriculum. For example, the advent of computerbased educational programs, including software such as the much touted "electronic cadaver" (e.g., A.D.A.M. or "Animated Dissection of Anatomy for Medicine," MacMan, Digital Anatomist, The Visible Human Data Set) [1-9] and contemporary "noninvasive" diagnostic imaging techniques such as computerized axial tomography (CAT), magnetic resonance imaging (MRI), and positron emission tomography (PET) have prompted a reexamination of the need for the more traditional or classical approach of anatomical study by human cadaveric dissection [10-22]. The social and educational pressures to accede to the digital/electronic approach are in keeping with our cultural drive to access the emerging "information superhighway " [7]. Other rationalizations for the proposed deemphasis and/ or removal of classical anatomy instruction based on the dissected cadaver from health professions training include considerations ofpracticality; concerns regarding the health and safety of students, faculty, and staff; a pedaThe authors wish to thank all those who continue to donate their remains for training new generations of caregivers. We are equally grateful to our students, whose continued enthusiasm for dissection-based anatomy learning keeps our morale high. In addition, we are most grateful to Drs. Sherwin, B. Nuland, and Edmund D. Pellegrino for their critical views and encouragement regarding our manuscript. Also, without Ms. Bonnie S. Cobbs' tireless secretarial contribution, this work may not have been completed. *Department ofAnatomy, Howard University College ofMedicine, 520 W St., NW, Washington , DC 20059© 1999 by The University of Chicago. All rights reserved. 0031-5982/99/4203-1103101.00 402 Aziz and McKenzie ¦ Cadaver-Based Anatomy in the Age ofElectronic Media gogic shift towards excessively reductionist approaches to human health and disease; and changes in medical school curriculum related to emphasis on problem-based learning [23-28]. The cadaver is, without doubt, an unwieldy tool, and its chief drawback is its lack of portability. Health and safety concerns include possible transmission of such communicable diseases as kuru (Creutzfeldt-Jacob Disease; transmissible viral dementia), hepatitis B, and acquired immunodeficiency syndrome (AIDS) through contact of accidental wounds with fixativeresistant viruses in bodily fluids and/or tissues [5-37]. In addition, the fixatives and various embalming fluids (formaldehyde, phenol, ethyl alcohol , etc.) used in the preservation of cadavers may themselves pose a significant health risk, especiallywith chronic exposure [38-45]. Finally, there is a growing number of students, non-anatomy faculty, and health care professionals who believe that the detailed study of human gross anatomy , particularly involving cadaveric dissection is archaic, baroque, timeconsuming , clinically irrelevant, and non-humanistic in light of current trends in cellular, molecular, and clinical medicine, and that cadaver-based learning should be reduced in, if not altogether eliminated from, the health sciences curriculum [7, 23-28]. The Cadaver and the Scientific Method in Medicine The past being prologue, it is pertinent to revisit the inclusion of the cadaver in anatomical and medical instruction. The human cadaver was introduced in the early universities ofItaly (Bologna, Padua) , France (Paris, Montpelier), Germany (Tübingen), and the Low Countries (Louvain, Ghent) during the 14th and 15th centuries. Dissections were performed for forensic and academic purposes; they were utilized to underscore written texts by earlier authorities, especially those by the Greek anatomistphysician , Galen (ad 169-200). In the 16th century, the Belgian anatomistsurgeon Andreas Vesalius (1514-1564) dissected the actual human heart and failed to corroborate Galen's description of a direct vascular flow from the right to the left ventricle through pores in the interventricular septum [46] . The publication of Vesalius' De Humani Corporis Fabrica marked the first use of an illustrated atlas of human anatomy based on dissection-based observations [47, 48] . For the first time Vesalius reversed the sequential relationship between hypothesis and observation by giving primacy to the latter [48] . To what extent Vesalius was influenced by Leonardo da Vinci's (1452-1519) earlier work...