To what extent is cadaver dissection necessary to learn medical gross anatomy? A debate forum

In this Olympic year of 2004 in Athens, Greece, which is considered the birthplace of modern Olympics, controversy was inescapable. Whether it was the points awarded by the judges for gymnastics, Paula Radcliffe dropping out of the women's marathon, or drug-testing scandals, controversy swirled. So, too, we find there is controversy within the arena of anatomical education for medical students. Athletes performed their tasks “just in time”; anatomical sciences educators, however, may have the luxury of time to contemplate the controversial issues they face today or they may have change thrust upon them—administratively, or through the fiat of best medical education practice. The controversial issue for this year's educational debate is to what extent is cadaver dissection necessary to learn medical gross anatomy. One of the moderators (G.D.G.) proposed a debate on whether dissection is necessary for learning medical gross anatomy for publication in The Anatomical Record (Part B): The New Anatomist. The question was refined to our current title. We bring this debate to the anatomy community through the pages of this journal and also through an online virtual issue on dissection and medical education, available at www.wiley.com/anatomy/dissection. The format of this debate forum was designed to be similar to a formal debate. The moderators invited several anatomists to present and defend their positions on the topic. There were two proponents: one pro, arguing that dissection is necessary to learn medical gross anatomy, and one con, arguing that dissection is not necessary to learn medical gross anatomy. The proponents stated their positions independently. There were also two rebuttal debaters, one pro and one con. The rebuttal writers had the opportunity to review the proponent papers for each position and then present a response supporting their own position. The authors were allowed only limited space to make their arguments and were encouraged to provide data and references in support of their positions. Dr. Noelle Granger, from the University of North Carolina School of Medicine, was the proponent for the pro position and presented arguments based on her and her students' experiences (Granger, 2004). Her position was supported by many references. Dr. John McLachlan from the Peninsula Medical School (Plymouth, U.K.), where cadaver dissection is not part of the anatomical education program, supported the con position and described the rationale for their institution's gross anatomy teaching program (McLachlan, 2004). The rebuttal for the pro aspect was coauthored by Dr. Wojciech Pawlina, from the Mayo Clinic College of Medicine, and Dr. Nirusha Lachman, of the Durban Institute of Technology in South Africa. Pawlina and Lachman (2004) expanded on some of the ideas discussed in the proponent papers and drew a link between dissection in the gross anatomy laboratory and the acquisition of clinical skills, as well as the development of professionalism and professional attitudes for medicine. Dr. Kimberly Topp, from the University of California, San Francisco, authored the rebuttal for the con aspect. Topp (2004) made a point-by-point rebuttal to the pro arguments presented by Granger (2004) and indicated where she believed cadaver dissection may not be necessary in medical education. It is worth noting that anatomy is not only the study of morphology or the structure and function of the members of the zoological or botanical kingdom, but also the geography of a biological entity. In this case, the human anatomist is actually a geographer of the human body. As geographers of the human body, we use atlases to find our way around. Many of us use exploratory learning such as dissection with other clinical resources like images generated by medical imaging modalities both to teach anatomy and to expand the anatomical knowledge base. After a number of visits, we become familiar with the places we have visited, just like one becomes familiar with a new town once one has driven around it. Value judgments aside, it is inescapable that the extent we experience hands-on and personal or emotional aspects of this educational journey directly affects not only how we teach the geography of the human body but also how and what our students learn. This also affects the knowledge they take with them into clinical practice as physicians. As more than one author has noted, though, many anatomists may now be faced with implementing new curricula with little or no dissection, regardless of the educational arguments the faculty present. Unfortunately, in this context, the points of this debate may seem moot or even inconsequential to deans committed to downsizing course hours in the face of budget cuts and expanding curriculum goals. Deans will also claim “BME” (best medical education) practice as justification for devaluing dissection in the curriculum. However, the ethical and personal challenges for anatomists remain because as educators, we like to believe that we are doing the right things the right way, and for the right reasons. That belief may become a forgotten luxury as the number of teaching anatomists, training programs, and available secured academic programs continues to decline. As a spin-off from this debate forum, we moderators pose a couple of questions to the readers. Does BME practice mean that one can merely learn anatomy using an atlas or medical images and then be able to navigate on or around the human body effectively? Can the streamlined, non-cadaver-dissection-based teaching or training approaches used in anatomy and physiology courses for nurses and allied health professionals be effectively and appropriately used in the anatomical education of medical students? This new debate is now open to the readers and we encourage your comments.