Dissecting a cadaver cannot be replaced by technology

I was browsing the now famous mini-lecture website, TED.com, when a certain video caught my eye.  The presenter began by naming the various pitfalls of anatomy dissection such as its high cost and noxious chemicals.  He whirled through a short demonstration using his brand new Automage Table, a 3D touch screen rendering of the human form.  In his virtual dissection, he quickly and effortlessly revealed various organs and vessels.  He isolated the circulation system, then just the heart floating in space.  Zooming in, he displayed the four chambers of the heart in perfect three-dimensional clarity.  He showed every view I could imagine, except for the best one: the real one.

Technology carries the future of medicine, and that excites me.  However, technology can never replace one of the most fundamental experiences of a physician.  Even as a mere first year medical student, I am confident that dissecting a cadaver will remain one of the most poignant moments of my career.   Learning anatomy from a computer would truly turn medical students into computers themselves.

I remember the first day of anatomy vividly.  A prior group had just begun on my cadaver, and my group peeled back the white tarp to see their work.  A visceral wave of nausea ran over me, and I stepped back and sat down on a nearby chair.  Otherwise, I would have crumpled to the floor.  Sweat beaded on my forehead and my vision blurred.  After a few moments I snapped out of my trance.  I eventually returned to the cadaver, now slightly more prepared than the first time.  One of my colleagues was not as lucky, as a startling thud brought the room to an eerie silence.  A classmate across the room had fainted, assumedly overcome by the same torrent of emotion.  I battled on, observing while some of my more eager teammates began the dissection.  The scalpel was ceremoniously passed around my group of four, each person continuing to cut vertically along the back of the cadaver.  I was last.  I felt the heat of my peers’ eyes piling on top of my own trepidation.  I pressed the scalpel firmly into the tough skin, feeling the resistance of the tensile and leathery tissue.  The blade broke through as I glided further down the cadaver’s middle back.  I felt the subtle vibration of the connective tissue splitting, revealing raw and withered muscles.  I was entranced.  The awe, the fear, the privilege, and the humility of the incision froze my thoughts.  I had gained absolutely no medical knowledge at that point, but the humanity of medicine enveloped me.  There, for the first time, I felt like a physician in training.

Perhaps this sounds like hyperbole, especially to those that have not performed a human dissection, but my experience is not unique.  Ask any physician about their memories of anatomy, and they will describe their cadaver in startling detail.  I will never forget holding the enlarged heart that ultimately led to my cadaver’s death.  I will never forget feeling the sharp edges of her broken ribs, ostensibly the result of a last-ditch effort to resuscitate her after cardiac arrest.   Most importantly, I will never forget my first true step towards becoming a physician.

Drew Kotler is a medical student. 

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  • http://twitter.com/IVLINE Aaron Sparshott

    Everything you have said is exactly what I thought when I saw that video. This technology is an adjuvant not a replacement for dissection anatomy teaching.  To me medical anatomy is about getting as many senses involved as possible, chiefly sight and touch. Secondly, and perhaps the most often under-rated fact about dissection is that every body is different, and that each one does not always comply to some generic map of the human body.

    • http://www.facebook.com/brianpcurry Brian Curry

       Not to mention that when I look in an atlas (which is essentially what that thing is, more or less), I don’t necessarily remember what I am looking at. But when I spend literally hours digging around in fat to find one little nerve, you bet your ass I will remember the name of that sucker, and perhaps a thing or two about it.

      Your point is well taken, though; between the three cadavers I dissected (one as a 1st-year, and two as a prosector), each had marked variation in their vascular patterns, to say nothing of the students at the other tables in the lab.

      Another really neat thing is that there is a lot of pathology in some of the cadavers, and it was a really great learning experience to have a pathologist come by every so often and take a look at something you found, and tell you a little bit about it.

      All in all, aside from the smell, I remember my experience in the gross lab fondly. Thanks for writing this, Drew.

  • westeasterly

    I have to disagree; cadaver anatomy is a far cry from fresh, live human tissue.  So much effort in anatomy lab is spent trying to avoid taking a breath at the wrong moment, avoiding splashes, protecting teaching resources (books, computers, screens), and just trying to figure out if that splotch of grey tissue is a small artery, nerve, or absolutely nothing at all (or is something, but is not important).  Not to mention all the precious time spent digging for things that never appeared.   And oh my, the drama of anatomy student groups!  I’m not suggesting it’s completely useless, but I learned far more about anatomy during my surgery rotation and reading outside the lab than I ever did from gross anatomy.  A well-designed virtual dissection would have been far more educational; substituting countless hours of unnecessary manual labor for time spent learning and understanding.  And this is coming from an extremely visual and hands-on learner.

    • Jimmy_Peanut

      I think you missed the point of the post.  You’re right that a lot of work in anatomy with a cadaver is tedious, and yes, modern technology can teach anatomy very well.  But the point here is the sense of humanity that you get from working with a real human body.  That humanity will never be replicated in a machine.

      • westeasterly

        If we’re just talking about humanity, and not educational value, I feel no differently.  Certainly there’s value in respecting the gift of a human cadaver, but is the human connection with a preserved corpse anything compared to the connection with a dying patient during years 3 and 4?  While cutting through the face with a hacksaw, did you feel a stronger bond with your cadaver than while playing PS3 with your peds heme/onc patient, only to watch him draw his last breath 5 days later?  Or the octogenarian with a DNR who was ready to die?  Any idea how the cadaver procurement process works, and which families are most likely to do it?  Here’s a hint; it’s much cheaper turning a loved one over to first year medical students than it is to have them buried.  No matter how respectfully done, it always struck me (and others in the anatomy department) that there’s a tremendous amount of inhumanity involved in the cadaver procurement, preparation, and dissection process.  But of course this can be justified as a necessary “evil” of medical education.  However, with emerging technologies the question becomes….is it really necessary after all?  I say no, unless we’re also talking about eliminating the clinical years of medical education.

  • Bridget Ryan

    As a donor — far in the future, I hope — I wonder if I’ll do any good for the care of patients given by the next generation of physicians.  Will my donation be appreciated and respected?  My ‘gift’ at my death is altruistic (I’ve had cancer twice and I want to contribute something besides another race for the cure).  Maybe I’m naive.  It’s my hope that whoever dissects me can see a glimpse of my humanity, not just diseased systems.

  • Dorothygreen

    A point here from a non- physician but an interested other.  I went to an autopsy because I wanted to see a particular patient’s trachea.  I wanted to see what and if any damage had been done by suctioning and managing the endotracheal tube balloon cuff.    

    I had cared for this patient.  And he was a person to me even then.   I never dissected a cadevar.  Had never seen a real trachea, just read about the possible damage that could occur with bad suctioning technique and over inflation of the tracheal cuff.  It was beyond text book damage.  It stayed with me forever and I tried to spread the word.  This was many moons ago.

    I can understand how important it may be to do a dissection to learn anatomy.  However, I think the message of having to search through mounds of fat (this should never be part of human anatomy) or my experience or some other profound revealation of a human abusing themselves, or as a result of improper care is a far more  lasting, beneficial experience for physicians and other health care practitioners who care for people.   So, why not go to autoposies as part of training.

      

  • Molly_Rn

    Humans are never quite like the book or for that matter the “virtual” cadaver. They must not have read the text. Their anatomy isn’t exactly like the next persons and seeing and touching the real thing is a totally different experience. Having done cadaver work as a student nurse, assisting in surgery and also attending many autopsies, the human body is amazing. The complexity astounds you and yet it all works without you even giving it a thought, probably a good thing; imagine controlling your liver for a day. YIKES!