Importance of Anatomy in medical education and practice: The basic objective of medical education and practice is to maintain good health taking care of the human body. Anatomy is the morphometric structural science of the human body, consisting of variations in normal shapes, sizes, locations, orientations, configurations and pathways of macro/microstructures of organs, limbs and systems of the body and its development from the zygote to complete body. Thus, morbid Anatomy (Pathology), functional Anatomy (Physiology) , imagery of normal/distorted anatomical structures (Radiology), manipulation for restoration, removal and replacement of morbid anatomical structures (Surgery) and restoration, activation, dissolution of extra growth or other structures through drugs (Medicine) cannot be mastered in medical education without a thorough comprehension of Anatomy. But more than this, diagnosis is based on thorough physical examination by inspection, palpation, percussion and auscultation .
Then, using the outcome of logical and precise analysis and the mapping of signs and symptoms is carried out as asked in questionnaire- Can the interrelation among the distortion, impairment of functions, signs and symptoms and disease be better understood by TTA through integrated cadaver or by alternative methods? 1. TTA 2. Alternative methods. The degree of injury/distortion, in structure organ or system, is required not only for severity of disease to plan type of treatment but also its chronology for surgery. The opinion regarding this has been obtained by-Can the images of distortions be interpreted without the knowledge of normal and distorted shapes? In more complicated cases of surgery, it is advisable to carry out practice on cadaver before performing actual surgery. So, question has been framed as-Can the exercise prior to surgery be performed on 1. cadaver or2. Alternative methods. These reflect the interrelation among disease processes, distortions or variations of anatomical structures, and the impairment of functions of organs and systems . To accomplish this analysis, a knowledge of anatomical structure in relation to activities and functions is crucial to interrelate the impairment through distortion with signs and symptoms, and this is aided by the ability to identify distorted images by radiology. Treatment follows these processes. Sound knowledge of sufficient Anatomy is ‘most essential’ and indispensable, not only in mastering medical education but in clinical practice. Besides these well-established observational inferences, many viewpoint surveys have revealed that Anatomy is highly useful in clinical practice and forms an integral part of medical education and practice [5, 15, 32, 43, 58].
Crisis of knowledge of Anatomy in medical education: In spite of the fact that Anatomy is so important in medical education and practice, many future doctors have been found to have an inadequate knowledge of Anatomy [5, 15, 32, 43, 48, 58]. This, in turn, is leading to a fall in the overall standard of medical practice . The reasons for this have been attributed to ignoring and neglecting the teaching of Anatomy, due to rapidly declining resources and infrastructure facilities together with reduction in the time scheduled for anatomy in medical curricula [4, 8, 10, 12, 18, 25, 50]. This trend is compounded by closure of dissection halls and Anatomy departments, and the lack of recruitment of experienced Anatomy faculty [9, 54, 60]. It has also been argued that, in addition, federal laws have been ignored in the USA, and GMC guidelines are not being followed in the UK [9, 10, 54].
Teaching methodologies of Anatomy in medical education: Many researchers have suggested improvements in teaching methodologies to improve the acquisition/delivery of knowledge of Anatomy . Feigl and Sammer , Kumar and Singh , Pais et al., , Patra et al.,  and Ramsey-Stewart  have carried out a very good study on model pedagogy of Anatomy, utilizing a blend of new and traditional teaching methodologies (updated traditional teaching of Anatomy) to improve the acquisition and delivery of anatomical knowledge. In another study, Singh et al.,  looked at the development of Anatomy as a subject, aiming to transform the comprehension of medical education and thereby clinical practice in general and the knowledge of Anatomy in particular in future doctors.
Comparative analysis of TTA and alternative methods from literature review: As elaborated above, for safe and successful clinical practice the clear concept of Anatomy is most important. Therefore, it is pertinent to compare the delivery of anatomical knowledge by both methods. The comparison of two methods of teaching is a debatable and controversial issue. However, the table of comparison gives the glimpses of advantages/disadvantages of two methods of teaching providing a clue for TTA to be superior to alternative method (Table 1).
Cadaver dissection: The most important, in TTA, is study of Anatomy through cadaver dissection. The dissection is used in Anatomy teaching for over 400 years ) providing value addition such as; thorough understanding, ability to apply in clinical practice, emboldening to face causalities, achieving experience of skill for surgery and understanding the relationship between patients’ symptoms and pathology [1, 20]. It also develops professionalism, spirit of working together, stress management and empathy . The cadaver dissection provides opportunity to detect more anatomical variations/anomalies  unlike plastination and preserve texture to a level close to those of living body which allow students to feel as if they are in the operating theatre .
Therefore, the dissection courses are still indispensable for learners to achieve anatomical knowledge . Majority of anatomists (69%) advocated for dissection  together with Kerby et al.,  and Davis et al.,  rated/discovered that anatomists and medical students found dissection as fittest method to teach Anatomy.
The cadavers’ color, texture and smell are different from real patient and they cannot be palpated, auscultated or usefully asked to change position . On the other hand, the dissection is not only costly, time-consuming and outdated [2, 34, 36, 53] but also, dissection is not being used in many medical schools in UK, US, and Australia [10, 13, 53]. The feel of touching the cadaver, incise the skin, and looking into the natural complexities of the body cannot be simulated perfectly. So, these newer technologies  can be used as an add on to visualize the anatomy of complex structures as elaborated by Kumar and Singh  also
Prosections: A prosection is an already dissected, sometimes plastinated specimen. Due to reduction in time schedule of Anatomy in medical education, prosections have been adopted as shortcut method to teach such a important subject like Anatomy which is indispensable not only to comprehend medical subjects but also to perform safe and successful clinical practice. The first medical school in UK namely, “The University of Warwick” adopted plastinated prosections to deliver Anatomy in 2009 . Thereafter, other medical school including St George's (London, UK) and Nottingham University (UK) followed the que. 94% of students found plastinated prosections as a useful tool for their anatomical learning. The prosection based teaching is prevalent in 19 Australian and New Zealand medical schools . However, the cumbersome and time-consuming process of preparing prosections by ample of skilled personal are a few constraints beside those explained in the Table 1. Furthermore, the medical trainees learned from prosection or plastination expressed that their anatomical knowledge is confusing and insufficient . The learning with plastinated prosections was perceived to be compromised because of limitations in terms of tactile and emotional experience. Still, some anatomists believe that prosections can replace full body dissection in teaching gross anatomy .
Medical imaging: The medical imaging is traditionally used during teaching Anatomy as an aid to clinical practice but teaching of Anatomy, exclusively, through imagery is constrained by the knowledge of normal and variant morphology and morphometry of shapes, sizes, locations, orientations, branching patterns, pathways and configurations of multitude of anatomical macro/microstructures in organs and systems derivable from teaching through cadaveric dissection. However as mentioned in a quote by author at the beginning, “If imagery is the third eye of a clinician for investigating disease, Anatomy is his sixth sense to comprehend and analyze the disease and prescribe treatments. Without the sixth sense, neither eye can sense an image nor can record it. So, together Anatomy and Radiology contribute, divided they demolish.”, sent a crystal clearly message that Anatomy and Radiology are, not to speak of, complement to each other, rather both are used to analyze Anatomy of the body of patient. However, images are images, but image cannot give a feeling of real. Though the studies through cadaver dissection give morphology and morphometry of real structures yet these structures are different from patient’s structures. But these are only sources of knowledge for clinical analysis. Therefore, to investigate the patient’s disease, delivery of sound knowledge of both Anatomy and Radiology is essential.
It is pertinent to mention here that the clinical practice, fundamentally, depends on development of structures and their relation with daily activities and functions in relation to morphology and morphometry of real structures and complications through distortions by infections through pathogens, exposure to extreme environmental conditions, traumas and injuries, side-effects and iatrogenic injuries. Thus, distortions are root cause of diseases. These distortions are interrelated with cascading effect on other structures and processes running in human body. These things can only be diagnosed and manipulated by the knowledge accumulated from complete integrated human body and images of distorted structures. So, this entire knowledge derived from extrapolation and interpolation from cadavers to be applied to patient with the help of recorded and interpreted imagery of distorted structures. So, the radiological images are used in teaching of Anatomy to see in vivo visualization of anatomical structure and physiology as well as insight into pathological processes with the help of computed tomography (CT), magnetic resonance imaging (MRI) and ultrasound to observe internal morphology in 2D and 3D and to interpret anatomically, the images in clinical context [7, 21, 24, 30, 37]. The brilliant and beautiful comments on the role of radiology and radiologist in anatomy teaching has been explicitly, brought out in an editorial .
Thus, the importance of imagery cannot be ignored as it helps to locate, identify, and interpret distortion [38, 47] but as regards teaching of Anatomy, be it, morphology and morphometry of normal/distorted structures, their configuration, their networks in entire body, systemic configuration, the development of structures/organs/systems and the use of histological study to see microstructures, is impossible. Medical imaging cannot substitute for the benefits of conventional dissection [2, 21, 23] as it has important limitations as a stand-alone approach. By denying students the opportunity to dissect, “the immediacy of the mortality of cadavers and patients is likely to be dissolved” . Though clinical practice is based on the analytic knowledge of Anatomy but Radiology provide the structural changes inside the patient body which otherwise are not possible.
Live anatomy: This is more akin to Patient’s Anatomy; therefore, this is more useful to calibrate the patient’s body to locate the normal/distorted structures from the surface in respect of clinical findings. The live Anatomy unlike cadaver provide similar color, texture and smell like real patient.
Peer physical examination (PPE) involves students physically examining each other . Some Students are willing some are not to participate in PPE . The students learn physical examination in primary diagnosis before switching over to the patients together with empathy and interaction skill [42, 59]. This method of examination is frequently used in medical education . Body painting in anatomy education refers to painting internal structures on the surface of the body using marker pens or wax crayons . Body painting enhances retention and recall of anatomical knowledge [19, 35] and is very helpful in surface anatomy and clinical skills.