Unearthing the Capital Choice for Learning Anatomy- A Study on the Students Perspectives on Cadaveric Dissection in India

doi:10.21203/rs.3.rs-1641264/v1

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Unearthing the Capital Choice for Learning Anatomy- A Study on the Students Perspectives on Cadaveric Dissection in India

https://doi.org/10.21203/rs.3.rs-1641264/v1

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Introduction

What is the role of cadaveric dissection in the current scenario of anatomy education? We attempted to provide a valid answer to this controversial topic through our study. We analysed the students perspectives of different aspects of learning anatomy with their positive and negative experiences and got a better understanding of their opinions and their experience

Methods

In this cross-sectional study, a pretested and validated questionnaire was used to collect information from the students after approval from the Institutional Ethics Committee. Informed consent was obtained from every student prior to their participation in the study.

Results

Three hundred seventy seven students took part in this study and the response rate obtained was 63.5 %. The majority of the students endorsed that cadaveric dissection has helped them in learning the basic anatomy and has deepened their understanding of complexity of human body and has helped in better performance in clinical postings. The smell of formaldehyde and eye irritation was cited as the major reasons for finding dissection sessions challenging. Most of the students agreed that counselling before dissection sessions will help to alleviate the emotional reactions to cadavers.

Conclusion

The students unanimously agreed that cadaveric dissection sessions are the best way to learn basic anatomy complemented with newer teaching tools like prosections and computer based approaches. However, the problems encountered by the students like smell and irritation of formaldehyde need to be addressed with usage of alternative techniques.

Anatomy

Cadaveric dissection

Medical education

Medical curriculum

Anatomy is regarded as the language and foundation of clinical medicine [1]. Cadaver dissection (CD) began in 300 BC [1,2^] and by the 15th century, it had become a tool for studying the structural details of the human body. Teaching anatomy with CD is important in the traditional undergraduate medical curriculum [3], and thus CD has remained an important part of anatomy teaching over the last four centuries.

Anatomy has traditionally been taught through a variety of methods such as lectures, practical sessions based on models, prosected materials, and cadaveric dissection, as well as newer methods such as computer-assisted learning models, interactive computer-based software, and radiological images. Several universities around the world have implemented modern integrated curricula that include problem-based learning (PBL) [4], case-based learning (CBL), team-based learning (TBL), and other computer-assisted teaching methods in undergraduate anatomy classes [5, 6, 7, 8]. However, cadaver-dissection-based learning of human anatomy is the most superior method of learning because it allows students to understand the surface anatomy of different structures, realise the texture of tissues and organs, and confirm that variation is very common [9].

Throughout the years, most students have enthusiastically participated in dissection, but some students have found dissection to be an intolerable experience and have avoided it. This behaviour necessitates faculty identifying, acknowledging, and validating students' emotional distress, as this distress can interfere with the acquirement of competency and skills [10, 11, 12].

The purpose of this study was to look into the perceptions and attitudes expressed by medical students at a tertiary care teaching institute in South India, who were recruited from a variety of cultural backgrounds, about their perceptions and attitudes towards cadaveric dissection.

A cross-sectional study design was used. The main objective of this study was to probe medical student’s perspective towards cadaveric dissection learning sessions. The study was conducted among medical undergraduate students of a tertiary acre teaching centre in Tamilnadu, India. This is one of India's largest private universities in the field of science and technology, and students from various social and cultural backgrounds are trained here. All the medical students of the university from second year to final year were included in the study. The data was collected during the period from January to March 2021. All Medical Students who had direct contact with the use of cadavers for learning and who signed the informed consent form to participate in the study were enrolled. Students who refused to participate in the study were excluded.

The actual sample size was calculated using the single population proportion formula with the following assumptions: p = 0.5 (prevalence), 95% confidence interval, and 5% margin of error. The total number of students was 594, and a 10% non-response rate was applied, yielding a final sample size of 259. The convenience sampling method was used to select the samples.

Data were collected by a structured and pre-tested questionnaire. The data collection tools were developed by reviewing different related literatures. A total of 377 medical students from second year to internship were included in the study. After obtaining formal permission from the Institutional Ethics Committee and consent from the participants, they were told about the objectives and relevance of the study before they filled out the questionnaires containing 25 items. The basic components of the questionnaire were an overview to the research, socio-demographic aspects of the participants, and queries the application of dissection related in their clinical training and explored a wide array of questions related to their attitude. The questionnaire was circulated through google form link

Data was downloaded from Microsoft excel. The principal investigator reviewed all the collected data for consistency and completeness. Using SPPS v21.0, suitable percentage and proportions were calculated in interpretation of the results obtained.

The questionnaire was sent to 594 students and 377 (63.5 %) completed the questionnaire. The mean age of the students were 21 ± 1.6 years. Table 1 shows the demographic features of the study participants.

All of the participants (n=377, 100%) agreed that cadaver based learning of gross anatomy have helped them to develop and enhance empathy and compassion which has helped during training in clinical postings. Majority of the participants (n=371, 98.4 %) acknowledged that cadaver dissection has deepened the understanding of anatomy with respect to complexity and variability of the human body and provided an effective learning experience that reinforced lecture and textbook material. Also 98% (n = 370) of the participants admitted that the anatomical knowledge gained through dissection could be applied in training in clinical skills/examination of patients. The participants endorsed that CD has also improved their critical thinking power and professionalism. As a result, it is right to state that performing on cadavers generate positive experiences for the further medical education.

Upon analysing the reasons for finding the dissection challenging, multiple factors rooted out as depicted in figure 1. Majority of the participants agreed that the odour of formaldehyde is a major limiting factor (n= 348; 92.3%). More than half of the participants complained of eye irritation as well (n=226; 60%). Other factors which were accountable were fear of infections (n=190; 50.3 %), fear of mutilating bodies (n=115; 30.5%) and dislike touching cadaver (n=42; 11.1 %)

On further analysis of factors that were related to the conduct of the cadaver-based learning of anatomy, 73.7 % (n=278) of the participants revealed that long durations of dissections were a disadvantage. Not comfortable with the peer groups was also put forth as a reason by a small fraction of participants (n = 58; 15.4 %). Few participants also expressed that the anxiety and stress related to dissection negatively impact learning (n=15; 4%). All of the participants agreed that they were contented with the current teaching methodologies followed for learning anatomy (n=377, 100%).

The solutions for the above-mentioned challenges were also unearthed. Counselling before entering dissection room about the possible emotional reactions to cadaver was considered as critical by all of the participants (n= 377; 100%). They also insisted that need of proper use of safety equipment (gloves and masks) should be emphasized throughout the period (n = 348; 92.3%). Majority of the participants (n = 342; 90.2%) agreed that suitable measures should be adopted to overcome the unpleasant odour (eg. face masks). The participants also emphasized the requirement for proper management of moulds/fungus on cadaver (n = 190; 50.4%) and maintaining general cleanliness of the dissection hall (n=148; 39.3%).

Regarding teaching-learning methodology, all of the participants agreed that small group teaching prior to discussion can be considered for better understanding of structures (n= 377; 100 %). They also facilitated the usage of newer teaching tools and technologies along with CD for making learning anatomy enlightening.

The purpose of this study was to look into medical students' perceptions of the positive and negative aspects of cadaveric dissection. Anatomy knowledge is extremely important in the practice of medicine. Hence cadaveric dissection is considered to be an indispensable part in medical education since centuries.

In this study, the majority of students had favorable attitudes toward the utility of cadaveric dissections in the teaching process of anatomy. Cadaveric dissection, according to the students, deepens their understanding of anatomy, improves their clinical examination skills, increases their respect for the human body, and delivers a better perception of patient examination skills while also making learning interesting. This perspective conveyed by the participants in this study is similar to that expressed in an Australian study by Dissabandara et al [13]. Furthermore, Abass Alhassan et al [14] stated that approximately 87.9% of the participants in their study regarded cadaveric dissection as essential and integral in the science of human anatomy.

Previous research has shown that, while the versatility of cadaveric dissection in the modern medical education system is being challenged, those who actively participated in cadaveric dissection performed quite well in written and oral examinations [13,15]. According to the findings of several studies, dissections promote deeper learning by providing students with a significant chance to study the exact complexity of human body tissue and their clinical significance [16, 17].

In this study, the major perceived downsides of cadaveric dissection were the smell of formalin, eye irritation, and fear of infection. Furthermore, the students expressed apprehension about mutilating bodies. The majority of students, however, universally agreed that cadaveric dissection was the most crucial tool for learning for anatomy in the first year. This finding is line with the observations of previous studies. Several studies [18, 19,20] found that most students reported experiencing anxiety and stress, which had a negative impact on their learning.

The problem in recognizing structures is typical with students who are being introduced to dissection for the very first time. However, this challenge is believed to enable critical thinking among students, which is an essential element of the Problem Based Learning which is quite often followed in the latest competency based medical curriculum. According to studies, sufficient pre-dissection preparedness using lectures, model-based sessions, and appropriate tutor assistance during the dissection session usually alleviates such problems. The students also recommended that counselling before entering dissection room about the potential emotional reactions to cadaver is essential. They also insisted that need of proper use of safety equipment (gloves and masks) should be emphasized throughout the period. Majority of the participants also agreed that suitable measures should be adopted to overcome the unpleasant odour. The participants also emphasized the requirement for proper management of moulds/fungus on cadaver and maintaining general cleanliness of the dissection hall

Cadaveric dissection is indispensable in teaching and learning anatomy. Better facilitatory sessions and newer teaching methodologies like flipped classroom sessions will help in improving the student’s attitude towards dissection which in turn will help the students to perceive an effective learning experience, perform well in examinations and as well as to apply this knowledge in clinical training.

Conflicts of Interests/funding: The authors did not receive support from any organization for the submitted work

Ethics approval: This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee of SRM Medical College Hospital & Research Centre, SRM Institute of Science and Technology No. 2179/IEC/2020

Consent to participate: Informed consent was obtained from all individual participants included in the study.

Author contributions

Conceptualization: Dr Sudha K

Methodology: Dr Jerin James, Dr Sudha K

Formal analysis and investigation: Dr Pratheepa Sivasankari Natarajan, Dr Jerin James

Writing - original draft preparation: Dr Pratheepa Sivasankari Natarajan , Dr Jerin James

Writing - review and editing: Dr Sundara Pandian S.

Funding acquisition: Nil

Resources: Dr Sundara Pandian S.

Supervision: Dr Sudha K, Dr Sundara Pandian S.

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Table 1: Demographic features of the study participants

Variables		N (%)
Age (in years)	Less than 18	0 (Nil)
	18-24	299 (79.3)
	> 24	78 (20.7)
Sex	Male	204 (54.1)
Sex	female	173 (45.9)
Attendance in dissection	Regular	315 (83.6)
Attendance in dissection	Irregular	62 (16.4)
Year of study	Phase II	138 (36.6)
	Phase III	160 (42.4)
	Internship	79 (20.9)

Table 2: Positive experiences of cadaveric dissection

Attitude area	Agree; n (%)	Disagree; n (%)
Help to develop and enhance empathy and compassion which is helpful during clinical posting	377 (100)	0
Deepen the understanding of anatomy with respect to complexity and variability of the human body	371 (98.4)	6 (1.6)
Provide an effective learning experience that reinforced lecture and textbook material.	371 (98.4)	6 (1.6)
Anatomical knowledge gained through dissection could be applied in training in clinical skills/examination of patients	370 (98)	7 (2.0)
Improved critical thinking power and professionalism	377 (100)	0

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Unearthing the Capital Choice for Learning Anatomy- A Study on the Students Perspectives on Cadaveric Dissection in India

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Abstract

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Introduction

Methodology

Results

Discussion

Conclusion

Declarations

References

Tables

Status:

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