Imaging the cadavers being dissected does not appear to improve the gross anatomy dissection...

Imaging the Cadavers Being Dissected Does Not Appear toImprove the Gross Anatomy Dissection Experience

To the Editors, Anatomical Sciences Education:

In their Letter to the Editor entitled “Are computed tomog-raphy scans of cadavers perceived as a useful educationaladjunct in a surgical anatomy course?” Cornwall and Stringerargue that incorporating CT scans of the actual cadavers beingdissected is of limited value in a surgical anatomy course(Cornwall and Stringer, 2014). The authors of this letter citeour study (Lufler et al., 2010), in which we examined theutility of providing CT scans of some of the cadavers beingdissected in a large first-year medical gross anatomy course.Despite numerous methodological differences, the conclusionsof both studies are consistent with each other.

In the study by Lufler et al. (2010), we provided the CTscans of four of the 22 bodies being dissected in the first yearmedical gross anatomy course. All students had access to thescans, but only 18% of the students dissected the bodies thathad been scanned. Individual student use of the scans wastracked by requiring that individuals log in to the computers inorder to access the scans. The results of that study demon-strated that those individuals who used the scans performedmore strongly on numerous measures of academic performancein the course. However, there were no differences in perform-ance between students who dissected the specific cadaver thatwas scanned and those that dissected one of the other bodies.

Despite being targeted at different populations (first-yearundergraduate medical students versus surgical residents) andhaving used different methods of assessment (examinationgrades versus surveys), our study and that of Cornwall andStringer find similar conclusions. Namely, making availablethe scans of the actual cadavers being dissected does not seemto impart any benefit beyond that of providing a generic CTscan. However, the methodological differences between thestudies should be emphasized. Unlike Cornwall and Stringer,we did not solicit any feedback from the students to determinehow they perceived the CT scans educationally. It is possiblethat the students who used the CT scans in our study felt thatthis practice was educationally useful, even if their examina-tion scores later proved to be indistinguishable from those oftheir peers. Because of the different methodologies it is diffi-cult to directly compare the results of these two studies.

Both sets of authors also make the caveat that this conclusionmay change if trainees are required to correlate their dissectionswith their scans in some way. The students’ use of the CT scansin both of these studies was optional and self-directed. It hasbeen shown that self-directed learning principles can elicit mixedfeedback from students on their educational value (Bergmanet al., 2013). In our study, students with kinesthetic learningstyles were most likely to use the scans, indicating that self-directed use of scans in the laboratory may only be appealing toa subset of the trainees. Given any lack of concrete purpose forthe scans, it is not surprising that there was no obvious benefitto being able to correlate the scans to particular cadavers.

However, it is not difficult to imagine educational scenariosin which it would be very useful to be able to correlate cadaver-specific CT scans with the students’ dissection activities. Forexample, Bohl et al. (2011) describe the use of web-based, self-guided clinical cases based on findings in postmortem CT scansof the cadavers in their first-year undergraduate course. Simi-larly, Jacobson et al. (2009) describe the creation of “virtualpatients” from the CT scans of the cadavers in their laboratory.The pathological findings from the CT images were used todevelop plausible clinical cases designed to highlight and explainthe abnormal anatomic findings encountered during the cadav-eric dissection. In both of these studies, students were encour-aged but not required to use these cases. However, with littleadditional work, tasks could be designed that require the stu-dents dissecting the scanned cadavers to use these virtualpatients’ findings to prospectively guide their dissections, espe-cially in the context of interesting pathologies or anomalies.

In conclusion, Cornwall and Stringer (2014) generally agreewith our conclusions by Lufler et al. (2010) that there is limitedutility of providing the CT scans of the actual cadavers beingdissected. It is reasonable to postulate that activities could bedesigned that would increase the utility of scanning the actualbodies being dissected. However, the pedagogical benefit of suchactivities must be weighed against the significant financial andtime expenses required to acquire the scans and produce the cor-responding educational tasks every year. Although the benefit ofscanning the same donors may be limited, evidence does supporta robust educational benefit of providing generic high qualityradiological images in the gross anatomy laboratory.

Rebecca S. Lufler, Ph.D.Department of Anatomy and Cellular BiologyTufts University School of MedicineBoston, Massachusetts

Ann C. Zumwalt, Ph.D.Department of Anatomy and NeurobiologyBoston University School of MedicineBoston, Massachusetts

*Correspondence to: Dr. Rebecca S. Lufler, Department of Anatomyand Cellular Biology, Tufts University School of Medicine, Boston,Massachusetts, USA. E-mail: rebecca.lufler@tufts.edu

Received 24 July 2013; Accepted 29 July 2013

Published online 2 October 2013 in Wiley Online Library(wileyonlinelibrary.com). DOI 10.1002/ase.1399

VC 2013 American Association of Anatomists

Anat Sci Educ 7:78–79 (2014) JANUARY/FEBRUARY 2014 Anatomical Sciences Education

LETTER TO THE EDITOR

LITERATURE CITED

Bergman EM, Sieben JM, Smailbegovic I, de Bruin AB, Scherpbier AJ, van derVleuten CP. 2013. Constructive, collaborative, contextual, and self-directedlearning in surface anatomy education. Anat Sci Educ 6:114–124.

Bohl M, Francois W, Gest T. 2011. Self-guided clinical cases for medical stu-dents based on postmortem CT scans of cadavers. Clin Anat 24:655–663.

Cornwall J, Stringer MD. 2014. Are computed tomography scans of cadaversperceived as a useful educational adjunct in a surgical anatomy course? AnatSci Educ 7:77.

Jacobson S, Epstein SK, Albright S, Ochieng J, Griffiths J, Coppersmith V,Polak JF. 2009. Creation of virtual patients from CT images of cadavers toenhance integration of clinical and basic science student learning in anatomy.Med Teach 31:749–751.

Lufler RS, Zumwalt AC, Romney CA, Hoagland TM. 2010. Incorporatingradiology into medical gross anatomy: Does the use of cadaver CT scansimprove students’ academic performance in anatomy? Anat Sci Educ 3:56–63.

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