DEBATE FORUM

To What Extent Is Cadaver Dissection Necessary toLearn Medical Gross Anatomy? A Debate ForumGEOFFREY D. GUTTMANN, RICHARD L. DRAKE, AND ROBERT B. TRELEASE

In this Olympic year of 2004 inAthens, Greece, which is consid-ered the birthplace of modern

Olympics, controversy was inescap-able. Whether it was the pointsawarded by the judges for gymnastics,Paula Radcliffe dropping out of thewomen’s marathon, or drug-testingscandals, controversy swirled. So, too,we find there is controversy within thearena of anatomical education formedical students. Athletes performedtheir tasks “just in time”; anatomicalsciences educators, however, mayhave the luxury of time to contem-plate the controversial issues they facetoday or they may have change thrustupon them—administratively, orthrough the fiat of best medical edu-cation practice.

The controversial issue for thisyear’s educational debate is to whatextent is cadaver dissection necessaryto learn medical gross anatomy. Oneof the moderators (G.D.G.) proposeda debate on whether dissection is nec-essary for learning medical grossanatomy for publication in The Ana-tomical Record (Part B): The NewAnatomist. The question was refinedto our current title. We bring this de-bate to the anatomy communitythrough the pages of this journal and

also through an online virtual issue ondissection and medical education,available at www.wiley.com/anatomy/dissection.

The format of this debate forumwas designed to be similar to a formaldebate. The moderators invited sev-eral anatomists to present and defendtheir positions on the topic. Therewere two proponents: one pro, argu-ing that dissection is necessary tolearn medical gross anatomy, and onecon, arguing that dissection is notnecessary to learn medical gross anat-omy. The proponents stated their po-sitions independently. There werealso two rebuttal debaters, one proand one con. The rebuttal writers hadthe opportunity to review the propo-nent papers for each position andthen present a response supportingtheir own position. The authors wereallowed only limited space to maketheir arguments and were encouragedto provide data and references in sup-port of their positions.

Dr. Noelle Granger, from the Uni-versity of North Carolina School ofMedicine, was the proponent for thepro position and presented argumentsbased on her and her students’ expe-riences (Granger, 2004). Her positionwas supported by many references.Dr. John McLachlan from the Penin-sula Medical School (Plymouth,U.K.), where cadaver dissection is notpart of the anatomical education pro-gram, supported the con position anddescribed the rationale for their insti-tution’s gross anatomy teaching pro-gram (McLachlan, 2004).

The rebuttal for the pro aspect wascoauthored by Dr. Wojciech Pawlina,from the Mayo Clinic College of Med-icine, and Dr. Nirusha Lachman, ofthe Durban Institute of Technology in

South Africa. Pawlina and Lachman(2004) expanded on some of the ideasdiscussed in the proponent papersand drew a link between dissection inthe gross anatomy laboratory and theacquisition of clinical skills, as well asthe development of professionalismand professional attitudes for medi-cine. Dr. Kimberly Topp, from theUniversity of California, San Fran-cisco, authored the rebuttal for thecon aspect. Topp (2004) made a point-by-point rebuttal to the pro argu-ments presented by Granger (2004)and indicated where she believed ca-daver dissection may not be necessaryin medical education.

It is worth noting that anatomy isnot only the study of morphology orthe structure and function of themembers of the zoological or botani-cal kingdom, but also the geographyof a biological entity. In this case, thehuman anatomist is actually a geogra-pher of the human body. As geogra-phers of the human body, we use at-lases to find our way around. Many ofus use exploratory learning such asdissection with other clinical re-sources like images generated by med-ical imaging modalities both to teachanatomy and to expand the anatomi-cal knowledge base. After a number ofvisits, we become familiar with theplaces we have visited, just like one be-comes familiar with a new town onceone has driven around it. Value judg-ments aside, it is inescapable that theextent we experience hands-on and per-sonal or emotional aspects of this edu-cational journey directly affects notonly how we teach the geography of thehuman body but also how and what ourstudents learn. This also affects theknowledge they take with them intoclinical practice as physicians.

Dr. Guttman is a moderator of this fo-rum and a member of the journal’sPanel of Reviewers. Drs. Drake and Tre-lease, both moderators of this forum,are members of this journal’s EditorialAdvisory Board.

We encourage reader feedback.Please direct all responses and com-ments to the editors at newanat@wiley.com and be sure to add “debateforum” to the subject line.

DOI 10.1002/ar.b.20042Published online in Wiley InterScience(www.interscience.wiley.com).

THE ANATOMICAL RECORD (PART B: NEW ANAT.) 281B:2–3, 2004

© 2004 Wiley-Liss, Inc.

As more than one author hasnoted, though, many anatomistsmay now be faced with implement-ing new curricula with little or nodissection, regardless of the educa-tional arguments the faculty present.Unfortunately, in this context, thepoints of this debate may seem mootor even inconsequential to deanscommitted to downsizing coursehours in the face of budget cuts andexpanding curriculum goals. Deanswill also claim “BME” (best medicaleducation) practice as justificationfor devaluing dissection in the cur-riculum. However, the ethical andpersonal challenges for anatomistsremain because as educators, we liketo believe that we are doing the rightthings the right way, and for the

right reasons. That belief may be-come a forgotten luxury as the num-ber of teaching anatomists, trainingprograms, and available secured ac-ademic programs continues to de-cline.

As a spin-off from this debate fo-rum, we moderators pose a couple ofquestions to the readers. Does BMEpractice mean that one can merelylearn anatomy using an atlas or med-ical images and then be able to navi-gate on or around the human bodyeffectively? Can the streamlined, non-cadaver-dissection-based teaching ortraining approaches used in anatomyand physiology courses for nurses andallied health professionals be effec-tively and appropriately used in theanatomical education of medical stu-

dents? This new debate is now open tothe readers and we encourage yourcomments.

LITERATURE CITED

Granger N. 2004. Dissection laboratory isvital to medical gross anatomy educa-tion. Anat Rec (Part B: New Anat) 281B:6–8.

McLachlan J. 2004. New path for teachinganatomy: living anatomy and medicalimaging vs. dissection. Anat Rec (Part B:New Anat) 281B:4–5.

Pawlina W, Lachman N. 2004. Dissectionin learning and teaching gross anatomy:rebuttal to McLachlan. Anat Rec (Part B:New Anat) 281B:9–11.

Topp K. 2004. Prosection vs. dissection,the debate continues: rebuttal toGranger. Anat Rec (Part B: New Anat)281B:12–14.

DEBATE FORUM THE ANATOMICAL RECORD (PART B: NEW ANAT.) 3