Putting a face on the dissection debateThe New Physician
He was the first person to teach me about the human body. Yet, he never spoke a word. He was the first person who taught me how to interact with patients. Yet, I never even knew his real name. He was the anonymous donor who generously had decided in life to donate his body in death so that I could learn to become a doctor.
My anatomy group named him Cody, and for 10 weeks, he taught me about the intricacies of the human body while forcing me daily to come face to face—literally—with death.
Cody was an integral part of my first year of medical school. But I worry that future classes will not have the chance to work with their own “Cody.”
Medical education is changing. One such change that has been stirring up controversy, but has yet to reach its full effect, is the abandonment of traditional dissection in anatomy class in favor of alternative approaches such as prosection or computer imaging.
The dissection versus prosection debate has a long history, and today U.S. medical students have aspects of both in their curricula. In the view of many, prosection should be the preferred method, since dissection is a slow and meticulous process. You must peel back the layers of skin, fascia and fat, and manipulate your way through a labyrinth of tissue to get a glimpse of what lies underneath.
Using prosections—pre-dissected specimens—students do not have to take time cutting, or even thinking about how to cut. They do not have to worry about finding and then dissecting out that brachial plexus, or wondering if it is an anatomic variation when they do finally locate that thyrocervical trunk. When you think about it, a lot of dissection time is spent on a preserved cadaver that does not fully resemble a living human.
The prosection program has been shown to be more efficient and time-sparing, freeing up more time for students to do independent study or pursue other activities. Studies have shown that students who learn through a prosection program perform similarly on practical tests as students who learn via dissection. In fact, prosection students may have better recall ability several years down the line.
Another strong argument in favor of prosection is that it presents less emotional strain for medical students than dissection. One study showed that 7 percent of dissection students reported recurring images of cadavers, and 2 percent had insomnia after commencing dissection. For some of us, gross anatomy was the first time we dealt with death, and that can be a difficult adjustment for some to make.
Yet faculty and students alike still find it hard to let go of cadaver dissection, no matter how inefficient and time-consuming it might be. It is a process that teaches us about teamwork as we spend long hours with our fellow students and teachers, dissecting and studying the cadaver. And it is a process of discovery, where the time spent searching is just as meaningful as what we find at the end.
Gross anatomy dissection also teaches us about professionalism. Each encounter with the cadaver must be treated as an interaction with a patient. We must be respectful in the words we use and the actions we take. That means covering the body appropriately, cutting and not slashing, and speaking as if a donor family member is standing nearby. Despite the scientific purpose in our dissection of his entire body, we never lost sight of the fact that Cody was once someone’s son, father, brother, partner or friend.
And finally, with dissection, you put a human face to death and learn how to deal with it. For me, that was the hardest but most important lesson to learn. Cody’s face remained covered with a cloth and bag until the last third of the anatomy course. When it came time to uncover it, I was terrified. My heart immediately started palpitating, and my throat became dry. And when I finally saw his face, my initial thoughts were how long his eyelashes were, and that he must have had beautiful doe eyes. However, I took a deep breath, composed myself and commenced the dissection.
I eventually learned to detach myself from the man Cody without sacrificing my compassion and mindfulness. After all, I like to think those are the qualities that drew me into medicine in the first place. Had I not gone through that experience in my first year, I do not know how I would have handled patient mortality when I got to the wards in my third year.
Without being too cliché, gross anatomy was a life-altering experience for me. I am sure many other students would agree. Although I can see gross anatomy evolving into something that is a blend and balance of dissection, prosection and radiology, I hope we have yet to see the end of traditional dissection. It is a rite of passage for the medical student. After all, dissection and human anatomy have gone hand-in-hand since the times of ancient Greece, and the use of cadavers has been a mainstay since the 15th century.
I think you would be hard pressed to find a physician who does not vividly recall his or her medical student dissection experiences. How often does one have the chance to open and look inside the human body? Is it time-consuming? Yes. Do you learn anything unique from the act of dissecting? Maybe not. Can it have a weird psychological effect to uncover the face of a cadaver, only to dissect it minutes later? Probably. Would I trade that learning experience for anything? Absolutely not.
At the end of those 10 weeks spent with Cody, I thanked him and said my goodbyes. We left a single lavender orchid on his chest, and with that, he was taken to be cremated. At our body donor memorial service several months later, I made a speech to the donors’ loved ones with reference to Cody. I referred to him not as the cadaver that we dissected in anatomy class, but as the body donor who had given us a gift from which we could learn.
Because of him, I said, I will become a better doctor. I hope future generations of medical students will be given the opportunity to say the same.
Nahal Rose Lalefar is a third-year at the University of California, Davis, School of Medicine.