For fledgling medical students, slicing into their first cadaver can be an important rite of passage.
They often enter the anatomy lab as skittish new trainees and leave it as self-assured future physicians, having spent weeks or months digging fingers-first into the secrets of the human body.
That, at least, is the view of Benjamin Rosser, the head of Saskatchewan’s only anatomy lab, a place that is now at the centre of a debate about whether all medical students – not just future surgeons or specialists – should still have to perform traditional dissections before they become MDs.
About half of Canada’s medical schools have already traded complete dissections for a combination of pre-cut body parts and new imaging technologies that offer a faster route to teaching basic anatomy. Speed is of the essence because, as medical knowledge expands, some schools are finding it difficult to squeeze a complete dissection into undergraduates’ jam-packed schedules.
The University of Saskatchewan’s College of Medicine decided earlier this year to phase out full dissections from the core curriculum for undergraduates, a move the school made as it prepares to build a new $3.85-million human structures laboratory that is expected to open in 2016 or 2017. Dissections will still be offered as an elective or clerkship.
But proponents of mandatory dissections, including Dr. Rosser, the head of anatomy and cell biology at the U of S, say medical students will miss out on something fundamental if they are not required to wield their own scalpels on their own cadavers.
“It’s like the difference between watching somebody show you how to drive a car,” he said, “and actually driving it.”
There is no accreditation requirement for active dissections at Canadian medical schools.
Research on the best way to teach anatomy is mixed, according to Nick Ovsenek, the associate dean of biomedical sciences and graduate studies at the medical college at the U of S, and author of the report that recommended doing away with mandatory dissections. “If you look at the literature, it’s a polarized environment. The jury is out,” he said. Dr. Rosser disagreed, saying full dissections remained a gold standard for teaching anatomy.
So the question for medical schools is: What is the best use of undergraduates’ limited time? Especially if the bulk of those undergraduates plan to become family doctors?
“There’s so much pressure to put other material in the curriculum, and [dissections] is one place where time and energy on the students’ part can be extracted,” said John Bertram, co-ordinator of anatomy teaching at the University of Calgary’s faculty of medicine, which already offers the anatomy teaching regime U of S is adopting. Of 170 first-year medical students at the U of C, he estimated that fewer than 10 usually choose the elective that includes full dissection.
Maxwell Hincke, head of the division of clinical and functional anatomy in the faculty of medicine at the University of Ottawa, pointed out that medical students who go on to become surgeons or other hands-on specialists dissect cadavers as part of their post-grad training.
“In the last few years there has been increasing emphasis on what is relevant to the family medicine practitioner,” he said, noting that dissections have been optional for more than 30 years at the U of O. “We know that more than 50 per cent of our students are going to be family doctors.”
In his report, Dr. Ovsenek of the U of S estimated that making active cadaveric dissections optional would cut the number of hours undergraduate medical students devote to gross anatomy by 70, from 92 hours down to 22.
His report suggested there could be a minor monetary savings to scaling back the school’s body donation program from 30 or 40 cadavers a year to roughly half that, something Dr. Rosser argued would be virtually impossible if the school intends to keep a fresh supply of pre-cut body parts on hand and to continue offering dissections as an elective.
Dr. Ovsenek said in an interview that U of S does not expect to save much money from cutting back on bodies, all of which are bequeathed by people who want their deaths to further the training of future MDs. Big savings would have been possible if U of S had opted to do away entirely with cadavers and the morgue and staff necessary to preserve and prepare them. But the school opted for a “middle route” instead, he said.
The country’s top medical schools, including those at the University of Toronto, McGill and the University of British Columbia, all still make complete dissections mandatory, as do the majority of U.S. medical schools.
First-year students at the U of T work in teams on their own cadavers, but have access to 70 bodies spread across nine labs. That allows students to view and touch bodies of all shapes and sizes, said Michael Wiley, a professor of anatomy at the school’s faculty of medicine.
The traditional method also instills a respect for life and death in budding doctors, he added. Before they cut into their cadavers, Dr. Wiley always tells his students: “This is your first patient and it is the most vulnerable patient you’ll ever have. It’s up to you to look after them.”