Medical students have been learning anatomy – by dissecting cadavers – in much the same way for hundreds years. But the method is time consuming.
And medical schools must cram in more content than ever to make sure students keep up with the latest science. Now, a growing number think they can teach students without bodies. But will they lose anything along the way?
A lot of doctors say their first patient was the cadaver in medical school.
“Who made the first incision, was it you or me?”
Four first year medical students are gathered around a cadaver in a busy anatomy lab at Brown University. They’re trying to remember who made the first incision in this body they’ve been learning about all year. It’s a big moment, a rite of passage, that first cut. Now it’s the end of the semester, and they’ve dissected nearly every part except the leg and foot.
“I’m not sure whether I’m cutting the retinaculum. I just want to make sure I'm not cutting anything important," says student Alexa Choy, who's working the foot. It’s tough, she says, to separate tendon from ligament, fat from tissue. Tough to figure out what’s important to study, and what can be cut away. In a structure like the foot, it can take hours, says student Lauren Park, to get down to the layers you need study.
“Despite all the layers we just took off, the fat pad and the skin, and the tough fascia, this is just the first layer of the foot muscle.”
Students at Brown have access to a state-of-the-art cadaver lab. But not every medical program can afford such a lab or maintain an expensive body donation program. So some medical educators find the next best thing.
“So, this is Iris," University of Rhode Island anatomy program head Ora Grandige introduces her newest teaching tool. Iris is a life sized synthetic cadaver called a SynDaver. From across the room, she looks like a skinless corpse, lying in an unzipped body bag, though up close you can tell she’s made of soft plastic. She’s got moveable veins and arteries, tendons, muscles, and bones. Her organs can be lifted out and inspected.
“The mouth is very realistic. You can actually intubate him and see the vocal cords.”
But it’s not quite like the real thing. I’ve brought Brown medical student Lauren Park to see the SynDaver, to get a sense of how she’d feel about learning anatomy on an imitation. Park says class with a SynDaver might go faster.
“Here you definitely would learn everything you need to learn very efficiently, without going through the fat.
But that’s not necessarily a good thing. In a real cadaver lab, every body is different: one might have had surgery, another shows signs of cancer. And spotting those differences is a teachable moment, says Park. That’s one reason she says she can’t imagine learning human anatomy without a real body. But educators at Case Western Reserve University in Cleveland are betting students can.
At a recent conference in Cleveland, I tried on a new Microsoft device called the HoloLens. It’s a virtual reality headset. And when I put it on, I see a holographic body in front of me. I can walk around it, put my hands into it, move things around. And this, says Case Western Reserve University radiology professor Mark Griswold, is the future. By 2019, he believes Case Western Reserve’s medical school will need no cadaver lab. Just HoloLenses. Griswold says teaching anatomy will be faster and better this way. First, it’ll be more accessible.
“Going to a cadaver lab is not fun. The smell is horrible. People actually have reactions to the formaldehyde that's there. We have students that can't do it because they really can't tolerate being in the room."
Second, a hologram can show students even more than a cadaver can.
“The one thing where we really see a benefit of this over traditional cadavers is in the nervous system. So in the brain for example, in the cadaver there’s nothing there, there’s just mush.
But Griswold says it’s easy to upload images of the brain’s intricate structures straight from an MRI into the HoloLens.
Watch Prof. Mark Griswold demonstrate HoloLens.
“Then it gives us this exquisite three dimensional structure you can’t get any other way.”
Next, anatomy classes can be taught much faster because students can zoom in on the exact structures they need to study without all the dissection. And time savers matter in a medical school curriculum that’s packed with more and more information every year.
But what might be lost when students aren’t handling an actual cadaver? What about learning how parts of the body actually feel? Griswold says that is a problem.
“The tactile sense that you get in a cadaver lab is important. There’s actual good scientific data that shows that it relates to memory, that being able to touch something relates to memory. So we’re working on ways to be able to replicate that.”
They’re not there yet, so that kind of learning will have to come from other experiences. But something else might be lost when you learn anatomy from a hologram. Brown University medical school staff psychiatrist Dr. Christine Montross says it’s the emotional connection.
“I feel strongly that interaction with a human body is something critical that can’t be replicated. For two reasons: one is anatomical, one is about the practice of being a physician.”
Anatomically, she says, real bodies teach better than any image could, because each one is different, and that’s closer to what students will experience in the real world. But there’s something else cadavers can teach students before they make their way into t the real world: how to deal with the emotions that come up when you work on a real body – making that first cut, dressing a wound.
Listen to an interview with Dr. Christine Montross about her book, "Body of Work: Meditations on Mortality from the Human Anatomy Lab."
“In our practices, we are not treating images, we are not treating holograms. We are treating human beings. And each of those human beings has their own distinct identities. And I think in some way identity in the anatomy lab is part of what makes it a profound experience.”
The American Association for Anatomists surveyed medical schools a few years ago and found that most maintain some kind of cadaver lab. But a new survey is underway. Researchers believe the number of full cadaver labs may be dwindling, and that more medical schools are adding digital tools to help teach anatomy.