The mere mention of the word 'cadaver' elicits vivid images of medical students meticulously and painstakingly dissecting a preserved human body under the tutelage of anatomy lecturers in a laboratory setting. Cadaveric dissection, the paradigm of anatomy teaching since the Renaissance and at one time "an almost universal expectation of medical courses" (McLachlan & Patten, 2006, p. 244), is in the process of being replaced by other methodologies in the teaching of human anatomy. This is due to a significant reduction in the amount of time allocated for the anatomy curriculum. The move towards an integrated curriculum in many medical schools has led to a reduction in the time given for lectures and practical classes in basic medical sciences.

The Cadaver as a Teaching Tool

Cadaver-based learning includes the actual dissection of cadavers by medical students under the supervision of qualified instructors and the study of prosected specimens where individual structures in the human body have been dissected and displayed by skilled dissectors. The benefits of cadaveric dissection or prosection are that it helps students observe the three-dimensional relationships between different anatomical structures and comprehend anatomical variations, encourage peer- and group-learning, and inculcate in students a professional attitude right from the start of medical school (McLachlan & Patten, 2006). In fact, one entire issue of the scientific journal, Clinical Anatomy, was solely devoted to the role of anatomy education in furthering the development of medical professionalism.

My first dissection class in medical school has been deeply etched in my mind. And having taught anatomy for a number of years, I have found that handling different parts of the human cadaver in the laboratory is an unforgettable experience not only for medical students but also cherished by students in pharmacy, nursing and life sciences taking the "Human Anatomy" module. Every first year student at the Yong Loo Lin School of Medicine has to take a pledge during the first laboratory session at the dissection hall to treat the once living human body with dignity as he or she uses the cadaver to further his or her professional goals.

One of the primary concerns in cadaver-based learning is the difficulty associated with acquisition of enough cadavers for teaching (Bay & Ling, 2007). Except possibly for Thailand, most countries in the rest of Asia do not have a large body donor programme, with unclaimed bodies being the main source for anatomical dissection. On top of that, the use of cadavers in "Human Anatomy" requires close supervision of students and there is presently a worldwide shortage of qualified anatomists. Anatomy teachers have a high teaching commitment and given the current emphasis on research for faculty promotion and tenure, it is not surprising that many graduate students would rather not become anatomy teachers (McCluskey, Carmichael & Kirch, 2005). It is also a known fact that anatomy teachers have a far larger number of student contact hours than those in the other basic science disciplines.

Other disadvantages of studying anatomy using cadavers include (a) the emotional impact on students as some may feel overtly anxious about this experience while others may become desensitised and develop a detached attitude with regard to death, and (b) health and safety issues for those exposed to chemicals such as formalin used during the process of embalming and the possibility of being afflicted by infectious and transmissible diseases (McLachlan & Patten, 2006).

Computer-aided Instruction (CAI)

With the advent of web-based technology coupled with the rapid increase in the availability of educational software and information databases through the Internet, computer-aided instruction (CAI) is becoming an important component of the medical curriculum. (McNulty, Espritu, Halsey, & Mendez, 2006). However, some anatomists argue that no matter how sophisticated a software package may be, images are still projected on a two-dimensional screen, whereas in cadaver-based learning, students develop a dynamic three-dimensional mental image of the human anatomy (Rizzolo & Stewart, 2006). Detractors of CAI firmly believe that even if computer-simulated dissection in a virtual environment should become available in the future, it can never replace the precious experience that a student will have using a cadaver.

Conclusion

Even within the anatomist community, the traditionalists and modernists differ in their views as to whether cadaveric dissection is a necessity in the learning of gross anatomy. In a survey of 112 professional anatomists, Patel and Moxham (2005) found that practical lessons using cadaveric dissection or prosection ranked higher than living and radiological anatomy, e-learning, didactic lectures alone and the use of anatomical models. It is therefore highly unlikely that CAI can effectively replace the "intellectual, educational experience afforded to medical students by cadaver dissection and even prosection" (Paalman, 2000, p. 2).

However, many would agree that given limited human resources, CAI, if integrated into the anatomy curriculum as supplements, can certainly complement and enhance the quality of cadaverbased learning. Having gone through a cadaverbased learning programme as a medical student, I personally subscribe to this view point. In a study at the University of North Carolina, Granger et al., (2006) showed that an interactive human anatomy web-based programme increased the quality and efficiency of instruction in the anatomy dissection laboratory. McNulty et al., (2006) also reported that in an anatomy curriculum where dissection is still a core component, students who used CAI as a supplement fared significantly better in the anatomy examination than those who did not use computer resources.

Finally, although CAI resources are increasingly being incorporated into the medical curriculum, I certainly would not relish the thought that my attending surgeon has learnt his or her human anatomy entirely from a computer!

References

Bay, B.H. & Ling, E.A. (2007). 'Teaching of Anatomy in the New Millennium'. Singapore Medical Journal, Vol. 48, pp. 182-183.

Granger, N.A.; Calleson, D.C.; Henson, O.W.; Juliano, E.; Wineski, L.; McDaniel, M.D. & Burgoon, J.M. (2006). 'Use of Webbased Materials to Enhance Anatomy Instruction in the Health Sciences'. The Anatomical Record (Part B: The New Anatomy), Vol. 289B, pp. 121-127.

McCluskey, R.S.; Carmichael, S.W. & Kirch, D.G. (2005). 'The Importance of Anatomy in Health Professions Education and the Shortage of Qualified Instructors'. Academic Medicine, Vol. 80, pp. 349-351.

McLachlan, J.C. & Patten, D. (2006). 'Anatomy Teaching: Ghosts of the Past, Present and Future'. Medical Education, Vol. 40, pp. 243-253.

McNulty, J.A.; Espritu, B.; Halsey, M. & Mendez, M. (2006). 'Personality Preference Influences Medical Student Use of Specific Computer-aided Instruction (CAI)'. BMC Medical Education, Vol. 6, pp. 7-11.

Paalman, M.H. (2000). 'Why Teach Anatomy? Anatomists Respond'. The Anatomical Record (Part B: The New Anatomy), Vol. 261B, pp. 1-2.

Patel, K.M. & Moxham, J. (2005). 'Attitudes of Professional Anatomists to Curricular Change'. Clinical Anatomy, Vol. 19, pp. 132-141.

Rizzolo, L.J. & Stewart, W.B. (2006). 'Should We Continue Teaching Anatomy by Dissection When.?' The Anatomical Record (Part B: The New Anatomy), Vol. 289B, pp. 215- 218.