spaz

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if you're a registered user (registration is free!) of latimes.com check this article out (front page, Sat 2.28.04):
http://www.latimes.com/news/science/la-sci-anatomy28feb28,1,762445.story?coll=la-home-headlines

it's too long to post all of it but i'll post some excerpts...


COLUMN ONE
Cutting Out the Cadaver
Dissecting human bodies in medical school anatomy labs, long a gruesome rite of passage for doctors, is going the way of house calls.


By Alan Zarembo, Times Staff Writer


SAN FRANCISCO ? The anatomy teacher propped up half a human pelvis on the lab bench and swiveled it to give the seven medical students a different view. The chemically preserved specimen, expertly dissected, was fitted with color-coded wire tabs that identified the neatly displayed parts.

The students at UC San Francisco stood a respectful distance away. They took notes. They wore street clothes. And, unlike past generations of medical students who spent months dissecting cadavers, they did not touch the pelvis.

It's a lot more efficient than "bushwhacking your way through the body," said one student, 29-year-old Sydney Sawyer.

For nearly a century, the dissection of human cadavers has been a dreaded and honored rite of passage for budding doctors.

But over the last two decades, the field has lost prominence at medical schools ? the victim of overly packed curriculums, a shortage of teachers and a general sense that dissection is an antiquated chore in a high-tech world.

Most medical schools have scaled back the time students spend in the anatomy lab to give them more time to study molecular biology or genetics. A few have eliminated dissection as a requirement for being a doctor. When UCSF, one of the top medical schools in the nation, did away with the requirement two years ago, it sent shudders through the field of anatomy.

The future is moving toward ready-to-view, professionally dissected specimens (known as "prosections") that allow students to scoot in and out of class with a minimum of mess, and computer simulations that do away with cadavers entirely.

.....

"We've been dumbing down medical students, anatomywise, for the last 20 years," complained Robert Trelease, who teaches anatomy at the UCLA School of Medicine.

Arthur Dalley, head of anatomy at Vanderbilt University, which has firmly defied the trend, said some young doctors are so uncomfortable with the vagaries of the human anatomy that they have come to rely more on instruments and tests than their hands to conduct routine physical examinations.

"I think it's heartbreaking," he said.

The decision at UCSF to eliminate the dissection requirement two years ago has reverberated through medical schools nationwide. Anatomists say they feel increasing pressure from administrators to condense dissection.

.....

Increasingly, there are fewer people to champion dissection's cause.

Few academics are willing to dedicate themselves to teaching an ancient field when university careers are increasingly driven by cutting-edge research.

The luminaries on campus these days are working in immunology, cancer and genetics.

"Training in anatomy pulls you out of the research lab," said Rick Drake, who heads pure prosection anatomy training for MD and PhD candidates at Case Western Reserve University. "Nowadays, to get promotion and tenure, you need to be doing research."

In a 2002 survey by the American Assn. of Anatomists, 83% of department heads who responded said they would have great or moderate difficulty in finding qualified new teachers over the next five years.
 

Gleevec

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I guess UCSF doesnt want to graduate any surgeons? :confused: :confused:

I mean, ideally, they could just have a prosected body for everyone to look at, and each person could still do the dissection in a group. Perhaps a resident or someone with actual experience can chime in, but expecting mastery of anatomy because Ive seen others do it and on a computer screen seems a lot like expecting me to master basketball because Ive been others do it and on the TV. Doesnt seem very effective at all.
 

Sweet Tea

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That's interesting. After a whopping semester and a half of med school, I've dissected a cadaver AND done house calls. Both were great learning experiences that I wouldn't trade for a demonstration at all. We had the expertly-dissected prosections of the pelvis, too, but you really do learn more by doing it yourself.
 
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Ideally, we should have both. I've had the experience of dissecting (animals), and not being able to see the appropriate structures, and of seeing an expertly done prosection and forgetting where everything was two minutes later.

I think part of the problem is that being an M.D. doesn't mean you're an expert in anatomy. I have a client who is a pulmonologist who also works in critical care, and she said she never uses knowledge of anatomy in working with her patients. It's all about test results. Granted, that's not the case for surgeons and certain other specialties, but it seems that anatomical knowledge is more crucial for some doctors than others.
 

Gleevec

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Originally posted by KarateGirl
Granted, that's not the case for surgeons and certain other specialties, but it seems that anatomical knowledge is more crucial for some doctors than others.

I agree completely, so doesnt that mean UCSF is hurting its prospective surgery students from the getgo?
 

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Originally posted by Gleevec
I agree completely, so doesnt that mean UCSF is hurting its prospective surgery students from the getgo?

People who want to go into surgery should take anatomy electives their 4th year anyway, and there they may be given one on one time with the cadaver.
 

Gleevec

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Originally posted by SoulRFlare
People who want to go into surgery should take anatomy electives their 4th year anyway, and there they may be given one on one time with the cadaver.

But prospective UCSF surgery students would still be at a comparative disadvantage to students at other medical schools who had gross anatomy lab and the electives? I dunno, it just seems kinda arbitrary.
 

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I used to think (before starting med school) that students at UCSF were going to be cheated by not being able to do dissections. I also considered longer anatomy sessions (like at Columbia or Michigan) to be of benefit for surgery, etc. However, now 2/3 of the way through anatomy at my own school, my opinion is that dissecting is a collosal waste of time and UCSF is moving in the right direction with its prosections. Besides, the students who are really interested in dissecting at UCSF may do so with an elective course.

Anatomy isn't emphasized much on Step1, and it is a very low yield subject. I don't personally enjoy the process of dissecting at all, and I don't feel that doing dissections really helps my understanding of anatomy. In fact, I haven't actively participated in our group's dissections in months and my scores in anatomy have actually gone up considerably because I've turned my focus away from the dissection procedure and instead concentrated on locating structures and reading up on clinical relevance.
 

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I think UCSF does offer an anatomy elective with dissections (which I believe you can take as early as first year) for those who want to take it in addition to the required prosection-based anatomy.
 

Gleevec

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Originally posted by blindsight
I used to think (before starting med school) that students at UCSF were going to be cheated by not being able to do dissections. I also considered longer anatomy sessions (like at Columbia or Michigan) to be of benefit for surgery, etc. However, now 2/3 of the way through anatomy at my own school, my opinion is that dissecting is a collosal waste of time and UCSF is moving in the right direction with its prosections. Besides, the students who are really interested in dissecting at UCSF may do so with an elective course.

Anatomy isn't emphasized much on Step1, and it is a very low yield subject. I don't personally enjoy the process of dissecting at all, and I don't feel that doing dissections really helps my understanding of anatomy. In fact, I haven't actively participated in our group's dissections in months and my scores in anatomy have actually gone up considerably because I've turned my focus away from the dissection procedure and instead concentrated on locating structures and reading up on clinical relevance.

Ah, I guess that's pretty good then for UCSF students, especially if its just a anachronistic waste of time.
 

exmike

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If we get rid of dissection, who will be trained to do prosection for medical students in the future? :confused:
 
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Jalby

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Originally posted by exmike
If we get rid of dissection, who will be trained to do prosection for medical students in the future? :confused:

Current surgeons.

I personally think it is great. Sure, you lose some skill of the actual cutting, but having been through Gross Anatomy, I know I could have learned what I learned in half the time just doing prosections and still know exactly the same amount. If were god of a medical school, I would have a week of dissection just so students can practive (maybe beofre starting third year) and have all of anatomy done on prosections or computers. I know I picked up hardly any dissecting skills from the actual disections.
 

gschl1234

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University of Missouri-Columbia also de-emphasizes anatomy because it's not heavily tested on the USMLE. People who want to go into surgery must take anatomy as a 4th year elective. In one way I think it's good for the rest of us who have no interest in surgery but in another way, I think that schools that do this are depriving us of a complete medical education. It's a toss-up but personally I'd prefer to have less anatomy, even if it means I don't have a very complete education. It's so mindlessly dull!
 

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Now why don't dental schools take this approach??? We had to disect the whole cadaver and we did it in 8 weeks...what a bitch!

Anatomy is a pain in the ass!
 

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But let me add this, doing it yourself does make it a hell of a lot easier to study. I can't even count how many times I have said "Oh damn, so thats how it really goes"

When you just look at it and not pick at it, you lose a lot. You really can't see the intervations, supplies, insertions...etc as well. Sometimes you really have to move a lot of crap away even if its a perfect disection.

But for dental school, gives us a break and only make us disect head and neck. Med school, I really see a huge benefit to you guys doing your own disections
 

carrigallen

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I think this is just a get-rich scheme by UCSF to save money on cadavers, and to put more students in their research labs.

I believe there is no greater disrespect for the human body than the exclusion of teaching it in med school.

Our culture fought for hundreds of years to be able to dissect the human body. Now these efforts are abolished by a few lazy academicians wielding cdroms and powerpoints. It is a shame. =/
 

exmike

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Originally posted by carrigallen
I think this is just a get-rich scheme by UCSF to save money on cadavers, and to put more students in their research labs.

I believe there is no greater disrespect for the human body than the exclusion of teaching it in med school.

Our culture fought for hundreds of years to be able to dissect the human body. Now these efforts are abolished by a few lazy academicians wielding cdroms and powerpoints. It is a shame. =/

i dont think saving a dozen or so cadavers will have a material impact on UCSF
 

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Actually, the article referenced mentions that while cadavers are donated, there are costs in maintaining the bodies from drying out, ventilation/lighting systems for the anatomy room, and ofcourse keeping those anatomists on the staff... The thought is the use of prosected cadavers in conjunction with computer models could add to the bottom line. In an era of shrinking endowments everyone is thinking about cost-savings. Whether this short-changes medical education is still up for debate.
 

CalBeE

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I actually kinda like UCSF's idea, and from a few posters here, it seems like you can learn a lot from computer model anyway.

That totally reminded me of an unrelated topic. This school year, when UCLA changed the curriculum and shortened the lecture hours, some students were concerned that they would learn less stuff and be less prepared for the Boards, but a member of the curriculum revision committee said something along the line of Med Students are given many information, and they'll probably forget many of the details soon anyway.

So I guess the same may apply to anatomy. Dissecting cadavers yourself can be a learning experience, but you'll probably won't retain much of that info unless you end up using that info on a regular basis.
 
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Additionally, with the explosion of medical knowledge if you want to keep the curriculum only four years long then something's got to give. Don't flame me but fifty years ago the medical students had more time for anatomy because there was, relatively speaking, less to learn in other areas.

Back then, medical students seldom specialized but "hung out their shingle" after completing an intern year as a generalist.

It would be a shame to see dissection completely eliminated. It seems so traditional and I am a very conservative guy. With that being said, I got very little out of gross lab and preferred to use my Rohen photographic atlas as a sort of "virtual" gross lab. I spent a lot of time, when I went to lab, fruitlessly picking through shredded muscle and goopy viscera.

Our school has gross lab for two years. We start with one semester of anatomy classes with one lab day a week to get the "big picture" and then for every organ system we spend a variable amount of time in lab until the end of second year. Cardiovascular, for example, had four lab days scheduled.

I stopped going to lab in the early part of second year because attendence was not mandatory and like I said, it might not be a waste of time but it was not "high yield" for me.

The funny thing is that I have had no problem recognizing structures during my various surgery rotations.
 

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Originally posted by Panda Bear


The funny thing is that I have had no problem recognizing structures during my various surgery rotations.

Recognizing is one thing, but finding a structure is another. I to used Rohens alot and during practicals can ID the structure, but come time to do some surgery I know I'm going to have a hard time finding things. Having been the lazy one in anatomy lab and always being the reader for the dissections, lets just say I'm not going into surgery or rads.
 

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i'll add that at vanderbilt (which was mentioned in the article), i think we had about 10 hrs of dissection and 5 hrs of lectures a week. the profs lectured using slides form grants and netter; textbook used was coa by moore/dalley; rohen as supplemental dissection atlas; about 20-30 bones w/ about two dozen tags on each bone to memorize for each exam; radiographic images from weir; and cross sections from clemente. yikes..... that was a rough semester...... personally, i think more prosections should be used.
 

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Once upon a time, we had an alumni from my school come in who was a 2nd year at UCSF. He was saying how they were shifting over to this no cadaver dissection curriculum. Anyway, i believe that those who want to emphasize in surgery down the road have the option of pre-dissecting these cadavers for the first year students.

Someone from UCSF should confirm but that was the plan back 2001. Could've changed though. Personally i think its a good idea, since cadavers are far and few to come by, regardless of what we see at med schools.
 
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