To Dissect or Not to Dissect: Part I

One last set of thoughts on dissection (probably) before I move on to other things.   I wanted to take a minute to explore why we dissect, and why increasingly some schools don't.  There's a lot to say on this, so I'll split it arbitrarily into two parts.  First, a little background:

At my school, the gross anatomy course lasts only 16 weeks  - it's one of the first things we do, and is probably where we spend at least 50% of our time and energy for the first four months of medical school. This is faster than some.  Many schools prefer a complete 'organ system' method, in which the gross anatomy of a given organ or system is paired with physiology, biochemistry and histology of that same system.  This gives the students a whole view of each system - but means they grow more slowly to a whole body view.  In our first semester we do the very small (general biochemistry) and the very large, which we follow with a more systemically organized view starting in the winter we do histology and physiology of each system at a time.  However, first we spend four straight weeks on the neurological system.  This is the only course I have taken that encompasses anatomy, histology and physiology all at once.  It's all neuro, all the time, for four weeks.  Importantly for this discussion while we, the students, do all the dissections in gross anatomy we do not dissect anything in neuro.  We observe whole and sectioned brains prepared for us by the course staff, and use photographs and prepared slices to study the rest.  

So.  Why do medical students dissect at all?  With programs like Zygote body, VH dissector (a program created by the Visible Human Project at the national library of medicine, the program is licensed, so you can't play with it, but we had access at school), some would argue that there's no need.  And we're awful at it!  You can imagine that 170 first year medical students, most with no dissecting experience at all, are going to do some damage while they work - particularly if they are working in time-pressured circumstances.  The arguments for dissecting range from "it's the way I had to do it when I was in med school" to the slightly stronger "rite of passage" to the even more realistic: "real patients vary, you need to see real bodies to see variations."   However, medicine gets more and more complex every year: remember that really it's only two years of classroom teaching to take us from bio minor undergrads to clinical students able to recognize normal human physiology, and anatomy and to understand pathologies (at least theoretically).  So as time goes by, some schools have done away with hands on dissection - replacing it with prosection and guided reviews.  In this model, more experienced dissectors (TA's) do the work, presenting students with an excellently dissected specimen that they then can talk through and the students can explore.  Computer programs and pictorial textbooks can supplement.  In other countries school go even further and students dissect whole cadaver models that are artificially synthesized.

So which method is preferable?  Should we dissect everything ourselves?  Learn only using computer programs and books?  Try to encompass the best of both worlds with prosection and reviews? I'll express my opinion next week!  

Anatomy Mystery Part II

For the beginning of this story, see Anatomy Mystery Part I.  This is the story as it stands now,  with the information we learned just a few weeks ago:

Anatomy Mystery Part I

It seems I will be forever apologizing for not updating.  But I think this story is fascinating enough to make up for it.  It concerns the cadaver I dissected, along with seven of my classmates, back in September through November.  Below is only the first part, the part that happened back then:

Transporting Skulls

Context is everything.  While I’ve done some strange things in medical school, I usually do them in the land of the utterly bizarre: the gross anatomy lab.  No matter how taken aback you might be for an instant, in that room you have only to look around as you dig through the layers of the human body to remember that everyone there understands. 

Not so with transporting skulls.  I recently had the opportunity to take a human skull home from school to study for our anatomy exam.  Have you ever had the chance to look - I mean really look - at a human skull?  They’re infinitely more complex than I had hitherto imagined.  I recall a lot of talk in undergraduate anthropology classes about the foramen magnum (Latin for big hole) and its position leaving us telltale clues about the development of bipedalism.  Little did I know that this is “the big hole” because there are approximately a zillion small ones.  Yes, a zillion.  Most of them have specific names, too, so in an effort to help us learn all the ins and outs of these sneaky passageways each pair of students was assigned our very own skull. 

So it is that I found myself one day last week boarding a city bus line with a very peculiar box.  The box is gray plastic with egg-carton foam lining the inside to protect the bones.  It’s kept closed tightly with a giant rubber band – like the kind for newspapers or broccoli, but bigger.  On either side it sports a white label marked: “Human.”  This is, I assume, so that the skulls of all types can be kept in an orderly fashion when not being used.  The box does not fit in my tote bag, where I was planning to keep it hidden from the other passengers.  It goes in, but the top doesn’t close.  This leaves the label, “Human,” clear for all to read.  I would prefer that wasn’t the case.  Even though I’m doing nothing wrong I have a guilty sensation.  I expect to be pulled into questioning by the transit police for transporting human remains.  I try to think of how I will prove I’m a medical student when this happens.  My student ID doesn’t specify my program and it’s not like I carry proof of registration with me.  I have an anatomy syllabus and a copy of Grant’s Dissector - a manual on how to dissect a human cadaver - in my bag.  Maybe those will be enough?   I tuck my scarf over the box, hiding the box from view. 

As I stagger to the back of the bus, I set the bag down reverently, gently.  I recall thinking that anyone observing must think there was a computer inside – because really what else would the modern commuter be carrying that’s so fragile and valuable?  I, of course, know the truth.  I’m carrying so much more than a computer.  I keep my hand on top of the bag trying to protect it from falling sideways as the bus turns and stops.  I still envision someone watching me.  Deciding to search my bag that so clearly contains something of value, something possibly dangerous.  In the end of course, nothing happens.  Just as no one ever cares what I have in my bag, no one cares today.  No one pulls aside my scarf to find the “Human” label on the side.

In the end this is just one of the moments of medical education when you stop and think: how strange were the things I did today?  Not only did I have the opportunity to cradle in my hands the place that once held this person’s brain - the seat of all that they were - but I put it in a gray plastic box and hid it in a tote bag to ride the bus.