Monday, April 05, 2004

"Anatomy Lessons, a Vanishing Rite for Young Doctors" by Abigail Zuger, New York Times, March 23, 2004.

Human dissection was forbidden in the Middle Ages. In 17th century, medical school dissections were open to the public and became something of a spectator sport. In the 18th and early 19th centuries, doctors and medical schools were periodically accused of dishonoring the dead, and the occasional riot ensued. By the 20th century, dissection was considered an essential component of education in medicine and related scientific disciplines. But despite some spectacular recent scandals concerning improper use of human material, such as at the Alder Hay in Britain, and UCLA and Tulane Universities in the U.S., it is not concerns about dishonoring the dead that are driving the current decline of formal anatomy training in medical school.

Modern medical students invest only something like 20% of the time their 1950's predecessors spent on dissections. Teaching hours in medical school have shifted from consideration of organs and tissues to molecular biology and genetics. Anatomy faculty members are aging, and fewer and fewer classically trained graduate students are available to replace them. The real basis of this decline may be that gross human anatomy is not a thriving area of research: startling new discoveries are few, and research funds are sparse.

Some medical schools spare students any hands-on contact with cadavers. Students study pre-prepared dissections (prosections), C.T. and M.R.I. scans of living patients, or "virtual" cadavers made of radiographs and digitized photographs of thin sections cut from single male and female cadavers (the National Library of Medicine's "Visible Human Project").

What is lost according to those sorry to see actual dissections leaving curricula? A grasp of the tremendous range of human variation: duplicated, absent, or aberrant structures are common, but may flummox the unprepared. A sense of reverence for human life and mortality. The emotional contact with a vulnerable human "patient." Comments from 4th year Yale medical students sum up the gains: "It's not just about the information, it's about the process," "It gives you a real appreciation for the beauty of the human body. It's amazing. You are so thankful for it. It made me stand in awe."

Speaking from personal experience in numerous anatomy labs, I agree totally with the student above. Thank you everyone who takes the plunge and donates their body for dissection so others can learn. It is a tremendous gift and not one I'm sure I would be happy to make.