medical education history

Anatomy teaching: ghosts of the past, present and

future
John C McLachlan & Debra Patten

ÔGhost of the Future,Õ he exclaimed, ÔI fear you

more than any spectre I have seen. But as I know INTRODUCTION
your purpose is to do me good, and as I hope to
live to be another man from what I was, I am Anatomy is widely appreciated as being among the
prepared to bear you company, and do it with a most significant components of medical education
thankful heart. Will you not speak to me?Õ and the study of anatomy through the dissected
Ebenezer Scrooge (Charles Dickens, A Christmas cadaver is viewed as the uniquely defining feature of
Carol) medical courses. However, it may be that we are now
entering a time of paradigm shift, aided by new
understandings and new technologies, and, as in all
INTRODUCTION Anatomy teaching has perhaps such times, views are held strongly and expressed
the longest history of any component of formalised emotionally.
medical education. In this article we briefly consi-
der the history of dissection, but also review the While the history of dissection has been well studied,
neglected topic of the history of the use of living less attention has been paid to the use of the living
anatomy. body in anatomy teaching. In this article, we briefly
review the use of the cadaver and make an initial
CURRENT DEBATES The current debates about the contribution to the history of living anatomy. Then
advantages and disadvantages of cadavers, prosection we review the debates on the value of dissection and
versus dissection, and the use of living anatomy and prosection, and on the use of the cadaver as opposed
radiology instead of cadavers are discussed. to the study of the living body and medical imaging.
Finally, we consider possible futures: in evaluation of
THE FUTURE Future prospects are considered, teaching methods; in the use of imaging and simu-
along with some of the factors that might inhibit lation techniques, and in the use of the arts in aiding
change. anatomical understanding.

KEYWORDS anatomy ⁄ *history ⁄ education;

teaching ⁄ *history; dissection ⁄ *history; cadavers; THE HISTORY OF DISSECTION
history, 17th century; history, 18th century; history,
19th century; history, 20th century. Cadaveric dissection has been the paradigm of
anatomy teaching since the Renaissance, and the
Medical Education 2006; 40: 243–253 defining experience of medical teaching since the
doi:10.1111/j.1365-2929.2006.02401.x 16th and 17th centuries.1,2 Subsequently, cadaveric
dissection featured regularly in medical training,
although often in an informal, semi-official man-
ner. In the UK and elsewhere, private anatomy
schools flourished alongside hospital-based profes-
School for Health, Durham University, Durham, UK sional courses. In 1822, however, the Royal College
Correspondence: John C McLachlan, Durham University, Queen’s of Surgeons determined that it would no longer
Campus Stockton, Holliday Building, University Boulevard, Thornaby, accept summer courses as a qualification for entry
Stockton-on-Tees TS17 6BH, UK. Tel: 00 44 191 334 0322;
Fax: 00 44 192 334 0321; E-mail: [Link]@[Link] to the college diploma. This began to inhibit the

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244 medical education history

A more profound psychological shift may also have

taken place at this time, when there was a shift from
Overview the indeterminateness of traditional medicine (folk
medicine) towards the formalisation and profession-
What is already known on this subject alisation of (literally) conventional medicine; that is,
the practice of medicine moved away from the
The study of anatomy is recognised as being personal, idiosyncratic and patient-focused view of
among the most significant components of the past to the standardised, diseased-focused world
medical education. of the Rationalist future. In the very uncertain world
of medicine in the late 18th and early 19th centuries,
What this study adds where no organised or rational bases for diagnosis or
treatment existed, it must have been a great comfort
This paper reviews the use of the cadaver and to turn (literally) to a body of anatomical knowledge
the history of living anatomy. It considers the which was regular, standardised and capable of
value of dissection, prosection and the use of shared and agreed observation by everyone working
the cadaver, as opposed to the study of the in the field.
living body and medical imaging. It evaluates
the use of imaging, simulation techniques and The move towards dissection may have been further
the use of art in aiding anatomical under- reinforced by the growing sense of the creation of a
standing. professional monopoly. The observation of dissection
in the anatomy theatre could be open to everyone,
Suggestions for further research male and female, medical practitioner and layperson
alike. Dissection, on the other hand, was not open to
Further evidence is needed to define which everyone and women were not permitted to take part
method of anatomy teaching leads to the most in anatomy classes. Along with the increasing pro-
effective clinicians and if the choice of method fessionalisation of medicine in the early 19th century
affects student selection. went a distinct masculinisation.

Dissection has thus been encultured into medical

education such that it has become an almost univer-
sal expectation of medical courses. More recently,
activities of private medical schools and the 1832 Dyer and Thorndike3 suggested that anatomy’s status
Anatomy Act reinforced this process. Stricter regu- as a science has diminished as it is no longer
lation of the methods by which bodies could be considered to be a research-led discipline. There is
obtained worked in favour of hospital-based anat- much debate over the nature of science. A more
omy schools, which could use the bodies of their conventional definition of science centres on the
own deceased patients (often as a quid pro quo for formation of a scientific hypothesis, which may be
free treatment while alive). This marked a key proved or disproved, and is qualified by statements of
transition from the Ôapprenticeship modelÕ of conditional probability. John Pickstone4 presented a
medical training (often limited to one-to-one rather different philosophy on the nature of science,
instruction) to a professional training model in suggesting that science, medicine and technology
which students were taught in larger groups by should be defined as an integrated enterprise of
individuals for whom teaching was among the main knowing and acting defined through four Ôways of
purposes of their employment. knowingÕ: extracting meaning; collecting and classi-
fying data; analysing, and experimenting. It is prob-
A useful distinction can be drawn between the ably true that the early anatomists founded their
observation of dissection (which was a mainstay of study of anatomy on the scientific method of data
Renaissance teaching, through the Ôanatomy theatreÕ) collection (direct observation of the body structures),
and active dissection by students themselves. The so- followed by hypothetical explanation and further
called ÔParis methodÕ of giving each student his or her observational testing of the hypothesis. Today, the
own cadaver was influential in the UK due to the discovery of new gross structures is unlikely, except
numbers of students who travelled abroad for part of perhaps in the field of neuroanatomy, and this has
their medical training. Gradually, dissection came to contributed to anatomy’s altered status as a science. It
be seen as the modern way and observation was seems that disciplines such as histology and embry-
relegated to a second class activity. ology, which evolved from anatomy, have superseded

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it in terms of research status and popularity.3 The anatomy class at the École des Beaux ArtsÕ, exhibited
anatomical body described in textbooks is presented in 1888, shows an eminent anatomist, Professor
as objective reality, as a series of common observa- Mathias-Marie Duval, carrying out a demonstration
tions in a structure which is simultaneously simple on a living male model in front of a class of students
enough to understand and complex enough to be a (Fig. 2). The teacher is holding the model’s right
lifetime study. This reality can be studied and arm at the wrist and upper arm in a slightly pronated
appreciated by everyone as part of a common position, and seems to be occluding the basilic vein.
experience. A scapula and arm bones, articulated as a unit, are in
front of him on the table, and have plainly been
recently used in the demonstration. Duval was a
THE HISTORY OF LIVING ANATOMY clinician and anatomist and presumably used living
anatomy in his medical teaching. However, academic
In contrast to the well described and documented literature documenting the uses of living anatomy is
history of anatomy teaching using the cadaver, the scarce. In 1931, the anatomist David Waterston
history of teaching anatomy through the study of the published Anatomy in the Living Model,5 in which he
living body has, as far as we know, been neglected. indicated: ÔIt is now several years since the study of
The living body was and is, of course, of major the living model was introduced into anatomy
interest to artists, and art history may provide an schools as a means of supplementing the training in
access route for this subject. Johann Zoffany painted anatomy obtained by the dissection of the cadaver.Õ
ÔDr William Hunter lecturing at the Royal AcademyÕ This suggests that it had not taken place before that
some time around 1775 (Fig. 1). This shows Hunter time in UK medical schools at least. Waterston also
demonstrating the rotation of the scapula on a living quoted the General Medical Council (GMC) as
male model, with a skeleton and a sculpture showing having recently recommended that Ôthe demonstra-
muscle groups available nearby. Sallé’s painting ÔThe tion of structure and function in the livingÕ should

Figure 1 Dr William Hunter lecturing at the Royal Academy. J Zoffany. With permission of the Royal College of Physicians.

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246 medical education history

Figure 2 The Anatomy Class at the E´cole des Beaux-Arts. F Sallé. With permission of the Art Gallery of New South Wales.

form an integral part of medical students’ profes- Ôlive models were rated superior to using cadavers,
sional training.5 However, the GMC itself appears to especially in demonstrating superficial anatomy and
have no record of this recommendation, due to the landmarksÕ. Both Barrows et al. and Stillman et al.
incompleteness of its records. In 1947, RD Lockhart preferred the use of professional life models to peer-
(Regius Professor of Anatomy at Aberdeen), pub- examination. By contrast, in 1982 Metcalf and
lished Living Anatomy,6 which went into a second colleagues9 proposed that peer-examination was
edition in 1949, and included the sound advice: more valuable than the use of life models, and
ÔKeep your eye on the body, especially the living body, introduced a living anatomy course in which com-
is the first principle in anatomyÕ. The photographic pulsory peer-examination, including breast and
illustrations, both male and female, are of Lockhart’s internal examinations, was practised in mixed sex
own students, which must have posed some chal- pairings. These authors and others10 refer to studies
lenges at that time and location. as an introduction to the physical examination, as
well as a way of studying anatomy per se. Currently,
In 1968, Barrows and colleagues7 recommended the the Anatomical Society of Great Britain and Ireland11
use of life models in anatomy teaching, commenting and the American Association of Clinical Anato-
that Ôduring the anatomy course, the students mists12 continually reiterate the necessity for identi-
gradually develop an objective but respectful attitude fying structures in the living throughout their
towards the cadaver. Paradoxically medical students ÔbenchmarkÕ core curriculum. However, studies of
do not seem to enter the clinical arena with the same anatomy teaching methods frequently omit living
objectivity concerning the disrobed human body.Õ anatomy as a study component.13,14
Their work was cited as the inspiration for the
programme of living anatomy introduced at the In more recent times, attention has focused on
University of Arizona College of Medicine by Stillman student views on participation in peer-examina-
and colleagues in 1978.8 The authors concluded that tion.15–19 These studies have generally concluded

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that students were willing to take part in peer More recently, medical students have cited an
examination, although there were reservations appreciation of the historical significance of dissec-
around particular sensitive areas of the body. A tion and the development of respect for the physical
variety of factors, including age, ethnicity, religious body as additional reasons to learn anatomy through
background and body image, proved influential for dissection.25
individual students. Equally, there are a number of
significant cultural problems with regard to partici- Disadvantages
pation in peer examination.
Some hold the belief that there are several important
negative factors associated with studying anatomy via
THE DEBATES dissection, which again fall into three domains: those
concerning the emotional impact of dissection;
Methods of teaching anatomy are briefly reviewed in health and safety issues for those handling cadaveric
the Appendix. However, there are a number of active material, and, lastly, the practicalities and cost of
debates currently taking place in medical education using cadavers.
on anatomy teaching methods, two of which are
summarised below. Proponents of the use of elec- In contrast to the reports that dissection may
tronic representations of the body have also joined promote a sympathetic understanding of death, some
the debate; however, there seems to be a widespread studies have reported dissection as causing extreme
consensus that these resources are currently inad- anxiety and emotional disturbances in some stu-
equate to be anything other than a support to dents26–31 and, at the other end of the spectrum,
anatomy learning by other means. levels of desensitisation which may result in an
undesirable detachment from death.26,32 Others have
Advantages and disadvantages of dissection suggested that the cadaver has little clinical rele-
vance,33 perhaps due to its appearance (colour and
Advantages texture), lack of mobility and smell.34

The majority of published papers on anatomy There are significant health and safety implications
teaching strongly recommend the use of dissection. central to the use of cadavers, which include expo-
Proponents of dissection generally identify a range of sure to embalming fluid chemicals and ⁄ or inad-
benefits that may spring from dissection.3,20–24 These equately preserved human material and infectious
benefits mostly fall into three domains: knowledge diseases such as transmissible spongiform encephal-
acquisition and integration; skills, and attitudes. opathies, human immunodeficiency virus, tubercu-
losis and hepatitis.35 In addition, there are legal
Benefits identified in the first domain include: requirements; for example, in the UK these relate to
development of cognitive anatomical knowledge and the Human Tissues Act and the Anatomy Act.
its specific vocabulary; appreciation of three-dimen-
sional relationships and anatomical variability; estab- There are also practical problems associated with
lishing a system for classifying tissues; laying the dissection such as the difficulties in acquiring cadav-
foundations for the study of other disciplines where ers, the cost of transporting, maintaining and dispo-
knowledge of structure is essential (e.g. physiology, sing of cadavers, the shortage of qualified anatomists
microbiology and pharmacology); participating in and the large amount of time required for study by
cadaver ⁄ patient-centred computer-assisted learning, dissection. Procurement of cadaveric material, for
and peer-group learning. example, is proving increasingly difficult and occa-
sionally fraught with tensions. Since 2001, there has
Skill-based benefits include developing fine motor been a 10% reduction in the number of bodies
control and a touch-mediated perception of the accepted by Her Majesty’s Inspector of Anatomy
cadaver ⁄ patient and developing competence in (HMIA) for anatomical studies (from about 670 in
diagnostic imaging and training for the medical 2001 to 600 in 2004 ⁄ 05; personal communication,
specialties. HMIA). In part this is due to a reduction in the
numbers of potential donors available following
Finally, attitudinal benefits include establishing the health and safety directives which do not permit
primacy of the patient; promoting professionalism donors diagnosed with mild dementia to be accepted.
through a direct encounter with the cadaver, and It is also likely that the public perception of anatomy
promoting attitudes conducive to team working. has been tarnished by the recent scandals at Alderhay

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248 medical education history

and Bristol, and perhaps by Gunther Von Hagen’s anatomy as a science, it seems more likely that the
controversial Body Worlds Exhibition and public greatest value of dissection is in the active learning
autopsy, which received a mixed response from the process and the self-discovery that occur during
general public. These factors, coupled with rising learning, rather than inculcation of the scientific
student numbers across the UK, including the method. Evidence-based medicine (EBM) and evi-
establishment of eight new medical schools, have all dence-based practice (EBP), now integral compo-
contributed to a reduction in the amount of cadav- nents of many medical curricula, are likely to be
eric material available for anatomical study. Short- more useful vehicles for espousing the inculcation of
ages of cadavers lead to high student:cadaver ratios, the scientific method.
which must inevitably detract from the value of
dissection as a useful learning activity. Developing a touch-mediated perception of the body
and motor skills may also be fostered in a clinical
Discussion skills environment where students palpate, percuss
and auscultate the living body. In fact, given the high
Despite the arguments in favour of dissection, often student:cadaver ratios reported in some studies,13,37
by anatomists who are self-professed enthusiasts for it is unlikely that many students dissect enough to
their subject and who have studied anatomy them- allow any extensive development of these skills.
selves by dissection, many anatomy departments
worldwide have adopted prosections as their primary Cadavers versus living anatomy and imaging
learning resource. The drivers for this change have
been the need to maximise the use of increasingly Anatomy is most commonly encountered by medical
scarce resources (cadavers and teaching staff), lim- practitioners in the form of living anatomy on the
ited teaching time and most importantly, to achieve one hand, and medical imaging on the other.43 It
improvements in outcomes for students in terms of would seem to be authentic to argue that these means
examination results and long term recall of anatom- therefore are how anatomy ought to be taught.44
ical knowledge.30,36–38 Thus, there is recognition Indeed, Biggs’ theory of Ôconstructive alignmentÕ45
amongst anatomy teachers that dissection may not be would advocate that learning activities and resources
the best means by which students can acquire and should be Ôconstructively alignedÕ to assessment. In a
retain anatomical knowledge and to date, no studies profession such as medicine, the assessment of a
have demonstrated that longterm retention of ana- competent clinician is ultimately about his or her
tomical knowledge is an outcome of dissection. ability to diagnose and treat patients effectively; this
interpretation would therefore argue that the learn-
The benefits of learning anatomy through dissection ing resources and activities employed to achieve this
are undeniable for some students, in particular for outcome should be centred around patients and,
those who report that dissection enables the mental with respect to anatomy, would advocate the use of
mapping of the body’s three-dimensional internal living subjects rather than cadavers.
structure,25,39,40 but some of the other reported bene-
fits are also fostered elsewhere in medical curricula. Potential advantages and disadvantages of living anatomy
and imaging
Today, the cadaver is often not the first patient that
the student encounters as some students meet Imaging technology and its application in clinical
patients in the first week of their studies, and it is fair medicine have advanced enormously in recent years.
to suggest that the first patient encounter is best A recent innovation, which has been explored
achieved with a real patient in a clinical setting or in particularly in the field of neurosurgery, employs the
the simulated environment of a clinical skills labor- use of real-time intraoperative magnetic resonance
atory. Similarly, the response of many UK medical imaging (IMRI). This technology, although costly,
schools to the recommendations of the GMC enables improved visualisation of soft tissues and the
(Tomorrow’s Doctors41 and Good Medical Practice42) has observation of tissue changes in real time as surgery
meant that there are more opportunities in medical proceeds.46,47 Imaging technology has and will con-
curricula for fostering team working skills and pro- tinue to become less expensive, easier to interpret
moting an understanding of death. and more widely available. Small portable ultrasound
scanners, for instance, are already available and can
It may be true that dissection allows for the inculca- be used in a new range of settings from emergency
tion of the scientific method which is the basis of medicine in the field to primary care in local and
diagnostic medicine,24 but given the loss of status of community settings. These devices can be used in

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undergraduate teaching, both in terms of their were generally hostile. The Times ran an article
diagnostic function as a clinical skill, and as a way of entitled ÔMedical School consigns cadavers to his-
viewing anatomy in the classroom. This has been toryÕ,57 which contained comments such as Ôtraining
attempted on a number of occasions,48–52 but there is being dumbed downÕ and ÔThere is no place for
are a number of difficulties which have been inad- squeamishness in medical educationÕ, and a generally
equately addressed. These include the potential traditionalist slant: Ô...for centuries the dissection of a
safety hazards arising from repeated scanning of corpse has been an essential learning aid … as well as
individuals for teaching purposes, the obtaining of a rite of passage … however, students at the school
informed consent from participants, and the possible will not dissect a single corpseÕ. The references to the
discovery of conditions requiring further investiga- value of history are interesting, as medical practice
tion. Internal live three-dimensional reconstructions, generally values change and improvement. An
both of ultrasound images and MRI scans, are equivalent use of terms during discussion of, say,
currently in clinical use and may feed into teaching blood-letting, is implausible. Channel 4 publicity
practice, especially where cadavers are unavailable or material, in association with a documentary series on
not used. Professor von Hagens, posed the question in the
following terms: ÔWould you mind if your doctor has
Simulation has contributed to the safety of proce- had no real, practical experience of human anat-
dures in a number of high-risk industries.53 It is likely omy?Õ58 Here, interestingly, real anatomy is explicitly
that this will be used increasingly in medical educa- equated with the dead rather than the living body.
tion,54 not only for exploring clinical skills, but also
for providing an apparently authentic introduction to On occasion the debate has been inadequately
the importance of anatomy in certain procedures. represented. For instance, rather than engaging in
Such simulations can employ manikins with increas- discussion of the value of living anatomy and imaging
ingly sophisticated responses, or virtual reality versus dissection, it has been asserted that Ôall the
approaches that can include haptic feedback. Al- anatomical teaching is carried out using plastic
ready, a number of laparoscopic trainers are available modelsÕ.58 Motives may also be misrepresented. For
which would be invaluable in aiding the importance instance, one critic wrote: ÔReading between the lines,
of anatomy, but their cost is currently prohibitive. the decision to do this seems to have been made for
Computerised simulations of anatomy and the body reasons of expense and resourcesÕ,59 although the
are also available, of course, but the consensus original article to which the writer referred explicitly
among anatomy teachers seems to be that these are stated that the authors were Ôprimarily concerned that
not yet of sufficient quality or development in terms our programme produces clinicians who are capable
of pedagogic principles to be a substitute for the of using their understanding of anatomy in the
dead or living body. management of clinical problemsÕ, and ÔIt is not
intended to imply that alternatives to cadavers are
Discussion intrinsically less expensiveÕ.44 Indeed, teaching that
relies heavily on medical imaging and consultant
Historically, the primary purpose of dissection and radiologist teaching is more expensive than the
the use of the cadaver has always been to gain cadaveric alternative. A third tactic is a straightforward
understanding of the living body. In clinical practice, dismissal of the non-cadaveric approach as being not
however, doctors are virtually always required to deal worthy of engagement in argument; for instance: Ôthe
with the living body, and study of the corpse is largely educational justifications simply do not existÕ.59
confined to various kinds of pathologists. Study of the
chemically preserved cadaver is even less common in Plainly, the response to the suggestion that working
medical practice. It is therefore fair to ask if this with cadavers may not be an essential part of medical
primary purpose can be better achieved through training has been emotive. Perhaps we can attribute
other means in undergraduate medical courses. such strongly and emotionally expressed views to the
paradigm shift currently underway.
Student, public and medical professional responses
to the suggestion that the dissection or study of the It may be possible that the nature of dissection, with
preserved human cadaver might be reduced in its cultural and physical challenges in handling and
medical teaching is overwhelmingly one of dimin- disaggregating the dead human body, may indeed
ishment and regret.20,55,56 Indeed, responses to a new have promoted the sense of a rite of passage, in the
medical school’s decision to employ the use of living phrase so revealingly used by The Times. Such rites are
anatomy and imaging in favour of cadaveric anatomy typically unpleasant, sometimes even painful, and

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250 medical education history

serve the function of binding together the initiates, However, only in time will the comparative merits of
while at the same time excluding those who have not different approaches become evident. This won’t
passed through the ritual. happen for at least 10 years after a particular
approach is initiated. As any new teaching method
A more generalised anxiety may also underlie the requires time to be developed, we may find that the
responses. Anatomists currently feel that their subject first year or even first two years of a new approach are
is under threat,3,55 with diminishing resources and not representative, and perhaps the research period
decreasing numbers of qualified teachers. A move should be extended accordingly. It is perennially
away from cadaveric dissection may be misinterpreted difficult in medical education to determine the
as a downgrading of the importance of anatomy itself clinical outcomes of a teaching intervention, and to
as a component of medical training. Nothing is measure these in clinical practice. Surrogate meas-
further from the truth; human structure remains an ures that have been used include dropout rates, time
extremely significant part of the knowledge base of to membership of professional bodies, time to pro-
students. The question is rather about what kind of motion, views of colleagues and patients, and num-
anatomy it should be. It is in anatomical under- bers of complaints.
standing that dissection must base its firmest defence.
However, anatomical knowledge per se is not the goal Another relevant area of research would concern the
of medical education: this, rather, is to produce good range of disciplines entered into by students who
doctors. have undergone different educational interventions
during their undergraduate careers. It would be
interesting if lack of exposure to cadaveric dissection
THE FUTURE in the undergraduate course made students less (or
more!) likely to undertake careers in surgery. Con-
The single most desirable improvement in anatomy comitantly, it would be of interest to explore whether
teaching would probably be in the field of evaluation. students were more or less likely to select courses
The question we must answer concerns which featuring different methods of instruction.
method of teaching about the structure of the body
produces the most effective clinicians. Sadly, evi- The use of arts and humanities in medical teaching is
dence of this kind is almost entirely lacking, due in likely to add a further dimension to the agenda (see
part to the difficulty of carrying out such studies and Appendix). ÔDesensitisationÕ is not necessarily of
in part to the lack of a sufficiently wide range of intrinsic value in the practice of medicine. It is the
approaches in the past which would enable compar- ability to carry out medical practice effectively,
isons to be made. To date, evaluation studies have despite the emotional difficulties involved, which is
frequently been of the Ôshow and tellÕ kind – Ôthis is the desired outcome, and greater insight may be a
what we do in our institutionÕ. better approach to this than decreased sensitivity.

It is no longer acceptable to publish student satisfac- Another fruitful area for exploration will be that of
tion studies, which are often poorly designed, with interprofessional working. In some professions allied
inadequate separation of the role of teacher and to medicine, such as nursing, the experience of
investigator. Such studies are merely likely to support anatomy has often been rather limited. In others,
the prejudices of teachers in either direction. It is such as physiotherapy, students gain a profound
essential to attempt to identify measurable outcomes, understanding of human anatomy in practice, prob-
employing both qualitative and quantitative approa- ably as a result of their experiences in extensive peer
ches, and to have some means of comparison between examination and living anatomy during the course of
different methods of instruction through comparisons the programme. There is also scope for co-operation
between different co-operating institutions. Such an between undergraduate and postgraduate students,
approach is feasible.60 However, the larger question including those engaged in professional develop-
concerns which method of instruction produces better ment, which is likely to be beneficial to both.
doctors, and this is less amenable to easy resolution.
Experimental power would be gained if institutions Just as dealing with cadavers is a profound event,
could be categorised along an axis of intervention, working with the living body has high emotional
where, for instance, greater or lesser participation in impact. It may even become an equivalent rite of
dissection or interactivity of anatomy learning is passage to that of dissection. It is common to witness
identified. This would aid in the construction of a new students placing their hands on the living human
dose–response curve for the processes under study. body for the first time, and becoming speechless, deaf

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 251

and blind in immediate consequence. This is because 13 Heylings D. Anatomy 1999–2000: the curriculum, who
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Funding: none. toward same-gender versus mixed-gender partnering
Conflicts of interest: none. in practising physical examination skills. Evaluation
Health Professions 2000;23:361–71.
Ethical approval: not required.
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49 Teichgraber UK, Meyer JM, Poulsen Nautrup C, von APPENDIX
Rautenfeld DB. Ultrasound anatomy: a practical
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50 Wittich CM, Montgomery SC, Neben MA, Palmer BA, Dissection
Callahan MJ, Seward JM, Pawlina W, Bruce CJ. Teach-
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Dissection describes the experience of students who
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trasonography. Acad Emerg Med 1998;5:58–63. every region of the body. This is becoming less

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common, and where dissection still takes place, it There are good arguments for a very significant input
often does so for selected regions only, or as part of by radiologists into the development of the curricu-
an optional activity such as a special study module or lum, as well as its delivery. It would not be inappro-
student-selected component. priate if 50% of student time was spent on medical
imaging so that students were able to build up an
Prosection understanding of the strengths and weaknesses of
each of the different individual approaches and learn
In prosection, the materials are dissected in advance how to interpret the anatomy as viewed through these
by a professional anatomist, and studied by the very distinct modalities, which give a very different
students as relevant. Prosections may suffer wear and experience to that of dissection and prosection of
tear in normal use, and their long term employment cadavers.
may be at odds with the desire of families for the
return and disposal of remains. A particular version Animal models
of prosection is plastination, where the material is
impregnated with stable polymers that enable it to be A common feature in anatomy teaching has been the
handled safely at room temperature. use of fresh animal materials such as lungs, hearts
and eyeballs. These are valuable in demonstrating
Living anatomy structures in their unpreserved state, and may be
used to demonstrate the effect of inflation on lungs,
Living anatomy may include palpation, percussion, for instance. Fresh eyeballs may be dissected to reveal
auscultation and study of musculoskeletal move- the fluid components that are lost on preservation.
ments, as well as marking surface reflections of
underlying structures. Surveys of student learning in Learning through arts and humanities
anatomy often neglect living anatomy as a category
and therefore information on its use is incomplete. There is some evidence that learning through arts
and humanities can have a significant impact on
Living anatomy may be conducted either with the use students’ understanding of the body.61–63 One risk of
of life models or through peer examination. Will- using cadavers is that it may objectify the body and
ingness to participate in peer examination depends lead to it being viewed in an overly detached manner.
upon an interaction of cultural and demographic Re-engaging with the arts and humanities’ view of the
factors, including sex, age, past history, ethnicity and human body has the potential of offering a more
religious beliefs. In some paramedical disciplines rounded perspective. Activities such as life drawing
(such as physiotherapy), participation in peer exam- and modelling, accompanied by reflective discus-
ination may be compulsory. sions, have the potential to offer a significant advance
in students’ understanding of their perceptions of
Life models are paid to take part in living anatomy, the body.
and should be distinguished from simulated patients
and patient examination. Their use has been Michael Sappol’s web-site ÔDream AnatomyÕ64 exhibits
recommended in several publications (see text) but a comprehensive selection of anatomical images of
anecdotal evidence suggests this still remains unu- historical and artistic significance from the 1500s to
sual. date and comments upon the changing artistic
representation of cadaveric anatomy during that
Medical imaging period. The use of body projection within art and
science also deserves a mention here. Krzysztof
Medical imaging includes X-rays and computerised Jurecki65 comments upon the Ôshocking, fearful and
axial tomography, MRIs, ultrasounds and other hideous imageryÕ created in Dariusz Gorczyca’s pho-
approaches to imaging. Modern technology offers tographic exhibition ÔCamera AnatomicaÕ, where
the opportunity to provide three-dimensional recon- images of anatomical structures were projected onto
structions of individual patients and this is now being the body of a young woman and photographed. In
used clinically. Since the discovery of X-rays, they has stark contrast, this concept has been successfully used
been used intermittently in medical teaching, despite to enable students to learn surface anatomy, locating
the fact that it is one of the two major modalities by gross anatomical structures found in cadaveric anat-
which clinicians experience anatomy in practice. omy on the surface of a living individual.

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