Tuesday, April 14, 2009

Dissection plus prosection vs prosection alone

There seems to some debate at the moment regarding whether the next generation of surgeons will lack a certain amount of expertise due to the phasing out of dissection in med schools. The UK is wrestling with this along with the imposition of the European Working Time Directive which will reduce the number of hours a surgeon will have under their belt by the time they are free to operate. The reason I mention this is that it may be a confounding factor when the time comes to analyse whether removing dissection has had a deleterious impact on the quality of surgeons produced.

Not that dissection is much of an option at the present time: I recall there being only 600 cadavers available in the UK in 2005 or thereabouts. Given the huge number of med students in the pipeline, even at twelve to a body the aren't enough to go around.

Twelve seems to be the max you can accommodate. There will be two or three students who are generally not that into it, two or three who are not in the correct state of mind and / or body during that particular class and two or three who are a bit too timid to get too involved thereby leaving four or so horribly assertive aspirational surgeons to get on with it. Any more than that would lead to ugly scenes, I would imagine, particularly as the cadaver gets smaller during the year.

Being the partial, unfinished and highly imperfect work-in-progress product of two med schools, one with dissection and one without, I've had chance to reflect (see first post) on the pros and cons of including dissection in the syllabus.

  • Dissection eases you into the physically challenging aspects of the course. You go from prosection, plastinated organs which are visually quite removed from the in situ organ, to body sections, to eventually the whole body, a process which help to get students comfortable with handling and examining body parts and, indeed, bodies. The process of respectfully gaining an understanding of anatomy via dissection provides the opportunity to apply challenging procedures to another human body.
  • Working around a cadaver was, I found, a good collegiate learning environment where discoveries could be shared and learnings consolidated through the process of dissection. It was also a strong bonding experience to be working in such a privileged environment.
  • Each and every student, as you would expect, maintained a high degree of professionalism at all times during the process: excellent preparation for future experiences.
  • Dissection provides the opportunity to understand how tissues relate to one another and how to remove certain tissues and organs to reach another. If you are a visual learner like what I am (grammar) , you can visualise what was where and how you got to it a long time after the event.
  • From the med school's point of view, it's a logistical and cost headache which is fair enough.
  • Dissection can prove too challenging for some to encounter so early in the course.
  • We're still waiting for proof, as far as I can tell, that experience with dissections makes for a better doctor, which would appear to be the clincher...
  • ...that and the fact that there aren't many donors anymore.

However, I found it one of the most valuable aspects of the course I started in the UK and will miss it here in Australia: if you have the choice, choose a school with dissection on the syllabus

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