Rethinking Anatomy 101
Date: February 1, 2013
For well over half a millennium, doctors in training have learned human anatomy by dissecting cadavers. Today, this iconic rite of medical school passage is deemed essential for mastering the basic construction of the human body.
But could high- and low-tech simulations of the human body provide a viable alternative?
The question of whether cadavers are strictly necessary to properly train doctors was one faced by the Perdana University Graduate School of Medicine outside Kuala Lumpur in Malaysia. Formed just two years ago in collaboration with the Johns Hopkins University School of Medicine, Perdana is Malaysia’s first post-graduate school of medicine.
In instituting the curriculum for the school’s first class of 24 students, the Perdana faculty and their supporting colleagues back in Baltimore immediately had to confront a challenge: The nation’s strong Muslim, Buddhist, and Hindu cultures place sharp restrictions on the use of cadavers for education.
“We needed to find a way to help the students integrate the necessary knowledge while maintaining respect for the culture,” says Nicole Shilkofski, a Hopkins critical care pediatrician who has taken on the role of vice dean for education at Perdana.
Speaking in October at a Baltimore gathering of representatives from the various hospitals and other health care facilities around the world that collaborate with Hopkins via Johns Hopkins Medicine International, Shilkofski noted that the culture clash went beyond cadavers. Malaysian people in general—and Malaysian women in particular—are typically highly uncomfortable submitting to pelvic and breast exams. That means Perdana also couldn’t recruit many people in the region, or even fellow medical students, to serve as “standardized patients,” who essentially play the role of a patient with a specific set of symptoms and who submit to an exam—another core teaching technique of Western medical schools.
“Standardized patients [SPs] are utilized here at Johns Hopkins School of Medicine in our Genes to Society curriculum,” says Shilkofski. “[SPs] are all the more important to Perdana, not only because we use the same curriculum, but because the students won’t have access to real patients for a few years until the school’s teaching hospital is completed.”
The solution to both problems involved turning to simulations. Hopkins vascular surgeon Ying Wei Lum juggled the Perdana anatomy curriculum to revolve around virtual dissection performed by students both on computers and on manikins. The computers run a powerful 3D human-body visualization program called VH Dissector, while the plastic manikins are specially designed to provide a fairly realistic dissection experience. Meanwhile, the standardized patient exam is being semi-simulated at the school by recruiting people to snuggle up against partial manikins that provide realistic imitations of the culturally sensitive body area. The students verbally interact with the live “patient,” but lay their hands on the plastic. “The idea isn’t that students will become experts in clinical techniques through this approach,” said Shilkofski. “But they'll get a sense of the clinical ramifications of what they’re learning in anatomy.”
Shilkofski and colleagues have been pre- and post-testing Perdana students exposed to the new techniques in order to ascertain the approach’s effectiveness. Those studies are still ongoing, she notes, but so far post-test results have averaged 87 percent higher than pre-test figures. “It looks as if these techniques are leading to long-term knowledge retention,” she says.
If the figures hold up, the tools could find their way into the Hopkins curriculum as well. “We're developing a research database on these techniques in collaboration with the Hopkins medical school,” she says. “We want to know what factors are predictive of success for students.”
Not that anyone at Hopkins is talking about ending the use of cadavers just yet. Six-century-old traditions don’t die easily. David H. Freedman