Training on Cadavers Still Essential for Medical Students

New technologies have emerged for teaching anatomy to medical students, from full-size replica human models to virtual reality programs. But training with cadavers — called donor dissection — remains a critical component of medical education.

“Everyone was excited about using technology and virtual reality, which has been great, but now people are starting to realize that it’s a supplementary tool, and it will not replace the work with the donors,” Joy Balta, MSc, MEd, PhD, chair of the body donation committee for the American Association for Anatomy, told MedPage Today.

That’s because it’s tough to replace the hands-on experience of donor dissection, said Balta, who is also director of the Anatomy Learning Institute at Point Loma Nazarene University in San Diego.

“Being able to have hands-on experience with real human tissue is not something that you can replace with technology or even any other simulation,” he said.

Annelise Silva, MD, EdM, national president of the American Medical Student Association, said experience with donor dissection was “a really pivotal moment” for her, especially when she started her surgery rotations during her third year of medical school.

“It’s such a privilege and an honor” to have the opportunity to learn through donor dissection, she said. “It was a really powerful thing for me to connect that with the donor experience. And I think it was invaluable to prepare me once I went into surgery to be able to build those skills.”

Students get much more than training on the fundamentals of human anatomy with donor dissection, said Margaret McNulty, PhD, vice chair for education in the ​department of anatomy, cell biology, and physiology at ​​Indiana University School of Medicine in Indianapolis.

They pick up skills that are “part of the hidden curriculum,” McNulty said.

“A lot of research has shown that students are able to foster these non-traditional skills, like empathy [and] emotional intelligence,” she said. “It’s also an exposure to death and dying.”

Demand for the hands-on experience of donor dissection is higher than ever, Balta said. Some of the increase is attributed to greater need among medical students, who may have limited time in the clinic. In addition, several medical residency programs, like general surgery, offer donor dissection to provide more opportunities for residents to develop skills that can’t be tested on living patients.

Donor dissection also has become increasingly popular in training for other medical professions, including physician assistants (PAs), nurse practitioners (NPs), physical therapists, occupational therapists (OT), athletic trainers, and kinesiologists, he said.

Finally, researchers have been working more frequently with body donors to develop new techniques and devices as well, he said.

“The work with donors now is not just strictly in anatomy. It’s been expanding more and more,” Balta said. “That’s why there’s been an increase in the demand and need for donors.”

Ethical Concerns

Though demand is high, some high-profile controversies have cast a shadow over the practice and revealed some of the ethical concerns around using donor bodies in medical education and research.

The most recent example came last week, when NBC News reported that a Texas state medical school was making money by selling or leasing body parts from recently deceased individuals whose bodies were unclaimed. And last year, federal prosecutors uncovered a similar scheme of selling body parts within the morgue at Harvard Medical School.

Balta said these are rare occurrences, but acknowledged that body donor programs in the U.S. are woefully under-regulated and under-supervised.

“There’s no oversight or regulation on how human material could be used in the United States,” Balta said, adding that there are “some regulations around the donation process.”

Much of the oversight comes from the Uniform Anatomical Gift Act, which was enacted in 1968 to establish a federal framework for body donations. It was revised most recently in 2006 to address shortages and encourage more body donations.

“A lot more needs to be done to help that process,” he added.

Balta said other countries, including the U.K., have human tissue laws that require all body donation programs be inspected to oversee how donor bodies are being used.

‘We Take It Very Seriously’

McNulty said body donation has come a long way despite those recent incidents.

“Getting consent is a huge part of the process, and we, anatomists, take that very seriously,” McNulty told MedPage Today.

While there are still cases of mismanagement at cadaver programs, McNulty said the field of anatomy has shifted substantially away from its darker days. In fact, the word “cadaver” has largely been replaced with “donor dissection” by many experts and academics, she said.

“We as a field have collectively tried to move away from cadaver to donor, trying to form more respect for the people who have literally made the ultimate gift: they’re donating their body,” she said.

McNulty said her institution follows a simple process that starts with an individual choosing to donate their body on their own. When the donor dies, their family members contact the program and a representative takes care of the donor’s body from pick up until their cremated remains are returned to the family.

Consent is a critical part of the process, she said, adding that body donation programs do not solicit donors directly.

Even without direct recruiting, McNulty’s institution still receives about 400 donations each year, and all of them agreed to donate their bodies prior to death.

Most institutions also have a student-led memorial service every year to honor the donors, where families are invited to attend, McNulty said.

“We’re stewards of your body, and we take that stewardship very seriously,” she added. “We pass that feeling on to our students as well.”

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