Is The Cadaver Dead?

It is one of the oldest traditions in medicine. For generations, medical students have begun their training by dissecting a dead body. But now this gory rite of passage, which many consider essential to the creation of educated and well-rounded physicians, may itself be dying. As new disciplines like genomics and neuroscience have emerged over the last 30 years, the number of hours students spend on gross anatomy has decreased steadily. No one sees this trend reversing, and many in the field expect that cadaver dissection will eventually be reserved for those students interested in anatomically oriented fields like surgery and radiology.

For the other students, cadaver dissection will be replaced by the study of "prosections"--predissected body parts--and an array of increasingly sophisticated images available on CD-ROM and the Web. Prosections offer students a neater, cleaner way to examine a particular limb or organ. The computer images enable them to explore the human body as easily as they might play a videogame.

Both are currently in wide use, and Dr. Geoffrey Guttmann, assistant professor of anatomy at the University of Saskatchewan College of Medicine, considers them more than adequate for students who plan on entering general practice. "As family practitioners, they need to know generally how to poke around the surface anatomy of a person," he says. "They need to know how the organs are arranged and what's going on there. But they don't need to have their hands necessarily inside the cadaver to get the total feel."

Good as they are, however, computer images do have their limits. No one knows this better than Dr. Robert Trelease, an associate professor of pathology at UCLA who is also involved in the development of computer-based anatomical imagery. "Cadaver dissection represents a special type of kinesthetic learning that cannot be replaced by computer simulations," he says. For the foreseeable future, Trelease argues, even with costly advanced virtual-reality technology, computers will not be able to provide the in-depth simulations that would be required to truly replace the cadaver.

And even if they could, would that be a good thing? While some consider cadaver dissection an old-fashioned discipline that requires students to memorize excessive, even irrelevant facts, others embrace the endless detail. "All the muscles, all the nerves, all the bones," says Dr. M. Ashraf Aziz, associate professor of anatomy at Howard University College of Medicine. "By touching them, you develop a map of the body."

If the cadaver dies, some doctors think students will have lost a vital link between physician and patient, between life and death. "There is nothing more valuable than gaining knowledge of the preciousness of each individual life," says Aziz. "It is the mortal aspect of any being that gives value to that life. And when the students encounter the cadaver, they are brought in very, very close contact with this, and the memories remain over a lifetime." For now, it's likely these are memories that fewer and fewer doctors will share.