DUE to the limited number of cadaveric donors in the country, medical schools are exploring alternative approaches to reshape how students learn anatomy.
Traditionally involving full-body cadaveric dissections, anatomy practical sessions are now incorporating technological advancements and dry specimens to complement – or even replace – wet dissections.
This, say experts, is the way forward in the evolving field of medical education.
According to Universiti Malaya (UM) Medical Faculty deputy dean of undergraduate studies Prof Dr Muhammad Yazid Jalaludin, the faculty uses a combination of wet dissections, plastinated specimens, polyvinyl chloride (PVC) human anatomy models, and online resources – such as Lecturio, online atlases and references – in its anatomy practical classes for preclinical students.
Prof Muhammad Yazid“The learning of human anatomy has improved over the years, from the incorporation of PVC models and educational videos to online resources and atlases, and now the development of virtual and augmented reality anatomy software.
“These new learning tools are very important to support the study of human anatomy through cadaveric dissections. UM is always ready to incorporate more ways to enhance anatomy education because it forms the core of medical learning,” he told StarEdu.
Universiti Kebangsaaan Malaysia (UKM) Medical Faculty deputy dean of undergraduate studies Assoc Prof Dr Jemaima Che Hamzah said her faculty recently acquired an interactive three-dimensional (3D) anatomy software that enables students to visualise, manipulate, edit and understand spatial relationships of anatomical structures with “stunningly realistic detail”.
“This supplements and enhances the anatomy teaching and learning process, especially by providing clear visualisation before performing cadaveric dissections, and allows students to do self-revision,” she explained.
Such models, she shared, can also guide students while studying prosected specimens and help explain relationships in structures that are too small or complicated to see in a cadaver.
Dr JemaimaDr Jemaima added that over the past 10 years, the UKM Medical Faculty, through its Anatomy Department, has been training dissection laboratory staff in the technique of cadaver plastination.
“Plastination is a technique used in anatomy to preserve bodies or body parts. Students are provided with specific plastinated body parts during practical sessions following a related lecture.
“Plastinated bodies are anatomically precise, clean, dry, easy to handle and retain the properties of the original specimens. This allows the same cadavers to be used throughout the year, preventing the wastage of body parts,” she said.
IMU University School of Medicine dean Prof Dr Sharifah Sulaiha Syed Aznal said the university does not use cadavers but instead utilises models, dry specimens, 3D complete anatomy apps, and Microsoft HoloLens for anatomy practical sessions.
Prof Sharifah Sulaiha“Studies have shown that the acquisition of knowledge and skills in anatomy is similar when using traditional methods or modern alternatives,” said the consultant in obstetrics and gynaecology.
Citing the challenges of using human cadavers – such as ethical concerns, consent issues, storage difficulties and chemical pollution – Prof Sharifah Sulaiha said there are no compelling reasons to continue incorporating cadaveric dissections in anatomy education among undergraduate medical students.
“I believe cadaveric dissections can be replaced almost entirely in undergraduate studies, though they may still be useful in certain postgraduate studies like forensic pathology.
“Many of our young surgeons from the last few decades did not have cadaveric dissections during their undergraduate years, yet they continue to succeed in their career paths,” she said.
She added that the training to become surgeons only begins when young doctors gain authentic experience by working with real patients in clinical settings.
“The training of doctors in modern medicine has evolved very much, as we insist on trainees progress in a spiral from beginner to mastery level in their competencies.
“Medical education and doctor training across all fields now also focus on transferable skills, where competencies achieved in simulated environments are applied to real-world practice,” she said.
Surgical skills, she asserted, can be developed through simulation training – for example, cutting techniques can be taught using virtual reality technology, while the identification of organs or body parts can be practised with 3D anatomy apps.
Why cadavers remain essential
While Prof Sharifah Sulaiha envisions a future where technology-assisted learning tools might potentially replace cadaveric dissections in anatomy education, particularly in undergraduate studies, she noted that the traditional method still has its role.
“This is especially true in areas where authentic dissecting skills on wet specimens are more beneficial. When such skills are required, the maturity of the handler to respect the body must be taken into account due to the potential ethical and legal implications,” she said.
Weighing in, Dr Jemaima emphasised that cadaveric dissection remains the main method for teaching and learning anatomy.
She shared that although newer technologies are available, the main barriers are the cost and availability of headsets, especially when using virtual reality in a class of 200 students.
“Cadaveric specimens are important as they give students hands-on experience in identifying and locating structures and their relationships within the human body.
“For example, students learn to locate the median cubital vein for blood taking, the appendix when diagnosing appendicitis and during appendectomy, and the surface markings of heart valves for cardiovascular examinations by placing the stethoscope in the correct locations.
“This experience is vital as students may perform procedures or assist in operations during their clinical years, and later specialise in various surgical subspecialties,” she said.
On ethical considerations and cultural sensitivities surrounding cadaveric dissections, Dr Jemaima explained that strict procedures are followed when acquiring cadavers from hospitals and transporting them to facilities for embalming.
Photo: Freepik
“While acquiring cadavers can be challenging due to beliefs held by certain ethnicities, cultures and religions – despite advocacy from religious leaders and public figures – there has been no resistance from the students during practical dissection sessions,” she added.
Agreeing that there are limitations to virtual anatomy tools that can only be addressed through cadaveric dissections, Prof Muhammad Yazid said these tools lack realism, textural feedback, and the 3D complexities of actual human tissues, where fibres are intertwined rather than simply layered on top of each other.
“They also have limited variations, as the virtual software is usually modelled from a single individual.
“Cadaveric dissections, in contrast, allow students to appreciate the real-life diversity of anatomical structures, since each cadaver is unique,” he said.
He added that modern tools lack the humanistic and emotional preparation aspects provided by cadaveric dissection.
“They also pose technical limitations and financial challenges due to expensive yearly subscriptions, as well as the risk of over-relying on technology, which can diminish critical thinking and problem-solving skills that are developed during cadaveric practicals,” he said.
Cognisant of the need for continued cadaveric dissections to foster emotional resilience and professional ethics among medical students, UM has been collaborating with Tzu Chi University in Taiwan since 2012 to organise the Silent Mentor Programme, where donors donate their bodies for medical education after death, he shared.
“Final-year medical students at UM can join clinical workshops to gain real-life experience performing surgical procedures on the silent mentors,” he said.
Dr Jemaima said her faculty has signed a memorandum of understanding with the Academy For Silent Mentor, making it possible to organise cadaveric dissection and surgical workshops for both undergraduate and postgraduate medical students.
Due to the limited availability of full-body cadavers, she said the university’s approach includes using both full and partially prosected formalin-fixed cadavers, as well as loose organs and plastinated specimens, to demonstrate anatomical regions of interest or topics related to lectures to students.
“As full-body cadavers are limited, medical students in our faculty do not perform dissections during practical sessions themselves. Instead, cadavers are dissected by experienced anatomists who demonstrate the procedures to the students,” she said.
Zhi Yong, 24, a medical student at Universiti Malaya, is a participant of the BRATs Young Journalist Programme run by The Star’s Newspaper-in-Education (Star-NiE) team. For updates on the BRATs programme, go to facebook.com/niebrats.
Views from the field
“Anatomy is a challenging subject for many medical students. Textbooks offer basic information but can be dry. While 3D anatomy apps are innovative, they are often not user-friendly. Hands-on exposure to wet dissections is immensely helpful, allowing me to see how body parts work together.
The Silent Mentor Programme benefits many, from specialists and postgraduates to medical students. This programme also adds a human element to dissection, reminding us that the body we study was once a person, just like us.” – Bonnie Lim Li Shuen, fifth-year medical student, UM
“In my earlier studies, I relied solely on wet cadaveric dissections. However, with the recent acquisition of a 3D equipment called Anatomage at my institution, my view on anatomy education has changed.
As an executive member of my university’s surgical society, I help organise events using Anatomage to explore surface anatomy and landmarks. This 3D tool has been key in enhancing our comprehension of muscle attachments, blood vessels and nerve pathways. It allows us to visualise anatomical structures more clearly by dissecting them layer by layer. Additionally, it supports self-practice and testing.
While wet dissection offers unmatched tactile learning, 3D tools like Anatomage provide valuable supplementary benefits. Combining both methods leverages their strengths, creating a more comprehensive approach to learning anatomy.” – Ngew Wai Kit, fifth-year medical student, Manipal University College Malaysia
“Wet dissection provides a hands-on experience that textbooks and 3D apps can’t match. By examining real specimens, students gain a deeper, intuitive understanding of anatomical structures and their spatial relationships. It also exposes them to natural variations in anatomy, offering a broader view of human diversity.
For orthopaedic surgeons, cadaveric dissection is crucial for a tactile understanding of musculoskeletal anatomy. Ultimately, the detailed knowledge from dissection leads to better preoperative planning, increased accuracy, and more effective patient outcomes, making it essential for orthopaedic training.” – Dr Justin Chin Zheng Yao, orthopaedic surgeon, Hospital Taiping
