Prosection or Dissection? 1
Running head: Prosection or Dissection?
Prosection or Dissection?
A Comparative Study of Student Opinions on the Use of Cadavers in Community Colleges
Darren C. Mattone
HAPS-I
In partial fulfillment of the requirements for Biol 505
Paul Krieger
June 13, 2008
Prosection or Dissection? A Comparative Study of Student Opinions Prosection or Dissection? 2
on the Use of Cadavers in Community Colleges
As the need for health care professionals increases, many community colleges and four-year colleges are instituting programs that will eventually fill the gaps in the health care field. To keep up with the current demand for workers in the burgeoning health care fields, many colleges are instituting new or modified programs to prepare students for future employment. Cadavers are often part of these programs. The majority of schools utilizing cadavers at the undergraduate level typically have allied health programs including mortuary science, chiropractic medicine (Conway, 1985) and/or nursing. Considering the fact that most allied health students only need an Associate’s degree to become qualified for employment, the concern is in the quality of the training they receive during their concentrated undergraduate education (Peterson, 1993). These students must reach an appropriate level of competency. One way to develop competency in anatomy is through the use of human cadavers.
Why invest in a cadaver laboratory when many high quality models, books, and pieces of technology available for learning anatomy? While the aforementioned resources are beneficial for learning anatomy, cadavers (prosected or dissected) provide a 3-D perspective not found with books or electronic media (Aziz et al.,
2002; Leung, Lu, & Tien-Shang, 2006; McLachlan, Bligh, Bradley, & Searle, 2004;
Yeager, 1996). Cadavers also lead to an understanding of the spatial orientation of the body, lead to a better understanding of large organs (Parker, 2002), and may provide insight into the anatomical variation that exists between humans (Jones, Prosection or Dissection? 3
1997; Skidmore, 1995). Cadavers also act as a mechanism to reinforce and apply concepts learned from lectures (McLachlan et al., 2004).
When implementing a cadaver-based lab curriculum into an existing program, colleges face many challenges including student involvement and mode of use (dissection v. prosection), time, space, class size, costs and issues of management. When deciding to add a cadaver component, it is also important for a college to recognize student views and attitudes toward this learning tool. Since there is little or no literature on these challenges or on undergraduate student perspectives, this paper addresses both of these issues
Student involvement is one key topic that needs to be addressed when using cadavers. Will the students dissect the cadavers or will they observe cadavers that have been predissected (prosected)? This question is not unique to undergraduate schools; it is also being contemplated at the graduate level. Many medical schools have turned to the use of prosected specimens due a decrease in allotted time for anatomy courses (Winkelmann, 2007).
A common concern of using prosected specimens is their value in learning.
Research has shown that student learning from prosected specimens is just as effective, if not more effective, than traditional dissection (McLachlan et al, 2004;
Parker, 2002). Sinclair (1965) illustrated that medical students learning anatomy through the use of prosected cadavers performed better on practical and subjective assessments than those learning through traditional dissection. Alexander (1970) showed that physical therapy students using prosected specimens showed no Prosection or Dissection? 4 significant difference in learning and recall from those learning through traditional dissection. Nnodim (1990), in a study similar to Sinclair’s, demonstrated that medical students learning the anatomy of the lower limb via prosection scored significantly better than those learning through traditional dissection. Further examination of these students revealed that learning with prosected cadavers helped them understand the material better than when they learned the upper limb through dissection. In addition, these students were able to complete their learning in about 74% of the time (Leung et al., 2006; Peterson, 1993). After five years retention rates of both groups showed no significant differences (Leung et al., 2006;
Nnodim, Ohanaka, & Osuji, 1996).
Use of prosected specimens may also reduce student anxiety, a recognized issue for students working with cadavers (Charlton & Smith, 2000; Conway, 1985;
Penney, 1985; Skidmore, 1995; Winkelmann, 2007). When students dissect cadavers anxiety about the physical act of cutting may linger through the entire dissection experience (Penney, 1985).
Another important issue to consider when implementing cadavers in a curriculum is class size. Consider the following scenario: A college intends for all its students to learn through dissection. It enrolls 240 students per year in its anatomy course. This would require the use of 30 cadavers, assuming a ratio of eight students to one cadaver. Space implications for housing 30 specimens and financial implications stemming from the annual turnover of the specimens become large limiting factors. On the other hand, this same college, for a much lower cost Prosection or Dissection? 5 and in an average sized space, could accommodate three to four prosected specimens. If organized properly, all 240 students could learn from those cadavers.
Additionally, with the proper care, the prosected specimens can last several years before needing to be replaced.
This paper describes a study conducted by the author on the views and attitudes of students relating to the use of cadavers in undergraduate anatomy and physiology courses and on student preferences for prosection or dissection. Data from this study may be used by schools when determining whether to implement cadavers and/or whether to require prosection or dissection procedures. This study will add to the existing body of research by presenting primary data from students that have worked with cadavers and from those that have not. It may also provide schools a starting point for developing their own survey instrument to answer questions not supplied by this study.
This study addressed the following questions regarding the use of cadavers at the undergraduate level:
(1) Are the views and attitudes between the schools similar?
(2) Do students believe there is a benefit in using cadavers to learning
anatomy?
(3) Is there any indication by students towards a preference for prosection or
dissection?
Prosection or Dissection? 6
Methodology
This mixed-method study was conducted at the end of the 2008 winter semester and involved students from two community colleges in the central region of western Michigan. Muskegon Community College, located in Muskegon,
Michigan, has a total student population of 4,466 (U.S. Department of Education,
2008), and currently does not use cadavers in its anatomy and physiology courses.
Grand Rapids Community College, located in Grand Rapids, Michigan, has a total student population of 15,224 (U.S. Department of Education, 2008), and currently has five prosected cadavers for use by their anatomy and physiology students
(Krieger, 2008). Despite the difference in population size, both colleges have very similar demographics (Table 1). These similar demographics make these two schools valid subjects for comparison.
Table 1: Demographic Information MCC GRCC Population 4,466 15,224
Full Time 40.9% 43.5%
Part Time 59.1% 56.5%
Female 56% 51.6%
Male 44% 48.4%
Full-Time Retention 62% 62%
White non-Hispanic 84% 78%
Black non-Hispanic 8% 10%
Hispanic 3% 6%
Asian/Pacific Islander 1% 2%
American Indian 1% 1%
Race/Ethnicity Unknown 3% 2%
Non-resident alien 0% 1%
Prosection or Dissection? 7
Muskegon Community College offers two one-semester anatomy and physiology courses. The first semester course (Biology 105) is a general overview of human anatomy. The second semester course (Biology 106) includes anatomy but emphasizes detailed physiology of the various organ systems and cellular metabolism. (Biology 105 is a prerequisite for Biology 106.) The entire human body is taught over two semesters, but this course sequence is not a conventional two- semester course (Muskegon Community College, 2008). Grand Rapids Community
College offers a traditional two-semester course sequence, Biology 121 and Biology
122, each covering approximately one half of the body systems per semester (Grand
Rapids Community College, 2008).
Muskegon Community College offered three sections of each course in the
Winter 2008 semester; approximately 140 and 160 students were enrolled, respectively (Muskegon Community College, 2008). The students sampled for this study were drawn from two of the daytime sections of Biology 106. Students in
Biology 105 were not asked to participate in this survey.
Grand Rapids Community College offered seven sections of Biology 121 and eight sections of Biology 122 during the Winter 2008 semester (Grand Rapids
Community College, 2008). Total enrollment in these courses was 252 and 288 students, respectively. The students from Grand Rapids Community College that participated in this study were drawn from one section of Biology 121 and two sections of Biology 122 (Krieger, 2008). Prosection or Dissection? 8
Students were asked to rate various statements about their anatomy and physiology lab experiences on a five-point scale from 1 (strongly agree) to 5 (strongly disagree) (Appendix A). These statements were designed to gather data about dissection in general, the use of models and cadavers, the use of time in the anatomy and physiology lab, and preference for prosection or dissection.
Qualitative data were collected from the Grand Rapids Community College students. They were also asked to write comments about their use of cadavers that may not have been addressed in the quantitative statements. Muskegon
Community College students were not asked for written responses, although in hindsight they should have been asked. These responses elicited deeper details that could not have been obtained through the survey questions.
Students participating in this study were not chosen randomly. End of the semester time constraints necessitated the use of a convenience sample, and students were asked to complete the survey voluntarily. Minimal extra credit, accounting for less than one percent of students’ total grade, was awarded to participants. Table 2 shows demographics of the survey participants. Despite the lack of randomness in the design, the demographics of participants were similar between both schools.
Prosection or Dissection? 9
Table 2: Respondent Demographics
MCC GRCC # given option to participate 97 71 # participating; % participation 89; 91.8% 60; 81.1% # females participating 64; 71.9% 46*; 76.7%
# males participating 25; 28.1% 13*; 21.7% Average Age ranges of students 21-30 yrs 21-30 yrs n=62; 66% n=39; 65%
# nursing students participating 38; 40.4% 18; 30.0%
# of students from other academic programs 56; 59.6% 42; 70.0%
* One student did not indicated gender, therefore male and female counts do not total up to 60.
Although the demographics of the participants (Table 2) are dissimilar to the overall demographics of the colleges (Table 1), anecdotally it is assumed that this is related to the number of allied health programs at each school that require anatomy and physiology courses as prerequisites. Between the schools, 37% (n=56) indicated that they were nursing students. The remaining participants were grouped into 12 other academic areas, seven of which were health-related fields. (This number excludes students indicating “undecided” or leaving the field blank.) Appendix B lists the different academic programs indicated by participants.
Data Analysis and Results
To assess student views on cadaver use, three major questions were asked.
Statements (Appendix A) were formulated to address each question, and students were asked whether they agreed or disagreed with each one. These responses and any written responses were tabulated and conclusions were drawn. Statistics for all statements are summarized in the following table (Table 3). Prosection or Dissection? 10
Table 3: Statement Statistics
Mean School M SD N t df p Difference
MCC 1.53 0.867 89 Statement 1 0.29 1.91 147 0.058 GRCC 1.82 0.965 60
MCC 1.45 0.754 89 Statement 2 0.12 No t-test performed GRCC 1.57 .0927 60
MCC 1.53 0.827 89 Statement 3 0.05 No t-test performed GRCC 1.58 0.889 60
MCC 1.28 0.754 89 Statement 4 0.35 2.38 146 0.019 GRCC 1.63 1.03 59
MCC 1.28 0.754 89 Statement 5 0.30 2.09 147 0.038 GRCC 1.58 0.996 60
MCC 4.28 1.18 89 Statement 6 0.16 No t-test performed GRCC 4.12 1.22 60
MCC 1.71 0.968 89 Statement 7 0.51 2.79 147 0.006 GRCC 2.22 1.26 60
MCC 2.67 1.20 89 Statement 8 0.39 2.06 147 0.042 GRCC 2.28 1.03 60
MCC 1.42 0.781 89 Statement 9 0.05 No t-test performed GRCC 1.47 0.873 60
Mean differences are absolute values. T-tests were performed on statements with mean differences >0.29.
Research Question 1: Are the views and attitudes between the schools similar?
Review of Table 3 shows that the difference between the means were minor.
It was determined that mean differences >0.29 were to undergo post-hoc analysis by t-test. This level was chosen since this seeed to be a natural cutoff point. Type I error was controlled using a Bonferroni correction (α = α/c where c=number of t- test): α= 0.01. T-test results indicated a significant difference between the means of statement 4, 5, 7 and 8. (Table 3). Although the p-values for statements 4, 5, and 8 Prosection or Dissection? 11 showed significant difference based on α=0.05, controlling for Type I error indicated that the p-value was not significant.
Research Question 2: Do students believe there is a benefit from using cadavers (to learning anatomy)?
• Statement 4: Using human cadavers would be/has been an effective way to learn human anatomy.
• Statement 5: Using human cadavers would be/has been beneficial for helping to see how the human body systems are interrelated.
Overall, students from both schools agreed that there was a benefit in learning anatomy from cadavers (Table 4).
Table 4: Statement 4 & 5 Statistics STATEMENT 4 Mean SD Number Number % Agreeing Agreeing MCC 1.28 0.754 89 85 95.5% GRCC 1.63 1.03 59 49 81.6% Mean Difference 0.35
STATEMENT 5 Mean SD Number Number % Agreeing Agreeing MCC 1.28 0.754 89 75 95.5% GRCC 1.58 0.996 60 52 86.7% Mean Difference 0.30
Grand Rapids Community College students that submitted general comments indicated specific benefits of working with cadavers. Comments, with number of responses in parentheses, included helpful (9); provides a real picture of the human body (4); an opportunity to apply lecture concepts; a good edition to the course; puts things in perspective (6); pictures, models, and cadavers all complement one another (3); and shows anatomical variations not seen in models. Prosection or Dissection? 12
Although students felt they would benefit from using cadavers, they also felt that other resources were important to learn anatomy, as indicated in their responses to statements two, three and nine (Table 4).
Statement 2: Using models to study the human body had been an effective way to learn human anatomy.
Statement 3: The lab models are beneficial for helping to see how the human body systems are interrelated.
Statement 9: Even with cadavers as part of the curriculum, it would still be important to use lab models to learn human anatomy.
The majority of the students from both schools (91.3%, n=136) agreed
(indicated strongly agree or agree) that using models was an effective way to learn anatomy (Statement 2). They also agreed (indicated strongly agree or agree) (91.9%, n=137) that models were beneficial for seeing the relationships between organ systems (Statement 3). When asked to respond to a similar statement about continuing to use models even with cadavers as part of the curriculum, 91.9%
(n=137) agreed (indicated strongly agree or agree) that this would be important
(Statement 9).
Table 5: Statement 2, 3, & 9 Statistics STATEMENT 2 Mean SD Number Number % Agreeing Agreeing MCC 1.45 0.754 89 82 92.1% GRCC 1.57 0.927 60 54 90.0% Mean Difference 0.12
STATEMENT 3 Mean SD Number Number % Agreeing Agreeing MCC 1.53 0.827 89 81 91.0% GRCC 1.58 0.889 60 56 93.3% Mean Difference 0.05
STATEMENT 9 Mean SD Number Number % Agreeing Agreeing MCC 1.42 0.781 89 82 92.1% GRCC 1.47 0.873 60 55 91.6% Mean Difference 0.05 Prosection or Dissection? 13
Fewer free response comments were received for these statement than for statements 4 and 5. Nevertheless, they were informative. One student indicated that he was a visual learner and models were helpful if something was difficult to see on a cadaver. Another indicated that while cadavers were more beneficial, models were still helpful to his understanding of anatomy. Other comments included:
• the use of models (and illustrations) were a nice complement to cadavers and “prepare[d] [students] for [many] interactions with anatomy.” • models provide a reference to the fine points of anatomy that might not be seen on a cadaver. • “Models are good for landmarks, illustrations are good for showing processes or mechanisms. A combinations [of all three] is the way to teach.” • “models are a good substitute when you don’t have a cadaver or when something cannot be seen on the cadaver.”
Conversely, some students did not realize the benefits of using cadavers. A nursing student from GRCC felt that “looking at a cadaver [was] the same as looking at a picture in a book.” Another student felt that there was not much difference between the cadaver and a model. Still another felt that the resolution on the cadavers was not as good that of pictures or drawings. These comments were in the minority.
Research Question 3: Is there any indication of a preference for prosection or dissection?
Statements 7 and 8 related directly with this research question. Prosection or Dissection? 14
Statement 7: Requiring students to be directly involved with the dissection of the cadavers would be an effective way to learn human anatomy.
Statement 8: Ample observation and learning time with the cadavers would be more beneficial to students than having students directly involved with the dissections.
There was a significant difference between the responses of MCC students and
GRCC students for statement 7 (t=2.79, df=147, p=0.006). This indicated that MCC students showed preference for traditional dissection while GRCC showed a preference for using prosected cadavers (Table 6).
Table 6: Statement 7 & 8 Statistics STATEMENT 7 Mean SD Number Number % Agreeing Agreeing MCC 1.71 0.968 89 73 82.1% GRCC 2.22 1.263 60 35 58.4% Mean Difference 0.51
STATEMENT 8 Mean SD Number Number % Agreeing Agreeing MCC 2.67 1.204 89 41 46.0% GRCC 2.28 1.027 60 35 58.4% Mean Difference 0.39
While GRCC students indicated preference towards using prosected cadavers, one
GRCC student did indicate that dissection would be the most effective method of learning anatomy. Another student emphasized that dissection “shouldn’t be required …or do[ne] by students—rather the professor [should do the dissection].”
This may stem from general anxiety toward dissection and working with cadavers.
Discussion
Overall, student responses to the statements did not reveal major differences between the groups of students. Even though five statements (1, 4, 5, 7, 8) differed by 0.29 or higher, only statement 7 showed a significant difference between the Prosection or Dissection? 15 means when subjected to t-test analysis. It is hypothesized that the lack of major differences stem from students’ understanding of the importance of anatomy to their future careers, the necessity of dissection to learning anatomy, and the need to utilize a variety of resources (models, books, or cadavers) to support their learning.
In addition, the demographic similarity between the survey respondents could have contributed to the similar responses.
Students from both schools felt there were benefits in using cadavers to learn anatomy; at least 80% of all students indicated agreement (indicated strongly agree or agree) to the statements 4 and 5. Interestingly, students from both schools also felt that cadavers should not be the only resource for learning. This implies that schools should not eliminate models and/or technology or they may consider adding additional models and/or technology to their lab curriculum.
Three specific comments though, did indicate that a very small minority of students did not favor the cadaver experience. Perhaps these students were enrolled in the Biology 121 course at Grand Rapids Community College and had limited experience with the cadavers. Maybe they were not seeing the overall value of using cadavers. More thorough statistical analysis would be needed to determine a correlation between response and gender, age, or academic program, respectively.
Statements 7 and 8 addressed student preference for prosection or dissection.
T-tests did indicate a significant difference in the mean response for statement 7;
MCC students agreed with this statement more than GRCC students did. This supports the idea that MCC students feel they should be directly involved with the Prosection or Dissection? 16 dissections while GRCC would rather learn from prosected specimens. This difference between the two groups likely stems from Grand Rapids Community
College students’ use of cadavers. They have found that prosected cadavers provide them with more time to study the structures of the cadaver. Support for this inference comes from the studies conducted by Nnodim (1990). This study showed that less time was needed (74% less) to learn specific anatomical structures. In addition, because Muskegon Community College students have not worked with cadavers, they likely do not understand the time commitment required to prepare a cadaver for study. Aside from models, the traditional dissection of fetal pigs and cats is the only experience they have to compare to working with cadavers.
Therefore, their experience with cat and fetal pig dissection could be influencing their agreement with this statement.
Summary and Conclusions
Students from two west Michigan community colleges were surveyed on their opinions towards certain aspects of anatomy lab. Included were statements relating to dissection in general, the use of laboratory models, the degree of student involvement with cadavers, and the general benefits of cadavers in the anatomy lab.
The results of this study provide data to schools considering whether to implement a cadaver lab into their curriculum. The data from this study show that students do favor the use of cadavers in their courses. It also indicated that schools should not remove traditional learning resources (models, illustrations) from their Prosection or Dissection? 17 curriculum. Students find a combination of different resources valuable to their learning experience.
Regarding whether students should use prosection or dissection, the data are inconclusive but suggest prosection. When making this decision, schools wanting to incorporate cadavers into their programs still need to consider space for cadavers, size of classes, time allotted for labs, and costs of lab setup and cadaver maintenance. Each school must carefully evaluate these variables to determine which option is right for them and the students they educate.
Further research could compare groups of students from schools that do not use cadavers. A study comparing groups of students from schools that do use cadavers would also be valuable. Research examining the retention of knowledge learned from prosection versus knowledge learned from models would also be an interesting study. (These studies would be similar to the studies by Sinclair (1965) and Nnodim (1990) but from an undergraduate perspective.) Until these studies are completed and published, however, each school must carefully evaluate the literature themselves and conduct their own surveys to determine which option may be right for them.
Prosection or Dissection? 18
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Appendix A Survey Questions
Statement 1: Dissection is an important part of learning human anatomy.
Statement 2: Using models to study the human body had been an effective way to learn human anatomy.
Statement 3: The lab models are beneficial for helping to see how the human body systems are interrelated.
Statement 4: Using human cadavers would be/has been an effective way to learn human anatomy.
Statement 5: Using human cadavers would be/has been beneficial for helping to see how the human body systems are interrelated.
Statement 6: Human cadavers should not be used for educational purposes by undergraduate institutions.
Statement 7: Requiring students to be directly involved with the dissection of the cadavers would be an effective way to learn human anatomy.
Statement 8: Ample observation and learning time with the cadavers would be more beneficial to students that having students directly involved with the dissections.
Statement 9: Even with cadavers as part of the curriculum, it would still be important to use lab models to learn human anatomy. Short Title 21
Appendix B Academic Programs Listed Indicated By Respondents
Program Frequency Percentage Biology 1 0.65% Biomedical Sciences 6 3.92% Chemistry 2 1.31% Dental Hygiene 8 5.23% Dual Enroll 1 0.65% Forensic Biology 1 0.65% Human Medicine 1 0.65% Not Indicated 46 30.07% Nursing 56 36.60% Occupational Therapy 8 5.23% Radiology 9 5.88% Respiratory Therapy 9 5.88% Arts and Sciences Degree 1 0.65% Social Work 1 0.65% Sonography 3 1.96% Undecided 1 0.65%