Flipping the Script – Adopting Autopsy Protocol for Cadaveric Dissection in Gross Anatomy

Abstract

Autopsy is a postmortem investigation of the body to determine the cause of death or extent of disease, also serving a quality assurance role by evaluating diagnostic and therapeutic procedures and outcomes in clinical medicine. Autopsy also holds promise in medical education as a focal point for integration and correlation of basic & clinical medical knowledge. Unfortunately, the vast educational potential goes unrealized due to several barriers such as clinicolegal risks, potential exposure to biohazardous materials, limited time, space, and negative stigma. On the other hand, cadaveric dissection in gross anatomy is in rapid decline in medical education as sweeping curricular changes continue to reduce contact hours in favor of systemic and clinical integration. The situation was exacerbated by the COVID-19 pandemic, which demanded expeditious online migration of classes and will likely have a long lasting and transformative impact on the educational landscape. At this time, a unique opportunity exists to adopt an autopsy protocol for cadaveric dissection in gross anatomy to actualize the untapped potential of clinical practice. Therefore, in a pilot project, the feasibility and perceived value of adopting autopsy protocol in cadaveric dissection were evaluated. Four students with regional gross anatomy dissection experience and faculty (n=2) completed dissections of four cadavers using an en masse autopsy protocol. First, external examination of the whole body noting all surface anatomy including scars, abrasions, contusions, and tumors, provided an opportunity to make acquaintance with the body donor. Second, thoracic and abdominopelvic organs were removed en masse (Figure 1) with minimal disruption to the musculoskeletal framework, preserving most neurovascular supply and anatomic relationships of multiple organ systems. The en masse organ block was further dissected into organ system blocks to demonstrate relationships of individual organs. Finally, the musculoskeletal system of the main body frame was regionally dissected. Unstructured interviews of faculty and students were conducted to gauge experience and perceptions of autopsy protocol in cadaveric dissection. A survey of student dissectors (n=4) and observers (n=4) was conducted to qualitatively assess educational value. All participants unanimously reported that autopsy protocol and the en masse organ blocks would benefit gross anatomy education. Students reported new knowledge gained on the boundary of the peritoneum, retroperitoneal structures, ligaments of the visceral organs, and spatial relationships of organ systems that are lost in regional dissections. These outcomes suggest that integrating an en masse autopsy protocol in a gross anatomy course is a viable option that offers a clinical approach to learning gross anatomy. Taken together, adopting autopsy protocol in some form in medical education holds ample opportunity to integrate multiple basic science subjects and clinical practice. Educational value of the autopsy protocol in gross anatomy education will be investigated in the future studies.