Dissection Experience Research Articles

Efficiency in Brain Removal Techniques: A Potentially Novel Approach

Dissection of the human brain is an important part of health professional education in the neuroscience curriculum. Therefore, it is critical that adequate protocols are utilized to preserve structures when removing brains from cadavers. Previous studies have looked at approaches to extracting the brain and associated structures from the cranial cavity which would best preserve these delicate structures. However, these methods require both extensive dissection experience and more time than suitable for routine use. The aim of this study was to determine the technique for brain removal that minimized the time required for the procedure while preserving key structures for future educational purposes.The time and ease for three aspects of brain extraction were assessed: removal of the calvaria, subsequent removal of the brain, and transection of the brainstem. Six dissectors (two faculty, four senior graduate students) with prior experience performed the removals. Each tested three calvaria‐removal approaches – circumferential only, circumferential plus a median cut, and circumferential plus a coronal cut. They also tested three approaches to brainstem transection—superiorly through the foramen magnum, inferiorly below C1 vertebra, or inferiorly after removal of an occipital wedge. The time for each procedure was recorded, and its ease was evaluated on a 5 point scale (1 easiest and 5 hardest). The combination of calvaria and brainstem approaches and the order of completion were randomized across dissectors and the 3 brains extracted by each. At the completion of brain removal, all brains were evaluated by two neuroscience course directors for utility in educational contexts. The evaluators rated structures on a list compiled from the laboratory handouts in the medical neuroscience course.Preliminary examination of the data suggests that removal of the calvaria using only the circumferential cut or using an additional coronal cut took about the same length of time, whereas performing circumferential and median cuts took somewhat longer. However, the ease of removal was greater when either the additional median or coronal cut was employed. Transecting the brainstem took less than a minute if performed through the foramen magnum or below C1, but it took substantially longer if the occipital wedge cut was executed. The ease of transection was greatest when performed below C1, and least when the occipital wedge was removed. There was no clear difference in overall quality of the brains removed by the various techniques.While there may be advantages to one or the other of the techniques for preservation of specific structures, it appears that all approaches tested were equivalent in yielding brains that could be used for educational purposes.

Appropriate Cardiac Anatomy

Various approaches, including inspection, palpation, percussion, auscultation, chest radiography, electrocardiography, echocardiography, computed tomography, cardiac magnetic resonance imaging, and other techniques for cardiac imaging, are the methodologies used to assess the inside of the heart from outside the body. It follows that exact knowledge of intrinsic cardiac anatomy is fundamental for accurate diagnosis. In addition, any kind of invasive cardiac procedure, requires an exact knowledge of cardiac anatomy so as to ensure safety of the investigation. In the light of the significant advances made in the resolution of the techniques for imaging now used by modern‐day cardiologists, far more detailed anatomical knowledge is required so as to obtain full value from the investigations. A basic knowledge of cardiac anatomy is initially achieved in the dissection lab. However, once the heart is removed from the donor, it is often oriented and studied in an attitudinally inappropriate manner when compared to its in‐situ orientation. This can lead to confusion and an incorrect understanding of the true location of cardiac components. For the purpose of not only maintaining, but improving the quality of anatomical knowledge, techniques based on modern cardiac imaging can provide a supplement to the dissection experience. In clinical settings, cardiac computed tomography can now provide ideal spatial resolution, at levels equal to or less than 0.5 mm. This permits the evaluation of the arrangement of even thin structures such as the valvar leaflets. Currently, by using datasets obtained from routine clinical scanning, all cardiologists have the ability to provide in‐depth three‐dimensional knowledge of intrinsic cardiac anatomy. This is achieved by interrogation of three‐dimensional reconstructions of multi‐planar two‐dimensional images, thus replicating real cardiac dissection. By means of such “virtual dissection”, the cardiac components can be shown in the blood‐filled living situation. By combining the reconstructed images, the anatomy of intrinsic features can be shown in relation to the pertinent surrounding extracardiac structures. Sections can be repeatedly acquired, using any desired plane viewed from multiple directions. Such “virtual dissection” is obviously performed without extracting the heart from the thorax, presenting an obvious advantage over the traditional cadaveric approach. All the analyses, furthermore, are performed in attitudinally appropriate fashion, without losing any of the coordinates relative to the components of the thoracic cage. Despite the obvious values of “virtual dissection”, it does not replace real dissection. It is the accurate knowledge based on real dissection that provides the basis for proper evaluation of the virtual images. This means that anatomists must themselves keep abreast of the advances made in modern clinical imaging. An appropriate collaborative approach between anatomists and cardiologists will self‐evidently continue to improve the educational values of the understanding of cardiac anatomy.

Assessment of the determinants of Knowledge, Attitude and Practice (KAP) of Ethiopian Medical Students towards ethical Cadaver Dissection

IntroductionAnatomy is one of the essential basic medical sciences and a key to understand the practice of medicine. Its stduy has been conventionally based around the use of cadaver dissection. Several findings ensured that dissection experience significantly improve KAP towards ethical use of human body. But, they are limited to such effect on early impression and single institution. The effect of dissection experience on KAP towards ethical use of cadaver in education and research in the subsequent years of study and evaluation of factors associated to them are lacking. ObjectiveThe purpose of this study was to investigate the Knowledge, Attitude and Practice of Ethiopian Medical Students towards ethical Cadaver Dissection. MethodMulti-centered cross-sectional study design was implemented. The study was conducted in selected Ethiopian Medical Schools among 279 Pre-clinical Medical Students of Jimma University, Addis Ababa University, Saint Paul's Hospital Millennium Medical College and University of Gondar from April 01 to April 30, 2019. Data were collected by a structured and pre-tested questionnaire and analysis was done by SPSS version 20.0. ResultsA total of 279 respondents were included in the study out of whom 156 (55.9%) were male and 123(44.1%) were female and most of the respondents were in the age groups of ≥ 21years (SD = 0.492 and variance = 0.242). The study result showed that about 45.5%, 48.7% and 39.1% of the study participants had adequate knowledge, favorable attitude, and good practice towards ethical cadaver dissection, respectively. Respecting cadaver as first patient (AOR = 2.098, 95%CI: 1.245-3.531), attending dissection session regularly (AOR = 0.572, 95%CI: 0.338-0.968), actively dissecting cadaver (AOR = 1.459, 95%CI: 0.284-0.742), utmost respect to cadaver (AOR = 0.720, 95%CI: 0.431:1.238), practice > 2 Hrs/day (AOR = 2.224, 95% CI: 0.947-5.228) and apprehension to cadaver dissection (AOR = 1.658, 95%CI: 0.537-0.962) were significantly associated with Knowledge, Attitude and Practice of Ethiopian Preclinical Medical Students towards Cadaver Dissection. ConclusionAlmost half of our study participants had favorable attitude towards ethical cadaver dissection. However, only 39.1% and 45.5% of our participants had adequate knowledge and good practice towards similar issues, respectively. Respecting cadaver as first patient, attending dissection session regularly, actively dissecting cadaver, utmost respect to cadaver, practice > 2 Hrs/day and apprehension to cadaver dissection were significantly associated factors among Ethiopian Preclinical Medical Students towards ethical Cadaver Dissection. Furthermore, though the proportion was low, exposure to cadaver dissection had lasting retention on bettter KAP towards human body usage. We envisage such experience will be translated into humanistic patient care.

A Single-Center Early Experience of Endoscopic Submucosal Dissection for Gastric Lesions in Thailand.

Endoscopic submucosal dissection (ESD) was also considered a “high risk” at the starting point with skillful endoscopic techniques and terrible complications. Still, it remains challenging yet has become widespread among institutes in many parts of the world. This study is aimed at further investigating the feasibility, efficacy, and safety of ESD of gastric lesions and at evaluating clinical outcomes in early experience. The patient characteristics, postoperative outcomes, and results of histopathological examinations were reviewed retrospectively between January 2017 and May 2019. Thirteen patients' gastric ESD were included with all of en bloc resections without recurrence. The long duration was related to the large lesion, the upper part of the stomach, and previous treatment. In this study, the ESD procedure of the stomach is a feasible and safe minimally invasive treatment option with organ preservation. It requires training and experience with a learning approach where skill may be improved to prevent unwanted complications.

An Experience in the Neck Dissection for Oral Squamous Cell Carcinoma

An Experience in the Neck Dissection for Oral Squamous Cell Carcinoma

Vagus nerve and phrenic nerve guided systematic nodal dissection for lung cancer.

Systematic nodal dissection (SND), which is defined as “all the mediastinal tissues containing the lymph nodes are dissected and removed systematically within anatomical landmarks”, is vital in surgical treatment for patients with non-small cell lung cancer (NSCLC) with curative intent (1). However, for avoiding surgical complications or other reasons, a variation of SND affects the thoroughness of lymph node dissection and the accuracy of pathologic nodal (pN) staging, which are the most significant prognostic factors in resectable NSCLC (2,3). Also, reduction in the severity and incidence of postoperative complications, such as nerve injury, is of utmost importance and remains challenging (4). Although some studies reported the experience and skills in mediastinal lymph node dissection (4,5), a standard and systematic procedure for nerve protection are still lacking. Therefore, an easy-to-follow standardized approach of SND, which can not only achieve regional en bloc lymph node resection but also effectively protect the nerves, is critically needed. Based on clinical practice experience, we discovered that the hilar and mediastinal lymph nodes are distributed along with the courses of these two nerves and connected in some anatomical regions (Figure 1). Thus, we first divided the lymph nodes into three areas of each side and developed an improved approach named “duo-nerve-guided SND” for resectable lung cancer, aiming to easily achieve complete resection of hilar and mediastinal lymph nodes as well as adipose tissue without increasing the nerve-related complications. Open in a separate window Figure 1 The anatomy of the thoracic vagus nerve and phrenic nerve and the distribution of lymph nodes. (A,C) The hilar and mediastinal lymph nodes were distributed along the vagus and phrenic nerves as well as their anatomical thoracic branches (pulmonary plexus, cardiac plexus, and esophageal plexus); (B,D) the regional lymph nodes distribution. Area A (green), the posterior area of the hilum; area B (blue), the anterior area of the hilum; area C (red), the anterior mediastinal area for the left side, the superior mediastinal area for the right side. (E) The subcarinal lymph nodes in left side (station 7); (F) the station 4L lymph nodes. RVN, right vagus nerve; LVN, left vagus nerve; LRLN, left recurrent laryngeal nerve.

Construct Validation of a Printed Bone Substitute in Otologic Education.

Nineteen residents (11 male, 8 female) from 9 graduate programs, attending a National Otolaryngology Conference, completed a mastoidectomy with posterior tympanotomy on identic 3D PBMs and a Likert scale (1-7) survey on subjective appreciation of the simulation. Four experts graded participant performance using the previously validated Welling Scale. ANOVA revealed significant performance differences between the junior/intermediate and junior/senior PGY cohorts. No difference was observed between intermediate/senior cohorts on the basis of PGY or subjective temporal bone dissection experience. Clustering aspects of the scale with specific focus on thinning tasks found a similar outcome to the composite scale scores.Subjective experience judged printed bone to be similar to cadaveric in drill-bone interaction. Participants believed the simulation would improve surgical performance, comfort with actual patients, and operative speed. Subjectively, printed bone compared favorably to cadaveric.The simulation demonstrated construct validity but was challenged in differentiating senior from intermediate trainee performance. This may be a function of the PBM inherent character, limitations in grading instrument fidelity or sample size. It is also possible that the dominant period of skill acquisition for mastoidectomy and posterior tympanotomy are primarily acquired during the junior training.

Dissection in the Modern Medical Curriculum: An Exploration into Student Perception and Adaptions for the Future.

For centuries cadaveric dissection has been a cornerstone of medical anatomy education. However, time and financial limitations in modern, compressed medical curricula, coupled with the abundance of alternate modalities, have raised questions about the role of dissection. This study was designed to explore student perceptions of the efficacy of a dissection program for learning musculoskeletal anatomy, and possible adaptations for appropriate inclusion of dissection in the modern medical curricula. A paper-based questionnaire was used to collect data from 174 medical students after completion of cadaveric dissections. Data were analyzed using both quantitative and qualitative methods. Students strongly believed that cadaver-based learning is essential to anatomy education and modern teaching modalities only complement this. Moreover, most students reported that dissection provided an additional, immersive learning experience that facilitated active learning and helped in developing manual competencies. Students with previous dissection experience or an interest in anatomy-related specialties were significantly more likely to attend dissection sessions. Students found that the procedural dissection components enhanced the knowledge of applied anatomy and is beneficial for the development of clinical skills. They welcomed the idea of implementing more procedure-based dissections alongside lectures and prosections-based practical (PBP) sessions. Cadaveric dissection plays an integral role in medical anatomy education. Time restraints and an increased focus on clinical significance, however, demand carefully considered adaptations of existing dissection protocols. The introduction of procedure-based dissection offers an innovative, highly engaging and clinically relevant package that would amalgamate skills essential to medical practice while retaining the benefits that have allowed dissection to stand the test of time.

Experience in Simultaneous Endoscopic Submucosal Dissection Treating Synchronous Multiple Primary Early Esophageal Cancers.

Objective: Synchronous multiple primary early esophageal cancers (SMPEEC) are rare and aggressive. Early detection of esophageal cancer can improve survival rate. Endoscopic submucosal dissection (ESD) is a minimally invasive endoscopic treatment of early esophageal cancers. However, ESD for SMPEEC is little known. We aimed to clarify the clinical outcomes of simultaneous ESD treating SMPEEC. Methods: We retrospectively reviewed the medical data of 34 patients, who underwent ESD for SMPEEC at Endoscopy Center of Zhongshan Hospital, Fudan University, between May 2013 and December 2014. The data of lesion size, histopathology, en bloc resection, curative resection, complication, and tumor local recurrence were analyzed. Results: Among 34 patients, 67 lesions were removed simultaneously in 33 cases; 2 lesions were removed in 2 operations for 1 case. For the simultaneous resection, the en bloc rate was 97.01% (65/67) and the curative resection rate was 92.54% (62/67). Postoperative stricture occurred in two cases and delayed bleeding occurred in one case. There was one local recurrence, no metastasis or procedure-related death. Conclusions: Simultaneous ESD as a treatment for SMPEEC is technically feasible, benefited from reducing hospitalization time and medical expenses. For the cases with risk factors of complications, simultaneous ESD needs to be avoided.

Association of Surgical Volume and Quality Management in Thyroid Surgery: A Two-Nation Multicenter Study.

High-volume caseload in thyroid surgery is associated with lower postoperative complication rates resulting to better outcomes. The aim of the present study was to investigate the correlation of the departments' annual number of thyroid surgeries on the adherence to consensus guidelines and on the implementation of measures for quality assurance. In 2016, we sent an anonymous electronic survey with questions related to the perioperative management in thyroid surgery to all directors of departments in operative medicine in Switzerland and Austria. We compared the pre- and postoperative management with the summarized recommendations of the four most frequently used consensus guidelines. Analogously, we analyzed the implementation of six measures for quality assurance related to thyroid surgery for each participating department. Using logistic regression analysis, we evaluated the correlation of number of guidelines respected and number of measures for quality assurance with the departments' annual number of surgeries performed. Furthermore, we evaluated the number of departments providing thyroid cancer surgery and their experience in neck dissection. The management corresponded in 64.0% to the summarized recommendations. Adherence to the summarized recommendations and implementation of measures for quality assurance were significantly more likely with increasing numbers of surgeries performed (p = 0.049 and p < 0.001). Ninety-two departments provided thyroid cancer surgery, whereas 12/92 (13.0%) were not able to perform central and/or lateral neck dissection. Consensus guidelines are insufficiently implemented within thyroid surgery, and quality management is associated with surgical volume.

Efficiency vs. Competency Development: What Interprofessional Health Professions Students Learn From, With, and About Each Other During Anatomy Dissection

The gold standard for anatomy instruction has traditionally involved a combination of lecture‐based learning and hands‐on discovery through cadaveric dissection. However, a full dissection is time‐intensive, and recent curricular changes are challenging educators to deliver content via more time‐efficient modalities. As a result, laboratory hours are often a place where reductions in instructional time are made. This tension between time and meaningful activity is heightened as curricular innovations such as simulation, 3D visualization, and prosection are shown to reduced teaching time and increase the student: cadaver ratios. However, the dissection experience is not only important for helping students understand the structure and function of the human body. It is also instrumental in helping students develop skills and attitudes related to professionalism such as teamwork, communication, and respect for each other and their future patients, learning opportunities that are often referred to as the “hidden” curriculum (Escobar‐Poni &amp; Poni, 2006; Warner &amp; Rizzolo, 2006). More recently, the ability of healthcare providers to work effectively in interprofessional teams has been added to this list of skills, and dissection experiences have been designed to explicitly incorporate interprofessional experiences into anatomy lab curricula (e.g., Fernandes et al, 2015). To date, the impact of an interprofessional learning environment within the anatomy lab on learners' perceptions of teamwork has not been thoroughly examined. To explore the impact of the interprofessional learning experience, students were asked to write a short essay reflecting on what they learned from their teammates and the donors, and how that will affect the way they approach clinical care and working in professional teams. Constant comparative analysis was used to compare themes from essays written by dental students working in interprofessional teams comprised of dental, physician assistant, and radiation therapy students to those written by dental students working in teams segregated by profession. Results of the study highlight the unique contributions of an interprofessional dissection environment on the learning experience of health professions students.This abstract is from the Experimental Biology 2019 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.

Student Evaluation of a Pilot Program in Clinically‐Oriented Dissection of the Upper Limb

IntroductionAnatomical teaching in the medical program at the University of Sydney is prosection‐based. Many students, however, seek the opportunity to dissect, particularly those with an interest in surgery. A one‐week dissection course on the upper limb was developed to provide students with an introduction to dissection within the limits of timetabling and departmental resources. Each day started with lectures on basic anatomy and clinical and surgical perspectives of a case relevant to the area being dissected that day. The remainder of the day was spent dissecting, with input from anatomical demonstrators and practising surgeons.This study sought to explore students' perspectives regarding their motivation and expectations prior to starting, their views on the course after completion, and whether any improvements could be made.MethodsAll students in the second year of the Sydney Medical Program were invited to apply, with twenty students selected for participation. Priority was given to those who had completed our departmental prosection workshop. A survey comprised of four open‐ended questions about goals, expectations and current knowledge was emailed to participants four days prior to the course. Immediately following the course, students were asked to complete another email survey comprised of seven open‐ended questions asking whether the course met expectations and learning goals, highlights and lowlights of the course, and ideas for improvement. The responses were de‐identified before analysis.ResultsOf the twenty students who took the course, nineteen returned the pre‐course survey. In the “goals” question nine students mentioned gaining dissection experience, while thirteen desired a better understanding of limb anatomy. A surgical perspective was sought by five responders. Seventeen students responded to the post‐course survey. All students reported an improved level of knowledge and that the course met or exceeded their expectations. All agreed the timeframe of the course was appropriate. The very few negative comments mostly concerned a lack of timely information prior to the course.ConclusionsThe expectations of the students aligned well with the course objectives, and all students responded very positively to the dissection experience. A similar course focussing on the lower limb is in production, with plans to extend the program to other body regions in the future. While traditional full body dissection remains the benchmark, the short timeframe of these courses allows more flexibility in resources, staff and student availability, potentially increasing access to dissection opportunities for students who seek a greater depth of anatomical knowledge.This abstract is from the Experimental Biology 2019 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.

An innovative approach to human gross anatomy for undergraduates

Prompted by demand for an anatomy laboratory to serve students considering pre‐medical professions, Geisel School of Medicine faculty and Dartmouth College anthropology faculty developed an interdisciplinary undergraduate course integrating human dissection, human evolution, and the art and history of human anatomy. Our goal was to create an active learning laboratory that was highly structured but also offered an opportunity for reflection and creativity. We were concerned that undergraduates, many of them undeclared majors, might not have the maturity and study skills to excel in an interdisciplinary human dissection laboratory with significant time demands. We designed the course to meet for 7 hours of instruction each week of the 10‐week term, with 1‐hour lectures on a topic in human evolution relating to three 2‐hour dissection laboratories where students worked in alternating teams of four to complete regional dissections or view prosections of human donors and comparative specimens. We replaced some laboratories with workshops examining Renaissance anatomical illustrations or sleuthing through local historical records of ‘body‐snatching’ in the library special collections. Applying a flipped‐classroom approach, students completed readings and readiness quizzes prior to each dissection laboratory. Students also wrote a reflection essay on the dissection experience and completed an art project to appreciate how anatomy bridges science and the arts and humanities. Two years of course evaluations and reflection essays reveal that students with science backgrounds were surprised that they benefitted from incorporating art and the humanities into their learning, and those without science backgrounds said they would not have dared enroll in an anatomy laboratory without the interdisciplinary approach. This course merging dissection and the liberal arts could serve as a model for other institutions interested in enriching the pre‐medical professions curriculum and engaging a variety of students in the anatomical sciences.Support or Funding InformationThis course was supported by Dartmouth's Innovative Course Award.This abstract is from the Experimental Biology 2019 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.

Evaluating the Integration of Pre‐Mortem Diagnostic Imaging in the Anatomical Study of Body Donors

IntroductionMedical faculties are embracing a modernistic approach to the teaching of anatomy that integrates diagnostic imaging largely through post‐mortem computed tomography (CT) scanning of body donors. Though this integration provides valuable learning opportunities, this approach still poses many challenges.AimThe purpose of this study was to assess the implementation of pre‐mortem donor‐specific imaging (DSI) on student learning and dissection experience in addition to gaining an understanding of the students' perceptions of the DSI‐anatomy integration on their preparation for physicianship.MethodsEthics approval was obtained by the McGill University Institutional Review Board. All donor imaging was acquired by legal donor consent and anonymized. Students in a fourth‐year medicine, cadaveric dissection‐based course were divided into two groups: group 1 received DSI with a relating case vignette (n=15) at the beginning of the course; group 2 received generic imaging (GI) relating to the type(s) of pathologies that their donor exhibited, though the DI was not of the donor's themselves. The GI group also received a donor‐specific case vignette (n=11) halfway through the course. A convergent, parallel mixed methods design was employed. Quantitative measures included statistical analyses of student dissection‐related assessment scores as well as student group responses to a simple study participant questionnaire. Using semi‐structured focus groups and inductive coding methods, the psychosocial aspects of the student dissection experience with or without DSI and students' perceptions on the use of DSI in the course were qualitatively explored.ResultsStatistically significant differences in student group responses for survey items assessing relevancy of imaging modality to student dissections, student understanding of anatomy and relevancy for future clinical practice was achieved. Students receiving DSI more positively supported the relevancy of imaging with anatomical dissection, expressed the importance of its implementation into later years of the medical curriculum in addition to suggesting integration earlier on within the medical curriculum as well. Academic assessment scores demonstrated insignificant differences and thus were not influenced by the type and timing of the imaging provided. Main themes arising from the qualitative analysis include the influence of DSI on future mindful practice, positive impact on dissection and humanization of the body donor through the combined use of DSI and case vignette.ConclusionThese results demonstrate that the integration of DSI into anatomical dissection provided a positive learning experience for students. This form of imaging integration not only provided a learning tool to enhance anatomical dissection, but also allowed students to further develop characteristics and skills relating to future mindful practice.Support or Funding InformationJonathan Campbell Meakins and Family Memorial Fellowship, Centre for Medical Education McGill UniversityThis abstract is from the Experimental Biology 2019 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.

Medical Students First Experience in Human Cadaver Dissection Across Culture

While the teaching of anatomy has evolved over the centuries, the cadaver remains its major resource at most medical schools. Approaching the embalmed human body for the first time induces a range of feelings which develop and change throughout an anatomy course. However, the background, cultural views, and experiences students bring to the dissection experience likely influence their reactions and the trajectory of their acclimation to dissection. This survey assessed the self‐rated importance of cultural views and emotional reactions among medical students from different cultural backgrounds. First year medical students from Oakland University William Beaumont School of Medicine (US), American University of Beirut (Lebanon), and Queens University Belfast (Northern Ireland) completed a survey one week before exposure to cadaver dissection (Time 1) and one week after cadaver dissection (Time 2). In terms of self‐reported effect of cultural views on experiences during dissection, the three groups manifested significant differences from each other, with students in the U.S. having the highest levels at Time 1 (Mean=2.30), followed by students in Lebanon (Mean=1.81), and then students in Northern Ireland (Mean=1.46; F=13.07; p&lt;0.001). In terms of the emotions at Time 1, students in Northern Ireland reported the lowest level (Mean=2.28), followed by students in the U.S. (Mean=3.00), and those in Lebanon (Mean=3.16). F= 11.96; p&lt;001). However, the three groups did not show any significant differences on this measure at Time 2. Finally, with respect to dissection as an anxiety‐provoking experience, students in Northern Ireland showed the lowest scores at Time 1 (Mean=1.70), compared to US (Mean=2.45) and Lebanon (Mean=2.36). While both students in the U.S. (Mean=2.11) and Northern Ireland (Mean=1.56) showed some decrease in reported anxiety at Time 2, students in Lebanon showed a much more dramatic decrease (Mean=1.60). Aggregate differences in reported anxiety at Time 2 were significant (F=6.78;p=0.001), driven by the pairwise difference between U.S. students and the other groups. In conclusion, this study suggests that students self‐perceive their cultural views as relatively unimportant in the dissection experience, yet significant group differences between students from different cultural context were observed. There appear to be differences between groups nested these different cultural contexts, not only prior to the dissection experience, but also in terms of how they acclimate to the emotional experiences during dissection. Additionally, while often the U.S. is considered acultural compared to other regions, the U.S. group reports significantly higher levels of importance on this measure than those from Northern Ireland or Lebanon.This abstract is from the Experimental Biology 2019 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.

Will Medical Students Cadaver Dissection Experience Influence their Proclivity toward Body Donation?

ObjectivePrevious work suggests that human dissection in medical school enhances a student's knowledge of and appreciation for the human body1. While most students report predominantly positive feelings toward their experiences in anatomy lab2, we do not currently understand the impact of cadaver dissection on a student's inclination to donate her own body. In this study we aim to determine whether human cadaver dissection impacts medical students' proclivity to donate their own bodies postmortem and whether initial inclination varies based on demographic factors.MethodsWe surveyed 140 first‐year medical students at the Baylor College of Medicine before they began anatomical dissection of human cadavers. The survey included items regarding race, religion, hometown, previous experience with human dissection, organ donor status, initial proclivity to donate one's own body and reasons underlying this proclivity. We employed Pearson's chi‐squared analyses to determine whether initial inclination to donate one's body varied based on the aforementioned factors. Students will be administered a similar survey again after completion of their anatomy course in February 2019. We will use this data to determine whether their experiences in lab influence their likelihood to donate their body.ResultsBefore beginning cadaver dissection, nearly equivalent proportions of the class said that they would vs. would not donate their body for medical education (48% yes vs. 52% no). We found no correlation between race, religion, or age and proclivity toward body donation. Fifty‐five percent (55%) of those who are registered organ donors indicated they would donate their body vs. 29% of those who are not registered organ donors (OR=2.88, p=0.0002). Additionally, the proportion of reasons underlying proclivity varied significantly between those who would vs. would not be inclined to donate their bodies. Fifty‐two percent (52%) of those who said they would donate their body cited ethical reasons vs. 4% of those who said they would not (p&lt;0.0001). In contrast, 12% of those who said they would donate their body cited religious reasons vs. 24% of those who said they would not (p=0.012).ConclusionsWe found that the best predictor of a student's initial proclivity toward body donation is organ donor status. While we found no correlation between demographic factors and proclivity toward body donation, we did find that the reasons underlying one's inclination toward or against donating her body varied significantly between the groups. Those who said they would donate their body were far more likely to cite ethical reasons, while those who said they would not donate were more likely to cite religious reasons. Come February we will finish analyses on the post‐lab survey to determine the effects of human dissection on inclination to donate one's body to medical education.This abstract is from the Experimental Biology 2019 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.

A Data‐Driven Design: Addressing Student Need for an Anatomy Pre‐matriculation Experience

The anatomical sciences are a perennial source of angst for recently accepted medical students. This is due to the volume of information presented in a truncated timeline, the fact that anatomy is not a prerequisite for acceptance, and that many students are reticent to interact with human cadaveric material. At Oakland University William Beaumont (OUWB) School of Medicine, the anatomy course is an intensive study of gross, microscopic, and developmental anatomy spanning the first 5 months of the M1 year. During the laboratory sessions, students work in teams to complete a full body dissection, and examine virtual microscopy slides. OUWB students have expressed a desire to learn more about anatomy and the anatomy curriculum prior to matriculation. Course evaluation data from the 2017 cohort (n=125) revealed that 87% of students would have utilized an online resource during the summer prior to their M1 year introducing them to the anatomy curriculum. Open‐ended responses suggested a plethora of topics including an introduction to the course, dissection laboratory, facilities, osteology, and terminology. The faculty are responding by beginning to develop a series of professionally produced, online pre‐matriculation videos. It is intended that exposure to these resources will alleviate student anxiety surrounding matriculation, and their first anatomical dissection experience. To evaluate the longitudinal impact of these videos, students will complete the State‐Trait Anxiety Inventory and a demographic questionnaire to compare the responses of pre‐matriculant students. Responses from the 2018 cohort were collected (n = 120), without exposure to the videos, and will serve as a control measure against future cohorts, who will have access to the videos. Future results could serve as a guide for anatomy educators seeking to ease their students' transition into medical school, and facilitate an environment of improved student well‐being.Support or Funding InformationDepartment of Foundational Medical Studies at Oakland University William Beaumont School of MedicineThis abstract is from the Experimental Biology 2019 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.

Implementation of endoscopic submucosal dissection for early upper gastrointestinal tract cancer after primary experience in colorectal endoscopic submucosal dissection.

Background Current guidelines recommend endoscopic submucosal dissection (ESD) as a treatment option for early cancers of the upper gastrointestinal tract with absent or minimal risk of lymph node metastasis. However, due to the low prevalence of these entities, it is difficult to achieve a competence level for ESD of upper gastrointestinal tract cancers in the Western World. Here, we present single-center data on the implementation of upper gastrointestinal ESD after previous experience with 89 colorectal ESD cases. Methods Retrospective case series of 39 consecutive patients with early cancers of the esophagus (n = 13) or cardia and stomach (n = 26) treated with ESD over a 4-year period. Results ESD was technically feasible in all cases with en bloc, R0, and curative resection rates of 100 %, 76.9 %, and 71.8 %, respectively, and a mean procedure time of 100 minutes (30 – 360 minutes). After an initial 20 procedures, the R0 and curative resection rates increased from 65.0 % to 89.5 %, and from 60.0 % to 84.2 %, respectively. Complications were observed in four patients (10.3 %): three perforations, one case of delayed bleeding, and one esophageal stricture. No case required emergency surgery; the 30-day mortality rate was 0 %. Conclusion In this modest case series from Europe, we observed an effectiveness and complication rate for ESD for early esophageal and gastric cancer that are comparable to other series from Europe but also to more abundant data from Asia. The results indicate that even small numbers of upper gastrointestinal cancers can be managed adequately in centers with expertise in colorectal ESD.

Not Just a Specimen: A Qualitative Study of Emotion, Morality, and Professionalism in One Medical School Gross Anatomy Laboratory.

Medical schools are increasingly integrating professionalism training into their gross anatomy courses, teaching ethical behavior and humanistic attitudes through the dissection experience. However, many schools continue to take a traditional, technical approach to anatomical education while teaching professionalism in separate courses. This interview-based study explored how students viewed the body donor and the professional lessons they learned through dissection at one such medical school. All students oscillated involuntarily between seeing the cadaver as a specimen for learning and seeing the cadaver as a person, with some students intentionally cultivating one of these ways of seeing over the other. These views shaped students' emotional and moral responses to the experiences of dissection. The "specimen" view facilitated a technical, detached approach to dissection, while the "person" view made students engage emotionally. Further, students who intentionally cultivated a "specimen" view generally felt less moral distress about dissection than students who intentionally cultivated a "person" view. The concept of respect gave students permission to perform dissections, but "person-minded" students developed more complex rules around what constituted respectful behavior. Both groups of students connected the gross anatomy experience to their professional development, but in different ways. "Specimen-minded" students intentionally objectified the body to learn the emotional control physicians need, while "person-minded" students humanized the body donor to promote the emotional engagement required of physicians. These findings support efforts to integrate professionalism teaching into gross anatomy courses, particularly content, addressing the balance between professional detachment and concern.

Lymphadenectomy in laparoscopic radical resection of distal cholangiocarcinoma

Lymph node metastasis is the important survival predictor in patients with distal cholangiocarcinoma. With the application of laparoscopic pancreaticoduodenectomy in radical resection of distal cholangiocarcinoma, it is of great clinical significance to explore lymphadenectomy in laparoscopic radical resection of distal cholangiocarcinoma. The American Joint Committee on Cancer (AJCC) Cancer Staging Manual (8th ed) has became the new global guideline for cancer diagnosis and treatment since January 2018, which provides a new recommendation for lymphadenectomy of distal cholangiocarcinoma. This review provides an overview of the clinical significance of total lymph node count and number of involved lymph nodes, en-block procedure in lymphadenectomy, membrane anatomy for lympha-denectomy, experience and skills in lymph node dissection, lymph node sorting after surgery, adjuvant therapy in the treatment of distal cholangiocarcinoma. Key words: Biliary tract neoplasms; Distal cholangiocarcinoma; Laparoscopy; Lymphadenectomy; En-block resection