Teaching anatomy with dissection in the time of COVID‐19 is essential and possible

To the Editor, Dr Saverino's letter (Saverino, 2020) addresses important issues in anatomy education, both perennial and current. We are writing to present our own perspectives, some of which support Dr Saverino's position and some of which are in respectful disagreement. Anatomy, including gross anatomy, histology, embryology, and medical imaging, is the fundament of medical education: it is not possible to learn the practice of medicine without understanding the structure and function of the human body. Anatomical education provides the solid foundation upon which all subsequent clinical courses and practice will build. Every disease process and every pathology happens to a piece of anatomy. We believe that anatomy is best learned using the tools that physicians, physical therapists, physician assistants, dentists, and other providers will employ in their practice: eyes, hands, surgical instruments, electronic resources, and teams. All of these tools are deployed, experienced, and mastered in dissection based anatomy courses, which should be at the heart of any medical or health science anatomy curriculum. Dr Saverino is correct that technology has an important role to play in anatomy education. This includes the e-books, models and simulations that he mentions: it extends to customizable 3D printed models that students can manipulate in their hands and explore; digital media to integrate medical imaging with cadaveric dissection at the dissection table; and online learning tools for self-assessment and delivery of histological and medical imaging material. Anatomy education is by nature multi-modal, innovative, and engaging. However, just as CT scans, MRIs, electronic medical records, and histopathological preparations are deployed at the service of actual patients, technology should serve as an adjunct to, not a surrogate for, dissection. Medical students should dissect real cadavers, not electronic ones, simply because patients are real people, not virtual ones. We are not aware of any studies showing that medical students make better physicians if they do not dissect, but there are many showing that dissection results in superior comprehension and performance (Chytas, Piagkou, Salmas, & Johnson, 2020). As Estai and Bunt conclude: “The best way to teach modern anatomy is by combining multiple pedagogical resources to complement one another, students appear to learn more effectively when multimodal and system-based approaches are integrated” (Estai & Bunt, 2016). Why is it better for physicians to learn anatomy using cadavers than electronic tools? There are many good answers to this question; here we focus our brief comments on three key things: dissection provides hands-on experience with three-dimensionally complex anatomical structures and relationships; dissection confronts our students with variation and diversity; and dissection develops compassion and empathy. Human anatomy is complex. No matter the quality of the resource, simulations and online instruction do not provide the same level of understanding of complex anatomical relationships as studying human bodies. Dissection steps like reflecting layers to see deeper structures, tracing neurovasculature along its pathways, and even removing fascia provide a deeper understanding of anatomical complexity. Actively working to reveal structures while problem-solving with their lab group provides students with a greater depth of anatomical understanding and experience in a team-based approach to medicine. Similarly, while numerous high quality atlases exist and can guide students through their learning of anatomy, the translation of a two-dimensional book, website, or app into a real patient requires some imagination. One of the most important concepts for our students to learn is that variation and diversity are the natural order of the human species. Human beings vary because of their backgrounds, their age, their sex, their medical history, and their personal experiences. By learning anatomy from numerous, diverse cadavers in the lab, our students can sample a small part of that variation, but more importantly, they develop the ineffable understanding that people vary, they come to expect their patients to vary: they learn to see their patients as individuals, and to treat them accordingly. We strive to educate providers who generate unique and customized treatment plans, and understand that there is no one-size-fits-all treatment modality for each condition. We know of no software that captures the sense of the unpredictability of the human physical experience. Paradoxically, dissection also teaches us that people are also very similar to each other in ways that skin color, hair color, tattoos, age, sex, and medical history, for example, cannot mask. In this way, dissection reveals some important basic truths about humanity that cannot be conveyed any other way. Just as our students need to see their patients as individuals, they also need to learn to nurture their compassion for them. For many students the cadaver is the first stranger that they are entrusted with, the first stranger they form an intimate relationship with. For many, the donor is their first “patient. ” Confronted with a donor who selflessly volunteered to be studied intimately so that they could learn and grow, our students express compassion, gratitude and empathy for their experience. Thus, dissection is an important antidote to the Received: 15 June 2020 Accepted: 20 June 2020