Pedagogical interest of Cadaveric Dissection Courses on surgery trainee’s knowledge and motivation

maghrebi houcine |

La tunisie chirurgicale - 2019 ; Vol 2019

Resumé

Introduction

Anatomy dissection courses using human cadavers have long been used to impart technical capacity and knowledge to surgical trainees. However, because of the recent technical progress in surgery, the new method of simulation learning, live surgery tools, the use of cadaveric dissection course is becoming less common.

Through this study, we aimed to investigate student perception of cadaveric dissection course and to determine their impact on surgery trainee’s knowledge.

Material and methods

Forty two surgery residents undertook surgical and theoretical cadaveric dissection courses.

The subsequent topics of the course were: technical and anatomical tips of colectomies. A formal evaluation was done before and after the course. For evaluation of the dissection program, we used an anonymous, self-administered, survey instrument. Data of the study was analyzed using the Statistical Package for Social Sciences version 19.

Results

A total of 42 students attended the course. All of them completed the question survey instrument. They declare that they were satisfied with the dissection program which had enhanced their knowledge and motivation.  All the students have found the goals clear, achievable. The majority of students were satisfied with the time allocated to the course.

Conclusion :

Our teaching programs must be innovative by including, in addition to theoretical courses, simulation sessions followed by practical experience in the operating room, under the close supervision of a senior. Cadaveric surgery is the simulation model that brings the most fidelity and realism.

 

Mots Clés

cancer

Introduction :

Up until a few years, learning of surgery was based on faculty teaching, companionship in operating room and cadaveric Dissection Courses. This last pedagogical tool has been used as a major way for learning surgery [1]. However, because of the recent technical progress in surgery, the new method of simulation learning, live surgery tools, the use of cadaveric dissection course is becoming less common.

Through this study, we aimed to investigate student perception of cadaveric dissection course and to determine their impact on surgery trainee’s knowledge.

Article

Methods

The study was conducted after the approval of the local ethics committee, among 42 surgery residents who undertook a surgical and theoretical cadaveric dissection courses. They were recruited through the four universities of medicine of Tunisia via an online registration. The subsequent topics of the course were: technical and anatomical tips of colectomies. The course was composed of both a theoretical lecture (90 min) and a practical cadaveric dissection course (3 hours). Before the start of the course, detailed advices were provided regarding the necessary prerequisite knowledge and ethical concepts (figure1). Each practical class contains no more than 5 students (figure2). A formal evaluation was done before and after the course. For evaluation of the dissection program, we used an anonymous, self-administered, survey instrument, comprising 20 questions. The main outcome measure was degree of satisfaction. The training was also appreciated by the students according to: the logistics, the general organization, the degree of realism and motivations of the residents as well as the impact of the training on their knowledge and their technicity. Data of the study was analyzed using the Statistical Package for Social Sciences version 19.

Results

A total of 42 students attended the course. All of them completed the question survey instrument. The median age was 29 years (25-34). Forty students (95%) indicated that they have never attended such a dissection course. While 2 students indicated they had attended once. All the students reflected positive perceptions of cadaveric dissections. They declare that they were satisfied with the dissection program which had enhanced their knowledge and motivation.  All the students have found the goals clear, achievable. The majority of students (76%) were satisfied with the time allocated to the course. Eighty-six percent of the participants found the interaction between medical educators and trainers of good quality. All the students declared that they recommend cadaveric dissection for their colleagues. Finally, the students suggested that cadaver dissection courses should be considered as an indispensable teaching tool for the acquisition of basic surgical procedures and that it must be integrated into surgery education programs at all stages of their curriculum.

Discussion

Anatomy dissection courses using human cadavers have long been used to impart technical capacity and knowledge to surgical trainees [1]. The current study demonstrated the usefulness of cadaveric dissections in studying surgery. It showed that a cadaveric surgical course is effective in improving surgical anatomy knowledge and surgery skills. This educational method has the advantage of providing a valuable insight into anatomy and surgery. It is appreciated by students who have found the goals clear, achievable. Another advantage of this pedagogical method is the interaction between medical educators and trainees. Indeed, cadaveric dissection is a teaching tool that is well accepted by learners and offers several advantages. This training allowed the various participants to acquire skills in three areas of knowledge: cognitive, sensorimotor and psycho-emotional [2]. Concerning the cognitive domain: it allows a good understanding of the anatomy as well as a better memory of the surgical technique [3]. As far as the sensorimotor domain is concerned, this teaching tool enables students to reinforce their technical abilities. Finally, cadaveric dissection provides students with knowledge of the psycho-emotional field through stress management and the ethics concepts. Since error is allowed, it reinforces in students the feeling of self-confidence. In addition to the fact that cadaveric dissection is a learning technique highly appreciated by students, it is considered superior to other modern techniques such as virtual simulation. Indeed, this learning puts the student in conditions very close to reality [1,4]. On the other hand, the forensic constraints that we experience because of the therapeutic vagaries make the passage through the simulation on cadaver a mandatory step in the curriculum of each surgeon [5]. It should be noted that the interest of such learning is not limited to surgery. Indeed, several other specialties can benefit from cadaver training such as: catheterization, locoregional anesthesia, joint infiltration ... Moreover, this teaching tool could be used for the development of scientific research in different fields. Dissection allows the recontextualization of the theoretical data of young surgeons. It is therefore an educational tool of choice for the integration of knowledge. Although the virtues of cadaveric dissection are well established, few residents have access to them [6]. Nowadays, surgical procedures are taught at the bedside and in the operating theater on the principle of companionship. The main constraints to this type of learning are mainly ethical, legislative, socio-cultural and religious. Indeed, the legal vacuum on the subject constitutes an obstacle to the generalization of this learning. On the other hand, in view of the socio-cultural traditions of the Arabic Muslim world, to establish an apprenticeship based on cadaver dissection is difficult despite the fact that our religion advocates solidarity, the preservation of life and the quest for knowledge [7]. Finally, our teaching programs must be innovative by including, in addition to theoretical courses, simulation sessions followed by practical experience in the operating room, under the close supervision of a senior. Cadaveric surgery is the simulation model that brings the most fidelity and realism.

Conclusion

Although we are invaded by many new surgery teaching tools, traditional methods such as dissection must remain an integral part of the teaching of surgery. Our study demonstrates the educational value and the positive impact of cadaver dissection in the learning of surgery. It revealed  important positive perceptions about the usefulness of cadaveric dissections courses as an effective approach to studying surgery. No matter how great is the technology progress, it could never substitute for teaching based on real surgical anatomy and cadaveric dissection

What is already know on this topic

Include maximum of 03 points of what is already known on this topic (in bullet points)

  • learning of surgery is based on faculty teaching, companionship in operating room
  • The use of cadaveric dissection course is becoming less common.
  • cadaveric dissection is a learning technique highly appreciated by students

What this study adds

Includemaximum of 03 points of what your study adds (in bullet points)

  • cadaveric Dissection Courses is a major way for learning surgery
  • cadaveric surgical course is effective in improving surgical anatomy knowledge and surgery skills
  • Cadaveric surgery is the simulation model that brings the most fidelity and realism

Competing interests

The authors declare no competing interest.

 

 

Figures legends:

Figure 1 :Theoretical lecture

Figure 2 :Practical cadaveric dissection course

Références

1.Winkelmann A. Anatomical dissection as a teaching methodin medical school: a review of the evidence. Med Educ2007;41:15—22

2. Vachera C, Delmas V. Faut-il encore des dissections en facultéde médecine?  Morphologie2009;93:6—8

3. Cundiff GW, Weidner AC, Visco AG. Effectiveness of laparoscopic cadaveric dissection in enhancing resident comprehension of pelvic anatomy. J Am Coll Surg 2001;192:492—7

4. Leblanc F, Champagne BJ, Augestad KM, et al. A comparison of human cadaver and augmented reality simulator models for straight laparoscopic colorectal skills acquisition training. J Am Coll Surg 2010;211(2):250—5.

5. Petit F, Raulo Y. Faut-il laisser les internes opérer ? Ann ChirPlastEsthet2002;47:656—7.

6. Gordinier ME, Granai CO, Jackson ND, Metheny WP. The effects of a course in cadaver dissection on resident knowledge of pelvic anatomy: an experimental study. ObstetGynecol1995;85:137—9

7. Majeed A. How Islam changed medicine. BMJ 2005;331(7531):1486—7.

 

Figures legends:

Figure 1 :Theoretical lecture

 

Figure 2 :Practical cadaveric dissection course