Publications by authors named "Cecilia Brassett"

18 Publications

  • Page 1 of 1

Alternatives to Student Outbound Mobility-Improving Students' Cultural Competency Skills Online to Improve Global Health Without Travel.

Med Sci Educ 2021 Jun 7:1-11. Epub 2021 Jun 7.

McGill University, Montreal, QC Canada.

Introduction: Student outbound mobility is a major element in internationalization of medical education and global health education. However, this approach is often criticized, as it is inherently inequitable. Internationalization is a newer concept that aims to provide students with international skills and experiences without exchange travel. We report detailed outcomes of an international online program during the COVID-19 pandemic, which aimed to include acquisition of cultural awareness and competency-similar to what the students would have obtained if they had travelled abroad.

Method: Sixty-eight students from 12 international universities participated in international small peer group collaborative work, and online networking. Perceived improvement of cultural competency using Likert scale and open-ended questions was used as a measure of success. Furthermore, students' definition of cultural competency in the different countries was obtained.

Results: Students improved their cultural competency skills. Data analysis supported statistically significant improvement of the above skills after the program, in comparison to the start of the program.

Discussion: Internationalization of medical education can be achieved -via structured online peer exchanges-and can provide students with intercultural skills and networking opportunities that are typically achieved via international in-person travel. The above represents a socially just and equitable way to reach students and can result in improvement of their cultural competency, preparing them for their work in global health, and thereby resulting in improvement of global health.

Supplementary Information: The online version contains supplementary material available at 10.1007/s40670-021-01332-9.
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http://dx.doi.org/10.1007/s40670-021-01332-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8184130PMC
June 2021

Initiating Students' Reflections on Life's Passing in the Anatomy Course - an International Observation at 14 Universities.

Ann Anat 2021 Sep 21;237:151741. Epub 2021 Apr 21.

McGill University, Montreal, QC, Canada.

Background: Medical and dental students' feelings and thoughts about the topic of death and life's passing are often associated with learning in the gross anatomy course, when students begin working with a deceased body donor in order to study human anatomy. Little is known of whether the format of anatomy teaching has an impact on these experiences. An observational study was performed to capture the initiation of students' sentiments on the topic of life's passing during the anatomy course at 14 international universities, identify common themes regarding these thoughts, and to study the connection to variations in anatomy course formats and included elements.

Method: Preclinical anatomy students reflected on one question (i.e., "How did your experience in the anatomy laboratory bring about your reflections on the meaning of life and human existence as well as the sanctity of one's passing?"). Written assignments were collected and anonymously coded. Information on anatomy courses was obtained via faculty questionnaires.

Result: A variety of themes were identified at the different schools, correlated with different anatomy formats and elements. Results indicate that the courses that offer hands-on cadaveric dissections may play an important role in triggering these sentiments.

Discussion: The initiation of students' sentiments about the topic of death varies and includes several themes. There can be a connection to the way anatomy is taught, particularly if hands-on comprehensive cadaveric dissection or prosections are included.

Conclusion: In summary, anatomy courses can initiate students' thinking about life's passing - particularly in schools that offer hands-on cadaveric dissections or prosections.
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http://dx.doi.org/10.1016/j.aanat.2021.151741DOI Listing
September 2021

COVIDReady2 study protocol: cross-sectional survey of medical student volunteering and education during the COVID-19 pandemic in the United Kingdom.

BMC Med Educ 2021 Apr 14;21(1):211. Epub 2021 Apr 14.

Nuffield Department of Primary Care Health Sciences, Medical Sciences Division, University of Oxford, Oxford, UK.

Background: The coronavirus disease 2019 pandemic has led to global disruption of healthcare. Many students volunteered to provide clinical support. Volunteering to work in a clinical capacity was a unique medical education opportunity; however, it is unknown whether this was a positive learning experience or which volunteering roles were of most benefit to students.

Methods: The COVIDReady2 study is a national cross-sectional study of all medical students at medical schools in the United Kingdom. The primary outcome is to explore the experiences of medical students who volunteered during the pandemic in comparison to those who did not. We will compare responses to determine the educational benefit and issues they faced. In addition to quantitative analysis, thematic analysis will be used to identify themes in qualitative responses.

Discussion: There is a growing body of evidence to suggest that service roles have potential to enhance medical education; yet, there is a shortage of studies able to offer practical advice for how these roles may be incorporated in future medical education. We anticipate that this study will help to identify volunteer structures that have been beneficial for students, so that similar infrastructures can be used in the future, and help inform medical education in a non-pandemic setting.

Trial Registration: Not Applicable.
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http://dx.doi.org/10.1186/s12909-021-02629-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8045566PMC
April 2021

An Observation of Healthcare Professions Students' Perceptions During the COVID-19 Pandemic.

Med Sci Educ 2021 Feb 18:1-9. Epub 2021 Feb 18.

McGill University, Montreal, QC Canada.

This study conveys preclinical healthcare professions students' sentiments at 14 universities during the 2020 COVID-19 pandemic. Essays about students' thoughts and experiences were thematically sorted and revealed a variety of sentiments spanning from positive (e.g., pride, respect) to the more negative (e.g., anxiety, guilt, disappointment, anger). Themes revealed respect for the healthcare profession, but also the realization of its limitations, sacrifices, and risks. Healthcare profession educators need to be aware that the COVID-19 pandemic has affected students emotionally and may have long-term effects on the global healthcare profession. This study can serve as a historic documentation of how this generation of students felt and adds to the literature on how the pandemic affected the healthcare profession.
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http://dx.doi.org/10.1007/s40670-021-01240-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7889410PMC
February 2021

Temporomandibular joint anatomy: Ultrasonographic appearances and sexual dimorphism.

Clin Anat 2021 Jan 9. Epub 2021 Jan 9.

Department of Anaesthesia, James Cook University Hospital, Middlesbrough, United Kingdom.

Introduction: Temporomandibular joint (TMJ) dysfunction is common, with a greater prevalence in females. While magnetic resonance imaging (MRI) is commonly used for clinical investigation, ultrasonography represents a potential alternative in some clinical scenarios. We designed a protocol for ultrasonographic evaluation of the TMJ and assessed its reliability. Presentation was compared between the sexes to establish whether an anatomical dichotomy underlies the female preponderance of TMJ dysfunction.

Materials And Methods: Ultrasound imaging of the TMJ was carried out in the longitudinal and oblique planes. Standard images were produced using model skulls and healthy volunteers. Measurements were made between the temporal bone, mandibular condyle, joint capsule and overlying skin, as well as of condylar translation during mouth opening. Both joints were scanned in 50 healthy volunteers. Measurements were repeated to evaluate reliability. A novel classification system was used to assess lateral condylar morphology.

Results: The protocol facilitated reliable visualization of key anatomical features of the TMJ (average intraclass correlation coefficient = 0.75, = 5.4E-03). Distribution of condylar morphology differed between the sexes. The capsular-cutaneous distance ('joint depth') and condylar-temporal bone distance ('interarticular distance') were significantly greater in males than in females.

Conclusions: Ultrasonography provides reliable views of the TMJ in two planes: longitudinal and oblique. Observed sexual dimorphism in TMJ anatomy might be associated with the female preponderance of dysfunction. With a standardized scanning protocol, ultrasound could provide a rapid, cost-effective alternative to MRI as a point-of-care imaging tool in TMJ clinics.
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http://dx.doi.org/10.1002/ca.23719DOI Listing
January 2021

Exploration of colonic looping patterns in undisturbed cadaveric specimens.

Clin Anat 2020 Nov 15. Epub 2020 Nov 15.

Human Anatomy Teaching Group, Department of Physiology, Development and Neuroscience, University of Cambridge, Cambridge, UK.

Introduction: This study examines sex differences in the disposition of the sigmoid and transverse segments of the colon in undisturbed cadaveric abdomens and relates these findings to the anecdotal observation that colonoscopy is more challenging in females through the formation of tortuous bowel loops.

Materials And Methods: One hundred and twenty two undisturbed cadaveric abdomens were inspected. Three distinct configuration grades were separately assigned to the sigmoid and transverse segments of the colon on the basis of the pattern of the bowel loops observed in situ. Pearson's chi-squared test was used to analyze sex differences in bowel loop configuration and Spearman's rank correlation coefficient was calculated to identify co-occurrence of configuration grades in the subjects.

Results: For the transverse segment, females had higher configuration grades corresponding to longer bowel loops with greater redundancy, compared to males (p = .000047). There was no sex difference in the sigmoid segment grade (p = .21636). Sigmoid and transverse segment grades were highly correlated in the subjects (coefficient = 0.9994).

Conclusion: Sex differences in the configuration grades of the sigmoid or transverse colonic segments may be a significant contributing factor to increased difficulty of colonoscopy in females.
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http://dx.doi.org/10.1002/ca.23702DOI Listing
November 2020

The role of the angle of the fibularis longus tendon in foot arch support.

Clin Anat 2021 May 8;34(4):651-658. Epub 2020 Oct 8.

Human Anatomy Teaching Group, Department of Physiology, Development and Neuroscience, University of Cambridge, Cambridge, UK.

Introduction: Understanding the contribution of the fibularis longus tendon to the support of the midfoot arches has potential therapeutic applications. This cadaveric study sought to quantify this support across both the transverse arch and medial longitudinal arch and to establish whether a correlation exists between this support and the angle at which the tendon enters the sole.

Materials And Methods: Markers placed in 11 dissected cadaveric foot specimens defined the arch boundaries. Incremental weights up to 150 N were applied to the fibularis longus tendon to simulate progressive muscle contraction, and associated changes in the transverse and medial longitudinal arch boundaries were recorded.

Results: A force of 150 N reduced the transverse arch distance by 4.6 (1.7) mm (mean [SD]) and medial longitudinal arch distance by 6.8 (1.4) mm. The angle of the fibularis longus tendon on the sole correlated well with changes in the transverse arch distance (slope ± s.e. = 0.56 ± 0.13 mm/degree, Pearson r = .83, p = .002) but only weakly with the medial longitudinal arch (0.18 ± 0.18 mm/degree, r = .32, p = .33).

Conclusions: The results of this preliminary study raise the possibility that physical therapies targeting the fibularis longus tendon may be valuable in the management of midfoot arch collapse. The correlation observed with the transverse arch suggests the possibility that surgical modification of the angle of the fibularis longus tendon on the sole may benefit patients with transverse arch collapse.
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http://dx.doi.org/10.1002/ca.23686DOI Listing
May 2021

Ultrasonographic visualisation of anatomical variation of the medial cutaneous nerve of forearm and its depiction by the novel use of a custom computer program to generate 2D diagrams.

Reg Anesth Pain Med 2021 Feb 22;46(2):182-183. Epub 2020 Sep 22.

Anaesthesiology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, Cambridgeshire, UK.

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http://dx.doi.org/10.1136/rapm-2020-101878DOI Listing
February 2021

The Segond fracture occurs at the site of lowest sub-entheseal trabecular bone volume fraction on the tibial plateau.

J Anat 2020 12 8;237(6):1040-1048. Epub 2020 Aug 8.

Human Anatomy Centre, Anatomy Building, Department of Physiology, Development and Neuroscience, University of Cambridge, Cambridge, UK.

In a series of human cadaveric experiments, Dr. Paul Segond first described the avulsion injury occurring at the anterolateral tibial plateau that later took his name. The fracture is thought to arise as a consequence of excessive tibia internal rotation which often also elicits damage to other connective tissue of the knee. The exact mechanism behind the avulsion is, however, unclear. A number of ligamentous structures have been proposed in separate studies to insert into the Segond fragment. Suggestions include the iliotibial band (ITB), biceps femoris and the controversial 'anterolateral ligament' (ALL). Despite increasing knowledge of tibial plateau bony microarchitecture in both healthy and disease states, no studies have yet, to our knowledge, considered the role of tibial sub-entheseal bone structure in pathogenesis of the Segond fracture. The goal of this study was thus to elucidate the differences in trabecular properties at regions across the tibial plateau in order to provide an explanation for the susceptibility of the anterolateral region to avulsion injury. Twenty human tibial plateaus from cadaveric donors were dissected and imaged using a Nikon-XTH225-μCT scanner with <80 μm isotropic voxel size. Scans were reconstructed using MicroView 3D Image Viewer and Analysis Tool. Subsequent virtual biopsy at ten anatomically defined regions of interest (ROI) generated estimates of bone volume fraction ('bone volume divided by total volume' (BV/TV)). The overall mean BV/TV value across all 20 tibiae and all 10 ROIs was 0.271. Univariate repeated-measurements ANOVA demonstrated that BV/TV values differed between ROIs. BV/TV values at the Segond site (Sα, Sβ or Sγ) were lower than all other ROIs at 0.195, 0.192 and 0.193, respectively. This suggests that, notwithstanding inter- and intra-specimen variation, the Segond site tends to have a lower trabecular bone volume fraction than entheseal sites elsewhere on the tibia. Since BV/TV correlates with tensile and torsional strength, the lower BV/TV at the Segond site could equate to a region of local weakness in certain individuals which predisposes them to an avulsion injury following the application of force from excessive internal rotation. The low BV/TV recorded at the Segond site also challenges the idea that the fracture occurs due to pull from a discrete 'anterolateral ligament', as the tension exerted focally would be expected to elicit a hypertrophic response in line with Frost's Mechanostat hypothesis. Our data would instead agree with the aforementioned reports of the fibrous band at the Segond site being part of a broader insertion of an 'anterolateral complex'.
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http://dx.doi.org/10.1111/joa.13282DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7704226PMC
December 2020

Are textbook lungs really normal? A cadaveric study on the anatomical and clinical importance of variations in the major lung fissures, and the incomplete right horizontal fissure.

Clin Anat 2021 Apr 17;34(3):387-396. Epub 2020 Aug 17.

Human Anatomy Teaching Group, Anatomy Building, University of Cambridge, Cambridge, UK.

Introduction: The lungs have three main fissures: the right oblique fissure (ROF), right horizontal fissure (RHF), and left oblique fissure (LOF). These can be complete, incomplete or absent; quantifying the degree of completeness of these fissures is novel. Standard textbooks often refer to the fissures as complete, but awareness of variation is essential in thoracic surgery.

Materials And Methods: Fissures in 81 pairs of cadaveric lungs were classified. Oblique fissures were measured from lung hila posteriorly to the lung hila anteriorly; and the RHF measured from the ROF to the anteromedial lung edge. The degree of completeness of fissures was expressed as a percentage of the total projected length were they to be complete. The frequency and location of accessory fissures was noted.

Results: LOF were complete in 66/81 (81.5%), incomplete in 13/81 (16.0%) and absent in 2/81 (2.47%); ROF were complete in 52/81 (64.2%), incomplete in 29/81 (35.8%) and never absent; RHF were more variable, complete in 18/81 (22.2%), incomplete in 54/81 (66.7%) and absent in 9/81 (11.1%). LOF and ROF were on average 97.1% and 91.6% complete, respectively, being deficient posteriorly at the lung hila. The RHF on average 69.4% complete, being deficient anteromedially. There were accessory fissures in 10 left and 19 right lungs.

Conclusions: This study provides a projection of the anatomy thoracic surgeons may encounter at operation, in particular the variable RHF. This knowledge is essential for optimal outcomes in both benign and oncological procedures influenced by the fissures.
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http://dx.doi.org/10.1002/ca.23661DOI Listing
April 2021

COVID-19 and anatomy: Stimulus and initial response.

J Anat 2020 09 6;237(3):393-403. Epub 2020 Jul 6.

Centre for Anatomy and Human Identification, School of Science and Engineering, University of Dundee, Dundee, UK.

The outbreak of COVID-19, resulting from widespread transmission of the SARS-CoV-2 virus, represents one of the foremost current challenges to societies across the globe, with few areas of life remaining untouched. Here, we detail the immediate impact that COVID-19 has had on the teaching and practice of anatomy, providing specific examples of the varied responses from several UK, Irish and German universities and medical schools. Alongside significant issues for, and suspension of, body donation programmes, the widespread closure of university campuses has led to challenges in delivering anatomy education via online methods, a particular problem for a practical, experience-based subject such as anatomy. We discuss the short-term consequences of COVID-19 for body donation programmes and anatomical education, and highlight issues and challenges that will need to be addressed in the medium to long term in order to restore anatomy education and practice throughout the world.
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http://dx.doi.org/10.1111/joa.13274DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7361297PMC
September 2020

Macroscopic appearance of the major duodenal papilla.

Gastrointest Endosc 2020 07;92(1):227-229

Human Anatomy Teaching Group, Department of Physiology, Development, and Neuroscience, University of Cambridge, Cambridge, United Kingdom.

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http://dx.doi.org/10.1016/j.gie.2020.02.005DOI Listing
July 2020

Configuration of the extra-renal venous system in relation to the left renal vein: A cadaveric study and new proposed classification.

Surgeon 2020 Dec 20;18(6):349-353. Epub 2020 Feb 20.

Human Anatomy Teaching Group, Department of Physiology, Development and Neurosciences, University of Cambridge, Cambridge, UK.

The advent of laparoscopic live-donor nephrectomy for renal transplantation has prompted the need to define the precise anatomical relations of the left renal vein (LRV) and its tributaries. The left kidney is preferred as the greater length of the LRV facilitates implantation in the recipient. While previous studies have described variations in the LRV system, the connections between the left ascending lumbar vein (LALV) and LRV tributaries have been less well-defined. This study aims to further characterise the LALV and proposes a novel classification for its relation to other veins. Dissection of the LRV system, including the left suprarenal vein (LSV), left gonadal vein (LGV) and LALV, was performed in 38 cadavers. Their drainage points into the LRV were recorded, and measurements taken of the distances from these points to the junction of the LRV and inferior vena cava (IVC). The position of the LRV in relation to the aorta was anterior in 35 cases (92%), entirely posterior in 1 case (3%), and circumaortic in 2 cases (5%). Duplication of the LSV and LGV occurred in 6 (16%) and 10 (27%) cases respectively. A direct posterior connection between the LALV and LRV was identified in 32 (86%) cases. The drainage point of the LALV into the LRV lay between the IVC and LGV in 8 (25%) cases. In 20 cases (63%), the drainage points of the LALV and LGV were equidistant from the IVC; and in 5 cases (16%), those of the LALV and posterior branch of the LRV were equidistant from the IVC. In these two groups, the vessels shared a confluent trunk in 10 and 4 cases respectively. In 3 cases, connections were observed between all three vessels (LALV, LGV and posterior branch of LRV). No confluence trunk was shared by the LALV and LSV. These results confirm the high incidence of communicating LALVs, which represent a potentially troublesome source of operative bleeding if unrecognised. Confluent venous trunks may also present difficulties during vessel ligation prior to nephrectomy. It is suggested that a novel classification of the relation of the LALV based on these findings may assist in surgical planning and reduce complications.
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http://dx.doi.org/10.1016/j.surge.2020.01.001DOI Listing
December 2020

'Knowing everything and yet nothing about her': medical students' reflections on their experience of the dissection room.

Med Humanit 2020 Dec 13;46(4):403-410. Epub 2020 Feb 13.

Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK.

Anatomy education by cadaveric dissection teaches medical students not only the formal curriculum in human anatomy, but also a 'hidden curriculum' whereby they learn the attitudes, identities and behaviours expected of doctors. While dissection has been investigated as a challenge to and training in emotional regulation, little attention has been paid hitherto to the forms of medical knowledge and identity which students encounter and develop in the dissection room. This study analyses a corpus of 119 tributes written by three consecutive cohorts of first-year medical students at a university to their cadaveric donors. We employ a Foucauldian discourse analysis methodology, seeking to elucidate the features of the subject position, the narrative 'I' or 'we' of the tributes, and the modes of knowledge which operate between that subject position and its object, the donor. We observe that students find themselves in a transitional state between personal and scientific modes of knowledge of the human, which correspond to different models of the subject position occupied by the student. While in many tributes these modes exist in an uneasy disjunction, others employ creative reflection to suggest new modes of knowledge and identity which may inform ethical practice.
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http://dx.doi.org/10.1136/medhum-2019-011708DOI Listing
December 2020

Neurovascular Anatomy at the "Box Junction": Considerations in the Anterolateral Thigh Flap.

J Reconstr Microsurg 2019 May 15;35(4):254-262. Epub 2018 Sep 15.

Department of Plastic and Reconstructive Surgery, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom.

Background:  The anterolateral thigh (ALT) perforator flap is one of the most widely used flaps in reconstructive microsurgery. This study investigated a previously unexplored and clinically relevant aspect of perforator anatomy: the "box junction" (BxJn), the point at which the perforator arises from its source vessel. Negotiating the BxJn can be a challenging and time-consuming step in flap harvest, due to the neurovascular structures in the area which must be protected from injury. However, as the presence and location of these structures have yet to be clearly defined, painstaking exploration is necessary on each occasion. Knowledge of BxJn anatomy could allow surgeons to harvest the ALT flap more rapidly and safely.

Methods:  We dissected 20 cadaveric thighs and identified perforators to the ALT region and investigated the neurovascular anatomy at their BxJns.

Results:  In 51 BxJns, two clinically relevant vascular structures were identified: an intramuscular artery arising from the perforator (23, 45% of cases) and a "deep" artery to the underlying muscle arising from the source vessel (29, 57% of cases). We confirmed the consistent presence of motor nerve branches and describe one previously unreported, clinically significant variation, in which the nerve to vastus lateralis crosses the BxJn (12, 24% of cases); 36, 71% of BxJns contained at least one vascular and one neural structure.

Conclusion:  Our study confirms that the BxJn is a site of potentially complex and challenging neurovascular anatomy for the surgeon. Based on these results, we propose an algorithm to guide inexperienced surgeons in negotiating this area.
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http://dx.doi.org/10.1055/s-0038-1670649DOI Listing
May 2019

Comparing transversus abdominus release and anterior component separation techniques in reconstructing midline hernias: A cadaveric study.

J Plast Reconstr Aesthet Surg 2018 10 25;71(10):1507-1517. Epub 2018 Jun 25.

St Andrew's Centre for Plastic and Reconstructive Surgery, Broomfield Hospital, Court Road, Chelmsford, Essex, CM1 7ET, United Kingdom. Electronic address:

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http://dx.doi.org/10.1016/j.bjps.2018.06.005DOI Listing
October 2018

Difference in real-time magnetic image analysis of colonic looping patterns between males and females undergoing diagnostic colonoscopy.

Endosc Int Open 2018 May 8;6(5):E575-E581. Epub 2018 May 8.

Human Anatomy Teaching Group, Department of Physiology, Development and Neuroscience, University of Cambridge.

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http://dx.doi.org/10.1055/a-0574-2478DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5943688PMC
May 2018

'Can You Be a Doctor, Even if You Faint?' The Tacit Lessons of Cadaveric Dissection.

Psychiatr Danub 2017 Sep;29(Suppl 3):247-253

University of Cambridge, Lucy Cavendish College, Lady Margaret Road, Cambridge, CB3 0BU, UK,

Background: The undergraduate Medicine course at the University of Cambridge has included cadaveric dissection as part of its anatomy teaching for over three centuries. In recent years, medical schools in the UK and the US have debated whether cadaveric dissection is a useful and efficient way of teaching anatomy. Existing research on this subject has focused narrowly on the knowledge-acquisition for medical students afforded through dissection, and thus we have broadened the scope of such considerations to include the emotional responses of medical students to the dissection process.

Subjects And Methods: The basis for this paper is a phenomenological analysis of response data gathered from 56 first year medical students at the University of Cambridge through written questionnaires and discussion groups before and after their first experiences of cadaveric dissection.

Results: Our research suggests that there are in fact many more lessons taught and acquired through studying in the dissection room: they are tacit, emotional, experiential and dispositional.

Conclusions: When this wider picture of the value of dissection is considered, a much stronger case for the continued inclusion of cadaveric dissection in the medical curriculum can be made, as it is a valuable and unique educational experience.
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September 2017