Keywords
cadaveric dissection - anatomy education - surgical trainee - surgery - surgical training
programs
Anatomy is a fundamental science in medical education, establishing the necessary
groundwork for basic sciences and clinically focused courses.[1] A thorough grasp of anatomy is indispensable for developing essential surgical proficiencies,
including patient history acquisition, examination, clinical reasoning for accurate
diagnoses, and effective patient care management.[2] Therefore, a robust understanding of anatomy is crucial for safe and effective surgical
practice.[3]
For many years, cadaveric dissection has been a cornerstone of teaching and learning
gross anatomy and a vital component of surgical training.[4]
[5] This method significantly aids students and trainees in developing their comprehension
of anatomical structures.[6]
[7] Anatomical education is currently navigating the integration of technological advancements
while effectively utilizing traditional approaches like cadaveric dissection. The
structure of anatomy education, including curriculum and teaching methodologies, has
continuously evolved to meet the changing needs of the medical profession.[8] Current global trends in medical school instruction show a shift toward student-centered,
integrated models with a clinical application focus, resulting in a notable decrease
in time allocated to traditional cadaveric dissection.[9] This change has prompted research into student perceptions and attitudes toward
these modifications and dissection itself.[10]
Students and trainees often express excitement during dissection sessions, largely
due to their first encounter with a cadaver, an experience that distinguishes them
from students in other fields.[11] However, some trainees do not consider dissection optimal for learning anatomy,
citing issues like unpleasant odors, nausea, irritation, and psychological effects
such as stress and emotional distress.[12] These students have suggested alternative learning methods. Despite these concerns,
anatomy educators continue to use dissection, often integrating it with modern teaching
technologies like interactive lectures, ultrasound, MRI, CT scans, laparoscopy, and
virtual cadavers.[13] However, these alternatives present challenges, including cost and the need for
specific operational skills, particularly in developing nations like Sudan. Consequently,
cadaveric dissection remains a primary effective method for teaching anatomy, regardless
of student perceptions. This research aims to explore the perceptions and attitudes
of surgical students and trainees toward cadaveric dissection in Sudanese medical
schools and evaluate their preferences for incorporating innovative supplementary
teaching approaches.
Materials and Methods
Study Design and Participant Recruitment Criteria
This cross-sectional study involved 161 participants, including third to sixth-year
medical students from two universities and first-year surgical trainees. These groups
were chosen because they had prior or current experience with cadaveric dissection.
First and second-year medical students and students from other programs were excluded
due to their lack of dissection experience. Potential participants could decline participation.
Sample Size Determination
The sample size was calculated as 168 participants using Yamane's Equation (1998),[14] including a 10% non-response rate adjustment. Simple random sampling was used for
participant selection.
Data Collection Tool and Procedure
A structured questionnaire with 26 Likert-style questions assessed participants' perceptions
and attitudes toward cadaveric dissection. The close-ended questions covered five
areas: positive experiences (eight items), negative experiences (seven items), emotional
impact (four items), attitudes (three items), and acceptability of dissection (four
items). The questionnaire was distributed online via email and social media. After
2 weeks and periodic reminders, 161 responses were collected.
Ethical Approval
Ethical approval was granted by the Joint Research Ethical Committee of the Ministry
of Health and the Ministry of Higher Education in Sudan (Reference number 25/854,
March 9, 2023). Participation was voluntary, and consent was indicated on the questionnaire.
Confidentiality was ensured by not collecting identifying information.
Results
Sociodemographic Characteristics of Respondents
As shown in [Table 1], of the 161 respondents, 54.3% (116) were female. Additionally, 65.7% (105) were
older than 25 years. Of the total participants, 99% (159) identified as Muslim.
Table 1
Demographic characteristics of study participants (N = 161)
|
Variables
|
Frequency
|
Percentage
|
|
Sex
|
|
Male
|
74
|
45.7%
|
|
Female
|
87
|
54.3%
|
|
Age (in years)
|
|
> 25
|
105
|
65.7%
|
|
< 25
|
56
|
37.3%
|
|
Religion
|
|
Christianity
|
2
|
1%
|
|
Muslim
|
159
|
99%
|
|
Others
|
0
|
0%
|
Respondents' Favorable Views on Cadaveric Dissection
[Table 2] shows that a significant portion of respondents agreed with statements reflecting
positive perceptions of dissection. Specifically, majorities indicated that dissection
aided recall (80%), made learning engaging (82.9%), deepened comprehension (80%),
and provided a three-dimensional understanding of anatomical structures (85.6%).
Table 2
Respondents' favorable views on the use of cadaveric dissection as a method for teaching
and learning anatomy
|
Variable
|
Strongly agree,
frequency (%)
|
Agree,
frequency (%)
|
Neutral,
frequency (%)
|
Disagree,
frequency (%)
|
Strongly disagree,
frequency (%)
|
|
Dissection deepened my understanding
|
56 (35.2%)
|
72 (44.8%)
|
23 (14.3%)
|
6 (3%)
|
4 (2.9%)
|
|
Dissection makes learning more interesting
|
58 (36.2%)
|
75 (46.6%)
|
19 (12.4%)
|
6 (3%)
|
3 (2.6%)
|
|
The dissection helped me to recall what I learnt
|
53 (33.3%)
|
75 (46.7%)
|
24 (15.2%)
|
6 (3%)
|
3 (2.6%)
|
|
Provides a three-dimensional perspective of the structures
|
78 (48.6%)
|
55 (34.3%)
|
18 (11.4%)
|
6 (3%)
|
3 (2.6%)
|
Respondents' Unfavorable Views on Cadaveric Dissection
[Table 3] presents negative perceptions. A substantial 86.7% disliked the smell of formalin.
Conversely, 48.5% disagreed that dissection is time-consuming. Notably, 90.7% disagreed
that dissection conflicted with their religion or culture, with 65.7% strongly disagreeing.
Furthermore, 44.8% found dissection stressful, and 48.5% reported difficulty locating
anatomical structures.
Table 3
Respondents' unfavorable views on the use of cadaveric dissection as a method for
teaching and learning anatomy
|
Variable
|
Strongly agree,
frequency (%)
|
Agree,
frequency (%)
|
Neutral,
frequency (%)
|
Disagree,
frequency (%)
|
Strongly disagree,
frequency (%)
|
|
Dissection was stressful
|
10 (6.7%)
|
61 (38.1%)
|
58 (36.2)
|
26 (16.2%)
|
6 (3%)
|
|
It was difficult locating structures
|
26 (16.2%)
|
75 (46.6%)
|
39 (24.8%)
|
15 (9.5%)
|
6 (3%)
|
|
It was time-consuming
|
10 (6.7%)
|
36 (22.9%)
|
33 (21%)
|
59 (37.1)
|
18 (11.6%)
|
|
I feel dissection is against my culture
|
1 (1%)
|
9 (5.7%)
|
42 (26.6%)
|
62 (39%)
|
42 (26.7%)
|
|
I did not like the smell of formalin
|
93 (58.1%)
|
46 (28.6)
|
15 (9.5%)
|
3 (1.9%)
|
3 (1.9%)
|
The Emotional Effects of Cadaver Dissection
[Table 4] indicates that 41.9% (60 of 161 respondents) experienced anxiety before, during,
or after dissection. Half (51.4%) felt mentally prepared. Approximately a quarter
(27.6%) had prior experience handling a deceased body, which helped 68.3% (72 participants)
adapt to cadaveric dissection.
Table 4
The emotional effects of cadaver dissection on the participants
|
Variable
|
Strongly agree,
frequency(%)
|
Agree,
frequency (%)
|
Neutral, frequency (%)
|
Disagree,
frequency (%)
|
Strongly disagree,
frequency (%)
|
|
I prepared mentally for dissection
|
26 (16.2%)
|
56 (35.2%)
|
39 (24.8%)
|
29 (18.1%)
|
9 (5.7%)
|
|
I had a prior exposure to a dead body
|
18 (11.4%)
|
26 (16.2%)
|
15 (9.5%)
|
46 (28.6%)
|
55 (34.3%)
|
|
The prior exposure helped me
|
51 (31.7%)
|
58 (36.6%)
|
43 (26.8%)
|
7 (4.9%)
|
0 (0%)
|
|
I had anxiety before during and after my first dissection
|
19 (12.4%)
|
47 (29.5%)
|
49 (30.5%)
|
24 (15.2%)
|
19 (12.4%)
|
Attitudes and Receptiveness to Cadaveric Dissection
[Table 5] demonstrates that most respondents viewed dissection as an effective method for
teaching and learning anatomy. A significant 73.3% believed not attending dissection
sessions would be a disadvantage. Most participants regularly attended dissection
sessions (69.6%), and a large majority (98%) acknowledged that the cadaver was once
a human being.
Table 5
Attitudes and receptiveness to cadaveric dissection
|
Variable
|
Strongly agree,
frequency (%)
|
Agree,
frequency (%)
|
Neutral,
frequency (%)
|
Disagree,
frequency (%)
|
Strongly disagree,
frequency (%)
|
|
I will be disadvantaged if I do not attend dissection
|
42 (26.7%)
|
76 (47.6%)
|
26 (16.2%)
|
10 (6.7%)
|
6 (3.8%)
|
|
I attend dissection regularly
|
46 (28.6%)
|
66 (41%)
|
35 (21.9%)
|
9 (5.7%)
|
4 (2.9%)
|
|
I know cadaver was once a human like me
|
95 (60%)
|
30 (19%)
|
21 (13.3%)
|
13 (8.6%)
|
0 (0%)
|
|
I prefer dissection over other forms of learning anatomy
|
24 (15.2%)
|
59 (37.1%)
|
38 (23.8%)
|
29 (18.1%)
|
9 (5.7%)
|
Factors Contributing to Experiencing Anxiety during Dissection
[Table 6] shows no statistically significant association between sex or religion and anxiety
(p-values of 0.395 and 0.702, respectively). However, a statistically significant association
was found between prior exposure to a dead body and anxiety (p-value of 0.000).
Table 6
Factors contributing to experiencing anxiety during dissection
|
Variables
|
Anxious, frequency (%)
|
Not anxious, frequency (%)
|
Neutral, frequency (%)
|
|
Sex
|
|
Male
|
6 (15.1%)
|
15 (34%)%
|
22 (50.9%)
|
|
Female
|
36 (31.7%)
|
27 (23.8%)
|
51 (44.6%)
|
|
Prior exposure
|
|
Yes
|
10 (24.4%)
|
17 (40%)
|
15 (35.6%)
|
|
No
|
46 (45.7%)
|
25 (25.7%)
|
28 (28.6%)
|
|
Religion
|
|
Muslim
|
34 (21.4%)
|
41 (26.2%)
|
83 (52.4%)
|
|
Christianity
|
1 (50%)
|
1 (50%)
|
0 (0%)
|
|
Others
|
0
|
0%
|
–
|
Discussion
Participants' Perception toward Cadaveric Dissection
Participants strongly believed that dissection enhanced learning by making it more
interesting (82.9%), aiding recall (80%), and providing a three-dimensional understanding
of anatomical structures (85.6%). It also deepened comprehension (80%), facilitated
lasting knowledge retention (67.6%), and fostered greater respect for the human body
(74.3%). A general sentiment of excitement about the initial dissection experience
was reported (65.7%). These positive perceptions align with Sharma and Gupta[15] and Dissabandara et al.,[2] where over 75% of participants expressed positive views. This study also supports
Izunya et al.,[16] where approximately 90% recognized dissection's indispensable role. Despite advanced
3D imaging technologies, these are often prohibitively expensive for resource-limited
countries like Sudan. Cadavers also provide trainees with an early experience similar
to working with patients, preparing them for clinical practice.
However, participants also voiced dissatisfaction with certain aspects: The unpleasant
smell of formalin (86.7%), difficulties identifying structures (48.5%), and dissection
being stressful (44.8%) and time-consuming (30.5%). These findings are consistent
with other studies.[10]
[17]
[18] Dissabandara et al.[2] also reported negative perceptions, including “being time-consuming” (59.3%), “difficulty
in identifying structures” (48.4%), and “dislike of the smell of preservatives” (45.1%).
Another study at the University of Development Studies corroborated these negative
experiences.[19]
Formaldehyde, the primary preservative, effectively hardens proteins and prevents
decomposition, but it has a pungent odor and irritates skin and eyes.[20] Exposure commonly results in mucosal irritation, experienced by participants. Experimental
studies highlight formaldehyde as a potential carcinogen and link it to harmful effects
on multiple body systems, underscoring the need for improved preservation methods.[20]
[21]
[22] This underscores the urgent need for anatomists and scientists to develop improved
methods of cadaver preservation that minimize these adverse effects.
Participants' Attitude toward Cadaveric Dissection
Most participants consistently attended dissection sessions (69.6%), expressed respect
and empathy for the cadaver (87.6%), and acknowledged its former human status (98%).
These results reinforce the dissection's value, aligning with Dissabandara et al.[2] Surgical students are typically enthusiastic about using cadavers, understanding
they were once living beings, similar to future patients. This awareness cultivates
empathy more effectively than learning through machines. Weeks et al.'s[23] research suggests dissection offers an opportunity to develop a relationship with
the donor, modeling the doctor–patient relationship.[24] Exposure to experiences fostering professional attributes like respect, dignity,
and compassion is essential. Dissection provides such opportunities.
The Emotional Impact of Dissection on Participants
Regarding emotional effects, 41.9% reported no anxiety, while 51.4% mentally prepared
themselves. This contrasts with previous studies documenting anxiety that negatively
affected learning.[12]
[25]
[26]
[27] For first-year medical students, dissection can be a challenging initiation, often
their first encounter with a deceased body, potentially causing emotional anxiety.
Factors like sex, religion, and cultural beliefs can influence anxiety. This study
found no correlation between sex and anxiety, despite previous research suggesting
males are less prone to it.[25]
[28]
[29]
[30] Similarly, no association was found between religion and anxiety, aligning with
Shalev and Nathan[31] but contradicting Aday,[32] who observed lower death anxiety among more religious Christians. It was proposed
that greater religious involvement might reduce death-related anxiety. Our study revealed
that prior exposure to a dead body had a statistically significant (p = 0.000) association with developing coping mechanisms and reduced anxiety during
dissection.
Acceptability of Cadaveric Dissection by Participants
Participants considered dissection indispensable. A majority (73.3%) believed not
attending would be a disadvantage, and 67.6% desired more dissection time. A substantial
proportion (75.3%) disagreed with replacing dissection with alternative methods. These
results align with other studies affirming dissection's acceptability, with few advocating
for replacement.[2]
[16]
[19]
[32] However, only a minority (38%) preferred dissection classes over other anatomy instruction,
supported by Dissabandara et al.[2] (∼36%). This suggests that while dissection is essential, incorporating innovative
complementary approaches is important.[33]
[34]
Limitations
This study, while providing valuable insights into the perceptions and attitudes toward
cadaveric dissection among medical students and surgical trainees in Sudan, has a
few limitations that should be considered when interpreting the findings. The study
relied on self-reported data from a questionnaire, which can be influenced by biases
such as social desirability or recall inaccuracies, potentially impacting response
validity. Furthermore, as the research was conducted with participants from two specific
universities and surgical training programs in Sudan, the findings, while offering
important local context, may not be broadly applicable to students and trainees in
other Sudanese institutions or in different countries with distinct cultural, educational,
and resource landscapes.
To address these specific limitations concerning data source and generalizability,
future research could employ mixed-methods approaches, triangulating questionnaire
data with qualitative insights from interviews or focus groups to provide deeper context
and validate findings. Ensuring robust anonymity and using carefully worded, neutral
questions can also help reduce reporting biases. Moreover, expanding research efforts
to include a more diverse range of institutions, both nationally across different
regions of Sudan and internationally through collaborative multicenter studies, would
significantly improve the representativeness and applicability of the findings to
varied cultural and educational settings.
Conclusion
This research demonstrates that participants hold notably positive perceptions and
attitudes regarding cadaver use in anatomy teaching and learning. The findings strongly
advocate for cadaveric dissection's definitive role in medical education, particularly
anatomy. Participants showed a clear preference for dissection, emphasizing its significant
contribution to their subject comprehension. However, the study highlighted challenges,
including the unpleasant odor of preservatives and the stressful nature of the activity.
Importantly, no discernible difference in emotional responses to cadavers was found
based on sex.
A significant finding is that cadaveric dissection is crucial for fostering essential
skills, courage, and the capacity to work confidently with the human body, all indispensable
for future surgical practice.
Based on these findings, several recommendations are proposed.
-
Recognize human dissection as an integral and fundamental component of surgical training.
Consequently, anatomy departments should allocate sufficient time for dissection activities.
-
Introduce a course on death and dying in the first year of medical education to provide
early exposure and facilitate coping mechanism development.
-
While vital, complement cadaveric dissection with alternative teaching methods, including
models, computer-assisted learning, prosected specimens, animation, and painting,
to enhance the learning experience.
Bibliographical Record
Elmuhtadibillah Babiker Yousif Gasoma, Leenah Mohammed Salih Mohammed. The Silent
Teacher's Role in Surgical Training: A Cross-Sectional Study on Medical Students'
and Surgical Trainees' Attitudes toward Cadaveric Dissection. Surg J (N Y) 2025; 11:
a26315735.
DOI: 10.1055/a-2631-5735
