Gowri, Ramadevi, Vedapriya, Janaki, Rao, and Mohiuddin: Awareness of dissection skills and tools session in preparing first MBBS learners for cadaveric dissection in medical school a qualitative analysis


Introduction

Dissection defines anatomy and teaches essential skills that support the development of a learner across the spectrum of medical education.1 Every learner is expected to do dissection in Anatomy. During dissection, especially at the beginning of the course, instructors can demonstrate dissecting skills that will greatly benefit students during their subsequent dissections.  Despite the advent of modern technology and evolving teaching methods, dissection continues to remain a cornerstone of anatomy curriculum.2 Its utility is also reflected in the perception of students who are of the opinion that dissection provides them with a foundation critical to development of clinical skills.2 Using proper technique during dissections is important for developing good dissection skills.3 Gaining technical skills in the lab makes the process of dissection more efficient and certainly facilitates students learning.4 If directed creatively, dissection provides the platform for the independent thinking that underpins the development of diagnostic aptitude. Dissection can thus play many roles in the educational process.4

In my observation for over past years most of the learners do not have sufficient knowledge of dissection tool kit, how to use the tools (for example how to insert the scalpel blade into the handle, how to wear gloves and the ways of using instruments in the dissection kit) and techniques of doing dissection. Because of this most of the learners in the initial days have injuries, take more time to dissect without knowing proper techniques and get easily fatigued. Some of them lose interest too which may lead to improper dissections. With proper dissection techniques, not only the learner will save time, but also will be able to better find, isolate and mobilize the structures. No existing research was done in this field which stimulated author to do so. Henceforth the main objective of this study is to sensitize the learners with dissection tools and skills so that the learner will be able to perform dissection with ease and enthusiasm. This would also increase the percentage of learners doing dissection effectively.

Objectives

  1. To assess the learners’ knowledge with dissection skills and tools prior to interventional session.

  2. To assess the learners’ knowledge with dissection skills and tools after the interventional session.

  3. Perceptions of learners with respect to interventional session.

Materials and Methods

Ethical Clearance for this study was taken from Institutional Ethics Committee of Osmania Medical College, Hyderabad, Telangana with Ref. No. IEC/ OMC/2021/M.No.(05)/ Acad. – 58 and REG. No. ECR/300/Inst/AP/2013/RR-19. A prospective cross-sectional study was carried out with 200 I MBBS learners in Anatomy department. Of which only 168 participated in answering the questionnaire. The study tools used were General lecture, demonstration with audiovisual aids, validated questionnaires. Pre-analysis was done with a validated questionnaire about their knowledge of dissection skills and tools. An interventional session was done after 1 month of entry of I MBBS Learners with General lecture followed by small group teaching with demonstration by trained faculty using projection of videos of how to use instruments, how to wear and remove gloves, how to wear mask, how to wash hands and techniques of doing dissection. The learners were allowed to practice. Later post-test analysis was done with same validated questionnaire. Perceptions of learners were also taken regarding session. The pre and post- test results were analysed and compared. Chi-square test was used to know the significance of intervention. P value was obtained to know the significance of study. Data was analysed by using Epi Info 7.1. Perceptions of all learners were taken with Likert scale regarding session.

Results

The results of pre and post analysis tests of 168 students are tabulated in Table 1 overall knowledge of dissection skills and tools improved after interventional session by 64%.

Significant improvement evident by P value <0.0000001 was seen after the interventional session on “Awareness of Dissection skills and tools in preparing I MBBS learners for cadaveric dissection”.

Most (80%) of learners felt that the session was very useful to them in stimulating interest, in-depth knowledge of the subject, acquiring dissection skills, performing qualitative dissections and a worthful session to be taken for every batch.

Table 1

Pre, post-test scores and percentages with validated questionnaire

Questionnaire

Pre - Test

Post-Test

Percentage Improved

Chi-square value

P Value

Score

Percentage

Score

Percentage

At what angle is scalpel used?

42

25

146

87

62

128.1

<0.001

Enumerate steps of inserting and removing scalpel blade from BP Handle of scalpel.

19

11

139

83

72

169.2

<0.001

Will you be able to demonstrate the above one with ease?

14

8

120

71

63

136.85

<0.001

Indicate where toothed and Non- toothed forceps are used?

30

18

152

90

72

175.5

<0.001

Give indications where hand lens is used in dissection?

6

4

149

89

85

241.5

<0.001

Are you aware of technique of wearing and removing gloves?

50

30

139

83

53

93.7

<0.001

If so, can you demonstrate the above one?

21

13

127

76

63

133.13

<0.001

Do you know how to wear a sterile mask?

60

35

157

93

58

119.91

<0.001

Enlist the names of instruments in dissection tool box?

96

57

152

90

33

46.57

<0.001

How to keep the dissections moist/ life like?

26

16

148

88

72

177.41

<0.001

How to reduce effect of formalin while doing dissections?

31

18

153

91

73

175.9

<0.001

Table 2

Perceptions of learners about the session

Question

Excellent /strongly agree

Very good/ Agree

Good/ Neutral

Fair/ disagree

Poor/ strongly disagree

The instructor stimulated interest in the subject

104

43

20

0

1

The instructor demonstrated in depth knowledge of the subject

81

68

14

3

1

This was a worthwhile class

86

57

23

0

1

How do you rate your experience with this session

67

70

22

32

2

Would you recommend this session to your juniors

106

48

5

1

4

Has this session improved your dissection skills

102

48

9

23

3

How do you grade this session?

91

60

11

0

2

Do you think this should be included in anatomy as a chapter

80

39

19

11

16

Discussion

Most of the researches were done with respect to efficacy of cadaveric dissection in learning and teaching Anatomy; what can replace or supplement cadaveric dissection due to reduced availability of number of cadavers.

This is a unique study and first of kind. No previous studies were seen where learners were primed with knowledge of dissection tools and skills initially, thereby increasing the percentage of learners performing dissection with ease.

In the present study, there was a significant improvement in the knowledge of learner with dissection skills and tools. The learner also had hands on experience and were able to apply it while doing dissections. 80% of the learners opined that the session stimulated interest the learning subject, improved dissection skills and their performance in dissection with ease. The learners felt it was a worthwhile class and recommend it to be done for their juniors too. The same perceptions were found in the study of Zhang G,4 where learners felt that dissection techniques made them better dissectors.

Study conducted by Ilker Selcuk et.al (2019)5 concluded that proper cadaveric dissections will improve surgical skills of undergraduates, residents and postgraduates.

Conclusion

It becomes evident from the present study that such interventional sessions at the initial phase of learning would improve, stimulate, increase the learners’ participation in dissections with perfection and ease. This would also help the learner to acquire better independent surgical skills and understanding in clinical phases of learning and therefore would recommend it in early phase of I MBBS Anatomy.

Source of Funding

None.

Conflict of Interest

The authors declare that there is no conflict of interest.

References

1 

W Pawlina N Lachman Dissection in learning and teaching gross anatomy: Rebuttal to McLachlanAnat Rec2004281B91110.1002/ar.b.20038

2 

SK Ghosh Cadaveric dissection as an educational tool for anatomical sciences in the 21st centuryAnat Sci Educ20171032869910.1002/ase.1649

3 

M Loukas B Benninger RS Tubbs Gray's Clinical Photographic Dissector of the Human Body E-BookElsevier Health Sciences201817

4 

G Zhang Mastering Cadaveric Dissection and Engaging Students: How to Become “An Amazing Asset” to Students in the Dissection LaboratoryAustin J Anaty201741106310.26420/austinjanat.2017.1063

5 

İ Selcuk I Tatar E Huri Cerrahi eğitimde kadavrada anatomi ve disseksiyonJ Turk Soc Obstet Gynecol20191672510.4274/tjod.galenos.2018.15931



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Article History

Received : 28-05-2021

Accepted : 17-06-2021

Available online : 06-07-2021


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https://doi.org/10.18231/j.ijcap.2021.022


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