When Perelman School of Medicine student Vidya Viswanathan encountered her very first patient, the experience was different than what she had initially imagined. She wasn’t able to ask her patient about aches and pains or check her pulse because her patient was already deceased. But the patient still had a lot to teach Viswanathan and her peers.
“I was overwhelmed with a multitude of feelings when I first saw my cadaver,” Viswanathan said. “My teammates and I took a moment to prepare before we removed the shroud covering her, and we then spent a good amount of time just observing and taking it all in.”
Gross anatomy is a rite of passage for all aspiring physicians, providing them with the foundation that will guide patient treatment and diagnosis for the rest of their careers. Throughout the course, which takes place from September through December during a student’s first year of med school, they learn about the human body, working from the bottom of their feet through the torso and eventually on to the brain.
“What we’re really trying to do is teach them what’s under the skin,” said Neal Rubinstein, MD, an associate professor of Cell and Developmental Biology in the Perelman School of Medicine, who directs the anatomy course. “Most physicians don’t cut into a body when they’re practicing medicine, but every physician needs to have a good three-dimensional picture of the body in their head.”
Understanding what’s underneath is important for all aspects of patient care, from interpreting radiographs, like x-rays, MRIs, or CT scans to diagnosing viruses and other illnesses. Through dissection, students learn what’s normal and more importantly, what is not normal. Every cadaver is a little different, with different medical histories and causes of death. You never know what you will get until you make the first cut – some bodies that have no outward abnormalities might have interesting stories to tell once you get to see the inside.
In fact, almost every medical advancement in history has its roots in dissection and anatomy. From the early days of body dissection when physicians were trying to learn each organ’s function and where it was located, to modern breakthroughs such as organ transplants; physicians and med students have been using cadavers to advance their skills for centuries. For example, the orthopedic team at Penn Medicine was able to successfully perform the world’s first pediatric hand transplant in August 2015, a medical feat that would not have been possible without studying and practicing on cadavers.
“Many people have tried using advanced technology or computers to teach students about the human body, but nothing provides a more complete understanding than dissection and active learning in a gross anatomy class,” Rubinstein said.
And the lessons go far beyond anatomy. By assigning four students per body, they gain another valuable skill that will be put to use throughout their careers: teamwork. The students dissect different portions of the body at the same time and must share the information they learn with each other during the course.
Students also learn how to process their feelings and handle difficult or uncomfortable situations, something else they will encounter over and over again in their careers.
“The cadaver really is their first patient,” Rubinstein said. “They begin to realize how important their work will be, not only for themselves but for the people that they will be treating as physicians.”
Most students may go into gross anatomy on the first day with some trepidation, whether they are nervous about being first-year medical students in general or because they have never encountered a dead body before. But by the end of the course, the experience will make them better physicians.
“One of my favorite memories was the student who, on the first day, rushed into the hallway, collapsed to the floor, turned about as white as possible, and started crying. She was sure her reaction to seeing a dead body for the first time meant her career was over before it had begun,” Rubinstein remembered. “This student went on to receive the highest score in the class on her anatomy exams.”
As the students progress through the class, they develop a relationship with the cadaver while also becoming more relaxed and confident about their skills.
“I never lost my sense of wonder about the human body,” Viswanathan said. “But I did learn to be more comfortable. My teammates and I developed a rapport where we could share our emotions about dissection — whether it was fear, disgust, curiosity, or even gratitude.”
When the students are done with the course, the bodies are brought down to the morgue and prepared for cremation. Sometimes, the students will leave notes or poems with the cadavers, thanking the person and their families for donating their body for the students’ education.
Viswanathan was so touched by her cadaver that at the end of the 2015-2016 school year, she joined her fellow med students from schools across Philadelphia to celebrate the generosity of all the people who donated their bodies to science. Each year, the Humanity Gifts Registry honors donors and their families with a remembrance ceremony to celebrate the life and the contribution each donor made to help advance medical science.
“People are inspired to donate their bodies to science for many reasons. Some might want to help find a cure for whatever ultimately killed them while others are simply motivated to help our future doctors. But whatever the reason, their contributions continue to teach our students and lead to lifesaving breakthroughs,” Rubinstein said.