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Anatomy education in the modern digital era: Are the examinations results affected by the use of cadavers?

To the Editor, It was our pleasure to read the article by Harris, Adey, and McKay (2020), who demonstrated that anatomy examinations performance was not markedly affected by withdrawal of prosected cadavers from the curriculum. Indeed, as it was noted, students of the modern era want to have information constantly available, via digital devices, at their fingertips. However, we would like to propose a different interpretation of the findings of the study. The major characteristic of the curriculum change in the last years was the use of plastinated specimens instead of prosected cadavers. Plastination includes replacement of water and fat of wet cadavers with polymers (Von Hagens, Tiedemann, & Kriz, 1987) and has, in the last decades, been used for anatomy education purposes. A recent review article by Chytas et al. (2019) demonstrated that this technique has promising anatomy teaching potential, although the majority of the retrieved articles evaluated only students' perceptions and not academic performance. In this review article, only the study by Baker, Slott, Terracio, and Cunningham (2013) was found to assess students' test scores in anatomy examinations when plastination was implemented for teaching purposes. More specifically, in the study by Baker et al. (2013), plastination was compared with cadaveric dissection in terms of effectiveness in dental students' anatomy examinations performance. Although statistical significance was not evaluated, it was noted that plastination led to better educational outcomes in comparison with cadaveric dissection. Also, in the review article by Chytas et al. (2019), no study was found to compare acquisition of anatomical knowledge after teaching via plastinated versus prosected cadaveric specimens. A more recent randomized controlled trial by James, Chapman, Dhukaram, Wellings, and Abrahams (2019) investigated the role of plastinates versus conventional anatomy education tools (dry bones and whole cadaveric feet) in teaching foot and ankle anatomy. The post-intervention test scores were higher for the students of the plastination group, but not significantly. To the best of our knowledge, there is no evidence in the literature that teaching anatomy via wet cadavers leads to better academic performance in comparison with plastinated specimens. Thus, it would be reasonable if we expected that, also in the study by Harris et al. (2020), wet prosected cadavers would not be proved superior to plastinates. We agree with the authors' statement that, in the modern educational era, tech-savvy students want information immediately and constantly accessible at their digital devices. However, it was stated that the curriculum change in the last years was characterized by absence of cadavers, while the consistent students' performance was correlated with the absence of cadavers from their education. Nevertheless, cadavers were not in fact absent, but just replaced by plastinated cadaveric material, which has not been proved by the literature as inferior to wet specimens, in terms of examinations outcomes. Thus, in our opinion, the conclusion that students' performance on anatomy examinations was surprisingly consistent, despite changing conditions, was not adequately supported. In conclusion, we believe that studies which will compare anatomy examinations performance using cadavers versus digital technologies are needed for the investigation of the potential value of students' selfdirected learning nowadays.