Medical Students Are Learning Anatomy From Digital Cadavers. Can Technology Ever Replace Real Human Bodies?
From interactive diagrams to A.I. assistants, virtual tools are beginning to supplant physical dissections in some classrooms
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Students learn anatomy from an Asclepius AI Table, which merges interactive elements and artificial intelligence.
Surglasses
Key takeaways: New technology is reinventing anatomy classes
- Digital cadavers—reconstructed human bodies that students interact with on a screen—are increasingly used to teach anatomy to medical students via virtual reality and artificial intelligence-based learning tools, offering experiences that can’t be replicated with a human cadaver. In some programs, they’ve fully taken the place of real cadaver dissection.
- Some researchers point to tactile and sensory experiences of cadaver dissection that seem irreplaceable by a digital alternative—and some applications will likely always require real bodies.
A human chest as large as a room fills your entire field of view. With a few commands, you shrink it down until it’s a mere speck. Then, you return it to life-size and lay it prone, where you proceed to strip off the skin and layers of viscera and muscle. Helpful text hovers in the air, explaining what you see, projected across your field of vision by a headset.
This futuristic experience is becoming more commonplace in medical schools across the country, as instructors adopt virtual reality tools and other digital technologies to teach human anatomy. On dissection tables in some classrooms, where students might have once gathered around human cadavers, digitized reconstructions of the human body appear on screens, allowing students to parse the layers of bones and tendons, watch muscles contract, and navigate to specific anatomical features.
Sandra Brown, a professor of occupational therapy at Jacksonville University in Florida, teaches her introductory anatomy class with exclusively digital cadavers. “In a way, the dissection is brought to life,” she says. “It’s a very visual way for [students] to learn. And they love it.”
The dissection of real human cadavers has long been a cornerstone of medical education. Dissection reveals not only the form of the organs, but how the structures of the human body work together as a whole system. The best way to understand the human body, researchers have argued, is to get up close and personal with one. But human dissection has also been controversial for hundreds of years, with a history burdened by grave robbers and unscrupulous physicians.
Now, with interactive diagrams, artificial intelligence assistants and virtual reality experiences, new technology might provide an effective alternative for students—no bodies necessary. Still, the shift toward these tools raises questions around what might be lost when real bodies leave the classroom—and whether dissecting a human body carries lessons that no digital substitute can teach.
“Is it helpful to be exposed to death, and is there something beyond just the functional learning of dissecting a cadaver?” says Ezra Feder, a second-year medical student at the Icahn School of Medicine at Mount Sinai in New York. “I don’t really have a great answer for that.”
“A new dimension of interaction”
Among the most popular new additions to anatomy classrooms are digital cadaver “tables.” These giant, iPad-like screens can be wheeled into the classroom or the lab. Anatomage, a California-based company that produces one such table, has seen its product adopted by more than 4,000 health care and education institutions. The company uses real human cadavers that have been frozen and imaged in thousands of thin sheets, then reconstructs them digitally, so students can repeatedly practice differentiating layers and systems of the body.
High school students show an Anatomage table to middle schoolers at California’s Esperanza High School in 2018. Jeff Gritchen / Digital First Media / Orange County Register via Getty Images/https://tf-cmsv2-smithsonianmag-media.s3.amazonaws.com/filer_public/03/0c/030cf246-60e8-4cb2-83a6-40b597e384af/gettyimages-1032093934.jpg)
Digital cadavers are not new, but they’re getting better, more realistic and more interactive. They’re so good that some schools have phased out real human cadavers entirely. Brown, who uses the Anatomage table, says digital dissection meets the educational styles preferred by her students. “They’ve had smartphones in their hands since they were born, practically. So, the fact that we have this massive virtual technology that they can use, and they can actually start to incorporate all the skills they have into learning—it was just a no-brainer for me,” she says. “It’s really fun.”
Brown’s students can rotate, move and manipulate the digital cadavers in ways that would be impossible with a real body. “They literally have the brain upside down, and they’re looking at it from underneath. You can’t really do a lot of that when you have a cadaver in front of you, because they’re so fragile,” she says. “It’s an errorless way for [students] to explore, because if they make a mistake, or they can’t find something, they can reset it, and they can undo it.”
Other companies, like Surglasses, which developed the Asclepius AI Table, are taking the digital cadaver model one step further. This table features A.I. assistants with human avatars that can listen and respond to voice commands from students and educators. The assistants can pull up relevant images on the table and quiz students on what they’ve learned. Recent research has shown that A.I. assistants can effectively support student learning and that those with avatars are particularly promising.
“Students really respond well to technology that’s accessible to them,” says Saeed Juggan, a graduate teaching assistant at Yale Medical School, which has its own suite of digital anatomy tools, including a 3D model of a body that students can access from their own devices. Still, Juggan is a bit wary of A.I. tools because of potential limitations with the data they’re trained on. “Suppose students ask a question that’s not answered by those resources. What do you do in that case? And what do you tell the bot to do in that case?” he says.
With virtual and augmented reality (VR/AR) anatomy programs, human dissection has become even more futuristic. Companies like Toltech have created VR headsets that transport students into an immersive digital cadaver lab, where they manipulate a detailed, annotated body standing in a gray void. While learning remotely during the Covid-19 pandemic, students at Case Western Reserve University donned bug-like visors to interact with holographic bodies that appeared to be floating in the students’ apartments.
Still, VR comes with complications. Some students experience motion sickness from the headsets, explains Kristen Ramirez, a research instructor and content director for anatomy lab at New York University’s Grossman School of Medicine. Her approach, and that of her team at NYU, is to tailor the technology to fit the type and content of instruction.
Ramirez and a colleague have created an in-house VR program that allows students to stand inside a human heart. Students can see “everything that the red blood cells would have seen if they had eyes and cognition,” she says.
A digital replica of a human skull appears to float in a room due to augmented reality, which overlays graphics against the backdrop of the real world. The pictured technology is used at Yale University. Ray Hill/https://tf-cmsv2-smithsonianmag-media.s3.amazonaws.com/filer_public/b2/0b/b20b2f6e-7c03-491a-a7d3-986f6af7a0e3/ezgif-3481ce6fa9aaa46b.jpg)
Kristen Ramirez explores the pterygopalatine fossa, a space between the cheek and nose, with New York University’s virtual reality technology. Kristen Ramirez/https://tf-cmsv2-smithsonianmag-media.s3.amazonaws.com/filer_public/d8/1a/d81a3603-745b-4951-ada8-22ff7551d993/img_8694025x.png)
For certain parts of the body, an immersive experience is the best way to understand them, Ramirez adds. The pterygopalatine fossa, for example, is a small space deep inside the face, roughly between the cheek and nose—and the only way to see it, until now, has been by sawing through a donor’s skull. Even then, the fragile structures are inevitably damaged. With VR, students can view that cavity as though they are standing inside it—the “Grand Central Station of the head and neck,” as Ramirez calls it—and access “literally a new dimension of interaction.”
The body on the table
Even as digital tools land in more medical school classrooms, some say that learning from an actual body is irreplaceable. William Stewart, an associate professor of surgery at Yale University who instructs gross anatomy, sees the embodied experience of dissection as vital. “There’s a view of learning called ‘gestalt,’ which is that learning is the sum of all of the senses as the experience occurs,” he explains.
“There’s seeing, there’s touching, there’s camaraderie around the table. There’s—I know this sounds silly, but it’s true—there’s the smell,” Stewart says. “All of those contribute, in one way or other, to the knowledge, and the more and more of those senses you take away, in my view, the less and less you learn.”
When it comes to preparing for surgery or getting tactile experience with a body, surveys suggest students generally favor cadaver dissection, with some citing better retention of concepts. Working solely with digitized, color-coded models that can respond to voice commands does students a disservice, Stewart argues. “It’s not seeing it, it’s finding it that makes the knowledge.”
The donation of one’s body to scientific learning and research is not taken lightly. It’s common practice for medical students to participate in a memorial service to honor the people who they will dissect as part of their studies. Jai Khurana, a first-year medical student at the Harvard-MIT Health Sciences Technology Program currently taking introductory anatomy, describes a respect and care for the human body that he and his fellow students learn through human dissection.
“We regularly stay many hours past our anatomy lab if we don’t think we’re going to finish,” he says. “You still want to finish what you’re doing, do it in a respectful way and learn everything that you can learn.”
Still, ethical violations have long plagued human dissection. In the 18th and 19th centuries, medical students dissected corpses stolen from graves and even those that had been murdered and sold by unscrupulous profiteers. At the time, dissection was implemented as an extra punishment for executed criminals in Britain to deprive them of a Christian burial; the boon to medical research was a bonus. Today, some countries around the world and many U.S. states still permit the dissection of “unclaimed remains,” or the bodies of those who die without family to properly bury them, raising concerns about consent. A recent investigation revealed that unclaimed corpses sent to the University of Southern California’s anatomy program were sold to the U.S. Navy, where they were used to train military operatives in the Israel Defense Forces.
This 1751 print by English artist William Hogarth is the fourth in a series called The Four Stages of Cruelty and depicts the body of a fictional murderer being dissected after hanging. Around the same time, the Murder Act established post-mortem dissection as a punishment for executed criminals. William Hogarth; Museum of Metropolitan Art, Harris Brisbane Dick Fund, 1932, under Public Domain/https://tf-cmsv2-smithsonianmag-media.s3.amazonaws.com/filer_public/51/13/51130c42-214d-47dd-9116-38d6fba1bc47/cruelty4.jpeg)
And despite the fact that most medical school cadavers in the U.S. are willingly donated, the donors and families are sometimes underinformed about what may happen to their remains. No federal agency monitors what happens to bodies donated for research and education. In an extreme case from this year, the former manager of the Harvard morgue pleaded guilty to stealing donated human remains and selling them to retailers for profit.
Digital cadavers, VR/AR and A.I.-enhanced anatomy technology could offer a way to skirt these issues by reducing the number of human bodies needed for education—and the cutting-edge tech might actually be less costly than human cadavers for some medical programs. Whatever way you swing it, bodies are expensive, even if they are donated. Supporting a cadaver lab requires administrative staff to coordinate body donations, a wet lab space equipped for dissections and infrastructure for disposing of human remains. Because of this, students typically work in small groups to use fewer bodies. Each human cadaver can be used only once for each procedure, but digital ones can be reset repeatedly.
For Brown, who teaches with the Anatomage table, the ideal lab would be a mix of synthetic, digital and real human dissection, where she could supplement a largely digital cadaver-based education with different tools to demonstrate various elements of anatomy. But given the financial constraints at Jacksonville University, Brown does what she can with the Anatomage table, having her students rotate the body’s shoulders, color code structures and create videos of their work to reference later. Her occupational therapy students are not preparing to be surgeons, so they would not have to practice cutting into flesh, she adds.
Learning from a human cadaver has long been considered a rite of passage for medical students, who typically must dissect a body during their first-year anatomy class. But the emotional weight of human dissection can sometimes hinder, not enhance, the experience.
“Cadavers can be scary, like a dead body laying in front of you that you have to look at,” says Brown. “And I think that [digital dissection] is just a safe way for [students] to explore.” She explains that some students enter the program expecting cadaver dissection and feel more comfortable when they encounter the digital models instead.
Perhaps there’s value to sitting with that discomfort. Ramirez says that students who were initially apprehensive to human dissection might never overcome their squeamishness when offered a virtual alternative. “Because they are getting such small moments of interaction with the cadavers, I definitely will still see students even a couple weeks in, you know, disappointed, if you will, that they’re at a cadaver station, hesitant about going and interacting with it,” she says.
For Feder, the student at Mount Sinai, dissecting a real human body elicited mixed emotions. In the lab, some students seemed to become desensitized over time to the cadaver’s humanity and treated it inappropriately, he says.
“For some people, it became so ordinary and routine that maybe they lost some respect for the body,” Feder adds. “Maybe these are coping mechanisms.” Regarding respect for the dead, he says, “I think I’d feel a lot more comfortable learning from a technology-based cadaver than a real human bone-and-flesh cadaver.”
Educationally, the physical cadaver dissection “was really invaluable,” Feder adds, and “a little bit hard to replace.” But he notes that the value of being exposed to death might vary between students, depending on what exactly they’re training for. “Overall, most doctors are in the business of keeping people alive.”
The future of learning from cadavers
While anatomy classes are increasingly using digitized bodies, cadaver dissection writ large is not likely to disappear anytime soon. It’s still a common way for surgeons to gain tactile experience with manipulating human flesh. Juggan, the Yale graduate student, explains that a neurosurgeon recently practiced a hemispherectomy on cadavers at the university before operating on a living patient. The procedure, which entails surgically separating different parts of the brain, is difficult, with a potential for catastrophic failure.
Practicing this surgery on a cadaver is “not necessarily looking at the tissue,” Juggan says. “It’s getting the muscle memory. It’s getting the tactile feel for … this anatomical structure.” It goes without saying: No living patient wants to be the beta test for brain surgery.
But not all cadavers are used to prep for such dramatic, high-stakes operations. As Mary Roach observes in her book Stiff: The Curious Lives of Human Cadavers, even plastic surgeons practice nose jobs on disembodied heads from donors. “Perhaps there ought to be a box for people to check or not check on their body donor form: Okay to use me for cosmetic purposes,” she writes in the book.
Though the tactile training of surgeons remains important, surgery itself is getting more technologically advanced. With more robot-assisted surgeries, it’s not hard to imagine that technology and anatomy teaching will become more deeply integrated. Take, for instance, laparoscopic surgery, meant to look inside the pelvis or stomach by inserting a tiny camera into the abdomen. The surgery feels almost like science fiction: The surgeon makes minute adjustments from a distance, while the patient’s organs appear on a glowing screen. “If you’re doing laparoscopic surgery, you’re putting three tiny holes in the abdomen, and you’re playing a video game,” Ramirez says.
There’s a conceivable future where the majority of medical students do not dissect an actual human body. The problem of tactile experience might also soon be solved by innovation, as synthetic cadavers—made of thermoplastic and organosilicate—mimic the physicality of the human body without limitations of ethics or decomposition. The anatomy classroom may soon be filled with digital dead people and synthetic approximations of flesh, rather than a decaying memento mori. Death’s banishment is, after all, in service of keeping more people alive longer.
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