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Dissection Videos Do Not Improve Anatomy Examination
Waqas Mahmud,1* Omar Hyder,2 Jamaal Butt,1 Arsalan Aftab1
Department of Anatomy, Rawalpindi Medical College, Rawalpindi, Pakistan
Department of Obstetrics and Gynecology, Rawalpindi Medical College, Rawalpindi, Pakistan
In this quasi-experimental study, we describe the effect of showing dissection videos on
first-year medical students’ performance in terms of test scores during a gross anatomy
course. We also surveyed students’ perception regarding the showing of dissection videos.
Two hundred eighty-seven first-year medical students at Rawalpindi Medical College in
Pakistan, divided into two groups, dissected one limb in first term and switched over to
the other limb in the second term. During the second term, instruction was supplemented
by dissection videos. Second-term anatomy examination marks were compared with firstterm scores and with results from first-year medical students in previous years. Multiple
linear regression analysis was performed, with term scores (continuous, 0–200) as the dependent variable. Students shown dissection videos scored 1.26 marks higher than those
not shown. The relationship was not statistically significant (95% CI: 21.11, 3.70; P 5
0.314). Ninety-three percent of students favored regular inclusion of dissection videos in
curriculum, and 50% termed it the best source for learning gross anatomy. Seventy-six
percent of students did not perform regular cadaver dissection. The most frequent reason
cited for not performing regular dissection was high student-cadaver ratio. Dissection
videos did not improve performance on final examination scores; however, students
favored their use. Anat Sci Educ 4:16–21. © 2011 American Association of Anatomists.
Key words: medical education; gross anatomy; laboratory dissection; computer-aided
instruction; dissection videos; learning styles
Cadaver dissection is used as a major tool in learning anatomy, owing to its perceived effectiveness for understanding
classification and inter-relationship of different body parts,
integration of theory and practice of anatomy, touch-mediated perception, humanistic care, three-dimensional perspectives of structures, and application of practical skills (Aziz
et al., 2002; Rizzolo, 2002; Hinduja et al., 2005; Lempp,
2005; Lachman and Pawlina, 2006; Azer and Eizenberg,
2007; Gogalniceanu et al., 2008, 2009; Sugand et al., 2010).
*Correspondence to: Mr. Waqas Mahmud, Department of Anatomy,
Rawalpindi Medical College, Tipu Road, Rawalpindi, Pakistan. E-mail:
[email protected]
Received 29 September 2010; Revised 7 November 2010; Accepted
22 November 2010.
Published online 3 January 2011 in Wiley
( DOI 10.1002/ase.194
© 2011 American Association of Anatomists
Anat Sci Educ 4:16–21 (2011)
The practice of cadaver dissection has been criticized for
being stressful and time consuming, demanding hard work,
requiring large groups of trained and dedicated staff, being
ethically unsound, and logistically difficult (McLachlan et al.,
2004; Shaffer, 2004; Sritharan, 2005; Memon, 2009). Therefore, despite its perceived effectiveness, cadaver dissection
alone may not be the ideal tool for learning gross anatomy.
Moreover, the need for detailed knowledge of normal and
variant anatomy necessitated by super-specialization within
surgical disciplines, and the routine use of minimally invasive
techniques in modern clinical practice requires an exploration
of tools that can supplement, enhance, and, in certain circumstances, even replace learning of gross anatomy through dissection of cadavers (Pawlina and Lachman, 2004; Trelease
and Rosset, 2008; Sugand et al., 2010). One such tool is eresources, such as videos of cadaveric dissection.
In a number of domains of preclinical medical sciences,
students have reported liking videos, but a notable improvement in examination scores has not been noted in reports,
which when compared videos with traditional teaching methods (Solomon et al., 2004; Bridge et al., 2009). McNulty
Anatomical Sciences Education
et al. (2009a) have noted that introduction of recorded lecture videos to anatomy curriculum did not improve average
examination scores. Research on usefulness of dissection videos suggests that they enhance the quality of the anatomy
course, are easy to use and liked by students, and improve
anatomy instruction and dissection hall learning experiences
(Inwood and Ahmed, 2005; Dilullo et al., 2006). An increase
in anatomy examination scores with the use of dissection videos has only been reported among veterinary anatomy students (Josephson and Moore, 2006). Dissection videos have
the potential to become a critical resource and a partial substitute for the dissection hall itself. However, their role as medium for learning is yet to be justified.
In this study, we describe the association of showing dissection videos with first-year medical students’ performance
in term tests of gross anatomy course. We also assessed students’ perceptions regarding showing of dissection videos and
their interest in dissection on cadavers.
This quasi-experimental study included all 287 students (199
females and 88 males) enrolled in the first-year M.B., B.S.
(Bachelor of Medicine and Bachelor of Surgery) program at
Rawalpindi Medical College, Rawalpindi, Pakistan, in 2009.
The study protocol was reviewed and approved by the
Research and Ethics Committee of Rawalpindi Medical College and allied teaching hospitals.
At this public medical college, students enroll immediately after graduating from high school (after 12th grade). All first- and
second-year medical students are required to take a two-year
course in gross and microscopic anatomy. Teaching in gross
anatomy over the two years comprises of didactic lectures, demonstrations, and tutorials on gross anatomy and neuroanatomy
(total of 240 hours), as well as demonstrator-guided dissection
of embalmed cadavers by students (total of 320 hours).
As per institutional protocols, at the beginning of the academic year, the first-year class is divided into two equal
groups (Group A and Group B). Allocation to the groups is
on the basis of alphabetical order of the students’ first name.
Lectures introducing the gross anatomy of the upper- and
lower-limb are delivered to the whole class, covering the
topics once during the academic year.
In the first-term of the course in gross anatomy, group A
dissects the upper limb on cadavers whereas group B dissects
the lower limb. Dissection is supplemented by small group
tutorials (20 students per group) with demonstrators who
exhaustively review the gross anatomy of the limb being dissected. At the end of the term’s six weeks, a term examination is conducted which comprises of a written examination
(short essay questions and multiple choice questions) and a
viva voce/practical examination (oral examination in gross
anatomy and spotting of anatomical structures on dissected
cadavers, prepared specimens, and artificial anatomical models). In the second-term, similar in duration to the first, the
groups switch limbs and start with another cadaver and an
undissected limb. Group A dissects the lower limb whereas
group B dissects the upper limb, each provided with the supplementary tutorials. At the end of term, the second-term examination is conducted. It is similar to the first-term examination in format and subject matter. Students are tested on
the gross anatomy of the limb that they dissected in the term
preceding the examination.
Anatomical Sciences Education
The intervention in this quasi-experimental study consisted of showing dissection videos in class in the second
term and making videos available at the college’s computer
laboratory. During college working hours, near the end of
term, during regular lectures in gross anatomy (60 minute
long) delivered to the whole class, which included students
from both group A and B, the videos were shown using a
multimedia projector. Videos of dissection of the whole of
upper limb, which comprised of a set of four videos, were
shown to all the students (both Group A and B), twice.
Because of time constraints videos covering dissection of the
lower limb could not be shown to the class, but the students
were strongly urged to view them at the computer laboratory
of the college, where links to all the videos were made prominently available on all the workstations. All the videos for
class and laboratory viewership were streamed from the University of Wisconsin-Madison IME Video Library of Gross
Anatomy Dissections, which allows their use for educational
purposes (UW, 2010). Table 1 presents, for both Terms 1 and
2, the limb allocations for groups, nature of the intervention,
and topics covered in lectures, dissections supplemented by
tutorials, and examinations.
The number of students present in class during the exhibitions of the videos was noted from attendance registers
sourced from the Department of Anatomy. An exit survey
was performed after the second-term examination, where 48
consecutive students were queried about viewing videos at
the workstations.
We surveyed the students using pretested questionnaires
inquiring about their rating of dissection videos as a source for
learning anatomy, positive and negative aspects of videos,
whether or not they performed cadaver dissection themselves,
and reasons for not performing dissection if they did not do so.
Response options for questions were prepared through a comprehensive discussion with a group of six second-year medical
students who had taken the gross anatomy course and both
term examinations during the previous academic year.
To account for distortion of effect of dissection videos on
term examination scores due to the learning curve between
the first- and second-term examination, as students progressively get comfortable with the medical school environment
and the nature of the taught courses, we also recorded firstand second-term scores from two previous first-year classes
(2007 and 2008), who underwent the same course of study in
anatomy but none of which were shown videos in class.
Scores for 2007–2009 classes were sourced from the Department of Anatomy at Rawalpindi Medical College, Rawalpindi. Past students’ gender was determined from their medical school admission record register.
Study data was managed and analyzed using the Statistical
Package for Social Science, version 16 (SPSS Inc., Chicago, IL).
For univariate analysis, term scores were first tested for normality of distribution using the Shapiro–Wilk test and as the
distribution was found to be skewed, the nonparametric
Mann-Whitney U test was used to test for statistically significant differences between scores on the first-term examination
and the second-term examination within the same year. To
adjust for possible confounding in addition to gender and
learning curve, multiple linear regression analysis was used.
The dependent variable was ‘‘score in term examination" (continuous variable, range 0–200). The explanatory variables
entered in the model were term (first or second), videos shown
(yes/no), gender (male/female), and year (2007/2008/2009).
The data from student survey and gender distribution of groups
Table 1.
Design of the Upper- and Lower-Limbs Anatomy Study by Group A and Group B During Terms 1 and 2, in Lectures, Laboratory
Dissection and Tutorials, Videos Shown, and Examination Topics
Dissection and tutorial
Upper limb
Upper limb
Upper limb
Upper limb
Lower limb
Lower limb
Lower limb
Lower limb
Upper limb (2 times in
class) and lower limb
(voluntary—in computer
Lower limb
Lower limb
Upper limb
Upper limb (2 times in class)
and lower limb (voluntary—in
computer laboratory)
Upper limb
was analyzed using frequencies. Chi-square test and the independent samples t-test were used for between-group comparison of gender distribution and mean age, respectively. P value
< 0.05 was considered statistically significant.
Description of Groups
Among the first-year M.B., B.S. class in year 2009, there
were 140 students in Group A, 30.7% of them male. In
Group B, there were 147 students, 30.6% males. The mean
age of students in Group A was 18.2 6 1.1 years, whereas
mean age of students in Group B was 18.4 6 1.2 years. Gender distribution and mean age did not differ significantly
between the two groups (P > 0.9).
All 287 students viewed the upper limb videos at least
once in class. An exit survey of 48 students found that
77.1% (n 5 37) reported accessing the videos posted at the
computer laboratory of the college at least once before the
examination. Among the 28 students surveyed from Group A
(who dissected lower limb in term two and were not shown
the relevant videos in class), 78.6% (n 5 22) reported accessing the videos, whereas among the 20 students who were
from Group B, 75% (n 5 15) reported the same.
Term Scores
For the 287 students enrolled in first-year class in 2009, the
median anatomy examination score in Term 1 was 119. In
Term 2, in which the videos were shown, the median score
was 125. Table 2 presents the comparison of term scores
from 2009 and the term scores of first-year students from
two previous classes in 2007 and 2008, in which videos were
not shown. In all three years, a statistically significant
increase was seen when Term 1 scores were compared with
Term 2.
To address possible confounding because of gender and a
difference in scores between the two terms in addition to the
learning curve and/or better adjustment to the medical school
environment, we performed multiple linear regressions with
the stage scores for all three years as the outcome variable. Table 3 shows the results of the analysis. After adjusting for gender, improvement of scores in addition to the learning curve,
and year of examination, the change in marks between students
who saw the videos and who did not, was 1.26 marks. The difference was not statistically significant (P 5 0.314).
Students’ Perceptions
Pretested questionnaires were distributed among students,
and completely filled forms were received from 69% (n 5
Table 2.
Comparison of Examination Scores in Term 1 and Term 2 During 2007–2009
Number of
Score in Term 1
(Median IQR)
Score in Term 2
(Median IQR)
Difference in median
term marks (second–first)
P valuea
119 (109, 127)
125 (115, 133)b
120 (111, 128)
127 (118, 132)
113 (106, 121)
125 (118, 134)
IQR 5 Inter-quartile range.
P value calculated using the Mann Whitney U test.
Videos shown during term 2, 2009.
Mahmud et al.
Table 3.
Results of Multiple Linear Regression Analysis with Stage Score
as the Outcome Variable
P value
95% CI
Showing videos
21.19, 3.70
Female gender
3.80, 6.53
20.32, 1.69
Second term
3.45, 6.53
CI 5 Confidence interval.
198) students. Half of the respondents (50%; n 5 99) opined
that dissection videos were the best learning source for gross
anatomy. Respondents were also asked to select from certain
positive and negative aspects of watching these videos. Table
4 lists their selections in order of preference. All 198 respondents chose to select one or more positive aspects, whereas
51% (n 5 101) selected one or more negative aspect. Ninetythree percent (n 5 184) respondents wanted regular inclusion
of dissection videos in anatomy curriculum.
Views of respondents about their participation in cadaver
dissection during dissection class were also sought. Only
24% (n 5 48) respondents reported performing dissection on
a regular basis, 59% (n 5 116) regularly observed other students doing dissection, whereas 17% (n 5 34) neither performed nor observed dissection on a regular basis. Students
who did not perform dissection regularly (n 5 150) were
asked to select among listed reasons for not performing regular dissection. The most frequently chosen reason was high
student to cadaver ratio (68%; n 5 102). Other reasons chosen were that dissection requires substantial effort and little is
gained (15%; n 5 23), other sources are equally helpful
(14%; n 5 21), and that performing dissection is a boring
task (10%; n 5 15).
be associated with improvements in anatomy examination
scores among veterinary students (Josephson and Moore,
2006) but not medical students; although a modest increase
was found among medical students, the data was analyzed by
level of use of videos, with higher use corresponding to
improvement in marks (Saxena et al. 2008). In this study,
where dissection videos supplemented hands-on cadaver dissection, after adjustment for possible confounding in addition
to gender and the learning curve between two consecutive
terms of study, the difference in scores between viewers and
nonviewers of videos was very small (1.26 marks on a scale
of 0–200 marks).
There could be a number of reasons why a significant difference may not have been observed. Among the class
exposed to videos, half of the students were shown the relevant videos twice, whereas the rest were prompted to watch
videos by themselves on the school computers. Over three
quarters of students from both groups reported accessing the
videos on the school computers at least once. Besides the students who were studying the corresponding limb and viewed
the videos twice in class, it is not known what the pattern
and level of use was on the school computers, which has
been noted as a predictor of change in examination scores
(McNulty et al., 2009a; Saxena et al., 2008).
Only a small number of student-related factors were available to us for multivariate analysis. We attempted to adjust
for improvement in the examination scores in the second
term resulting from better acclimatization to medical school
environment and the subject (learning curve) by including the
first- and second-term scores from the two previous years’
classes to the model. The addition of this factor to the model
mainly accounts for the decreased magnitude of the difference
between the nonvideo and video term scores (Table 3). However, lack of a difference because of unmeasured confounding
Table 4.
Student Response Regarding Positive and Negative Aspects of
Watching Dissection Videos (n 5 198)
Exhibition of dissection videos was associated with a small,
nonstatistically significant increase in anatomy term test
scores. Students favored the use of dissection videos, the majority preferring regular inclusion of dissection videos in the
curriculum, and almost half of the respondents regarded
them as the best source for learning anatomy.
The evidence on the usefulness of e-learning or computer
aided learning through streaming video is inconclusive. Bridge
et al. (2009) found that availability of streaming video of lectures and presentations to basic medical sciences students had
a neutral effect on the United States Medical Licensing Examination (USMLE) Step 1 scores. Showing video clips has been
reported to improve comprehension of theoretical anatomy
among medical students (Pereira et al., 2004). However, students receiving gross anatomy teaching solely through dissection videos have been found to score lower than students dissecting cadavers. This association is consistent among students of human and veterinary anatomy (Granger and
Calleson, 2007; Theoret et al., 2007). Viewing dissection videos as a supplement to cadaver dissection has been shown to
Anatomical Sciences Education
% (n)a
What are the positive aspects of viewing dissection videos?
Anatomy was presented on fresh bodies
and minute structures were exposed
73% (144)
Less effort was required in learning
38% (76)
Videos are good review tools
10% (20)
What are the negative aspects of viewing dissection videos?
Videos didn’t give a sensory experience,
which is better for understanding
and retaining
35% (69)
Anatomy was not presented in all three
10% (20)
English language was difficult to
6% (12)
Multiple options could be chosen by each respondent.
cannot be ruled out. There is little published evidence that
notes confounding factors for the relationship of dissection
videos with examination scores and we adjusted for the ones
that we adjudged to be justifiable. In the absence of consensus on which domain of anatomical learning is benefited the
most by cadaver dissection, the outcome measure that was
used for the study is also debatable. A possible difference in
scores on components of anatomical education that may be
affected by video dissection could be obscured by components
not affected by video dissection. As this possible heterogeneity of the components of the outcome measure was acknowledged before the initiation of the study, the aforementioned
lack of consensus on specific domains prompted us to consider an outcome measure based on uniformity of application
to all the students. Therefore, term examination scores were
Despite the apparent lack of evidence on improvement of
anatomy course results, medical students seem to like dissection videos. In the study by Dilullo et al. (2006) assessing students’ perception regarding custom-made dissection videos,
most students agreed that dissection videos helped them in
laboratory dissections, identification of structures, preparation for examinations, and recommended their use to others.
In this study, students indicated preference for dissection videos for better anatomic understanding and revision.
If the results of the test scores, showing no statistically
significant difference with or without videos, are considered
as such then student support for videos raises interesting
questions for exploration in future research. Why did medical
students express a remarkable interest in a pedagogical technique that makes no improvement in quantifiable terms? Proposed explanations are that students may prefer videos over
dissection because it may takes less effort to watch videos
than to perform hands-on dissection. Flexibility of scheduling
the learning experience, the uninterrupted availability of the
content, and the opportunity to learn at their preferred pace
have been noted as factors underlying students’ preference for
e-learning resources such as streamed video (Solomon et al.,
2004; Bridge et al., 2009). Criticism has been leveled on the
availability of videos leading to students not attending classes
in person (Dev et al., 2000). However, due consideration
should also be given to the fact that there are known difficulties in procuring enough cadavers to satisfy pedagogical needs
in medical schools in Pakistan (Memon, 2009), leading to
students complaining of not getting to do dissection because
of too many students per cadaver–usually one cadaveric limb
is allotted to a group of 12 students in each term at this medical college. Could it be that the shortage is causing students
to seek apparently useless alternative methods to learn anatomy? Cadaver shortage is the problem facing medical schools
all over the world (McLachlan and Patten, 2006), so these
and other determinants of the preferences would be interesting avenues for further research. As a number of studies,
including this one, have showed a neutral effect of dissection
videos as a tool for revision, it is proposed that use of dissection videos in preparation for cadaver dissection by students
should be evaluated. Table 3 notes another finding that
would be interesting to explore in future work, that female
medical students showed a remarkably greater increase in
examination scores between the two terms. Although gender
and learning styles have been shown to be among the determinants of utilization of videos (Romanov and Nevgi, 2007;
McNulty et al., 2009b), interaction between the use of
streaming video and gender differences in learning should be
explored in-depth in future research on the role of traditional
and e-learning resources in gross anatomy.
There is no consensus on the best methods for teaching of
anatomy (Older, 2004; Winkelmann, 2007). Tools for better
learning, based on evolving technologies, are being actively
sought and evaluated. This study has contributed to that
search by showing that dissection videos do not improve
scores in term tests when used as an adjunct to cadaver dissection, though students favor their use. It is an insight into
the needs of students, highlighting the need to seek the best
approach for teaching anatomy and to close the gaps in the
availability of established teaching tools.
The authors thank Dr. Zarmina Saga and Dr. Gaiti Ara from
the Department of Anatomy, Rawalpindi Medical College,
for their support and assistance in coordinating the data collection, and the Reviewers for their time and their valuable
advice in improving the manuscript.
WAQAS MAHMUD is a fourth-year medical student at Rawalpindi Medical College, Rawalpindi, Pakistan. His research
focuses on evaluating efficacy of innovative teaching methods
in medical education in developing countries.
OMAR HYDER, M.B., B.S., M.Sc., is an epidemiologist
and biostatistician at the Department of Obstetrics and Gynecology, Rawalpindi Medical College, Rawalpindi, Pakistan.
He teaches courses on healthcare research methods to medical students and carries out research on medical education
and maternal health in developing countries.
JAMAAL BUTT is a fourth-year medical student at Rawalpindi Medical College, Rawalpindi, Pakistan. He is interested in medical education research.
ARSALAN AFTAB is a third-year medical student at Rawalpindi Medical College, Rawalpindi, Pakistan. He has a
research interest is medical education.
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