The Silent Teacher's Role in Surgical Training: A Cross-Sectional Study on Medical Students' and Surgical Trainees' Attitudes toward Cadaveric Dissection

Abstract

Background

Cadaveric dissection is a cornerstone of surgical training, offering an essential educational tool for surgeons to develop and refine their surgical skills, anatomical knowledge, and understanding. This study aimed to investigate the socio-cognitive perceptions and attitudes of medical students and postgraduate surgical trainees regarding human body dissection. Specifically, the study sought to determine participants' satisfaction and engagement with factors that enhance positive learning outcomes.

Materials and Methods

This descriptive cross-sectional study utilized an online questionnaire with 39 items, distributed via forms to the study population. Data were downloaded, organized in Microsoft Excel®, and analyzed using SPSS with descriptive and inferential statistics. Ethical considerations were addressed, and informed consent was obtained.

Results

A significant majority of participants (77.3%) found dissection engaging and considered it the most effective method for learning and understanding human anatomy. Approximately 84.1% reported that dissection helped them recall theoretical knowledge. Furthermore, 77.7% of participants agreed that dissection should not be replaced by other learning methods in the classroom.

Conclusion

Cadaveric dissection is strongly perceived as a favorable teaching and learning method for anatomy. It provides participants with the knowledge, courage, and confidence to operate on the human body. Incorporating cadaveric dissection into surgical training programs allows surgeons to gain a deeper understanding of anatomical variations and complexities they might encounter in diverse patient populations. This knowledge is invaluable in preparing them to deliver quality surgical care across different cultural and geographic contexts.

 

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Keywords

cadaveric dissection - anatomy education - surgical trainee - surgery - surgical training programs

Anatomy is a fundamental science in medical education, establishing the necessary groundwork for basic sciences and clinically focused courses.[1] A thorough grasp of anatomy is indispensable for developing essential surgical proficiencies, including patient history acquisition, examination, clinical reasoning for accurate diagnoses, and effective patient care management.[2] Therefore, a robust understanding of anatomy is crucial for safe and effective surgical practice.[3]

For many years, cadaveric dissection has been a cornerstone of teaching and learning gross anatomy and a vital component of surgical training.[4] [5] This method significantly aids students and trainees in developing their comprehension of anatomical structures.[6] [7] Anatomical education is currently navigating the integration of technological advancements while effectively utilizing traditional approaches like cadaveric dissection. The structure of anatomy education, including curriculum and teaching methodologies, has continuously evolved to meet the changing needs of the medical profession.[8] Current global trends in medical school instruction show a shift toward student-centered, integrated models with a clinical application focus, resulting in a notable decrease in time allocated to traditional cadaveric dissection.[9] This change has prompted research into student perceptions and attitudes toward these modifications and dissection itself.[10]

Students and trainees often express excitement during dissection sessions, largely due to their first encounter with a cadaver, an experience that distinguishes them from students in other fields.[11] However, some trainees do not consider dissection optimal for learning anatomy, citing issues like unpleasant odors, nausea, irritation, and psychological effects such as stress and emotional distress.[12] These students have suggested alternative learning methods. Despite these concerns, anatomy educators continue to use dissection, often integrating it with modern teaching technologies like interactive lectures, ultrasound, MRI, CT scans, laparoscopy, and virtual cadavers.[13] However, these alternatives present challenges, including cost and the need for specific operational skills, particularly in developing nations like Sudan. Consequently, cadaveric dissection remains a primary effective method for teaching anatomy, regardless of student perceptions. This research aims to explore the perceptions and attitudes of surgical students and trainees toward cadaveric dissection in Sudanese medical schools and evaluate their preferences for incorporating innovative supplementary teaching approaches.

Materials and Methods

Study Design and Participant Recruitment Criteria

This cross-sectional study involved 161 participants, including third to sixth-year medical students from two universities and first-year surgical trainees. These groups were chosen because they had prior or current experience with cadaveric dissection. First and second-year medical students and students from other programs were excluded due to their lack of dissection experience. Potential participants could decline participation.

 

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Sample Size Determination

The sample size was calculated as 168 participants using Yamane's Equation (1998),[14] including a 10% non-response rate adjustment. Simple random sampling was used for participant selection.

 

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Data Collection Tool and Procedure

A structured questionnaire with 26 Likert-style questions assessed participants' perceptions and attitudes toward cadaveric dissection. The close-ended questions covered five areas: positive experiences (eight items), negative experiences (seven items), emotional impact (four items), attitudes (three items), and acceptability of dissection (four items). The questionnaire was distributed online via email and social media. After 2 weeks and periodic reminders, 161 responses were collected.

 

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Ethical Approval

Ethical approval was granted by the Joint Research Ethical Committee of the Ministry of Health and the Ministry of Higher Education in Sudan (Reference number 25/854, March 9, 2023). Participation was voluntary, and consent was indicated on the questionnaire. Confidentiality was ensured by not collecting identifying information.

 

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Results

Sociodemographic Characteristics of Respondents

As shown in [Table 1], of the 161 respondents, 54.3% (116) were female. Additionally, 65.7% (105) were older than 25 years. Of the total participants, 99% (159) identified as Muslim.

Table 1 Demographic characteristics of study participants (N = 161)

Variables	Frequency	Percentage
Sex
Male	74	45.7%
Female	87	54.3%
Age (in years)
> 25	105	65.7%
< 25	56	37.3%
Religion
Christianity	2	1%
Muslim	159	99%
Others	0	0%

 

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Respondents' Favorable Views on Cadaveric Dissection

[Table 2] shows that a significant portion of respondents agreed with statements reflecting positive perceptions of dissection. Specifically, majorities indicated that dissection aided recall (80%), made learning engaging (82.9%), deepened comprehension (80%), and provided a three-dimensional understanding of anatomical structures (85.6%).

Table 2 Respondents' favorable views on the use of cadaveric dissection as a method for teaching and learning anatomy

Variable	Strongly agree, frequency (%)	Agree, frequency (%)	Neutral, frequency (%)	Disagree, frequency (%)	Strongly disagree, frequency (%)
Dissection deepened my understanding	56 (35.2%)	72 (44.8%)	23 (14.3%)	6 (3%)	4 (2.9%)
Dissection makes learning more interesting	58 (36.2%)	75 (46.6%)	19 (12.4%)	6 (3%)	3 (2.6%)
The dissection helped me to recall what I learnt	53 (33.3%)	75 (46.7%)	24 (15.2%)	6 (3%)	3 (2.6%)
Provides a three-dimensional perspective of the structures	78 (48.6%)	55 (34.3%)	18 (11.4%)	6 (3%)	3 (2.6%)

 

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Respondents' Unfavorable Views on Cadaveric Dissection

[Table 3] presents negative perceptions. A substantial 86.7% disliked the smell of formalin. Conversely, 48.5% disagreed that dissection is time-consuming. Notably, 90.7% disagreed that dissection conflicted with their religion or culture, with 65.7% strongly disagreeing. Furthermore, 44.8% found dissection stressful, and 48.5% reported difficulty locating anatomical structures.

Table 3 Respondents' unfavorable views on the use of cadaveric dissection as a method for teaching and learning anatomy

Variable	Strongly agree, frequency (%)	Agree, frequency (%)	Neutral, frequency (%)	Disagree, frequency (%)	Strongly disagree, frequency (%)
Dissection was stressful	10 (6.7%)	61 (38.1%)	58 (36.2)	26 (16.2%)	6 (3%)
It was difficult locating structures	26 (16.2%)	75 (46.6%)	39 (24.8%)	15 (9.5%)	6 (3%)
It was time-consuming	10 (6.7%)	36 (22.9%)	33 (21%)	59 (37.1)	18 (11.6%)
I feel dissection is against my culture	1 (1%)	9 (5.7%)	42 (26.6%)	62 (39%)	42 (26.7%)
I did not like the smell of formalin	93 (58.1%)	46 (28.6)	15 (9.5%)	3 (1.9%)	3 (1.9%)

 

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The Emotional Effects of Cadaver Dissection

[Table 4] indicates that 41.9% (60 of 161 respondents) experienced anxiety before, during, or after dissection. Half (51.4%) felt mentally prepared. Approximately a quarter (27.6%) had prior experience handling a deceased body, which helped 68.3% (72 participants) adapt to cadaveric dissection.

Table 4 The emotional effects of cadaver dissection on the participants

Variable	Strongly agree, frequency(%)	Agree, frequency (%)	Neutral, frequency (%)	Disagree, frequency (%)	Strongly disagree, frequency (%)
I prepared mentally for dissection	26 (16.2%)	56 (35.2%)	39 (24.8%)	29 (18.1%)	9 (5.7%)
I had a prior exposure to a dead body	18 (11.4%)	26 (16.2%)	15 (9.5%)	46 (28.6%)	55 (34.3%)
The prior exposure helped me	51 (31.7%)	58 (36.6%)	43 (26.8%)	7 (4.9%)	0 (0%)
I had anxiety before during and after my first dissection	19 (12.4%)	47 (29.5%)	49 (30.5%)	24 (15.2%)	19 (12.4%)

 

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Attitudes and Receptiveness to Cadaveric Dissection

[Table 5] demonstrates that most respondents viewed dissection as an effective method for teaching and learning anatomy. A significant 73.3% believed not attending dissection sessions would be a disadvantage. Most participants regularly attended dissection sessions (69.6%), and a large majority (98%) acknowledged that the cadaver was once a human being.

Table 5 Attitudes and receptiveness to cadaveric dissection

Variable	Strongly agree, frequency (%)	Agree, frequency (%)	Neutral, frequency (%)	Disagree, frequency (%)	Strongly disagree, frequency (%)
I will be disadvantaged if I do not attend dissection	42 (26.7%)	76 (47.6%)	26 (16.2%)	10 (6.7%)	6 (3.8%)
I attend dissection regularly	46 (28.6%)	66 (41%)	35 (21.9%)	9 (5.7%)	4 (2.9%)
I know cadaver was once a human like me	95 (60%)	30 (19%)	21 (13.3%)	13 (8.6%)	0 (0%)
I prefer dissection over other forms of learning anatomy	24 (15.2%)	59 (37.1%)	38 (23.8%)	29 (18.1%)	9 (5.7%)

 

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Factors Contributing to Experiencing Anxiety during Dissection

[Table 6] shows no statistically significant association between sex or religion and anxiety (p-values of 0.395 and 0.702, respectively). However, a statistically significant association was found between prior exposure to a dead body and anxiety (p-value of 0.000).

Table 6 Factors contributing to experiencing anxiety during dissection

Variables	Anxious, frequency (%)	Not anxious, frequency (%)	Neutral, frequency (%)
Sex
Male	6 (15.1%)	15 (34%)%	22 (50.9%)
Female	36 (31.7%)	27 (23.8%)	51 (44.6%)
Prior exposure
Yes	10 (24.4%)	17 (40%)	15 (35.6%)
No	46 (45.7%)	25 (25.7%)	28 (28.6%)
Religion
Muslim	34 (21.4%)	41 (26.2%)	83 (52.4%)
Christianity	1 (50%)	1 (50%)	0 (0%)
Others	0	0%	–

 

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Discussion

Participants' Perception toward Cadaveric Dissection

Participants strongly believed that dissection enhanced learning by making it more interesting (82.9%), aiding recall (80%), and providing a three-dimensional understanding of anatomical structures (85.6%). It also deepened comprehension (80%), facilitated lasting knowledge retention (67.6%), and fostered greater respect for the human body (74.3%). A general sentiment of excitement about the initial dissection experience was reported (65.7%). These positive perceptions align with Sharma and Gupta[15] and Dissabandara et al.,[2] where over 75% of participants expressed positive views. This study also supports Izunya et al.,[16] where approximately 90% recognized dissection's indispensable role. Despite advanced 3D imaging technologies, these are often prohibitively expensive for resource-limited countries like Sudan. Cadavers also provide trainees with an early experience similar to working with patients, preparing them for clinical practice.

However, participants also voiced dissatisfaction with certain aspects: The unpleasant smell of formalin (86.7%), difficulties identifying structures (48.5%), and dissection being stressful (44.8%) and time-consuming (30.5%). These findings are consistent with other studies.[10] [17] [18] Dissabandara et al.[2] also reported negative perceptions, including “being time-consuming” (59.3%), “difficulty in identifying structures” (48.4%), and “dislike of the smell of preservatives” (45.1%). Another study at the University of Development Studies corroborated these negative experiences.[19]

Formaldehyde, the primary preservative, effectively hardens proteins and prevents decomposition, but it has a pungent odor and irritates skin and eyes.[20] Exposure commonly results in mucosal irritation, experienced by participants. Experimental studies highlight formaldehyde as a potential carcinogen and link it to harmful effects on multiple body systems, underscoring the need for improved preservation methods.[20] [21] [22] This underscores the urgent need for anatomists and scientists to develop improved methods of cadaver preservation that minimize these adverse effects.

 

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Participants' Attitude toward Cadaveric Dissection

Most participants consistently attended dissection sessions (69.6%), expressed respect and empathy for the cadaver (87.6%), and acknowledged its former human status (98%). These results reinforce the dissection's value, aligning with Dissabandara et al.[2] Surgical students are typically enthusiastic about using cadavers, understanding they were once living beings, similar to future patients. This awareness cultivates empathy more effectively than learning through machines. Weeks et al.'s[23] research suggests dissection offers an opportunity to develop a relationship with the donor, modeling the doctor–patient relationship.[24] Exposure to experiences fostering professional attributes like respect, dignity, and compassion is essential. Dissection provides such opportunities.

 

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The Emotional Impact of Dissection on Participants

Regarding emotional effects, 41.9% reported no anxiety, while 51.4% mentally prepared themselves. This contrasts with previous studies documenting anxiety that negatively affected learning.[12] [25] [26] [27] For first-year medical students, dissection can be a challenging initiation, often their first encounter with a deceased body, potentially causing emotional anxiety. Factors like sex, religion, and cultural beliefs can influence anxiety. This study found no correlation between sex and anxiety, despite previous research suggesting males are less prone to it.[25] [28] [29] [30] Similarly, no association was found between religion and anxiety, aligning with Shalev and Nathan[31] but contradicting Aday,[32] who observed lower death anxiety among more religious Christians. It was proposed that greater religious involvement might reduce death-related anxiety. Our study revealed that prior exposure to a dead body had a statistically significant (p = 0.000) association with developing coping mechanisms and reduced anxiety during dissection.

 

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Acceptability of Cadaveric Dissection by Participants

Participants considered dissection indispensable. A majority (73.3%) believed not attending would be a disadvantage, and 67.6% desired more dissection time. A substantial proportion (75.3%) disagreed with replacing dissection with alternative methods. These results align with other studies affirming dissection's acceptability, with few advocating for replacement.[2] [16] [19] [32] However, only a minority (38%) preferred dissection classes over other anatomy instruction, supported by Dissabandara et al.[2] (∼36%). This suggests that while dissection is essential, incorporating innovative complementary approaches is important.[33] [34]

 

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Limitations

This study, while providing valuable insights into the perceptions and attitudes toward cadaveric dissection among medical students and surgical trainees in Sudan, has a few limitations that should be considered when interpreting the findings. The study relied on self-reported data from a questionnaire, which can be influenced by biases such as social desirability or recall inaccuracies, potentially impacting response validity. Furthermore, as the research was conducted with participants from two specific universities and surgical training programs in Sudan, the findings, while offering important local context, may not be broadly applicable to students and trainees in other Sudanese institutions or in different countries with distinct cultural, educational, and resource landscapes.

To address these specific limitations concerning data source and generalizability, future research could employ mixed-methods approaches, triangulating questionnaire data with qualitative insights from interviews or focus groups to provide deeper context and validate findings. Ensuring robust anonymity and using carefully worded, neutral questions can also help reduce reporting biases. Moreover, expanding research efforts to include a more diverse range of institutions, both nationally across different regions of Sudan and internationally through collaborative multicenter studies, would significantly improve the representativeness and applicability of the findings to varied cultural and educational settings.

 

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Conclusion

This research demonstrates that participants hold notably positive perceptions and attitudes regarding cadaver use in anatomy teaching and learning. The findings strongly advocate for cadaveric dissection's definitive role in medical education, particularly anatomy. Participants showed a clear preference for dissection, emphasizing its significant contribution to their subject comprehension. However, the study highlighted challenges, including the unpleasant odor of preservatives and the stressful nature of the activity. Importantly, no discernible difference in emotional responses to cadavers was found based on sex.

A significant finding is that cadaveric dissection is crucial for fostering essential skills, courage, and the capacity to work confidently with the human body, all indispensable for future surgical practice.

Based on these findings, several recommendations are proposed.

1. Recognize human dissection as an integral and fundamental component of surgical training. Consequently, anatomy departments should allocate sufficient time for dissection activities.

2. Introduce a course on death and dying in the first year of medical education to provide early exposure and facilitate coping mechanism development.

3. While vital, complement cadaveric dissection with alternative teaching methods, including models, computer-assisted learning, prosected specimens, animation, and painting, to enhance the learning experience.

 

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Conflict of Interest

None declared.

Authors' Contributions

E.G. was involved in study design, data acquisition, drafting the article, critical revision, and final manuscript approval. L.M.S.M. was involved in data acquisition and manuscript approval. Both authors have read and approved the manuscript.

Data Availability Statement

All data generated or analyzed during this study are included in this published article. Some supporting data are available from the Ministry of Health/Ministry of Higher Education Sudan, but restrictions apply; they were used under license and are not publicly available. Data are available from the authors upon reasonable request and with permission from the Ministry of Health/Ministry of Higher Education Sudan.

Ethical Approval

Ethical approval was obtained from the Joint Research Ethical Committee of the Ministry of Health and the Ministry of Higher Education in Sudan on March 9, 2023 (Reference number 25/854). Experimental protocols were approved by the Joint Research Ethical Committee, and the study protocol was performed in accordance with relevant guidelines. Data are anonymized, and informed consent was obtained.

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Publikationsverlauf

Eingereicht: 23. April 2025

Angenommen: 08. Juni 2025

Artikel online veröffentlicht:
27. Juni 2025