A Novel Cadaver-Based Educational Program in
General Surgery TrainingCatherine E. Lewis, MD
Warwick J. Peacock, MD, Areti Tillou, MD, O. Joe Hines, MD
Jonathan R. Hiatt, MD
Department of SurgeryDavid Geffen School of Medicine at UCLA
Anatomy in Surgical Education
Knowledge of anatomy/exposure
essential
Time devoted to anatomy decreasing
Interns lack adequate knowledge
Cadaveric dissection is irreplaceable
Ideal model for surgical skills
training
Support basic and complex
operations
Superior to other models /
simulators
- Realistic
- Provides haptic feedback
- Representative surgical anatomy
Cadaver-Based Education
Specific Aims
Describe UCLA Surgery anatomy program
Assess resident attitudes toward program
UCLA Surgery Anatomy Program
Conceived by emeritus faculty member
UCLA Surgery Anatomy Program
Conceived by emeritus faculty member
Rembrandt Harmenszoon van Rijn,The Anatomy Lesson, c 1632
UCLA Surgery Anatomy Program
Conceived by emeritus faculty member
Utilizes fresh-frozen cadavers
Provides education, skills and research
for undergraduates, graduates & postgraduates
Implemented for general surgery
residents ascomponent of core education conferences
Anatomy Theater
Anatomy Theater
Anatomy Theater
Anatomy Lab
Cadavers
Fresh frozen at -17C to -20C
Stored in special facility
Defrosted prior to use
Ethically donated per patient’s
bequest
Anatomy Program Costs
Each body approximately
$2,500
Donated / without charge: Instruments Faculty time Facilities
UCLA Anatomy Curriculum
Core general surgery
procedures
Junior resident skills sessions
Senior resident skills sessions
PGY1 dissection program
UCLA Anatomy Curriculum
Core general surgery
procedures
Junior resident skills sessions
Senior resident skills sessions
PGY1 dissection program
Core General Surgery Procedures
Lecture on relevant surgical anatomy
Demonstration on fresh cadaver
Resident performance of procedures:Groin herniorrhaphy Thoracic outletLiver harvestPancreatectomyThyroidectomy GastrectomyAbdominal aortic aneurysmectomy
Resident Skills SessionsJunior Senior
Group size
4-5 3-5
Instructors
Faculty & Sr residents
Faculty
Procedures
Wound repair Intestinal anastomosis Chest tubes Abdominal incisions
Trauma exposuresNeck exposuresPercutaneous trach
Resident Skills SessionsJunior Senior
Group size
4-5 3-5
Instructors
Faculty & Sr residents
Faculty
Procedures
Wound repair Intestinal anastomosis Chest tubes Abdominal incisions
Trauma exposuresNeck exposuresPercutaneous trach
Resident Skills SessionsJunior Senior
Group size
4-5 3-5
Instructors
Faculty & Sr residents
Faculty
Procedures
Wound repair Intestinal anastomosis Chest tubes Abdominal incisions
Trauma exposuresNeck exposuresPercutaneous trach
Type N
Demographics Select from list 2
Attitudes toward program
5-Point Likert Scale 6
Compare to other modalities
Rank-order 3
Preferred format Rank-order 1
Cadaver Education Survey
Response Rate 89% (n = 40)
Cadaver Sessions are a Good Way to Learn Anatomy
0%
43%
49%
6%3%
StronglyDisagree
Disagree Neutral Agree StronglyAgree
Cadaver Sessions are a Good Way to Learn Steps of an Operation
0%
34%
40%
23%
3%
StronglyDisagree
Disagree Neutral Agree StronglyAgree
Cadaver Sessions Increase my Confidence in Doing an
Operation
0%
14%
37%37%
11%
StronglyDisagree
Disagree Neutral Agree StronglyAgree
I Would Like to Have More Cadaver Sessions
0%
28%
56%
13%
3%
StronglyDisagree
Disagree Neutral Agree StronglyAgree
I Would Spend Free Time in the Cadaver
Lab
3%
18%
49%
21%
10%
StronglyDisagree
Disagree Neutral Agree StronglyAgree
Trainees Should do an Operation on a Cadaver Before
Real Patient
5%
23%
36%
28%
8%
StronglyDisagree
Disagree Neutral Agree StronglyAgree
Comparison of Learning Modalities
LearnAnatomy
Cadaver
Textbooks
Simulators
Websites
Animate labs
Lectures
Increase Confidence
Cadaver
Simulators
Textbooks
Websites
Animate labs
Lectures
Learn Steps of Operation
Cadaver
Simulators
Animate labs
Websites
Textbooks
Lectures
Comparison of Learning Modalities
LearnAnatomy
Cadaver
Textbooks
Simulators
Websites
Animate labs
Lectures
Increase Confidence
Cadaver
Simulators
Textbooks
Websites
Animate labs
Lectures
Learn Steps of Operation
Cadaver
Simulators
Animate labs
Websites
Textbooks
Lectures
Comparison of Learning Modalities
LearnAnatomy
Cadaver
Textbooks
Simulators
Websites
Animate labs
Lectures
Increase Confidence
Cadaver
Simulators
Textbooks
Websites
Animate labs
Lectures
Learn Steps of Operation
Cadaver
Simulators
Animate labs
Websites
Textbooks
Lectures
Preferred Session Format
Perform dissection under direct
supervision
Self-guided dissection and review of findings with instructor
Watch instructor perform a dissection
AuthorsProcedures/
skills Fac Fell Res Student
Anastakis, Are, Holland
Open GS X X
Cundiff, Katz, Supe, Udomsawaengsup,Giger, LeBlanc
Lap GS X X
Gunst, Aboud Trauma X X X
Reed, Mitchell Vascular X
Castle Urologic X
Lewis (current) Lap, open GS X X X
Fresh Cadavers in Surgical Training
AuthorsProcedures/
skills Fac Fell Res Student
Anastakis, Are, Holland
Open GS X X
Cundiff, Katz, Supe, Udomsawaengsup,Giger, LeBlanc
Lap GS X X
Gunst, Aboud Trauma X X X
Reed, Mitchell Vascular X
Castle Urologic X
Lewis (current) Lap, open GS X X X
Fresh Cadavers in Surgical Training
AuthorsProcedures/
skills Fac Fell Res Student
Anastakis, Are, Holland
Open GS X X
Cundiff, Katz, Supe, Udomsawaengsup,Giger, LeBlanc
Lap GS X X
Gunst, Aboud Trauma X X X
Reed, Mitchell Vascular X
Castle Urologic X
Lewis (current) Lap, open GS X X X
Fresh Cadavers in Surgical Training
AuthorsProcedures/
skills Fac Fell Res Student
Anastakis, Are, Holland
Open GS X X
Cundiff, Katz, Supe, Udomsawaengsup,Giger, LeBlanc
Lap GS X X
Gunst, Aboud Trauma X X X
Reed, Mitchell Vascular X
Castle Urologic X
Lewis (current) Lap, open GS X X X
Fresh Cadavers in Surgical Training
AuthorsProcedures/
skills Fac Fell Res Student
Anastakis, Are, Holland
Open GS X X
Cundiff, Katz, Supe, Udomsawaengsup,Giger, LeBlanc
Lap GS X X
Gunst, Aboud Trauma X X X
Reed, Mitchell Vascular X
Castle Urologic X
Lewis (current) Lap, open GS X X X
Fresh Cadavers in Surgical Training
AuthorsProcedures/
skills Fac Fell Res Student
Anastakis, Are,Holland
Open GS X X
Cundiff, Katz, Supe, Udomsawaengsup,Giger, LeBlanc
Lap GS X X
Gunst, Aboud Trauma X X X
Reed, Mitchell Vascular X
Castle Urologic X
Lewis (current) Lap, open GS X X X
Fresh Cadavers in Surgical Training
Comparison of Cadaver TypesFresh frozen Embalmed
Duration of use Days to wks Months to yrs
Cost $$ $Basic skills training Excellent GoodOperative simulation Excellent PoorTissue consistency Pliable RigidTissue color Good PoorTissue plane preservation
Excellent Poor
ID of small structures Excellent PoorFlexibility for positioning
Excellent Poor
Infection risk Low None
Future Directions
Continue to expand curriculum
Dedicated facility nearing
completion
Program validation using surgical
skillsassessment and demonstration of improved operative performance
Summary: Cadaver-Based Education
Efficient and effective educational tool
Useful in teaching anatomy, surgical
skills,complex open & laparoscopic procedures
Increase confidence in performing
operations
Positive perception by residents
More effective than other learning
modalities
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