July 11, 2002

     That was actually Newsweek's headline several issues ago. The idea was the oldest tradition in Medicine where medical students begin by dissecting a dead body may itself be dying. Newsweek reporter D. Noonan writes and I quote, "As new disciplines like genomics and neuroscience have emerged over the last 30 years, the number of hours students spend on gross anatomy has decreased steadily. No one sees this trend reversing, and many in the field expect that cadaver dissection will eventually be reserved for those students interested in anatomically oriented fields like surgery and radiology."

     So you have to decide on your specialty the first day of medical school to stay away from the cadaver? Let's say you choose Pediatrics, cadaver dissection will be replaced by the study of "prosections" - predissected body parts - and an array of increasingly sophisticated images available on CD-ROM and the Web. Somewhere out there, a classmate, known to us as "look 'ma, no touch!" because he hasn't touched a cadaver in his lifetime is screaming his lungs out - "why didn't we have that during my time?"

     C'mon Dr. O., back then, we didn't have Playstation 2 either.

     This technology is already widely in use in the U.S. and Canada. Dr. Geoffrey Guttmann, assistant professor of anatomy at the University of Saskatchewan College of Medicine (I don't know exactly where that is), considers them more than adequate for students who plan to enter general practice. He tells Newsweek, "As family practitioners, they need to know generally how to poke around the surface anatomy of a person. They need to know how the organs are arranged and what’s going on there. But they don’t need to have their hands necessarily inside the cadaver to get the total feel."

"The old didactic approach to medical training—in which students spent their first two years attending lectures and memorizing facts before being dumped clueless on the wards in their third year—is as dead as the cadavers they cut up in gross anatomy."

     I'm sorry but I have to disagree. For sentimental, practical reasons and the fact that we may never get a chance to lay our hands on this technology anyway. Madonna has more chances of becoming a nun. If our College of Medicine can only afford five cadavers for 120 students then the only technology it can afford is a computer that plays "Donkey Kong".

     Dissecting cadavers is a rite of passage which many believe is essential to the creation of educated and well-rounded physicians. Would you be proud of being called a doctor when the only thing you've dissected all your life is a bullfrog? "Cadaver dissection represents a special type of kinesthetic learning that cannot be replaced by computer simulations," says Dr. Robert Trelease, an associate professor of pathology at UCLA, as quoted by Newsweek. While some consider cadaver dissection an old-fashioned discipline that requires students to memorize excessive, even irrelevant facts, others embrace the endless detail. "All the muscles, all the nerves, all the bones," says Dr. M. Ashraf Aziz, associate professor of anatomy at Howard University College of Medicine, also in Newsweek. "By touching them, you develop a map of the body. There is nothing more valuable than gaining knowledge of the preciousness of each individual life. It is the mortal aspect of any being that gives value to that life. And when the students encounter the cadaver, they are brought in very, very close contact with this, and the memories remain over a lifetime."

     Come to think of it. If we take away the cadavers, what will happen to the all-too-familiar stench at Rizal Hall? You were in pre-med, the first week of August, the irritating smell of an ancient preservative filled the air, and you couldn't help but admire the group of people in white lab gowns, masks and goggles surrounding dead bodies. You couldn't wait to be like them. You idolized them as if they're some medical cowboys who just saved the world from bio-terrorism.

     And then that day came. The day when it's your turn to endure the stench, to hold a scalpel and to dissect a cadaver. You never felt so excited. It's your turn to be idolized, to look at the heads of pre-meds trying to take a peek inside the dissection room. Then reality set in. You failed your first practical exam badly. Excitement turned into self-examination why you entered medical school in the first place.

     Inside the dissection room is a lone poster that says, "In here, the dead will teach the living." If we do away with the cadavers, that would be very disappointing since they are actually better teachers than some of the living.

     We were close to 120 students during our first year of medical school. Since there were only five cadavers, we were divided into 10 groups of 12 students, each group responsible for half of a cadaver. 24 students converging on one specimen was not a pretty sight. During the first few weeks, we looked like flies feasting on a single rotten raisin. Towards the middle of the semester, only two or three remained, patiently dissecting to expose a nerve or a blood vessel, while the rest of us just looked forward to memorizing.

     The statement that cadaver dissection should be reserved for those students interested in anatomically oriented fields like surgery and radiology is frivolous. Who decides on a specialty on the first day of medical school anyway? Yeah, right, you always wanted to be a surgeon, but you may still change your mind when you meet a surgical consultant who makes his residents do push-ups whenever they screw up. Oh no, your mother probably never told you there would be days like this. Is this a boot camp or what?

     Advances in technology and in-depth simulations may never replace the personal touch when you deal with a real specimen or a real patient. However, to some, especially to medical schools in the United States, they are necessary. Medical schools around the country are turning to technology to help their students learn even as they recognize the need to emphasize the human touch. This may be due to three reasons - students here don't have access to real patients like we do with service cases, the availability of the technology, and of course, the ever constant threat of lawsuits.

     I have watched a feature on TV several months ago (Wild Chicago on PBS) about how a prominent medical school here teaches students how to interview patients and perform physical examinations by hiring professional actors and actresses to simulate certain conditions like schizophrenia, bleeding PUD, etc. A student and the actor are holed up in a room equipped with a video monitor that feeds the interview to a professor in another room. While this may be effective, this is done primarily because these students have limited access to real patients. Personally, I won't mind interviewing/examining an actress for a patient especially OB-Gyne cases, would you? Is Assunta available? Huh?

     In the article "Wiring the New Docs" in the same Newsweek issue, it clearly illustrates how technology is transforming the practice of medicine and the experiences of patients, and how future American doctors are being trained - "At UCLA’s David Geffen School of Medicine, where PDAs are required for students but microscopes are optional, the students, faculty and administrator are surfing this technowave with gusto. Since 1996, when the school first required medical students to have computers, UCLA has spent millions turning itself into the very model of a 21st-century medical school. "Every patient is a little different," says Zane Amenhotep, who just completed his third year, "so there’s always going to be a limitation to technology. You can’t use it as the only tool, but it’s an excellent foundation."

     "In practice, the technology serves two basic purposes. The simulators enable students to gain hands-on clinical experience sooner and without any risk to patients, while the PDAs, the CD-ROMs and the Web-based curriculum (each course at UCLA has its own Web site) help them manage and absorb an enormous and ever-expanding amount of information. At UCLA and other leading schools, the rise of technology has accompanied fundamental curriculum reforms that emphasize small-group, case-based learning right from the start. As a result of these dual trends, today’s medical students learn much earlier to act like doctors, to think like doctors and to behave like doctors. The old didactic approach to medical training—in which students spent their first two years attending lectures and memorizing facts before being dumped clueless on the wards in their third year—is as dead as the cadavers they cut up in gross anatomy."

     Problem-Based Learning (PBL), anyone?

     With all the technology upon us, one thing's for sure - cutting-edge technology can never replace a doctor’s best judgment.

     And the cadaver ain't dead.

'I am not making this up' department

     A boardmate told me this creepy story years ago. He insisted then that it's true but I have no way of confirming it so whether this is true or not, it's up to you.

     Juan (not his real name), was a first year medical student at one of the major universities in Manila. The school has at least 30 cadavers divided into 3 or 4 different sections in his class. Juan's group's cadaver was located near the end of the dissection room so that Juan had to pass a lot of cadavers before he got to his.

     Each time Juan passed a certain area in the dissection room, he felt a certain sensation like someone's touching his forearm. He didn't see anyone near so for a couple of weeks he dismissed it as the table or the cloth covering one of the cadavers.

     Days passed, and the sensation of being touched was becoming more prominent. What boggled Juan's mind was it only occurred in a certain area, near a particular cadaver and not just anywhere in the room.

     Juan mustered enough courage one day, passed through the same spot and after feeling the sensation, turned around, removed the covering cloth and stared straight at the dead specimen.

     It was his long-lost mother.

What's wrong with the picture?

     I may not be able to spell "Missisippi" correctly but certainly, I know how my home country is spelled. In my previous column, I posted a picture I took from the Precious Moments studio in Carthage, Missouri where PHILIPPINES was spelled incorrectly. I presume that's an honest mistake on the studio's part but I still sent them a copy and if possible correct the error.

     Dr. Robert Montenegro (1988) was the first to e-mail about this little "contest" of mine. I wish I could give Robert a prize like say, a trip to Carthage? I apologize for now. Maybe a postcard will do. Thanks also to Dr. Gigi Gallos-Martir (1991).

     Delight, Robert's wife and classmate had the opportunity to tour the Precious Moments doll factory years ago when it was still operational. Robert also mentioned that there were volunteer workers from Doane Baptist Church in the doll factory. In the studio exhibit in Carthage, there was a picture captioned "Baptist school students working on dolls in the very first factory of Precious Moments in Asia."

From the Inbox

     From new reader Magic, "Re: Valentine Confessions blind items. I don't think you are referring to me as the well-documented playboy who had a hard time wooing a classmate. For the record, I was never a playboy. Truth to tell, my wife is my first love. About the classmate you were dating secretly (illicit love affair?) back then, she married Joseph Fiennes (moustache included) not Freddie Prinze, Jr. Re: the Bombo incident, the lady involved then is again involved in another scandal worthy of Bombo airtime. Call me for details."

     Geez, here's to another sleazy column material.

     From Dr. C. Ossorio, "I was surfing for information about Manapla Hospital and I came upon your 2 articles which I enjoyed very much. It is very sad for me to hear about the unraveling of Victorias Milling Company/associated community. I have very fond memories of it as a child when my great grandfather Michael Ossorio and my father Luis Ossorio (and my uncles particularly Jose and Alfonso) worked so hard and were so proud of what they helped create. Jose and Eric are the only remaining children of Michael. I am one of 14 grandchildren."

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     The author's e-mail address is at drgarcia@wvsumedaa.com

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