Effectiveness of laparoscopic cadaveric dissection in enhancing resident comprehension of pelvic anatomy.
BACKGROUND
Anatomic instruction during preclinical years of medical school has been in decline recently. There is evidence that residents already lose a considerable portion of basic anatomic knowledge in the transition from student to clinician, and this deficit is even more dramatic in residents who start their training with a decreased understanding of anatomy. We questioned whether anatomy could be adequately retaught to new residents as surgical anatomy. In an effort to address this deficiency, we developed a program to teach pelvic anatomy in fresh cadavers using a laparoscopic approach. The purpose of this investigation is to determine if such a program is effective in enhancing residents' pelvic anatomy comprehension.


METHODS
An obstetrics and gynecology residency was divided into intervention (n = 15) and control (n = 13) groups. The intervention was a 4-hour laparoscopic dissection in a fresh cadaver. Outcomes measures included a multiple-choice test, practical exam, faculty evaluation, and satisfaction assessment. The faculty evaluation and satisfaction assessment used a visual analog scale. Univarate and nonparametric analysis were used when appropriate.


RESULTS
Initial test scores (p = 0.32), faculty evaluations (p = 0.25), and satisfaction scores (p = 0.17) were similar. Both groups improved their anatomic knowledge based on test scores (p = 0.004) and faculty evaluations (p < 0.001), and final test scores were not significantly different (p = 0.19). Data measured on a 10-cm visual analog scale suggested higher faculty evaluations in the intervention group (14mm versus 10.3mm, (p = 0.23). Similarly there were higher scores on the cadaver test in the intervention group (65% versus 50%), (p = 0.13). The intervention group was significantly more satisfied with their anatomic training (16.1 mm versus-10.1 mm, p = 0.001).


CONCLUSIONS
This study did not have sufficient power to demonstrate that a single laparoscopic cadaveric dissection improves cognitive measures of anatomic perception, but suggested that it improves spatial perception of anatomy and is perceived by residents to be a valuable educational approach.
Cundiff
G W
GW
Department of Gynecology and Obstetrics, Johns Hopkins Medicine, Baltimore, MD 21287, USA.
Weidner
A C
AC
Visco
A G
AG
D000715:Anatomy / Q000193:education*; D001291:Attitude of Health Personnel; D002102:Cadaver; D002983:Clinical Competence / Q000592:standards; D004210:Dissection / Q000379:methods; D004503:Education, Medical, Graduate / Q000379:methods*; D005180:Faculty, Medical; D005260:Female; D006176:Gynecology / Q000193:education*; D006801:Humans; D010535:Laparoscopy / Q000379:methods; D008505:Medical Staff, Hospital / Q000193:education / Q000523:psychology; D013513:Obstetric Surgical Procedures / Q000379:methods; D009774:Obstetrics / Q000193:education*; D010388:Pelvis / Q000033:anatomy & histology*; D015397:Program Evaluation