Creation of 21st century anatomy facilities: designing facilities for integrated preclinical education in the Middle East.

BACKGROUND: The establishment of new anatomy facilities needs to accommodate a combination of modern teaching modalities that best align with evidence-based best teaching practices. This article describes the process in which our state-of-the-art anatomy laboratories were designed and implemented, and how these facilities support aspects of modern anatomy education. METHODS: A list of best practices for anatomy education in a modern medical curriculum was summarized from the literature. To assess student satisfaction, a survey related to student perception of the anatomy facilities (5-point Likert scale) was conducted. RESULTS: Our educational modalities include a broad range of teaching approaches. The Instructional Studio houses prosected and plastinated specimens, and cadaveric dissections are performed. Each of our three Dry Laboratories allow for active learning and interaction between small student groups. The Webinar Room acts as a conference room for departmental and online meetings, discussions with students, and dialogues with affiliated hospitals via the internet. The Imaging Center is equipped with a Sectra® medical educational platform, CAE Vimedix® Virtual Medical Imaging Ultrasound Training System, and Philipps Lumify® Ultrasound devices to train students to conduct and interpret sonographic images. Moreover, the Complete Anatomy® program is made available to all our students. CONCLUSION: The layout of our newly created Anatomy Facilities allows for all aspects of modern medical education mentioned in the literature. These educational modalities and teaching approaches are highly appreciated by our faculty and students. Moreover, these technologies allowed for a smooth transition from on-site anatomy teaching to online education during the COVID pandemic.

International Learner Perceptions, Educational Value, and Cost Associated With the Use of Start-to-Finish Surgical Simulation Compared With Cadaveric Models.

BACKGROUND: Graduate surgical education is highly variable across regions and institutions regarding case volume and degree of trainee participation in each case. Dedicated educational curriculum using cadaveric tissue has been shown to enhance graduate surgical training, however with associated financial and utility burden to the institution. OBJECTIVE: To investigate the utility of educational and cost applications of a novel method of combining mixed organic hydrogel polymers and 3-dimensional printed anatomic structures to create a complete "start-to-finish" simulation for resident education in spinal anatomy, instrumentation, and surgical techniques. METHODS: This qualitative pilot study investigated 14 international participants on achievement of objective and personal learning goals in a standardized curriculum using biomimetic simulation compared with cadaveric tissue. A questionnaire was developed to examine trainee evaluation of individual anatomic components of the biomimetic simulators compared with previous experience with cadaveric tissue. RESULTS: A total of 210 responses were acquired from 14 participants. Six participants originated from US residency education programs and 8 from transcontinental residency programs. Survey results for the simulation session revealed high user satisfaction. Score averages for each portion of the simulation session indicated learner validation of anatomic features for the simulation compared with previous cadaveric experience. Cost analysis resulted in an estimated savings of $10 833.00 for this single simulation session compared with previous cadaveric tissue sessions. CONCLUSION: The results of this study indicate a strong potential of establishing biomimetic simulation as a cost-effective and high-quality alternative to cadaveric tissue for the instruction of fundamental spine surgical techniques.

High titers of infectious SARS-CoV-2 in corpses of patients with COVID-19.

OBJECTIVES: The prolonged presence of infectious SARS-CoV-2 in deceased patients with COVID-19 has been reported. However, infectious virus titers have not been determined. Such information is important for public health, death investigation, and handling corpses. The aim of this study was to assess the level of SARS-CoV-2 infectivity in the corpses of patients with COVID-19. METHODS: We collected 11 nasopharyngeal swabs and 19 lung tissue specimens from 11 autopsy cases with COVID-19 in 2021. We then investigated the viral genomic copy number by real-time reverse transcription-polymerase chain reaction and infectious titers by cell culture and virus isolation. RESULTS: Infectious virus was present in six of 11 (55%) cases, four of 11 (36%) nasopharyngeal swabs, and nine of 19 (47%) lung specimens. The virus titers ranged from 6.00E + 01 plaque-forming units/ml to 2.09E + 06 plaque-forming units/g. In all cases in which an infectious virus was found, the time from death to discovery was within 1 day and the longest postmortem interval was 13 days. CONCLUSION: The corpses of patients with COVID-19 may have high titers of infectious virus after a long postmortem interval (up to 13 days). Therefore, appropriate infection control measures must be taken when handling corpses.

Cadaveric emergency cricothyrotomy training for non-surgeons using a bronchoscopy-enhanced curriculum.

BACKGROUND: Emergency cricothyrotomy training for non-surgeons is important as rare "cannot intubate or oxygenate events" may occur multiple times in a provider's career when surgical expertise is not immediately available. However, such training is highly variable and often infrequent, therefore, enhancing these experiences is important. RESEARCH QUESTION: Is bronchoscopy-enhanced cricothyrotomy training in cadavers feasible, and what are the potential benefits provided by this innovation for trainees? METHODS: This study was performed during implementation of a new program to train non-surgeon providers on cadaveric donors on our campus. Standard training with an instructional video and live coaching was enhanced by bronchoscopic visualization of the trachea allowing participants to review their technique after performing scalpel and Seldinger-technique procedures, and to review their colleagues' technique on live video. Feasibility was measured through assessing helpfulness for trainees, cost, setup time, quality of images, and operator needs. Footage from the bronchoscopy recordings was analyzed to assess puncture-to-tube time, safety errors, and evidence for a training effect within groups. Participants submitted pre- and post-session surveys assessing their levels of experience and gauging their confidence and anxiety with cricothyrotomies. RESULTS: The training program met feasibility criteria for low costs (<200 USD/donor), setup time (<30 minutes/donor), and operator needs (1/donor). Furthermore, all participants rated the cadaveric session as helpful. Participants demonstrated efficient technique, with a median puncture-to-tube time of 48.5 seconds. Bronchoscopy recordings from 24 analyzed videos revealed eight instances of sharp instruments puncturing the posterior tracheal wall (33% rate), and two instances of improper tube placement (8% rate). Sharp instruments reached potentially dangerous insertion depths beyond the midpoint of the anterior-posterior diameter of the trachea in 58.3% of videos. Bronchoscopic enhancement was rated as quite or extremely helpful for visualizing the trachea (83.3%) and to assess depth of instrumentation (91.7%). There was a significant average increase in confidence (64.4%, P<0.001) and average decrease in performance anxiety (-11.6%, P = 0.0328) after the session. A training effect was seem wherein the last trainee in each group had no posterior tracheal wall injuries. INTERPRETATION: Supplementing cadaveric emergent cricothyrotomy training programs with tracheal bronchoscopy is feasible, helpful to trainees, and meets prior documented times for efficient technique. Furthermore, it was successful in detecting technical errors that would have been missed in a standard training program. Bronchoscopic enhancement is a valuable addition to cricothyrotomy cadaveric training programs and may help avoid real-life complications.

A thematic analysis of students' discussions on death and body donation in international online focus groups.

Historically, Anatomy education is an in-person discipline involving exposure to human body donors that facilitates personal and professional growth through, in part, the initiation of reflection on the topic of death. However, during the COVID-19 pandemic the decreased exposure to cadaveric anatomy for many health professions students may have influenced the depth of their individual reflections on this topic. Accordingly, this study aimed to investigate the effect of an alternate approach-focus group discussions between peers with varying degrees of exposure to cadaveric material-that may offer one strategy to stimulate deep reflection on the topic of death. A programmatic intervention was introduced, wherein students (n = 221) from 13 international universities discussed differences in their anatomy courses during small focus group sessions as part of an online exchange program. An inductive semantic thematic analysis was conducted on responses to an open-ended text-response question on how the activity influenced students' reflections about death. Resulting themes were organized into categories that described the content and topics of the students' discussions as they grappled with this sensitive topic. The students reportedly engaged in deep reflection and expressed an increased sense of connectedness with their peers, despite their disparate exposure levels to cadaveric anatomy and being physically distanced. This demonstrates that focus groups with students experiencing different laboratory contexts can be used to help all students reflect on the topic of death and that interchanges between dissecting and non-dissecting students can initiate thoughts about death and body donation among non-dissecting students.

What can autopsy say about COVID-19? A case series of 60 autopsies.

INTRODUCTION: Autopsies in SARS-CoV-2 infected cadavers are mainly performed to distinguish patients who died with SARS-CoV-2 infection from those who died of COVID-19. The aim of the current study is to assess the most frequent autopsy findings in patients who died of COVID-19 and to establish an association with clinical records. MATERIALS AND METHODS: 60 patients died between April 2020 and March 2021 after SARS-CoV-2 infection underwent a full autopsy performed at Fondazione Policlinico Universitario Agostino Gemelli IRCCS (Rome). Ante-mortem diagnosis of SARS-CoV-2 infection was microbiologically confirmed. RESULTS: 55 (92%) of cases had at least a comorbidity. At microscopic examination, 40 (67%) of the patients presented pulmonary intravascular coagulation with an inflammatory pattern. Pulmonary microangiopathy was a rare finding (n = 8; 13%). Myocardiosclerosis was the main heart finding (n = 44; 73%). Liver involvement with congestion and hypotrophy was found in 33 (55%) of cadavers. Renal tubular epithelial exfoliation (n = 12; 20%) and intravascular coagulation (n = 4; 7%) were frequent observations. During hospitalization 31% of patients (n = 19) developed acute kidney injury (AKI). CONCLUSIONS: Lungs and kidneys have been shown to play a pivotal role in COVID-19. The gradual worsening of renal function and AKI might be the result of the progressive collapse of cardiopulmonary system.

Medicine Faculty Students' Perspective on Cadaver and Organ Donation in the COVID-19 Pandemic.

BACKGROUND: COVID-19 is an important pandemic that affects the whole world. Another branch of the wreckage its devastating effects on the health care system is organ and cadaver donations. This article aimed to raise awareness about cadaver and organ donation during the COVID-19 period, with the support of student opinions. METHODS: Twelve opinions about cadaver and organ donation during the COVID-19 pandemic were presented to the fourth-, fifth-, and sixth-year students at the Kafkas University Faculty of Medicine. The answers were compared between male and female students using the χ2 test. RESULTS: It is seen that the data obtained about cadaver and organ donation are important. In addition, the storage conditions of cadavers and organs, the risk of disease transmission, and the risk of contamination are discussed with striking data. CONCLUSIONS: It is understood from the obtained data that awareness about cadaver and organ donation is always on the agenda. In particular, conferences and meetings should be held frequently to keep medicine faculty students informed. The handling of COVID-19 has also given a significant impetus to the research throughout.

Piloting an interprofessional virtual cadaveric dissection course: Responding to COVID-19.

Interprofessional learning improves students' clinical and interprofessional competencies. COVID-19 prevented delivering in-person education and motivated the development of a virtual interprofessional cadaveric dissection (ICD) course. This study reports on the effects of a virtual ICD course compared to a previously delivered in-person course, on students' readiness for, and perceptions about, interprofessional learning. Students attending the ICD course in-person (2019-2020) or virtually (2020-2021) completed the Readiness for Interprofessional Learning Scale (RIPLS) and the Interdisciplinary Education Perception Scale (IEPS). Students in the virtual course also provided written feedback. Thirty-two (24 women; Median: 24 [Q1-Q3: 22-25] years) and 23 students (18 women; 22 [21-23] years) attended the in-person and virtual courses, respectively. In the virtual cohort, the RIPLS total score (82 [76-87] vs. 85 [78-90]; p = 0.034) and the roles and responsibilities sub-score (11 [9-12] vs. 12 [11-13]; p = 0.001) improved significantly. In the in-person cohort, the roles and responsibilities sub-score improved significantly (12 [10-14] vs. 13 [11-14]; p = 0.017). No significant differences were observed between cohorts (p < 0.05). Themes identified in the qualitative analysis were advantages and positive experiences, competencies acquired, disadvantages and challenges, and preferences and suggestions. In-person and virtual ICD courses seem to have similar effects on students' interprofessional learning. However, students reported preferring the in-person setting for learning anatomy-dissection skills.

Substantial decrease in SARS-CoV-2 RNA after fixation of cadavers intended for anatomical dissection.

With the onset of the COVID-19 pandemic, a problem arose with classic body donation programmes for obtaining cadavers for anatomical dissections, science and research. The question has emerged whether bodies of individuals who died of COVID-19 or were infected by SARS-CoV-2 could be admitted to Departments of Anatomy. To determine the risk of SARS-CoV-2 transmission to employees or students, the presence and stability of SARS-CoV-2 RNA in cadavers after fixation agents' application and subsequent post-fixation baths over time were examined. The presence of viral RNA in swabs from selected tissues was assessed by the standardized routine RNA isolation protocol and subsequent real-time PCR analysis. To support the results obtained from the tissue swabs, samples of RNA were exposed in vitro to short and long-term exposure to the components of the injection and fixation solutions used for the bodies' conservation. Substantial removal of SARS-CoV-2 RNA was observed in post-mortem tissue following perfusion with 3.5% phenol, 2.2% formaldehyde, 11.8% glycerol and 55% ethanol, and subsequent post-fixation in an ethanol bath. In vitro experiments showed significant effects of formaldehyde on SARS-CoV-2 RNA, while phenol and ethanol showed only negligible effects. We conclude that cadavers subjected to fixation protocols as described here should not pose a considerable risk of SARS-CoV-2 infection while being handled by students and staff and are, therefore, suitable for routine anatomical dissections and teaching.

Not for Room 101.

The emergence of the COVID-19 pandemic in March 2020 disrupted learning and teaching and brought in-person teaching to an abrupt halt, leading to a rapid pivot towards online and technological solutions including in Anatomy where access to cadaveric specimens and labs were halted. But emerging from the pandemic and with the resumption of more in-person teaching, would these technological innovations find the metaphorical "Room 101" or could some of them successfully enhance the anatomy educators' toolkit? In this chapter, two such technological adaptations that we intend to continue to use in our institution are described. Their development and the pedagogy underpinning their successful use will also be described.The first of these is "Live from the Lab" which is a cadaveric demonstration livestreaming session. Teaching Anatomy through demonstration is not a new concept, however, beaming demonstrations of cadaveric material to students in remote locations need consideration of ethics and the Code of Conduct for students and teachers alike which will be described here along with how to set up such a session.Next, the use of an online assessment platform for spotter-type Anatomy assessments will be described along with their benefits. Both adaptations involve online use of images and/or videos of cadaveric material but have proven to be pedagogically useful.

In jars: The integration of historical anatomical and pathological potted specimens in undergraduate education.

INTRODUCTION: Across the UK, many anatomy departments possess historical potted wet cadaveric specimen collections, such as organs preserved in fluid-filled jars. Although considered obsolete by some for anatomical education, there is immense potential for their utilisation in teaching, particularly in institutes that have limited access to cadavers or have had body donation rates impacted by the Covid-19 pandemic. Another benefit of historical potted cadaveric specimens is that severe pathology, often not seen today, can be observed by the student. MATERIAL AND METHODS: The aim of this study was to understand students' opinions and attitudes towards the use of historical anatomical and pathological potted wet specimen collections in undergraduate science teaching. Following their integration into the anatomy program of a Clinical Sciences degree, seventy-seven undergraduate students completed a five-point Likert questionnaire on their perspective for the integration of the historical potted specimens in anatomical education. This study was approved by the Research Ethics committee at the University of Bradford RESULTS: The study demonstrated that 90 % of students found the collection useful in teaching, 92 % would like to see the collection used more in teaching, and 76 % of students found that the collection encouraged them to consider medical ethics and the donor. CONCLUSIONS: In conclusion, the survey findings suggest that further utilisation of historical potted wet specimen collections would be useful in the teaching of anatomy and that these collections could potentially encourage conversations on post-mortem bodily integrity, ethics, and organ donation.

The Current Regulations in Handling Autopsy of COVID-19 Corpses: A Narrative Review.

The COVID-19 pandemic has affected millions of people around the world either directly or indirectly. Deaths have been attributed to COVID-19 as the underlying cause of death or as a contributing cause of death. It is estimated that millions of excess deaths were associated with the COVID-19 pandemic in 2020 and 2021. The importance of a clinical autopsy on COVID-19 corpses lies in understanding the pathogenesis of the disease better. Moreover, a forensic autopsy may be performed on a COVID-19-infected corpse when indicated for medico-legal purposes. From the autopsy perspective, handling COVID-19-infected corpses requires specific guidelines and safety measures to be followed to limit the transmission of SARS-CoV-2, the causative virus. This is essential as COVID-19 is an emerging infectious disease caused by a newly discovered virus. This review narrates the safety measures that should be followed at different stages of handling COVID-19 corpses, starting from the death scene to burial and funeral. Ethical issues in handling COVID-19 corpses are also briefed in this review. As COVID-19 can be transmitted through infected bodies, it is crucial to wear recommended personal protective equipment, specifically for aerosol-generating procedures. There are specific safety measures to be considered before transporting the body to the mortuary, with particular requirements to be implemented there, such as specific engineering controls, staff training, and autopsy room precautions. After conducting the autopsy, disinfection of the tools and equipment, body bags, transport vehicles, and the autopsy room should be considered.

Collaborative, Two-Directional Live Streaming to Deliver Hands-on Dissection Experience during the COVID-19 Lockdown.

Cadaveric dissection is widely used in anatomy teaching worldwide. This method develops anatomical knowledge and practical dissection skills, as well as communication and team working. At the School of Anatomy, University of Bristol, two of our undergraduate units depend on dissection as a teaching tool.Social distancing guidelines brought about by COVID-19 brought challenges and meant it was not possible for all students to be present around a cadaver simultaneously. We adapted with secure, two-way live streaming, facilitated by ceiling-mounted cameras.Our units utilised the technology in slightly different ways. In a larger cohort, students were not able to attend the dissection room simultaneously and 2-4 students from each group attended, with the remainder (6-8 students) attending via Zoom. In the smaller cohort, all students attended, though only two students could be present around the cadaver, with Zoom used to stream the dissection to those distanced around the room. Those present narrated and ensured visibility of the dissection, whilst posing questions to those at home. The home group provided feedback, generated discussion, and conducted research.This chapter reflects on our experiences using this innovative teaching method. It was a valuable alternative to being in person. Whilst students might have spent less time in the dissection room, their dissection time equalled or was greater than pre-pandemic. Students developed digital confidence and built cohorts, and whilst we reflect on the need for effective communication and digital equity, we offer our best practice and solutions.Whilst in-person teaching has resumed in 2021-2022, investment in this technology enables us to rapidly pivot to a reduced in-person, or an entirely online delivery where required, and we are confident that our delivery will be effective in either case. There are also exciting opportunities for new forms of delivery as well as national and international collaborations.

From Lecture Halls to Zoom Links: How Can Educational Theory Help Us to Deliver Effective and Engaging Teaching in an Online Environment?

Anatomical education has a long and colourful history, ranging from the anatomical theatre and artistic flourish of the renaissance period to modern-day virtual reality. Over the centuries, the body has been taken apart and mapped in exquisite detail. We are now able to access virtual models of the body anywhere, anytime, which allow for unlimited dissection and manipulation. Despite this progress, the majority of anatomical educators continue to deliver anatomy in a laboratory setting, using hands-on learning approaches such as dissection of cadaveric material. These methods are robustly supported by educational theories, such as information processing theory and experiential learning but require students to be present in a dissection room with access to human cadaveric material.The 2020 COVID-19 pandemic forced anatomy educators out of familiar dissection laboratories and into unfamiliar and uncomfortable virtual environments. When moving online during the pandemic, active learning theories, which form the basis of face-to-face classes, were used to construct interactive anatomy webinars to replace the on-campus practical laboratory-based teaching. The focus of these webinars was on student interactivity, and visual content with drawing activities, breakout groups, virtual three-dimensional models, and identifying activities being integrated into each session. Student feedback showed an appreciation of the interactive nature of these sessions, and staff were surprised at how well the webinars delivered engaging and interactive teaching at a time of limited social contact. This approach was not only useful during the restrictions of a pandemic but could offer a complementary approach to delivering practical anatomy teaching as we return to blended and on-campus learning again.

Cadaver dissection for oculoplastic procedures: A beginner's guide.

The purpose of this article is to form a basic guide for beginning the cadaver dissection training programs focused on oculoplastic surgical procedures. Ours was a collaborative study between the departments of Ophthalmology and Anatomy in a tertiary care teaching institute. We formed a step-wise approach to begin the cadaver dissection focused on the oculoplastic surgical procedures. The basics of cadaver procurement, processing, and preparation for dissections were described. The operative requirements of trainees, surgical handling of cadavers, and basic oculoplastic surgical steps were discussed. The types of embalming (cadaver preservation process) and steps have been described in detail. We have emphasized the preoperative discussion about the proposed dissections using standard teachings and skull models for easier understanding. Additional helping tools like soft embalming and injectable substances for better intra-dissection understanding (intra-arterial, intravenous and orbital injections) have been described. Post-dissection cadaver handing and soft-tissue disposal protocols have also been described. Overall, the cadaver dissections provide holistic surgical learning for the residents, specialty trainees, and practitioners. This article may act as a basic step-wise guide for starting the cadaver-based oculoplastics lab dissection in various institutes and workshops.

Rate of shed of SARS COV-2 viral RNA from COVID-19 cadavers.

BACKGROUND: At what rate does the RNA of SARS CoV-2 shed from cadavers? Although, there have been numerous studies which have demonstrated the persistence of the virus on dead bodies, there is a lack of conclusive evidence regarding the variation of viral RNA content in cadavers. This has led to a knowledge gap regarding the safe handling/management of COVID-19 decedents, posing a barrier in forensic investigations. METHODS: In this study, we report the presence of RNA of SARS CoV-2 by real time RT-PCR, in nasopharyngeal swabs collected after death from two groups of bodies - one who died due to COVID-19 and the other who died due to other diagnoses. A prospective study on 199 corpses, who had tested positive for COVID-19 ante-mortem, was conducted at a tertiary care center. RNA testing was conducted at different time intervals (T1-T5). RESULTS: 112(56.3%) died primarily due to COVID-19 and 87(43.7%) died due to other diagnoses. 144(72.4%) were male and 55(27.6%) were female. A total of 115 (57.8%) tested positive for COVID-19 after death at different time points. The mean age was 50.7 ± 18.9 years and the length of hospitalization ranged from 1 to 50 days with a mean of 9.2 ± 7.6 days. Realtime RT-PCR positivity of SARS CoV-2 RNA decreases with time. CONCLUSION: We observed that real time RT-PCR positivity, indicating viral RNA detection, decreases with time. Therefore, it is advisable to follow appropriate COVID-19 precautions to carry out scientific studies, medico-legal investigations and mortuary services on suspected/confirmed COVID-19 corpses.

Implementation of an Active Screening Program for SARS-CoV2 - Experience at an Academic Medical Center.

BACKGROUND: This study documents the experience of an academic medical center implementing SARS-CoV2 screening of asymptomatic research personnel to support the "return-to-work" initiative and donor cadavers to support in-person student education. METHODS: Testing was performed on samples received June 1, 2020 (for the cadaver program) and July 20, 2020 (for the personnel screening program) through September 30, 2021. Data were evaluated to document the number of cases and the positivity rate. RESULTS: Approximately 3000 specimens were tested across both programs, with an overall positivity rate of 2.5% and 3.6% in the personnel and cadaver screening programs, respectively. DISCUSSION: This screening program serves as an example of institutional investment in the safety of its faculty, staff, and students alike to address specific needs of a global pandemic.

Innovation in Delivering a Live, Virtual Cadaver Dissection Course.

SUMMARY: The availability of advanced telecommunication technology and the social restrictions introduced by a global pandemic have compelled the medical community to explore new avenues of surgical education. Although cadaver courses have long been a fundamental method for learning surgical anatomy and improving operative preparedness, the COVID-19 pandemic has made traditional dissections less practical. The need for quality virtual learning experiences motivated the authors to design and assess the feasibility of organizing a live, virtual upper extremity peripheral nerve cadaver dissection course. Three phases were critical when developing the course: preplanning, planning, and execution. The success of the live, virtual cadaver dissection depended not only on a detailed curriculum, but the technological audio-video-internet needs to effectively communicate and interact with the viewers. Virtual learning mitigates the risks of in-person dissection courses during a global pandemic and can be enhanced with interactive media (e.g., illustrations and schematics) to augment learning experiences.