Blending Tradition and Innovation: Student Opinions on Modern Anatomy Education

Abstract

Anatomy education has evolved significantly with the introduction of diverse instructional techniques. This review evaluates these methods, including traditional cadaver dissection, three-dimensional (3D) model printing, virtual dissection using tools like the Anatomage table, problem-based learning (PBL), and the use of wax and plastinated models. Each approach presents unique benefits and challenges. Cadaver dissection remains invaluable for providing hands-on experience and a deep understanding of anatomical structures, although it faces ethical, logistical, and financial constraints. Wax and plastinated models offer durable, precise representations of anatomical structures without the ethical concerns associated with cadavers. Additionally, 3D printing and virtual dissection have emerged as effective supplementary tools, enhancing spatial understanding and allowing repeated practice. PBL integrates anatomical knowledge with clinical reasoning, promoting critical thinking and problem-solving skills. The main aim of this study was to gather and analyze students’ opinions on various anatomy teaching methods, while a secondary objective was to review the literature on novel and traditional approaches in anatomy education. This review emphasizes the importance of incorporating a variety of teaching methods to create a dynamic and engaging anatomy curriculum, preparing students for clinical practice.

1. Introduction

Anatomy, the oldest scientific discipline in medicine, is essential for medical education, providing future doctors with the foundational knowledge required for developing crucial clinical skills. Surgeons, pathologists, and radiologists all benefit significantly from a deep understanding of human anatomy, and novel surgical techniques must first be mastered on cadavers before being used on patients. The development of new medical devices also heavily relies on research conducted on cadavers [1].

Clinical anatomy is one of the most ethically debated practices in the medical field. Cadaveric dissection, a cornerstone of anatomy education since the third century BCE, offers an unparalleled hands-on learning experience. Often referred to as the “first teacher” for medical students, it has been considered the “gold standard” of anatomy teaching by numerous scholars [2,3,4]. However, this practice is fraught with ethical dilemmas. Dissecting human bodies for scientific purposes can conflict with religious and moral beliefs, raising concerns about the sanctity of the body. To address these concerns, some practitioners have introduced ceremonies to honor cadavers, thereby acknowledging their once-living identities and connecting with their families [1].

In recent years, three-dimensional (3D) model printing has been successfully integrated into various medical fields, including education. High-quality 3D-printed models of cadaveric material are now used to teach anatomy [5,6], with plans to develop models for anatomical structures that are difficult to visualize on real cadavers [7,8]. These 3D models have the potential to replace cadavers as teaching tools, addressing some of the practical deficiencies associated with real cadavers [9]. The Anatomage table offers a life-size virtual representation of the human body, allowing students to visualize, manipulate, and dissect anatomical structures using detailed 3D models. This technology enhances the learning experience by providing a comprehensive view of human body structures and offering haptic tools that allow students to navigate through different layers, study physiological and pathological forms of tissues and organs, and gain spatial perception. Studies have shown that using the Anatomage table as a supplementary resource improves students’ assessment of gross anatomy [10,11].

Over the past few decades, the use of human dissection in universities worldwide has declined. This shift is often attributed to the rise of new technology-related teaching methods, which offer alternative ways to study anatomy. While it may seem that modern technologies have led to a decrease in traditional dissection practices, these advancements have actually developed to complement and overcome the limitations associated with traditional methods [1,7]. The specialized literature reports conflicting opinions on human dissection, with many professionals recognizing its benefits for anatomical education, such as providing hands-on experience and a deep understanding of human anatomy. However, they also acknowledge its limitations and ethical concerns, including the high cost, the limited availability of cadavers, and the potential emotional impact on students. New learning methods are not entirely new discoveries; instead, each technological advancement is an improved version of traditional techniques in certain aspects. For example, virtual dissection tables in medical education enhance traditional cadaver dissections by allowing students to visualize and interact with 3D models of the human body, providing a more detailed and versatile learning experience.

In recent years, students have increasingly expressed concerns regarding the effectiveness and accessibility of traditional teaching methods [12]. Many report difficulties in fully grasping complex spatial relationships and retaining detailed anatomical knowledge through cadaveric dissection alone, especially given limited access to cadavers and the often overwhelming emotional and psychological impact [12,13]. Additionally, while technological advances such as 3D models and virtual dissection tools provide a more flexible and visually engaging learning environment [7,8,10], some students feel these methods lack the hands-on, tactile experience that traditional dissection offers. There is also a growing recognition of the need for a more integrated, multimodal approach to anatomy education, combining traditional and innovative methods to cater to diverse learning preferences and enhance retention. These factors highlight the need to explore students’ preferences and adapt teaching strategies to bridge the gap between modern educational innovations and traditional hands-on learning, ultimately creating a more effective and supportive learning environment.

Our aim is to review significant papers published in recent decades that describe traditional and newly developed teaching methods in anatomy, with a focus on students’ perceptions of these learning aids worldwide. By evaluating the strengths and weaknesses of both modern and traditional approaches, we seek to enhance anatomical education for future medical professionals. This study addresses various educational tools and their implications, offering a comprehensive perspective on modernizing anatomy education while upholding ethical considerations and improving the quality of medical training.

2. Material and Method

2.1. Study Eligibility Criteria

For the first part of the literature review, which describes the five main teaching tools, inclusion and exclusion criteria are listed in

Table 1. Inclusion and exclusion criteria.

Inclusion Criteria	Exclusion Criteria
English written	Articles in other languages
Papers on anatomy teaching tools	No abstracts/reviews/letters to editor
Papers from the last 10 years	Published before 2013
	Not relevant to the topic

. The second part of the literature, discussing students’ perceptions, was structured using the PICO framework to guide the selection process (population: medical students, undergraduates; intervention: education/technology; comparison: any comparison between methods that investigates an outcome in the acquisition of anatomy; outcomes: knowledge retention) (

Table 2. PICO framework.

PICO	Inclusion Criteria	Exclusion Criteria
Population	Medical undergraduate students	Postgraduate students, undergraduate students from other universities
Intervention	Human anatomy teaching	Other types of anatomy teaching (e.g., veterinary)
Comparison	Any comparison between one or more teaching methods (subjective)
Outcome	Knowledge acquisition (subjective or objective)

). While the general inclusion criteria remained consistent across both parts of the review, the second part’s focus on students’ perspectives required the additional use of PICO to structure the investigation. The review aims to examine anatomy as a preclinical science; therefore, only undergraduate students were included in the assessment.

2.2. Identification and Selection of Studies

When selecting studies for this review, we adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines [14]. The current literature review is based on bibliographic searches in Google Scholar (2013–2023), Scopus (2015–2023), and PubMed (2013–2023), using both manual and automated searches with MeSH terms.

Initially, research studies were hand-searched in the aforementioned databases using the following keywords: “human cadaver dissection”, “teaching in anatomy”, “Anatomage”, and “3D model print anatomy”. Subsequently, a second search was performed using the MeSH term option in PubMed with the following terms: ((“dissection” [Mesh]) AND “cadaver” [Mesh]) AND “anatomy” [Mesh]; ((“teaching” [Mesh]) AND “anatomy” [Mesh]) AND “students” [Mesh]; AND “learning” [Mesh]; and ((“tools” [Mesh]) AND “anatomy” [Mesh])).

2.3. Data Extraction Process

The lead investigator (A.M.Ș.) screened the most pertinent publications based on their title, abstract, and a quick glance at the full research manuscript. Abstract screening and the literature database review were then conducted independently by two scientists. All selected articles were added to a Microsoft Excel table with columns for improved subsequent management and organization of the review: title, authors, year and journal of publication, and the specific type of publication. The articles were analyzed and subsequently structured into five pre-identified themes (human dissection materials, 3D models, virtual reality tools, wax/plastinated models, PBL), which were selected based on prior knowledge of common teaching tools in anatomy education and are explored in this review. While the primary focus of this review is on gathering and analyzing medical students’ perceptions of these different teaching methods, it was necessary to first provide a comprehensive description of each method to offer context.

2.4. Overview of Studies Included in the Review

Finally, after the application of the inclusion and exclusion criteria, 48 articles were chosen for the literature review as they fulfilled all the stated requirements. The process followed for selecting the articles is summarized in the PRISMA diagram (Figure 1). We emphasized important data and results, focusing on the pros and cons of each teaching method and their limitations. The articles were grouped as follows:

• Anatomy Teaching Methods: 28 selected articles, including some of the most relevant articles regarding the role and limitations of diverse teaching methods;
• Comparison between Methods (using PICO framework): 20 selected articles, focusing on students’ perception and knowledge retention.

3. Teaching Tools and Methods in Anatomy Education

3.1. Human Dissection

While there are variations among medical schools in terms of resources, such as the cost of acquiring cadavers, the overarching goal of anatomy education is to produce highly qualified physicians [15]. Despite these differences, human dissection remains a fundamental component of anatomy education in many underdeveloped countries due to the easy availability of cadavers. Medical professionals, including radiologists, surgeons, anatomy faculty, and researchers, must be proficient in human dissection to perform procedures safely [16]. In traditional medical curricula, learning anatomy through human dissection remains vital for many students [17], and it has continued to play a significant role in anatomy education over the centuries.

Conversely, undergraduate anatomy education worldwide has experienced a significant reduction in teaching hours and resources specifically dedicated to human dissection. This trend reflects a shift in educational strategies, with many institutions seeking alternatives due to the high costs, ethical concerns, and logistical challenges associated with using cadavers. Despite this, countries in Africa [18] and North America [19], such as the United States and Canada, as well as several European countries like Germany [20] and Italy [21,22], continue to heavily rely on cadaver dissection in their medical curricula. A survey gathering data from 65 medical universities in the United States and Canada indicated that the majority of these institutions still heavily depended on human dissection [23]. Human dissection is also still an important tool in several Asian countries [24,25,26,27,28,29]. While many prestigious medical schools continue to adopt this approach, some colleges in Europe have abandoned it [30,31]. Whole-body dissections are a dependable teaching strategy, according to Burgess et al. [32], and they enhance students’ understanding of anatomy following the dissection course. They stated that skipping cadaver dissection could result in a lack of understanding of anatomy.

There is an increasing trend to reintroduce cadaveric dissection into the medical curriculum, fueled by legal and ethical reforms that promote body donation. Several countries are adapting their laws to encourage body donation posthumously. Young anatomical fellows are actively advocating for this change, highlighting its potential benefits for future students. A comprehensive review indicates that while many European countries have established regulations, some areas still lack a rigorous legal framework. National regulations are in place in 18 out of 39 countries, with some relying on unclaimed bodies to fulfill educational needs [33]. This legal and ethical support is essential for ensuring a consistent supply of cadavers for anatomical study, which is crucial for providing medical students with the highest-quality training.

Another study discusses the specifics of recent legislation from Italy aimed at optimizing the effectiveness of body donation for educational purposes. The paper addresses issues such as the eligibility of partial donations, the simultaneous donation of organs and tissues for transplantation, and the need for a more flexible approach to the donation process [34]. This legal framework is essential for enhancing the quality of medical education and ensuring that body donation programs can meet the evolving needs of anatomical studies. For example, there are no official regulations in the United States specifying the details required on the donation form when donating a human body. Nonetheless, the “Best Practices Guide for Donation Programs” was created by the American Association of Clinical Anatomists to address this problem [21]. These recommendations provide a thorough framework outlining best practices that donation programs should implement to ensure ethical behavior, transparency, and consistency in the donation process.

The integration of cadaver dissection in neuroanatomy education provides an invaluable experience that aids in understanding the structures of the nervous system. Arantes et al. [35] conducted a systematic review identifying various tools and resources that can improve neuroanatomy education, highlighting the need for diverse teaching methods to address neurophobia and enhance learning outcomes. The ongoing debate in the educational community focuses on finding the best methods to teach neuroanatomy effectively [36,37].

The combination of traditional cadaveric dissection with modern technologies appears to offer a comprehensive approach, catering to various learning preferences and addressing the shortcomings of each method when used in isolation [38].

3.2. Three Dimensional (3D) Printed Models

Three-dimensional model printing is often used to train medical residents in anatomy education. This novel technology has shown great promise as an educational tool in various areas, such as autopsy, computer simulation, plastination, and anatomical imaging. Over the last decade, 3D anatomy has been increasingly used in the teaching of anatomy to students [39].

Digital and 3D anatomical education has demonstrated consistent learner satisfaction, outperforming traditional approaches in several studies [40,41,42,43]. Additionally, 3D anatomy offers benefits not only in real-time clinical practice but also for teaching doctors at multiple levels.

Other tools, such as wax and plastination models, are being created and used more frequently. Wax models, historically significant and artistically detailed, provide a durable and reusable resource for studying human anatomy. However, they can be fragile and require meticulous care. Plastinated models, on the other hand, offer a more robust and realistic alternative. These models involve replacing bodily fluids with plastics, resulting in durable and life-like specimens that can be handled without the need for preservatives. A study found that both wax and plastinated models were beneficial in teaching anatomy, but plastinated models had a slight edge due to their durability and the realistic representation of human tissues [44]. These older methods provide tangible, hands-on experiences that are crucial for anatomical understanding and can be more cost-effective in the long run.

Anatomy museum collections are invaluable in enhancing the learning experience of students by providing a diverse range of preserved specimens, models, and displays that complement traditional teaching methods. These collections can include dissection parts, plastinated models, wax figures, and even skeletons, offering students the opportunity to study anatomical structures in detail and at their own pace. Museum collections allow the repeated study and long-term preservation of unique pathological specimens or rare anatomical variations, which might not be easily accessible in dissection labs. Additionally, these collections often contain historical specimens, providing students with insights into the evolution of anatomical knowledge and medical history. By incorporating both normal and abnormal specimens, museums help students develop a more rounded understanding of anatomy and pathology, making these resources essential for a well-rounded medical education [45].

Nevertheless, 3D anatomy education should not be viewed as a simple teaching tool conversion and requires an explicit pedagogical framework. Educators and researchers should incorporate digital teaching methods as tools into the teaching of anatomy and its clinical practice.

3.3. Virtual Dissection (Anatomage Table)

The Anatomage dissection table can be utilized as a stand-alone medical teaching aid for anatomy instruction or in conjunction with human cadavers. Even the smallest features of various anatomical structures are depicted in the table. Tissues can be cut or removed in different layers to improve learning and student attention. Anatomage allows users to accurately and in great depth visually dissect human anatomy. This reduces ethical problems and preserves resources by allowing students to investigate the complexities of the human body without using cadavers [40]. Additionally, it uses high-resolution medical imaging data to produce realistic reconstructions of anatomical features, including MRI and CT scans. With this degree of detail, users can examine anatomical structures from various viewpoints and angles, making for an outstanding learning experience.

Investing in Anatomage certainly brings a modern edge to anatomical education. However, its substantial cost raises important considerations, especially for educational institutions with limited budgets. Anatomage units can cost upwards of USD 80,000 to USD 100,000, not including maintenance and software updates. While its advanced imaging and interactive features offer a unique learning experience, many argue that these funds might be better allocated to body donation programs. Real dissection provides hands-on experience and a deeper understanding of human anatomy that many believe is unmatched by any simulation [46]. Body donation programs not only facilitate this vital aspect of medical training but also carry significant educational and ethical benefits, fostering profound respect for the human body. Thus, when budget constraints are tight, prioritizing real dissection programs could offer more substantial educational value compared with the high-tech allure of virtual dissection tools.

Therefore, Anatomage serves as a comprehensive and innovative learning aid for anatomy education, offering a dynamic blend of advanced technology, interactivity, and clinical relevance to support the learning needs of students and professionals in the medical and healthcare fields.

3.4. Problem-Based Learning and Integrated Teaching

Problem-based learning (PBL) is an educational approach that emphasizes active learning and critical thinking through the exploration and resolution of real-world problems or scenarios. Small groups of students collaborate to examine clinical cases or anatomical issues that require the application of their anatomical knowledge during PBL sessions in the context of anatomy teaching [47]. A clinical case or scenario that highlights a disease or anatomical difficulty is presented to the students. They then work together to identify pertinent anatomical features, understand their roles, and provide recommendations for treatments or diagnosis. PBL integrates anatomical knowledge with clinical reasoning, builds cooperation and communication skills, and empowers students to take charge of their education. By engaging in problem-solving activities, students develop a deeper understanding of anatomical concepts and their practical applications in clinical practice [48,49].

Integrated education combines several disciplines or areas to provide students with a comprehensive understanding of a topic or idea. The goal of integrated anatomy education is to connect anatomical knowledge with relevant fields such as radiography, physiology, pathophysiology, and clinical medicine [50]. Anatomical structures are often presented in integrated anatomy courses within the broader context of physiological processes, pathological alterations, imaging methods, and clinical connections. Students gain a more thorough understanding of how anatomical structures relate to disease processes, diagnostic techniques, and treatment options by integrating anatomy with other disciplines. Integrated teaching approaches help students appreciate the clinical relevance of anatomy and prepare them for the complexities of medical practice by emphasizing the interconnectedness of anatomical, physiological, and pathological concepts [51]. Nausheen highlighted that the vast majority of students surveyed agreed that the integrated anatomy laboratories enhanced their learning experience [52].

Traditional teaching, often referred to as the “didactic” or lecture-based model, is a teacher-centered approach where information is primarily transmitted from the instructor to the students through structured lectures. This method emphasizes the acquisition of factual knowledge, with a focus on memorization and recall. Assessment in traditional teaching usually relies on standardized exams that test knowledge retention [15]. While traditional teaching is effective for transmitting a large amount of information efficiently, PBL and integrated teaching tend to promote deeper understanding, critical thinking, and real-world application, although they may require more resources and active student engagement [12,15].

4. Medical Students’ Opinions on Anatomy Teaching Resources

Traditional cadaver dissection is declining, while three-dimensional anatomy models and virtual reality tools are becoming increasingly popular as supplements to conventional anatomy teaching tools [53]. Replacing human cadaver dissection with other anatomy teaching tools is not an option, although these tools can be useful supplements (Figure 2). An Anatomage dissection table can be beneficial for implementation and repetition in several countries. Nonetheless, Cahill, McLachlan, and Collins reported problems that could arise from the decrease in cadaver dissection hours in medical universities [54]. The prevailing opinion among African anatomists is that the Anatomage table should be a complementary teaching tool to cadaver dissection and cannot entirely replace it [55].

The meta-analysis of Yammine and Violato primarily used experimental designs, with 28 out of 36 studies being randomized. These studies compared the effectiveness of 3D visualization technology in teaching anatomy with other methods, often using control groups. The outcomes measured were factual and spatial knowledge test scores and learners’ perceptions, showing that 3D visualization led to improved factual and spatial knowledge, as well as higher user satisfaction compared with other teaching methods [56]. An analysis of medical student perceptions indicated that, on average, approximately 57% favored cadaver dissection-based learning over other laboratory modalities, while when considering performance on anatomy knowledge, every comparison that was investigated (dissection versus 3D models, dissection versus virtual dissection, dissection versus prosection) led to no major difference [57]. The majority of students participating in medical surveys regarding cadaver dissections perceived this experience positively, enhancing their respect for the human body. It provided an opportunity to appreciate the human body by evaluating how much damage a body can sustain, and it nurtured essential attributes for medical professionals, such as compassion and respect [39,58,59].

A study by Wainman et al. used an experimental design to compare different teaching methods for pelvic anatomy. Groups of students were exposed to various conditions, including physical models, VR, and mixed reality, with and without stereopsis. Results showed that physical models significantly outperformed both VR and mixed reality in structure identification. The advantage of VR and mixed reality over 2D presentations was reduced when stereopsis was blocked. This indicates that physical models remain superior, and depth perception is critical for learning anatomy effectively [60]. Another study revealed the differences in anatomy learning between human cadavers and virtual reality models, concluding that medical students exposed to human dissection showed increased accuracy in structure identification before and after anatomy courses (70% vs. 25%) [61]. Although medical students consider online anatomy resources important for learning anatomy [55], their value in replacing face-to-face anatomical teaching is not supported [62].

Boscolo-Bertolo et al. investigated the advantages of combining virtual dissection with conventional techniques. According to their research, as opposed to the control group, students who used both traditional and virtual dissection performed better on follow-up tests assessing their grasp of anatomy, particularly in comprehending spatial relationships in two and three dimensions [63]. Most students (78.7%) reported that virtual reality dissection enhanced their understanding of anatomy and its clinical applications [64]. One study used an experimental design, specifically a randomized controlled crossover study, to evaluate student perceptions of plastinated and 3D-printed models. A 41-item survey, using a Likert scale, was developed to assess learning satisfaction, self-efficacy, and the limitations of these models. Their aim was to evaluate if the instrument is psychometrically reliable and valid for measuring student perceptions of these modern anatomy tools [53].

A study by Ye et al. [65] collected data from 27 documents on how residents or students learned anatomy using 3D-printed models and how it affected their grades compared with those who used standard teaching aids. In the student group, the use of 3D-printed models showed statistically significant differences in grades compared with the control group. However, no statistical difference was found in the resident group. Students expressed positive feedback on orientation and the ability to recognize anatomical details, preferring to use innovative 3D-printed anatomical models as learning aids for human anatomy [39,66,67]. Furthermore, they listed several advantages of employing 3D models, including color labeling, ease of handling, reduced concern about damaging the structure compared with human cadavers, and less psychological inhibition [68]. In tests of medical students’ anatomical knowledge using both standard cadavers and 3D models, the 3D model group outperformed the cadaver group [69,70].

Afsharpour et al. noted that while theoretical exam scores did not change, the practical exam scores of students who used the Anatomage table improved significantly when compared with the group of students who used cadaver dissection and anatomy models as a learning tool [43]. The majority of participating students who participated in an electronic questionnaire viewed Anatomage as an additional tool in addition to human cadavers to gain a thorough understanding of human anatomy [40,71]. According to Brown et al., most medical students voted in favor of Anatomage’s inclusion as a useful teaching tool and expressed a greater desire to participate in the educational process [72]. Nearly 80% of students thought that the Anatomage tool aided in the classroom learning process, according to Anand et al. [37]. Another systematic review revealed that the Anatomage table is comparable to the cadaver dissection procedure [46]. A cross-sectional study conducted on students at Imam Mohammad Ibn Saud Islamic University found that Anatomage tables combined with plastinated specimens are more efficient in teaching anatomy than human cadaveric dissections [73]. The growing interest in Anatomage over time indicates a transitional moment for incorporating new technological tools into medical education [47,74].

A study by Khaki evaluated students’ answers on a short questionnaire and demonstrated that first-year medical students found PBL to be more effective in helping students learn when compared with a typical teaching regimen [47]. On the contrary, studies by Hinduja and Bains highlight that, compared with students taught in technology-enhanced integrated courses, those taught using traditional methods possess a greater degree of anatomical knowledge [49,75].

We analyzed 20 surveys regarding medical students’ perceptions of the possible replacement of cadaver dissection with mixed-teaching methods (

Table 3. Surveys taken regarding students’ opinion on teaching anatomy.

Study/Year	Country	Question Asked	Percentage of Students Who Agreed
Mustafa et al., 2013 [76]	Jordania/Malaysia	Would you prefer cadaver dissection over other teaching methods?	50.4%
Kraszpulska et al., 2013 [77]	USA	Would you completely replace cadaver dissection?	94%/85%
Cho et al., 2013 [58]	Korea	Would you still use dissection as a learning tool?	91.3%
Haspel et al., 2014 [78]	USA	Would you prefer other teaching methods over dissection?	38%
Schofield et al., 2014 [79]	USA	Would you recommend cadaver dissection?	86%
Davis et al., 2014 [80]	UK	Would you completely waive human cadaver dissection versus other methods?	99%/90%
Cornwall et al., 2014 [81]	New Zealand	Would you use other teaching methods (CT scans) in learning anatomy?	38%
Weerasuriya et al., 2014 [25]	Sri Lanka	Would you still use dissection over pre-dissected material?	85%
Marom et al., 2015 [82]	Israel	Would you choose human dissection over other teaching methods?	69%
Dissabandara et al., 2015 [3]	Australia	Should cadaver dissection still be used as a teaching method?	85%
Brown et al., 2015 [72]	UK	Did Anatomage significantly improve your understanding of anatomy versus classic methods?	63%
Nwachukwu et al., 2015 [19]	USA	Would you still use dissection over other methods?	64%
Malhotra et al., 2016 [83]	India	Would you still choose cadaver dissection over other teaching tools?	97.6%
Sheikh et al., 2016 [84]	Ireland/UK	Would you choose cadaver dissection over other teaching tools?	65%
Anand et al., 2017 [37]	India	Does the Anatomage table help you gain knowledge?	51%
Bharati et al., 2018 [73]	India	Can Anatomage be an adjunct or added tool to cadaveric dissection but not its replacement?	90%
Chakrabarti et al., 2020 [85]	India	Would you use cadaver dissection over other teaching tools?	75.3%
Deming et al., 2020 [86]	USA	Would you engage with cadaver dissection if it was optional?	94.3%
Abdulrahman et al., 2021 [74]	Saudi Arabia	Can the Anatomage table and plastinated models be used in conjunction?	72.8%
Choi et al., 2022 [87]	Korea	Would you supplement learning aids?	51%

). In every study, when asked, students preferred human cadaver dissection as the main teaching tool with supplementary learning aids. The majority of these surveys were conducted in the United States, where human cadaver dissection remains of utmost importance as a learning aid in many medical schools [15].

5. Advantages and Limitations

In the past, and even now, dissecting human cadavers has remained the most effective method to learn anatomy, and it continues to be a crucial teaching technique. Nevertheless, there are numerous limitations associated with this method. Many medical students find cadaver dissection to be a stressful experience, which can result in various bodily symptoms such as elevated heart rate, difficulty breathing, nausea, and disturbed sleep [88,89,90]. Many students have unpleasant memories of their time spent dissecting human corpses, but they develop problem-focused coping mechanisms to manage their stressful experiences. Thus, it is unlikely that stress from witnessing human cadaver dissection will have a detrimental effect on students’ learning in anatomy dissection halls [91].

In religious circles, there is a significant debate concerning the dissection of human corpses. Many experts will not dissect a human cadaver without first conducting a religious ceremony. Nonetheless, students gain a great deal from the skills and knowledge acquired during the actual experience. It facilitates understanding the links between various structures and the orientation of organs. Viewing cadavers as first patients through dissection enhances one’s capacity to respect them even after they have passed away. Many practitioners regard cadavers as “first teachers” in medical schools.

Over the last two to three decades, many medical universities have reduced or stopped dissection in undergraduate curricula. Despite this, recently published literature from different countries has shown that dissection is still practiced, though it is modified and practiced in integrated forms.

Table 4. Advantages and disadvantages of human cadaveric dissection.

Advantages	Disadvantages
Enhances empathy and respect in students [4]	Several steps in preserving cadavers that may require care and attention [1,18]
Increases surgical ability [1,3]	Costs [3,5]
Can use inspection, palpation, percussion [3]	Many countries have decreased availability [1]
Can visualize relationships [3]	Time-consuming [1,4]
Can instill a mental graph of the human body [1]	Ethical and moral reasons [4]

presents several advantages and disadvantages of this learning method.

Many emotional and physical limitations may be diminished by introducing alternative teaching methods. One of these learning aids is the Anatomage virtual table, which could be integrated into medical education and undergraduate curricula worldwide. The incorporation of the Anatomage table in anatomy education is inspiring, as it offers several benefits compared with traditional methods [92]. Virtual dissection (using the Anatomage table) is useful in determining the path and route of arteries, veins, nerves, organ placement, and other structures in sequential order. It can also help sidestep ethical and moral concerns surrounding the destruction of human cadavers, which is unavoidable in some cases. Several papers reviewed this method in medical schools and students’ perceptions of it, with the following outcomes: students agreed that it helps in organ visualization, understanding structures, and their relationships. However, they were not satisfied with the graphics, technical errors, and cost of such a table. Despite these issues, the vast majority agreed they benefited from it. Most of the studies published reported positive outcomes after using the Anatomage table as an additional anatomical learning method [93,94,95]. It is also important to note that performing 3D body dissection on a virtual imaging table requires sufficient training, making progress in both areas important and unavoidable. The advantages and disadvantages of this learning method are listed below (

Table 5. Advantages and disadvantages of virtual dissection.

Advantages	Disadvantages
Time and cost efficiency [11,94]	Limited sensory experience (tactile, percussion) [92]
Ability to reproduce many structural anomalies [11]	Requirement of proper training [11]
Flexibility and accessibility of digital tools during pandemic times [11]	Risk of “robotizing” students [92]
Can revisit anytime [92]	Limited exposure to new structural abnormalities [11]
Comfortable environment [87]	Technical errors [94,95]
Individual study options [87,92]	Dependence on technology [92]
Additional learning features (sections, quizzes, CT/MRI data) [11,87]
Interactive features (the structures can be rotated or magnified) [11]

).

One of the most recent methods in medical education is the development of 3D-printed anatomical models aimed at improving student learning. Many papers have described the potential benefits of 3D-printed models within the medical field, particularly for student education [96]. In recent years, the average cost of 3D model printing has substantially decreased, making its application in the majority of medical schools more feasible. Numerous surveys published in the last few years have assessed the benefits of 3D models as supplements to traditional methods, and the vast majority concluded that they produce positive outcomes within the groups using 3D models [97,98] (

Table 6. Advantages and disadvantages of 3D model prints.

Advantages	Disadvantages
Cost-efficient duplication of anatomical body parts [5,68,99]	Lack of understanding of real size (if using scaled models) [7]
Good integration with other educational tools [7,99]	Limited relation to other anatomical components [5]
Fast reconstruction of structures [5,9,68]	Potential accuracy limitations [7,9]
High fidelity of anatomical representation [5,6,7]	Cost of equipment and materials [7]
Ability to replicate difficult-to-access structures [5,6,7]	Material limitation [68,99]
Accessibility from computers anytime [7,9]

). However, this learning method comes with both advantages and disadvantages. While 3D model printing offers many benefits, it also faces challenges such as ethical issues, problems with precision structure, and product quality. According to research by Lim et al. [99], 3D-printed models can be a useful addition to a curriculum based on cadavers and may even offer advantages over cadaveric materials. Future research on the external validity of this technology in a broader educational setting is planned, as the use of 3D printing in medical education continues to develop.

While PBL can enhance critical thinking skills and clinical reasoning in students during their first year of medical school, it has limitations in the context of anatomy education. One challenge is the potential for students to miss out on the comprehensive coverage of anatomical content, as PBL may prioritize problem solving over a detailed study of anatomical structures. Additionally, there may be variability in the depth of anatomical knowledge gained among students, as the focus can shift depending on the specific clinical cases presented. Moreover, PBL requires significant facilitation and resources, including time and expertise, which may not always be feasible in anatomy curricula, especially in recent years. Lastly, PBL may not adequately prepare students for standardized assessments or clinical practice, where memorization of anatomical details is often necessary [47,49,75].

Innovative teaching techniques in anatomy education can enhance research and clinical practice in various medical areas, such as gastroenterology, internal medicine, and ophthalmology, by providing a deeper understanding of complex structures [100,101]. All methods face several challenges, such as those listed above. We look forward to the continuous progress of 3D printing technology and virtual dissection, and expect medical schools to implement them in anatomy laboratories.

6. Conclusions

Human cadaver dissection holds a pivotal role in anatomy education. Despite the passage of many years since this method was first introduced, it continues to be vital for enhancing anatomical knowledge. Historically, currently, and likely in the future, students regard human cadavers as their “first teachers”. These dissections not only deepen anatomical comprehension but also foster a positive attitude toward patient care. Our study specifically explored students’ opinions on both traditional and modern methods, revealing that while technological advancements like virtual dissection and 3D anatomical model printing are promising, students still highly value cadaveric dissection as an irreplaceable learning tool. These newer techniques, though effective, were viewed as complementary tools rather than substitutes for cadaveric dissection, underscoring the enduring importance of hands-on dissection in fostering comprehensive anatomical education and professional development.