Effectiveness of laparoscopic cadaveric dissection in enhancing resident comprehension of pelvic anatomy - 02/09/11

Doi : 10.1016/S1072-7515(01)00815-8

Geoffrey W Cundiff, MD ^a,⁎, Alison C Weidner, MD ^b, Anthony G Visco, MD ^b
^a Johns Hopkins Medicine (Cundiff), Baltimore, MD, USA
^b Duke University Medical Center (Weidner, Visco), Durham, NC, USA

^*Correspondence address: Geoffrey Cundiff, MD, Johns Hopkins Medicine, Department of Gynecology and Obstetrics, 600 N Wolfe St, Harvey 319, Baltimore, MD 21287

Abstract

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.

STUDY DESIGN:

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 (14 mm versus 10.3 mm, (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.

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