Viewers of TV medical drama The Pitt (which screens here on Neon) may have noticed the ubiquity of the portable Butterfly ultrasound. In one episode, medical students rushed around a mass multi-trauma event diagnosing, for example, intracranial bleeds after ultrasounding a patient’s eye. The depiction is really one of a zeitgeist moment in medical practice: point-of-care, or bedside, ultrasound. Use of the handheld Butterfly device, producing images that can be displayed on a clinician’s phone, is fast becoming an extension of the traditional physical examination, especially in emergency departments. And these days, doctors of all stripes commonly apply their anatomy knowledge via modern imaging such as CT scans, MRI and ultrasound every hour of every day.
“Most of the organs I see in my clinical practice are scans,” says cardiothoracic surgeon, honorary professor and interim dean of medicine at the University of Waikato, David McCormack. Though he spends his operating life with his highly trained fingers in people’s hearts, lungs, and aortas, the medical educator is clear about the digital implications for learning anatomy.
“For most of humanity, the closest approximation of living anatomy was dead anatomy. That is not true any more both in terms of how we learn, but also how we practise.”
The structure of the planned University of Waikato medical school – to be known as the New Zealand Graduate School of Medicine when it opens in 2028 – will be based on similar graduate schools in Australia. And like some of those schools, instead of a human body bequest programme, the human laboratory lab (to be called the Digital Anatomy Studio) will have a number of 65-inch Sectra virtual dissection tables. These allow students to learn anatomy on a virtual cadaver: detailed reconstructions built mostly from CT scans of donated male and female bodies (one of each). Every student will be issued with a laptop, VR headset and software on entry to the four-year course.
Students will be able to isolate areas of interest such as the viscera, vasculature, or the musculoskeletal system. They will use a virtual scalpel, zoom in to their heart’s content, or use the “undo” function – not possible on human tissue. The system also has a bank of pathologies contributed from around the world and, importantly, with corresponding radiology. (In a human cadaver lab, the availability of pathologies is limited.)
The imaging-forward approach isn’t in itself groundbreaking, but indicative of trends in training. At the University of Auckland School of Medicine, anatomy and medical imaging department head Associate Professor Miriam Scadeng has halved the dissection component of training in favour of radiology teaching. But the Cambridge-trained radiologist, who spent more than 20 years teaching in anatomy labs in the US, draws attention to the so-called “soft skills” that a modern human anatomy laboratory uses dissection to address.
Dissection also works as an induction to the responsibility of medicine itself. On the first day at Auckland School of Medicine, a lot of time is spent speaking with new students about the generous gift of body donation – not just from the deceased but from their families, who may not get their loved one’s remains returned for years. Before students lift a scalpel, they are asked to consider the gravity of what they’re about to do. Only after this kōrero do they enter the laboratory for the first time, for the whakanoa (lifting of tapu) and to say karakia.
“The students gain a huge amount of empathy and appreciation for their donor,” says Scadeng. “We also hold a ceremony for the donor so the student can show their appreciation and write letters or stories to the cadaver and provide flowers for them. It gives the students a real sense of being a doctor.”
Auckland has no plans to stop its remaining cadaver dissection just yet, but is in the acquisition phase for a digital anatomy table of its own.
At Waikato, McCormack’s argument is that human dissection isn’t the only way to initiate students into a clinical life of duty and responsibility, and he has thought considerably about the issue. “If somebody has a terminal illness, what does that person, as they look down the short barrel of the remainder of their life, need their nurses, and doctors and allied health professionals to understand?
“As their whānau are facing that challenging transition where someone is no longer available to talk to – what does that whānau need their doctor to know, and do, about this?”
In association with the move away from dissection, he believes asking these slightly more profound questions will help to “inform how we train, how we help our doctors, our nurses, our midwives to be most beneficial and serve society best”.
He’s also aware cadaver dissection can be traumatic for many people who could go on to become excellent doctors or even surgeons.
“The confrontation of seeing a dead body and interacting with it every week is psychologically unsafe and traumatic,” he says. Added to that is the pressure of having to dissect a body in front of classmates, while narrating what is happening.
“Stepping forward in front of a crowd to do an irreversible act on a body that everyone wants to show the most immense respect for places enormous pressure on that student. And some students have more comfort in that space than others.”
That way of learning doesn’t have the most value today, says McCormack, whereas a digital cadaver lab “allows us to provide a safe environment for people to learn anatomy, where they can make mistakes and just do it over again. You cut the ureter and take it out, you just push a button and put it back in again. You can go further, move things around, take them apart and put them back together again.”
The digital lab is better suited to the condensed, four-year graduate course Waikato will offer, its designers believe. Waikato will be the country’s only medical school to offer graduate entry. In Australia, graduate medical schools now outnumber undergraduate programmes.
AFTER THE FIRST YEAR OF BIOMEDICAL science teaching on the Hamilton campus, the software and vitual reality equipment can go on the road with students on immersive rural placements, so the university or a hospital no longer needs to be a physical hub where tutorials are delivered.
This is also better for the schedules of clinicians delivering tutorials and for rural-based specialists. These are just some of the areas Waikato hopes to tweak to improve the prospect of a graduate going into rural practice, another aim of the new school.
With New Zealand’s existing medical school model, only 15-20% of graduates move into general or rural practice – both areas acknowledged as of great need to NZ’s ageing population, with an ageing GP workforce and under-served districts outside main centres. Overseas, courses similar to that which Waikato hopes to deliver – such as at Canada’s Northern Ontario School of Medicine University, and James Cook, Flinders and Deakin universities in Australia – see an average of 40-50% of graduates working in general and rural health.
Sylvia Giles is a doctor at Waikato Hospital and a graduate of the University of Auckland School of Medicine.
