Short Practise in Human Body Dissection Benefits Acquisition of the Musculoskeletal System in First Year Medical Students at University of Castilla-La Mancha (Spain)
Round 1
Reviewer 1 Report
The paper investigates whether a short cadaveric dissection course would improve the anatomy grade of first year medical students. There are a few significant concerns the authors MUST address.
One major issue is that ethical approval was unclear. The authors stated that the study was “granted by the academic unit.” But, the “institutional review board statement” and “Informed consent statement” were “not applicable.” Informed consent is extremely important when human participants are involved, even though only questionnaires were administered. I believe this manuscript should not be processed further without ethical approval and informed consent of the participants.
The findings of this study are only applicable to musculoskeletal anatomy. The thorax, abdomen, perineum, and etc were not dissected. The terms “human anatomy” and “anatomy” or equivalent should be changed to “musculoskeletal anatomy” wherever applicable including in the title.
Concerning participants’ selection, I am curious how the subjects were divided into two groups? Was it a random process? Students should be assigned randomly to ensure homogeneity between the two groups and to rule out possible factors/bias that potentially lead to between-group differences.
How was it possible to dissect so many regions of the body in only two hours? Please clarify.
If I understand correctly, there were only 2 students per group (out of 4-6 students per group) who performed the dissection. First, I still doubt how it was possible for only 2 students to dissect more than five regions of the body in under two hours? Second, it means that not every student in the dissection group got an opportunity to dissect. What were the remaining students (the ones that did not dissect) doing in the meantime?
The dissection group had an extra 2 hours class time. How about the control group? Let’s forget about the dissection for a minute. I wonder if the improved grades were the consequence of this additional 2-hr period rather than the dissection itself? My point is that the “intervention time” for both groups MUST be equal for the grade comparison to be appropriate. This issue should be discussed AND also noted as a limitation.
There are several formatting issues. Please go through them.
- Line 213: [15, for Neuroanatomy]
- Line 206: change “2hr” to “2 hours”
- Line 227: do not need to subscript reference 18
- A dash (-) is missing in the seventh row (last column) of Table 1.
- The sentences in lines 220-222 lack a reference.
- Line 226: Other studies? Only one reference was cited.
- Font of the references and the table does not match the MDPI template.
Author Response
Manuscript ID: Anatomia-1867285
Title (revised): Short Practise in Human Body Dissection Benefits Acquisition of the Musculoskeletal System in First Year Medical Students at University of Castilla-La Mancha (Spain)
Ricardo Insausti , Maria del Mar Ubero , Monica Muñoz López *
Special Issue
State-of-the-Art Anatomical Research in the Mediterranean Region 2022
R1
The paper investigates whether a short cadaveric dissection course would improve the anatomy grade of first year medical students. There are a few significant concerns the authors MUST address.
R1: One major issue is that ethical approval was unclear. The authors stated that the study was “granted by the academic unit.” But, the “institutional review board statement” and “Informed consent statement” were “not applicable.” Informed consent is extremely important when human participants are involved, even though only questionnaires were administered. I believe this manuscript should not be processed further without ethical approval and informed consent of the participants.
Authors: We agree and appreciate the concern of R1. Ethical approval in research is fundamental and, in our studies, we always pursue it. However, in this case, the questionarie was part of an internal assessment of the effectiveness of our own teaching, whereby questionnaires and grades are handled and analysed according with the European Data Protection Regulation (EU) 2016/679 (2018). This involves data handling totally and completely anonymously, without any consequence for the students. This is done all the time in our faculty. The Anatomy Unit approved this questionarie as it is in line with the University policy. In fact, our students fill in as many questionnaires as teachers they see in the classroom (in all courses/years). This is a complex procedure run by the Vice-chancellor delegated in the Vice-Dean of Quality of Education in the Medical School with the help of a team of 5 fellow students. The Vice-Dean happens to be Dr Muñoz since April 2021 and until 2024. We can assure to R1 that was this study to be a larger project, our Local Ethics Committee would have been involved beyond our Anatomy unit and the University.
We are about to embark in a more ambitious project we hope may become a PhD thesis on Medical Education, and for that, we will be submitting the whole project to the appropriate ethics committee.
It is our hope R1 would reconsider his position of assessing this small piece of work within this context.
R1: The findings of this study are only applicable to musculoskeletal anatomy. The thorax, abdomen, perineum, and etc were not dissected. The terms “human anatomy” and “anatomy” or equivalent should be changed to “musculoskeletal anatomy” wherever applicable including in the title.
Authors: We thank Reviewer 1 for this point. We have changed the title, so it now conveys better the subject of the report.
R1: Concerning participants’ selection, I am curious how the subjects were divided into two groups? Was it a random process? Students should be assigned randomly to ensure homogeneity between the two groups and to rule out possible factors/bias that potentially lead to between-group differences.
Authors: This brief report, far away from trying to be a scientific experiment close to a clinical trial, is a short opinion one. Our aim was to, on the basis of an add-on teaching initiative -very short dissection experience- the students were offered as part of their first-year medical training. This is a limitation of this report and it is stated now that in the discussion section. Something else perhaps we should state in the report is that first-year medical students tend to pass Anatomy, but not with very good grades, so we try to find ways to improve this. This study should be interpreted more in this context, rather than in a purely scientific one.
R1: How was it possible to dissect so many regions of the body in only two hours? Please clarify. If I understand correctly, there were only 2 students per group (out of 4-6 students per group) who performed the dissection. First, I still doubt how it was possible for only 2 students to dissect more than five regions of the body in under two hours? Second, it means that not every student in the dissection group got an opportunity to dissect. What were the remaining students (the ones that did not dissect) doing in the meantime? The dissection group had an extra 2 hours class time. How about the control group? Let’s forget about the dissection for a minute. I wonder if the improved grades were the consequence of this additional 2-hr period rather than the dissection itself? My point is that the “intervention time” for both groups MUST be equal for the grade comparison to be appropriate. This issue should be discussed AND also noted as a limitation.
Authors: Students were offered those dissections, but needed to choose one of them. No is highlighted in the methods section. Students took turns at dissecting, with some, preparing and helping to follow the instructions, some observed and supervised the structures. It is all part of a team work, but we consider the whole experience as dissection. In regards to “intervention time”, see previous comment.
R1: There are several formatting issues. Please go through them.
Authors: We greatly appreciate R1 specific comments.
- Line 213: [15, for Neuroanatomy]
- Line 206: change “2hr” to “2 hours”
- Line 227: do not need to subscript reference 18
- A dash (-) is missing in the seventh row (last column) of Table 1.
- The sentences in lines 220-222 lack a reference.
- Line 226: Other studies? Only one reference was cited.
- Font of the references and the table does not match the MDPI template.
Reviewer 2 Report
This is the next in row manuscript presenting the value of the dissection over new teaching technologies. I strongly agree with the authors (specially as teaching anatomist) however I think that despite the good quality of the text it does not bring specifically new information.
Authors used references from a "high level" citing papers of most renown anatomists : Moxham, Tubbs, Iwanaga, Pawlina etc. There are however many papers dealing with the problem of body sissection and its value coming from other countries (African, India etc.) worth to mention. Besides for me the core text is the one published years ago (2008) in Annals of Anatomy.
Students lear proper approach to the body - and they should remember about the gratitude that is their due to the donors.
Translational Research in Anatomy. Volume 25, November 2021, 100149. Knowledge and attitude towards ethical cadaver dissection among medical and health sciences students, 1997–2020: A systematic review and meta-analysis. Yoseph Merkeb Alamneh. https://doi.org/10.1016/j.tria.2021.100149
Translational Research in Anatomy. Volume 19, June 2020, 100067. Assessment of the determinants of Knowledge, Attitude and Practice (KAP) of Ethiopian Medical Students towards ethical Cadaver Dissection
Madebo Ergano, Asfaw Gerbi, Niguse Hamba, Bekalu Getachew, Tesema Etefa, Tilahun Alemayehu Nigatu, Lemessa Debela, Mitiku Bajiro, Wakjira Kebede, Solomon Tesfaye. https://doi.org/10.1016/j.tria.2020.100067
The dissection course – necessary and indispensable for teaching anatomy to medical students Horst-Werner Korf , Helmut Wicht , Robert L. Snipes , Jean-Pierre Timmermans , Friedrich Paulsen , Gabriele Rune , Eveline Baumgart-Vogt, Ann Anat 190 (2008) 16—22
Translational Research in Anatomy. Volume 26, March 2022, 100159, Benefits and pitfalls of learning anatomy using the dissection module in an indian medical school: A millennial Learner's perspective. Sneha Guruprasad, Kalthur Arvind, Kumar Pandey, Sushma Prabhath. https://doi.org/10.1016/j.tria.2021.100159
Acknowledging the use of human cadaveric tissues in research papers: Recommendations from anatomical journal editors Joe Iwanaga, Vishram Singh, Aiji Ohtsuka, Youngil Hwang, Hee-Jin Kim, Janusz Moryś, Kumar Satish Ravi, Domenico Ribatti, Paul A. Trainor, José Ramón Sañudo, Nihal Apaydin https://doi.org/10.1002/ca.23671 Clinical Anatomy Volume34, Issue 1 January 2021 Pages 2-4
Author Response
R2
R2: This is the next in row manuscript presenting the value of the dissection over new teaching technologies. I strongly agree with the authors (specially as teaching anatomist) however I think that despite the good quality of the text it does not bring specifically new information.
Authors: We greatly appreciate the positive view of R1 over our small study. With our small study we want to demonstrate that dissection works in first-year medical school, and we agree with R2 that is not new. In fact, we have known that for centuries. However, there are reports against it (For example, McLachlan JC, Bligh J, Bradley P, Searle J. Teaching anatomy without cadavers. Med Educ. 2004 Apr;38(4):418-24. doi: 10.1046/j.1365-2923.2004.01795.x. PMID: 15025643).
Given the globalization of the academic world with which the dissection in the classroom of medical students runs a more global risk of decreasing and even disappearing. There are medical schools in prestigious institutions, like New York University (NYU), who already use virtual reality instead (https://nyulangone.org/news/can-you-teach-anatomy-without-cadavers).
We showed that, despite of all the technology at our student’s hands in 2022, dissection STILL is favourable for leaning human anatomy. That is our new message. We think it is relevant
R2: Authors used references from a "high level" citing papers of most renown anatomists : Moxham, Tubbs, Iwanaga, Pawlina etc. There are however many papers dealing with the problem of body dissection and its value coming from other countries (African, India etc.) worth to mention. Besides for me the core text is the one published years ago (2008) in Annals of Anatomy.
Authors: We thank R2 for the references, which we appreciate greatly. However, to revise all the literature falls far and away from the means of a short of report of this kind, and therefore, we decided to include only a small number of references. We thank R2 for those interesting references and safe them cited by R2 for a longer future report.
R2: Students learn proper approach to the body - and they should remember about the gratitude that is their due to the donors.
Authors: Students are properly informed of the body donation program and taught to treat with due respect and appreciation all the material used in the dissection classes. The authors include an statement to that effect in Acknowledgements.
Translational Research in Anatomy. Volume 25, November 2021, 100149. Knowledge and attitude towards ethical cadaver dissection among medical and health sciences students, 1997–2020: A systematic review and meta-analysis. Yoseph Merkeb Alamneh. https://doi.org/10.1016/j.tria.2021.100149
Translational Research in Anatomy. Volume 19, June 2020, 100067. Assessment of the determinants of Knowledge, Attitude and Practice (KAP) of Ethiopian Medical Students towards ethical Cadaver Dissection
Madebo Ergano, Asfaw Gerbi, Niguse Hamba, Bekalu Getachew, Tesema Etefa, Tilahun Alemayehu Nigatu, Lemessa Debela, Mitiku Bajiro, Wakjira Kebede, Solomon Tesfaye. https://doi.org/10.1016/j.tria.2020.100067
The dissection course – necessary and indispensable for teaching anatomy to medical students Horst-Werner Korf , Helmut Wicht , Robert L. Snipes , Jean-Pierre Timmermans , Friedrich Paulsen , Gabriele Rune , Eveline Baumgart-Vogt, Ann Anat 190 (2008) 16—22
Translational Research in Anatomy. Volume 26, March 2022, 100159, Benefits and pitfalls of learning anatomy using the dissection module in an indian medical school: A millennial Learner's perspective. Sneha Guruprasad, Kalthur Arvind, Kumar Pandey, Sushma Prabhath. https://doi.org/10.1016/j.tria.2021.100159
Acknowledging the use of human cadaveric tissues in research papers: Recommendations from anatomical journal editors Joe Iwanaga, Vishram Singh, Aiji Ohtsuka, Youngil Hwang, Hee-Jin Kim, Janusz Moryś, Kumar Satish Ravi, Domenico Ribatti, Paul A. Trainor, José Ramón Sañudo, Nihal Apaydin https://doi.org/10.1002/ca.23671 Clinical Anatomy Volume34, Issue 1 January 2021 Pages 2-4
Reviewer 3 Report
The paper by Insausti et al. analyzed what authors call a “short practical experience” in human body dissection, and whether it improves anatomy grades in first-year medical students at the University of Castilla-la Mancha (Spain). They evaluated grades and student satisfaction using a Likert scale 0-5, and have concluded that human body dissection, even for a limited time (2 hrs), has a positive impact on human anatomy grades in first-year medical students.
Unfortunately, the” satisfaction” variable seems to have been lost (it’s never really discussed). I think that using this term in abstract only, and “Likert scale” passim in the text, might act a bit confusing.
A more informative discussion would most certainly yield from Bergman, et al. 201 https://pubmed.ncbi.nlm.nih.gov/21355704/ . To be honest, this reference is a bit outdated, so Burgess et al. 2022 could adequately take its place – also not used, whatsoever https://pubmed.ncbi.nlm.nih.gov/21355704/ . Like ways, Petersson et al. 2009. https://pubmed.ncbi.nlm.nih.gov/19363804/ could be used in improving the discussion.
I did a plagiarism check as a part of the routine, and I found an extremely low rate of similarity.
Author Response
Manuscript ID: Anatomia-1867285
Title (revised): Short Practise in Human Body Dissection Benefits Acquisition of the Musculoskeletal System in First Year Medical Students at University of Castilla-La Mancha (Spain)
Ricardo Insausti , Maria del Mar Ubero , Monica Muñoz López *
Special Issue
State-of-the-Art Anatomical Research in the Mediterranean Region 2022
R3
R3: The paper by Insausti et al. analyzed what authors call a “short practical experience” in human body dissection, and whether it improves anatomy grades in first-year medical students at the University of Castilla-la Mancha (Spain). They evaluated grades and student satisfaction using a Likert scale 0-5, and have concluded that human body dissection, even for a limited time (2 hrs), has a positive impact on human anatomy grades in first-year medical students.
Unfortunately, the” satisfaction” variable seems to have been lost (it’s never really discussed). I think that using this term in abstract only, and “Likert scale” passim in the text, might act a bit confusing.
Authors: We are really sorry for this. Satisfaction is the overall students mean of the questionaries’. We now clarified it in the outset (abstract). Motivation and cognitive aspects of the questionnaire were, then analyzed separately.
R3: A more informative discussion would most certainly yield from Bergman, et al. 201 https://pubmed.ncbi.nlm.nih.gov/21355704/ . To be honest, this reference is a bit outdated, so Burgess et al. 2022 could adequately take its place – also not used, whatsoever https://pubmed.ncbi.nlm.nih.gov/21355704/ . Like ways, Petersson et al. 2009. https://pubmed.ncbi.nlm.nih.gov/19363804/ could be used in improving the discussion.
Authors: We thank R3 for her/his comments in these two references. We have changed Bergman et al.
R3: I did a plagiarism check as a part of the routine, and I found an extremely low rate of similarity.
Authors: Thanks to R3 for this.
Author Response File: 
Author Response.pdf
Round 2
Reviewer 1 Report
I thank the authors for their clear explanations. I have no further issues and I believe that the manuscript is acceptable for publication. Congratulations!
On another note, I am not sure whether the manuscript uploaded by the authors was the correct version or not. It was not prepared using the MDPI template.
Reviewer 3 Report
thank you.
