Effectiveness of laparoscopic cadaveric dissection in enhancing resident comprehension of pelvic anatomy

BACKGROUND: Anatomic instruction during preclinical years of medical school has been in decline recently. There is evidence that residents already los e a considerable portion of basic anatomic knowledge ill the transition fro m student to clinician, and this deficit is even more dramatic in residents who start their training with a decreased understanding of anatomy We ques tioned whether anatomy could be adequately retaught to new residents as sur gical anatomy. In an effort to address this deficiency, we developed a prog ram to teach pelvic anatomy in fresh cadavers using a laparoscopic approach . The purpose of this investigation is to determine if such a program is ef fective in enhancing residents' pelvic anatomy comprehension. STUDY DESIGN: An obstetrics and gynecology residency was divided into inter vention (n = 15) and control (n = 13) groups. The intervention was a 4-hour laparoscopic dissection in a fresh cadaver. Outcomes measures included a m ultiple-choice test, practical exam, faculty evaluation, and satisfaction a ssessment. The faculty evaluation and satisfaction assessment used a visual analog scale. Univarate and nonparametric analysis were used when appropri ate. RESULTS: Initial test scores (p = 0.32), faculty evaluations (p = 0.25), an d satisfaction scores (p = 0.17) were similar. Both groups improved their a natomic 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 IO-cm visual analog scale suggested higher faculty evaluations in the intervention group (14 mm versus 10.3 mm, (p = 0.23). Si milarly there were higher scores on the cadaver test in the intervention gr oup (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 an atomic perception, but suggested that it improves spatial perception of ana tomy and is perceived by residents to be a valuable educational approach. ( J Am Coll Surg 2001;192:492-497. (C) 2001 by the American College of Surgeo ns).