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ESRA19-0695 PRO
  1. M Szarko
  1. University College London, Division of Surgery and Interventional Sciences, London, UK


Anatomical training for regional anaesthesia is critically important, due to the necessity of understanding the course of neurovasculature as well as the layers of tissue needing to be appreciated to enable reliable, effective anaesthesia. There are many training options that do exist, including cadaveric sessions, novel IT solutions in the form of websites and apps for, and, depending on the hospital in which one is based, simulation suites. Unfortunately, once employed as an anaesthetist, very little time is available for furthering anatomical understanding. the following discussion will describe the limitations of current cadaveric training and outline potential ways for ensuring that necessary anatomical understanding can be effectively achieved.

It is important to understand that anatomical instruction in medicine arguably can consist of two groupings: undergraduate and post-graduate. Undergraduate anatomical training is meant to cover the entirety of the human body, and as such, the important subtleties of anatomical structures that directly affect clinical practice are not able to be appreciated. the majority of available anatomical training currently caters to undergraduate learners as they form a greater number of people. Post-graduate anatomical training needs to be focussed, more detailed, and directly applicable to clinical practice. the breadth of covering all major structures at a more superficial level as occurs during undergraduate anatomical training, is instead replaced with targeting a deeper level of knowledge that is necessary to fully understand and enhance specialist clinical practice.

The current ‘gold standard’ for anatomical training is based on cadaveric inspection. Cadaveric training is expensive, time intensive, and can be limited in its applicability for regional anaesthesia. In addition to the facility costs, and the ability to provide for the precious resources that are cadaveric specimens, cadaveric anatomical training necessitates expert facilitators, a team of technical specialists, and a relatively large amount of uninterrupted time. as such, cadaveric training is limited to irregular occurrences, which is counter-productive for knowledge retention in a discipline such as anatomy that requires a high degree of memorisation. In a typical post-graduate cadaveric laboratory experience for anaesthesia, specialists arrive, review the fundamental anatomy, and, depending on the laboratory, are able to do medical imaging-guided approaches. the benefits to this approach are the access to anatomical and clinical experts and dedicated time to focusing on anatomical fundamentals as needed to further clinical practice. the negatives are a lack of prior focus (which will be described below), variable specimen quality that ultimately does not mimic an in vivo condition, and teaching that can quickly be forgotten as it is given in a large dose of knowledge that limits the ability for deep, long term learning to occur. In sum, cadaveric anatomy is expensive, difficult to arrange time to attend, and gives the learners often more knowledge than can be remembered at one time.

With such challenges facing cadaveric anatomy training, what alternative teaching methods could be used instead? Technological solutions focused on web-based and app based electronic learning (E-Learning) have the ability to offer and likely exceed the learning able to be offered in a cadaveric environment for post-graduate learners. Such E-Learning solutions have the greatest benefit in their accessibility. Having expert anatomical knowledge accessible in a timely fashion allows the immediate application of that knowledge. This creates a context of deep learning because knowledge that is used shortly after learning has a greater propensity to be retained. the accessibility of E-Learning also allows repeated viewing of the material at a pace in which the learner isn’t overwhelmed with information, which allows greater understanding of difficult subjects such as anatomy. An interesting aspect of E-Learning is that the learner is in control of what they want and need to learn. This furthers memory retention due to the post-graduate learner being able to simply ‘fill in the gaps’ of their knowledge, or completely revise an area they had forgotten. By having the learner searching for the level of anatomical knowledge that they want also helps to create a scenario where the learner has reflected on what they do know and more importantly what they don’t know, prior to engaging with the E-Learning. There are many cases where learners who go to cadaveric courses do not prepare before entering the lab because the expert trainers act as a safety net to ensure that important material is covered. When the onus is placed on the learner, further contextual links of new anatomical information can be easily created with previously understood anatomy, because the learner is forced to make the contextual links themselves, rather than being given them. This makes for a more active learning process which has repeatedly been shown to improve deeper learning than passive learning, such as listening to an expert trainer. Like all things, E-Learning for post-graduates is not perfect, mainly due to the fact that it is very time consuming to make educational materials, as well as the fact that the level of anatomical information needed by post-graduate anaesthetists generally needs to be created by experts in the area who often do not possess the time to create the material. There are a number of online E-Learning tools that simplify the creation of E-Learning materials, but a greater concerted effort is needed, likely by medical societies who have access to a large number of experts, and therefore can lessen the time constraint on any one individual to make contextually useful anatomy materials for an anaesthetic specialist.

In sum, it is possible that cadaveric training can and likely will be replaced by other training methods. Technology enhances accessibility to anatomy and allows deeper learning that is immediately able to be used. However, until there are concerted efforts to make more complete E-Learning anatomical solutions for anaesthetic specialists, it is likely that cadaveric training will remain an important method for post-graduate anaesthetic training.

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