Eric Smith has just gained new appreciation for the pancreas.
It’s “so unassuming,” he says. Pulling the pancreas out of the gastrointestinal tract and holding it in mid-air, he regards it with a sense of awe.
“In surgery people always say don’t touch the pancreas, and I thought it would be this ugly thing. ... But it is cute. It looks like a shrimp.”
Smith, a first year medical student at UC San Francisco, then tucks the “cute” organ back in place, between the liver and the large intestine. He’s not using gloves, a scalpel or a surgical mask. Instead of having a cadaver in front of him, he’s moving around a large room in a 3-D headset. On the wall-mounted 72-inch screen in UCSF’s virtual anatomy learning center Smith sees a skeleton with stomach, intestines and liver attached to the bones.
Fellow student Sheyda Aboii is helping him study the digestive system.
“The coronary ligament attaches the liver to what structure?” Aboii asks.
“Anterior abdominal wall?” Smith hesitates.
“No.” Aboii responds. “What lies right above?”
“Oh, the diaphragm!” Smith says.
Smith and Aboii are part of a new generation of doctors-in-training who are learning anatomy with the help of Virtual Reality. The VR lessons allow students to see a complete three dimensional picture of body parts, easily move virtual organs in and out of the body and memorize medical terms — each organ displays its name tag once you hover over it.
Running a 3-D learning center is also less expensive than a cadaver lab and less toxic to be around, say proponents. However, some medical professors believe the benefits of learning anatomy through real bodies will never be replaced. VR doesn’t give students the same experience they get from a human body with its unique structure.
VR Arrives on the Scene
For over a 100 years medical students in the United States have been studying anatomy on cadavers. Curriculums hadn’t really changed much until about five or six years ago, with the introduction of VR technology as a new educational option.
Derek Harmon, an assistant adjunct professor at UCSF’s Department of Anatomy, who has been teaching the VR course for over a year, says virtual reality brings an important technological innovation to medical students.
They can walk around the virtual model in the 3-D space getting the 360-degree view of the body they can’t get in the lab: the cadaver lies facing up or down providing only a 180-degree view.
Dissecting virtual organs and tissues is easier, and does not require surgical finesse. Students can move tissues apart and back together as many times as they want, while in the lab they have to keep organs in place so the next group of students can study on the same body.
Stacey Yu, assistant manager of the anatomy lab at UCSF, guides Sheyda Aboii, a student, while she uses virtual reality to study the GI, or digestive, system at the UCSF School of Medicine. (Lauren Hanussak/KQED)
Sometimes virtual reality can give students motion sickness, but Harmon says it only affects about 20 percent of them.
A virtual learning center may also be a healthier place to study, as it has no smell of formaldehyde used for embalming dead bodies. Formaldehyde inhalation triggers dry mouth, eye and throat irritation.
The 3-D space revolution has already engulfed dozens of American medical colleges that have introduced not only virtual, but also augmented and mixed reality to their curriculum.
The University of Nebraska Medical Center teaches on virtual dissection tables; California’s Western University is actively using holographic displays and Oculus rift stations.
Western University’s College of Dental Medicine built their virtual reality learning center for just about $120,000, while the cost of maintaining the cadaver lab runs at about $2 to 4 million a year, according to the college Associate Dean of Simulation, Immersion and Digital Learning Robert W. Hasel.
Hasel is one of the most vocal critics of cadaver labs, because of their high operational cost and use of toxic chemicals like formaldehyde recognized by the American Cancer Society as carcinogenic. Chemical compounds used for embalming bodies have not changed in 100 years.
He also questions learning efficiency in cadaver labs. He says students leave the bodies so “hacked up” that it is hard to recognize organs and tissues. As a result, “students make mistakes, and you can't recover,” says Hasel.
According to Hasel, since Western University introduced VR technology in its curriculum about five years ago, students’ grades on their anatomical sciences national board exams have gone up 15 to 20 percent.
Medical students Sheyda Aboii (left) and Eric Smith use virtual reality to study the GI, or digestive, system at the UCSF School of Medicine. (Lauren Hanussak/KQED)
Traditional Anatomy Classes Here to Stay, For Now
The numbers don’t convince Douglas Gross, professor of cell biology and human anatomy at UC Davis, who likes to stick to the good old practice. He has been teaching anatomy for 42 years and believes that 3-D could be valuable adjunct, but not a replacement for studying a human body.
He says programs that try to get rid of their dissection studying labs are doomed to a “pretty dismal failure.”
Gross says it is important for students to touch and feel a real human body as they learn anatomy, literally squeeze the organs in their fingers. Lack of this tangible experience won’t allow them to become good doctors.
Beyond that, “changing curriculum in a medical school is like moving a glacier,” says Gross. Faculty members, scientists and clinicians often have different opinions on teaching strategies. And even small changes take a lot of time.
An Appreciation for Cadavers
Aboii just like the majority of medical students at UCSF welcomes VR lessons. But she sees them as a useful fun tool and doesn’t admire them as much as she does the traditional anatomy classes.
VR anatomy lessons are gaining popularity, but traditional learning using cadavers isn't going away any time soon. (Lauren Hanussak/KQED)
She says the smell of formaldehyde doesn’t bother her. And knowing that the bodies students work on were donated for research and education fills her respect.
“There is a certain gravity to that,” Aboii says. “Each of the cadavers is unique. In life, they were unique human beings, and now they are unique donations. For a trainee, like myself, it's good to start getting used to that spectrum of life and death.”
Virtual lessons help memorize and review, but they don’t show “the unique human variability,” she says.
“You get almost like an average idealized artistic rendering of what the human body looks like,” says Aboii. However in real life things might be different. Arteries, for example, may not always be connected in the same way on a cadaver.
Harmon is convinced cadaver labs are here to stay, at least for now, but the number of VR platforms in medical schools will skyrocket in the next couple of years and will be especially useful for medical professions that use a lot of 3-D scans in their practice, like radiologists.
“VR in medicine is going to explode," says Harmon. "And it is exciting."