What is lost when we lose in-person learning.
BY MICHAEL DENHAM
Last year, my first in medical school at Columbia University, I used a bone saw to slice through the top half of a cadaver’s skull, revealing a gray brain lined with purple blood vessels. This was Clinical Gross Anatomy, the first-year course that has fascinated or devastated (or both) every medical student. You never forget the day you open the skull.
Cutting into the brain, unlike the muscles of a forearm or the arteries running down a thigh, feels personal. As a cloud of aerosolized bone dust particles darkened overhead, reinforced by the thickening smell of singed bone, I wondered how much of my donor’s body I was inhaling. How much of that dust would be engulfed by the immune cells in my respiratory system? And how much of the dust would linger in my airways until my grave?
The physical body is messier, but it’s also easier to manipulate. Perception is lost without that physicality.
It was the culmination of months of learning to be comfortable with the body in front of us, a process that accumulated in small pauses between tasks, before digging in with tweezers and a scalpel. How does it feel to hold someone’s lifeless hands for the first time? How do you respectfully flip the body over to crack open the spine? We were required to face these emotions head on, perhaps out of fear that relying solely on textbook diagrams would leave us insulated from the grim realities of human anatomy.
What would happen if Clinical Gross Anatomy became one more casualty of COVID-19? Dissections across the country were reformatted or suspended when lockdowns began in 2020, even as medical educations continued online. Physicians often consider the numerous hours spent in gross anatomy lab to be the most formative of their medical school careers. They transcend the cutting of flesh under the stench of formaldehyde. It’s about learning how to treat someone’s body with respect, work in a team, deal with death. “The anatomy lab is part of the gelling of camaraderie and team-building and peer-to-peer teaching. It’s a rite of passage,” says David Morton, an anatomist at the University of Utah School of Medicine.
The challenge of adapting education to a pandemic is by no means unique to medical education. Educators across a wide range of settings—from preschools1 to boarding schools2 to trade schools3—have struggled to adjust their teaching modalities to this new normal. Researchers have argued that the sudden switch to virtual learning will exacerbate social inequalities, including for children with poor Internet access4 and for women who disproportionately shoulder childcare responsibilities5 as many schools remain closed. In a study published in April in the Proceedings of the National Academy of Sciences, researchers analyzing data from the Netherlands found that students made little to no progress during the country’s eight-week lockdown.6
Then there are the more “ordinary” ramifications of this shift away from in-person learning. I mourn the buzz of informal conversations held in liminal spaces, the awkward laughter concluding a light joke offered in a crowded elevator, the accidental bumping into the acquaintance-more-than-friend, the expansion of chatter beyond one’s immediate friend group, the in-between. Although private Zoom messaging—the virtual equivalent of passing notes in class—may allow for some degree of small talk, it occurs at the expense of learning rather than as a supplement to it.
Medical education—particularly Clinical Gross Anatomy—offers a window into what is lost when we lose in-person learning. The pandemic has forced medical schools to re-examine this 259-year-old tradition in the training of American physicians with approaches ranging from limited, socially distanced cadaver-cutting to replacing the entire experience with virtual reality programs. Ultimately, the switch to virtual learning across all areas of education asks us to reflect on the role that physical space and tactility play in our ability to process new information. For medicine in particular, the pandemic has brought debate over the digitalization of anatomical teaching to a head. Streamlining medical education could undermine the knowledge and skills—both scientific and humanistic—physicians are expected to have.
“The last time we had a change of this magnitude was when the Flexner Report came out,” says Jonathan Wisco, an anatomist who teaches at Boston and Northeastern Universities. He’s referring to the landmark 1910 report7 on standardizing medical education that led to sweeping changes in admissions, facilities, and teaching practices, causing one third of American medical schools to be shuttered. The need for physical proximity feels more dire when your education literally depends on touching other beings, both living and dead…