Impact of Hands-on Cadaveric Dissection Courses on the Improvement of Surgical Skills of Ear, Nose, and Throat Surgeons: A Survey of the Consultants and Postgraduate Trainees

By Saleh Khurshied¹, Altaf Hussain¹, Mujahid Raza², Nawal Khurshid¹, Maesum Ali¹, Mehrunnisa Nawaz¹

Affiliations

1. Department of ENT-HNS, Pakistan Institute of Medical Sciences, Islamabad, Pakistan
2. Department of Radiology, Pakistan Institute of Medical Sciences, Islamabad, Pakistan

doi: 10.29271/jcpsp.2025.10.1350

ABSTRACT
A cross-sectional observational study was carried out at the Department of ENT-HNS, Pakistan Institute of Medical Sciences, Islamabad, Pakistan, from April 2023 to May 2024, to determine the impact of hands-on cadaveric dissection courses on the improvement of surgical skills of Ear, Nose, and Throat trainees. Three courses were conducted with a gap of six months each. Participants were given a feedback form at the end of the workshop. Out of 312 participants, 298 (95.5%), 301 (96.4%), 278 (89.1%), and 283 (90.7%) agreed that it helped in learning anatomy, understanding the steps of surgeries, and increasing their confidence, respectively, and they would attend future courses. Eighty-three (26.6%) were not satisfied with the course fees. A total of 305 (97.8%) participants and almost all 55 HODs (96.5%) recommended that these workshops should be made an integral part of postgraduate training. Thus, it is recommended that hands-on cadaveric workshops should be made an integral part of postgraduate training programmes.

Key Words: Workshop, Cadaver, Learning, Academic training, Anatomy.

Over the past ten years, there have been significant changes in head and neck surgical techniques due to advances in radiotherapy and chemotherapy, which have lowered the learning curve.¹ Cadaveric dissection is considered the gold standard for learning surgery and has long been a requirement for otology education, as anatomical knowledge is essential for performing surgical procedures adequately. Despite the rapid evolution and development of surgical practice, there are few opportunities for training.² Due to the complex and intricate anatomy of the head and neck region, surgery in this area necessitates a high level of surgical expertise and in-depth anatomical knowledge. Cadaveric hands-on workshops undoubtedly aid in improving students' surgical proficiency and confidence.³

 

By obtaining official opinions from ENT consultants and post- graduate trainees(PGTs) regarding the significance of cada- veric dissection and its inclusion as a standard component of training, this study seeks to explore the effect of hands-on courses on enhancing surgical skills of trainees in ear, nose, and throat  care.

This cross-sectional study was carried out at the Pakistan Institute of Medical Sciences, (PIMS), Islamabad, Pakistan, from April 2023 to May 2024. Three cadaveric hands-on dissection courses were organised by the Department of ENT–HNS, PIMS, Islamabad, with a gap of six months each. These workshops included temporal bone dissection, basic and advanced functional endoscopic sinus surgery (FESS), rhinoplasty, and head and neck surgery. A total of 110 surgeons participated in each course. All participants who attended all sessions of the workshop, regardless of age, gender, institute, or seniority, were added in the study. At the end of each workshop, participants were given a feedback form regarding their experience and opinion. An electronic form was sent to the Head of Department (HOD) of each CPSP-accredited ENT training institute to obtain their feedback and opinion. Data were analysed using SPSS version 23; frequencies (percentages) were calculated, and results were presented in the form of graphs and tables, where applicable.

Table I: Feedback from participants of hands-on cadaveric courses (n = 312).

Questions to participants	Agree	Disagree
Was this hands-on cadaveric course useful for learning anatomy?	298 (95.5%)	14 (4.5%)
Did it help you in learning the steps of an operation?	301 (96.5%)	11 (3.5%)
Did it make you confident in performing future surgeries?	278 (89.1%)	34 (10.9%)
Would you like to get enroll in such courses in future?	283 (90.7%)	29 (9.3%)
Was the amount paid for the workshop worth it?	229 (73.4%)	83 (26.6%)
Should these courses be made a regular part of training?	305 (97.8%)	7 (2.2%)

Table II: Opinion from HODs of CPSP-accredited ENT training institutes (n = 57).

Questions to HODs	Agree	Disagree
Are hands-on cadaveric courses useful for PGTs in learning anatomy?	52 (91.2%)	5 (8.8%)
Do these courses help PGTs learn the steps of an operation?	46 (80.7%)	11 (19.3%)
Do these courses make PGTs more confident in performing future surgeries?	50 (87.7%)	7 (12.3%)
Should these workshops be arranged on a regular basis?	56 (98.2%)	1 (1.8%)
Should these courses be made a regular part of training?	55 (96.5%)	2 (3.5%)

The three courses on cadaveric hands-on dissection involved a total of 330 doctors, comprising 121 (36.7%) consultants and 209 (63.3%) PGTs. However, only 312 (94.5%) participants returned the feedback form. The answers to several queries are displayed in Table I. Of the 77 HODs who received the opinion form, 57 of them replied, yielding a 74% response rate. Responses from the HODs are displayed in Table II.

The findings of this research unequivocally demonstrated that most of the participants believed that hands-on cadaveric workshops were helpful in teaching anatomy, understanding the steps of a surgery and making a surgeon more confident before performing surgery, and that these workshops should be conducted more frequently and integrated into training. Comparing the findings with previous research, Selcuk et al. concluded in their study that cadaveric workshops are crucial for surgical education and aid in enhancing surgical expertise, gaining experience, and building confidence.⁴ They also suggested that residency and postgraduate training programs should include practical cadaveric sessions.

According to the results of Trivedi et al., nearly 80% of participants believed that learning and developing surgical skills could be aided by hands-on cadaveric workshops.³ Ghosh reported that cadaveric dissection is currently the primary means of teaching gross anatomy to ensure safe medical practice.⁵ Consistent with the present findings, Asad et al. also reported the importance of a dissecting room in teaching clinical and interpersonal skills related to anatomical instructions.⁶

One of the study's limitations was that it covered only a small number of participants attending a specific type of workshop on head and neck operations. Based on the findings of this research, it is recommended that hands-on workshops be incorporated into CPSP postgraduate training, similar to other mandatory workshops.

To conclude, most participants in the hands-on cadaveric dissection workshops believed that the courses helped them learn anatomy and surgical procedures, increased their confidence to perform future surgeries, and motivated them to attend similar courses in the future. Similarly, most ENT departmental heads felt that their trainees had benefited from these courses and concurred that they helped students understand anatomy, surgical procedures, and future surgery techniques. They also recommended that these workshops should be included as a required component of postgraduate education.

ETHICAL APPROVAL:
Ethical Approval was obtained from the Ethics Research Review Board of PIMS, Islamabad, No. F.3-1/2023(ERRB)/ Chairman.

PARTICIPANTS’ CONSENT:
Informed consent was obtained from each participant.

COMPETING INTEREST:
The authors declared no conflict of interest.

AUTHORS’ CONTRIBUTION:
SK: Concept and designs, data collection, interpretation of the results, and referencing.
AH, MR, NK: Revision and review of the manuscript.
MA, MN: Data collection.
All authors approved the final version of the manuscript to be published.
 

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