Pirri Carmelo, Stecco Carla, Porzionato Andrea, Boscolo-Berto Rafael, Fortelny René H, Macchi Veronica, Konschake Marko, Merigliano Stefano, De Caro Raffaele
Department of Neurosciences, Institute of Human Anatomy, University of Padova, Padova, Italy.
Medical Faculty, Sigmund Freud Private University, Vienna, Austria.
Front Surg. 2021 Jun 23;8:641581. doi: 10.3389/fsurg.2021.641581. eCollection 2021.
Anatomical education and surgical training with cadavers are usually considered an appropriate method of teaching, above all for all surgeons at various levels. Indeed, in such a way they put into practice and exercise a procedure before performing it live, reducing the learning curve in a safe environment and the risks for the patients. Really, up to now it is not clear if the nonuse of the cadavers for anatomical education and surgical training can have also forensic implications. A substantial literature research was used for this review, based on PubMed and Web of Science database. From this review, it is clear that the cadaveric training could be considered mandatory, both for surgeons and for medical students, leading to a series of questions with forensic implications. Indeed, there are many evidences that a cadaver lab can improve the learning curve of a surgeon, above all in the first part of the curve, in which frequent and severe complications are possible. Consequently, a medical responsibility for residents and surgeons which perform a procedure without adequate training could be advised, but also for hospital, that has to guarantee a sufficient training for its surgeons and other specialists through cadaver labs. Surely, this type of training could help to improve the practical skills of surgeons working in small hospitals, where some procedures are rare. Cadaver studies can permit a better evaluation of safety and efficacy of new surgical devices by surgeons, avoiding using patients as ≪guinea pigs≫. Indeed, a legal responsibility for a surgeon and other specialists could exist in the use of a new device without an apparent regulatory oversight. For a good medical practice, the surgeons should communicate to the patient the unsure procedural risks, making sure the patients' full understanding about the novelty of the procedure and that they have used this technique on few, if any, patients before. Cadaver training could represent a shortcut in the standard training process, increasing both the surgeon learning curve and patient confidence. Forensic clinical anatomy can supervise and support all these aspects of the formation and of the use of cadaver training.
尸体解剖教育和外科培训通常被认为是一种合适的教学方法，尤其是对各级外科医生而言。事实上，通过这种方式，他们在实际操作之前进行练习并实践一种程序，在安全环境中降低学习曲线以及患者的风险。实际上，到目前为止尚不清楚不使用尸体进行解剖教育和外科培训是否也会产生法医学影响。本综述基于PubMed和科学网数据库进行了大量文献研究。从这次综述中可以清楚地看出，尸体培训对外科医生和医学生来说都可被视为强制性的，这引发了一系列具有法医学影响的问题。确实，有许多证据表明尸体实验室可以改善外科医生的学习曲线，尤其是在曲线的第一阶段，这一阶段可能会出现频繁且严重的并发症。因此，可以建议对未经过充分培训就进行手术的住院医生和外科医生追究医疗责任，同时也应对医院追究责任，因为医院必须通过尸体实验室为其外科医生和其他专科医生提供充分的培训。当然，这种培训有助于提高在小型医院工作的外科医生的实践技能，因为在这些医院一些手术较为罕见。尸体研究可以使外科医生更好地评估新手术器械的安全性和有效性，避免将患者当作“小白鼠”。的确，在使用新器械且没有明显监管监督的情况下，外科医生和其他专科医生可能会承担法律责任。为了实现良好的医疗实践，外科医生应向患者告知不确定的手术风险，确保患者充分理解手术的新颖性以及他们此前很少（如果有的话）对患者使用过这种技术。尸体培训可能是标准培训过程中的一条捷径，既能提高外科医生的学习曲线，又能增强患者的信心。法医临床解剖学可以监督和支持尸体培训的形成和使用的所有这些方面。
