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• W3189256431 abstract "Many people would be aware of the famous oil painting “Anatomy of Dr Nicholaes Tulp” by Rembrandt van Rijn, which can be viewed at the Royal Picture Gallery Mauritshuis in the Hague, The Netherlands. It was commissioned for the Amsterdam Guild of Surgeons in 1632 (Ingham, 2010). Dr Tulp, a practicing physician and surgeon, was at that time appointed as Praelector in Anatomy in charge of public dissections. What is remarkable about this painting (despite some anatomical errors) is the master strokes of Rembrandt in displaying anatomical details and muscle function. For instance, Dr Tulp elevates the flexor digitorum superficialis of the dissected forearm with his right hand to demonstrate the movements produced by this muscle (flexion of the digits) with his left hand (Mellick et al., 2007). Remarkably, the lesson was conducted in an anatomy theater during a live demonstration of the autopsy on a criminal Adriaen Adrianson, who was condemned to death by hanging (Afek et al., 2009). Although many experts have opined that this is not a true depiction of how an anatomical dissection was performed, but rather a dramatization of the actual scene to accentuate the persons in this fascinating work of art that has been acclaimed worldwide (Parker, 2014). The word “theater” is derived from the ancient Greek language (θέατρον) (theatron, which means “a place for viewing”) and θεάμαι (theaomai, “to see”, “to watch”, or “to observe”) (Macchi et al., 2014). Following the construction of the first temporary anatomy theater in Padua in 1594, famous and beautiful permanent anatomy theaters were subsequently built, such as those in Bologna, Venice, Paris, and other European cities where the theaters were designed to allow the audience to see live dissection demonstrations and listen to the professor's commentary (Papa et al., 2019; Marre and Villet, 2020). The public dissections, which lasted three days and held in a carnival-like atmosphere, played a significant role in the history of medicine, with many renowned anatomy teachers imparting their knowledge to captivated audience (Brockbank, 1968; Ferrari, 1987). Interestingly, the audience not only comprised students with an interest in medicine but also included fishmongers, shoemakers, tailors, and other carnival goers (Klestinec, 2007). During the Renaissance, the anatomy discipline was thought to be an “artistic and spiritual exploration of life, suffering, and death” (Papa and Vaccarezza, 2013). Yet, that period in European history also gave birth to the era of scientific human anatomy, with the publication of De Humani Corporis Fabrica by Andrea Vesalius (Papa and Vaccareza, 2013). Vesalius, who is acknowledged as the father of modern anatomy, was known to conduct his dissections in anatomy theaters at Padua and Bologna (Brockbank, 1968; Stolberg, 2018). In fact, the anatomy dissections at Padua were also believed to have had a strong influence on William Harvey's discovery of the blood circulation (Bylebyl, 1979). Fast forward into 2021, the severe acute respiratory syndrome coronavirus-2 (SARS Cov-2) has infected 198,861,345 individuals globally, resulting in 4,234,771 deaths (CSSE, 2021). In response to the urgent need to curb the spread of this disease with measures such as reducing social interactions, many educational courses, including human anatomy, have been moved on line. Covid-19 has resulted in a less optimal environment for the learning of human anatomy (Evans et al., 2020; Franchi, 2020). For instance, there is a shortage of cadavers due to a decreased number of body donors made worse by the pandemic, with suspension of body donor programs in countries such as the United Kingdom (Singal et al., 2019; Brassett et al., 2020; Saverino, 2021), India (Ravi, 2020), Spain (Manzanares-Céspedes et al., 2021), and limited access for students to dissection rooms. After all, anatomy is a practical, hands-on, and experience-based subject (Brassett et al., 2020; Pather et al., 2020), and cadaveric dissection has been touted as the gold standard for imparting anatomy knowledge, as they allow students to learn the intricacies of the human body by hands-on exploration of the anatomical structures in the body (McLachlan et al., 2004; Ghosh, 2016; Brassett et al., 2020). Hence, there is a concern that the quality of anatomy education could be affected (Franchi, 2020; Iwanaga et al., 2021). The rapid move of traditional face-to-face classes to online learning, necessitates effective integration of e-learning platforms and innovative technologies such as augmented reality and virtual reality, which enhance the learning of anatomical structures in 3D (Moro et al., 2017; Chytas et al., 2020; Uruthiralingam and Rea, 2020). There is also a need for the development of pedagogies that allow educators to present more effective learning opportunities to students, impacting their acquisition of knowledge (Hew et al., 2020). In a survey on multiple professional associations of anatomy educators, comprising members from mainly the United States and some international participants, Harmon et al. (2021) noted that in-person lectures were markedly decreased during Covid-19 (76% before Covid vs. 8% during Covid-19), while not in-person lecture delivery showed significant increase from 11% (before Covid-19) to 67% (during Covid-19). As anatomy classes such as lectures and practical demonstrations are moved online, the lecturer has inevitably become the center piece of attention. This brings into mind a parallel comparison of the anatomy theaters of old, where the professor would be lecturing from an elevated chair, while an assistant demonstrated the various structures of the cadaver (Lind, 1975). Facing the camera to deliver his/her class, the anatomy lecturer is now akin to an actor performing in a scenic space, which has now been transformed to a remote “learning space” for the students (audience) (de Carvalho Filho et al., 2020, 2021). In fact, in Rembrandt's painting of Dr Tulp, the dissection of the body in an anatomy theater has been called a “performative act” (Ingham, 2010). Incorporating theater practices into medical education is not new (Unalan et al., 2009; McCullough 2012; Hobson et al., 2019). Actors have been involved in teaching communication and clinical skills to medical students for a long time (Shapiro and Hunt, 2003; Kohn et al., 2011; de Carvalho Filho, 2020). Like the actor on stage, the lecturer can also adopt principles of acting that “leverage on nonverbal communication, generate awareness of body language, and understand the hidden meanings of silence” (de Carvalho Filho et al., 2020). Furthermore, as enunciated by the same authors, lecturers can work with the concept of “scenic intelligence,” which is defined as the capacity to self-assess and direct themselves while performing in real time. Moreover, theater techniques, such as improvisational theater where the scene is produced spontaneously almost in entirety by the actor (Hobson et al., 2019), teaches practitioners to prepare for unpredictability (Watson, 2011). In fact, Augusto Boal, a renowned Brazilian theater director, considered theater a pedagogy—a way for co-construction of knowledge, building awareness, motivating reflection, and preparing for action (Boal, 1979; de Carvalho Filho et al., 2020). The pandemic currently continues unabated with the emergence of variants that are more virulent than the original SARS Cov-2 virus and the capacity to escape vaccine-induced neutralizing antibody responses (Gómez et al., 2021; Hoffmann et al., 2021). As countries accelerate their vaccination programs to reduce the burden of Covid-19, there is the possibility that the efficacy of the vaccine may be reduced against evolving variants, which perchance may give rise to “pandemics within a pandemic” (Boehm et al., 2021). However, as life must go on, people are advised to continue to be vigilant and practice protective measures, such as social distancing and avoiding crowded places (WHO, 2021). The “new normal” is now the buzz word of the day. There is no doubt that the pandemic has caused disruptions in anatomy education and posed challenges for anatomy educators, technical staff (in the preparation of teaching materials), students, and resources (access to software and support for online teaching) but at the same time have presented opportunities such as acquisition of skills in online pedagogy and digital media production (Evans et al., 2020; Pather et al., 2020). As we transition to the “new normal” of learning in this unprecedented time, online learning platforms are likely to be used for a protracted period of time. There is, therefore, a need for anatomy academics to adapt and be flexible, accepting the fact that traditional teaching practices need to be changed (Pather et al., 2020), for example the use of anatomy studio for high-quality, real-time, live-feed transmissions from the anatomy laboratory (de Carvalho Filho et al., 2021) combined with technology-based approaches, such as virtual and immersed reality, and other digital resources as alternatives to cadaveric dissection (Iwanaga et al., 2021). In this regard, theatrical principles could also be applied in the preparation of online teaching." @default.
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• W3189256431 title "Back to the past: Are anatomy online classes reminiscent of the anatomy theaters of old?" @default.
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